Acupuncture Improves Sleep Disorders and Depression among Patients with Parkinson's Disease: A Meta-Analysis

Treatment options for depression in Parkinson's disease: a mini-review

Depression is a common comorbidity in Parkinson's disease (PD), significantly reducing patients' quality of life. This mini-review examines pharmacological and nonpharmacological therapies for managing depression in PD, analyzing their benefits, and limitations. Pharmacological options include tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), levodopa, dopaminergic agonists, and monoamine oxidase B inhibitors. Nonpharmacological strategies involve brief psychodynamic therapy, cognitive-behavioral therapy (CBT), physical exercise, phytomedicine, massage therapy, music therapy, phototherapy, yoga, repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, electroconvulsive therapy (ECT), and deep brain stimulation. SSRIs, SNRIs, and some dopamine agonists have shown effectiveness and good tolerability, especially when combined with CBT or rTMS. For severe or refractory cases, ECT remains a viable option. Although many of these therapies show promise, the limited number and scale of studies for each treatment restrict the strength of current evidence. Further large-scale, multicenter randomized-controlled trials are essential to validate these preliminary findings and establish evidence-based guidelines. In addition, the potential benefits of social support and brief psychodynamic therapy in the context of PD-related depression require further exploration to provide holistic care strategies for this population.

A bibliometric analysis of acupuncture for Parkinson's disease non-motor symptoms from 2003 to 2023

BACKGROUND

Parkinson's disease non-motor symptoms (PD-NMS) significantly affect patients' quality of life. Acupuncture has emerged as a potential complementary therapy for PD-NMS. This study aims to investigate general research status, hotspots and trends of acupuncture as a treatment for PD-NMS.

METHODS

Literature on Web of Science Core Collection (WoSCC) from 2003 to 2023 was retrieved, and bibliometric analysis was conducted using VOSviewer and CiteSpace software.

RESULTS

159 publications by 894 authors from 37 countries, 300 institutions, and 96 journals were retrieved and analyzed. The number of publications in this field is generally on the rise yearly. China was the leading contributor with 57 publications, and the United States followed with 36 publications and had the highest total citation count of 1562. Guangzhou University of Chinese Medicine ranked the highest with a total of 12 publications, while Harvard University had the highest average citation rate of 70 citations per publication. Evidence-Based Complementary and Alternative Medicine was the most prolific journal with 11 articles that had accumulated 122 citations. Park Hi-Joon was the leading contributor with seven articles and 314 citations. The keyword analysis highlighted emerging areas of interest like "deep brain stimulation" and "alpha-synuclein".

CONCLUSION

Different countries, institutions, and authors should enhance cooperations, and the underlying mechanisms of acupuncture for PD-NMS should be demonstrated. This study will be helpful for better understanding the current knowledge and gaps in the areas of acupuncture as a treatment of PD-NMS.

An overview of systematic reviews of acupuncture for Parkinson's disease

Background

Many systematic reviews (SRs) have reported the efficacy of acupuncture in improving Parkinson's disease (PD), but the quality of evidence is unknown. Therefore, it is necessary to comprehensively summarize and objectively evaluate the evidence of acupuncture for PD.

Methods

Seven databases were searched to retrieve SRs on the acupuncture for PD. Two reviewers independently completed literature retrieval, screening, and data extraction. The methodological quality, risk of bias (RoB), evidence quality of the included SRs were assessed by the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2), the Risk of Bias in Systematic Reviews (ROBIS), the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool.

Results

A total of 24 SRs were included. According to AMSTAR 2, 6 (25%) were rated as high quality, 6 (25%) were rated as moderate quality, and 12 (50%) were rated as very low quality. The application of the ROBIS tool showed that 12 (25%) SRs were at low risk of bias. The results of GRADE showed that 8 (7.62%) outcomes provided high quality evidence, 23 (21.9%) outcomes provided moderate quality evidence, 42 (40%) outcomes provided low quality evidence, and 32 (30.48%) outcomes provided very low quality evidence.

Conclusion

The overview indicates that acupuncture shows promise as a treatment for PD, although the evidence is limited and inconclusive due to methodological flaws and the heterogeneity of existing studies. Future research should focus on fully reporting methodological details and following review guidelines to produce more reliable and consistent evidence on the effectiveness of acupuncture for PD.

Systematic review registration

https://inplasy.com, identifier INPLASY202480049.

Acupuncture and Sleep Quality Among Patients With Parkinson Disease: A Randomized Clinical Trial

Importance

Poor sleep quality greatly impairs quality of life and accelerates deterioration in patients with Parkinson disease (PD), but current remedies remain limited. Acupuncture, used as an adjunctive therapy with anti-Parkinson medications, has shown positive effects in patients with PD. However, high-quality clinical evidence to support the effectiveness of acupuncture for patients with PD and poor sleep quality is lacking.

Objective

To assess the safety and efficacy of real acupuncture (RA) vs sham acupuncture (SA) as an adjunctive therapy for patients with PD who have poor sleep quality.

