Non-Pharmacological Interventions for Depression and Anxiety in Parkinson's Disease.

Non-pharmacological interventions, including cognitive-behavioral therapy (CBT), non-invasive brain stimulation (NIBS), electroconvulsive therapy (ECT), light therapy (LT), and physical rehabilitation/exercise, have shown promise as effective approaches to treat symptoms of depression and anxiety in individuals with Parkinson's disease (PD). In this narrative literature overview, we discuss the state-of-the-art regarding these treatment options and address future perspectives for clinical practice and research. Non-pharmacological interventions hold promise to treat depression and anxiety in PD. There is meta-analytic evidence for the efficacy of CBT, NIBS, ECT, LT, and exercise on improving depressive symptoms. For the treatment of anxiety symptoms, CBT shows large effects but scientific evidence of other non-pharmacological interventions is limited. Importantly, these treatments are safe interventions with no or mild side-effects. More research is needed to tailor treatment to the individuals' needs and combined interventions may provide synergistic effects.We conclude that non-pharmacological interventions should be considered as alternative or augmentative treatments to pharmacological and neurosurgical approaches for the treatment of depression and anxiety in individuals with PD.

Mindfulness Training among Individuals with Parkinson's Disease: Neurobehavioral Effects.

Objective. To investigate possible neurobehavioral changes secondary to a mindfulness based intervention (MBI) training for individuals living with Parkinson's disease (PD). Background. In the context of complementary medicine, MBIs are increasingly being used for stress reduction and in patient populations coping with chronic illness. The use of alternative and complementary medicine may be higher in patients with chronic conditions such as PD. However, behavioral effects of mindfulness training in PD have not yet been reported in the literature and this points to an unmet need and warrants further examination. Methods. A total of 27 out of 30 PD patients completed a randomized controlled longitudinal trial. Questionnaires and the UPDRS I-IV were obtained at baseline and 8-week follow-up. Results. Significant changes after the MBI were found including a 5.5 point decrease on the UPDRS motor score, an increase of 0.79 points on Parkinson's disease questionnaire (PDQ-39) pain item, and a 3.15 point increase in the Five Facet Mindfulness Questionnaire observe facet. Conclusions. To the best of our knowledge, this is the first quantitative analysis of neurobehavioral effects of MBI in PD.

Training with verbal instructional cues results in near-term improvement of gait in people with Parkinson disease.

PURPOSE: To assess immediate and near-term effects of an instructional set on select gait parameters in people living with Parkinson disease (PD). SUBJECTS: Five individuals with early stage PD participated in a within subject design in Part One. Eleven individuals with early stage PD were randomly assigned to a treatment group (n = 5) or a control group (n = 6) in Part Two. METHODS: The treatment consisted of a 10-day training program of walking 1800 feet per day and with the instructions to take long steps. Testing occurred before treatment (baseline), immediately after treatment, one week after treatment, and one month after treatment. Measurements of step length, velocity, and cadence were taken without the use of the instructional set. RESULTS: There was a significant increase in step length and velocity and a significant decrease in cadence between baseline and all post-test measures for part one. For part 2, step length of the treatment group significantly increased between baseline and all 3 post-tests and there was a significant difference between the treatment group and control group at all posttests for step length. CONCLUSIONS: The instructional set was effective in improving parameters of gait for at least 4 weeks. These data support the concept that people with Parkinson disease have a potential for motor learning.