Design, Setting, and Participants

This single-center randomized clinical trial was performed at The First Affiliated Hospital of Guangzhou University of Chinese Medicine in China from February 18, 2022, to February 18, 2023. Patients with PD and sleep complaints were recruited and randomized (1:1) to receive RA or SA treatment for 4 weeks. Data analysis was performed from April 12 to August 17, 2023.

Intervention

Treatment with RA or SA for 4 weeks.

Main Outcomes and Measures

The main outcome was the change in Parkinson Disease Sleep Scale (PDSS) scores measured at baseline, after 4 weeks of treatment, and at 8 weeks of follow-up.

Results

Of the 83 participants enrolled, 78 (94.0%) completed the intervention and were included in the analysis. Their mean (SD) age was 64.1 (7.9) years; 41 (52.6%) were men and 37 (47.4%) were women. A significant increase in PDSS scores from baseline was observed for both the RA group (29.65 [95% CI, 24.65-34.65]; P < .001) and the SA group (10.47 [95% CI, 5.35-15.60]; P < .001). Compared with the SA group, the RA group had a significant increase in PDSS scores after 4 weeks of treatment (19.75 [95% CI, 11.02-28.49]; P < .001) and at 8 weeks of follow-up (20.24 [95% CI, 11.51-28.98]; P < .001).

Conclusions and Relevance

In this randomized clinical trial, acupuncture proved beneficial in improving sleep quality and quality of life among patients with PD. These findings suggest that the therapeutic effects of acupuncture could continue for up to 4 weeks.

Trial Registration

Chinese Clinical Trial Registry Identifier: ChiCTR2200060655.

Efficacy of acupuncture as adjunct therapy for sleep disorders in Parkinson's disease: A systematic review and meta-analysis

OBJECTIVE

The purpose of this study was to summarize existing clinical studies through a systematic review to explore the efficacy of acupuncture in treating sleep disorders in PD patients.

METHODS

According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we retrieved the papers through 30 April 2023 from eight databases. The experimental group was treated with acupuncture plus conventional therapy, while the control group was treated with conventional therapy alone or combined with sham acupuncture. The sleep quality was the primary outcome. A team of researchers meticulously performed literature screening, data extraction and risk of bias assessment following the Cochrane Handbook. A meta-analysis was synthesized using Review Manager Version 5.4 software if feasible. The quality of the evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool.

RESULTS

A total of 973 papers were identified, with 15 papers involving 957 patients were included in this systematic review. The results showed that acupuncture interventions included manual acupuncture, electroacupuncture, moxibustion and bleeding, with 1-7 times every week implemented during 2-12 weeks. Acupuncture as an adjunct therapy compared to conventional therapy alone showed better effect in sleep quality and overall symptoms of PD. Risk of bias assessment showed deficiencies in blinding and allocation concealment. All included studies were synthesized in a meta-analysis, as the result of which, acupuncture improved PDSS scores(MD =16.57; 95% CI, 7.24-25.90; I2 = 97%) and effective rate for sleep disorders (OR = 5.91; 95% CI, 1.71-20.39; I2 = 54%); meanwhile, acupuncture reduced UPDRS scores(MD = -4.29; 95% CI, -6.54 - -2.03; I2 = 77%) and improved effective rate for PD (OR = 3.22; 95% CI, 1.81-5.72; I2 = 0%). The quality of evidence ranged from low to moderate by GRADE.

CONCLUSION

This study provides initial evidence that acupuncture as an adjunct therapy might be associated with improvement of sleep disorders in PD. Due to the lack of high-quality studies, larger sample size studies with sham acupuncture groups should be conducted in future.

REGISTRATION NUMBER

CRD42022364249 (PROSPERO).

Efficacy of non-pharmacological interventions for sleep quality in Parkinson's disease: a systematic review and network meta-analysis

Background

Sleep disorders are one of the most common non-motor symptoms in PD. It can cause a notable decrease in quality of life and functioning in PD patients, as well as place a huge burden on both patients and caregivers. Currently, there are numerous non-pharmacological interventions available to improve sleep quality in PD, with disagreement as to which intervention is most effective. This network meta-analysis was performed to compare and rank non-pharmacological interventions to explore their efficacy in improving sleep quality in PD and to select the best interventions, with a view to providing references and bases for the development of clinical treatments and care programs.

Methods

The PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang databases were searched from inception to December 6, 2023. Two authors independently screened all studies, extracted the data, and evaluated risk of bias of included studies. STATA software version 17.0 was used to conduct the network meta-analysis.

Results

Our network meta-analysis included 29 studies involving 1,477 participants and 16 non-pharmacological interventions. Although most nonpharmacological interventions showed non-significant effects, the surface under the cumulative ranking curve (SUCRA) values indicated that the best non-pharmacological intervention for sleep disorders was massage therapy (97.3%), followed by music therapy (94.2%), and Treadmill training (85.7%).

Conclusion

Massage therapy can be considered as an effective therapy for improving sleep quality in patients with PD. Due to limited quantity and quality of the included studies, more high quality studies are required to verify the conclusions of this network meta-analysis.

Systematic review registration

identifier CRD42023429339, PROSPERO (york.ac.uk).