Advances in the Pharmacological and Non-pharmacological Management of Non-motor Symptoms in Parkinson’s Disease: An Update Since 2017

Abstract

Background: Non-motor symptoms (NMS) are an important and ubiquitous determinant of quality of life in Parkinson’s disease (PD). However, a robust evidence base for their treatment is still a major unmet need. Objective: To provide an updated review on advances in pharmacological, non-pharmacological, and exercise- based interventions for NMS in PD, covering the period since the publication of the MDS Task Force Recommendations. Methods: We performed a literature search to identify pharmacological, non-pharmacological, and exercise- based interventions for NMS in PD. As there are recent reviews on the subject we have only included studies from the 1 st of January 2017 to 1 st of December 2021 and limited our search to randomised and non-randomised (including open-label) clinical trials. Results: We discuss new strategies to manage NMS based on data that have become available since 2017, for instance on treatment of orthostatic hypotension with droxidopa, several dopaminergic treatment options for insomnia, and a range of non-pharmacological and exercise-based interventions for cognitive and neuropsychiatric symptoms, pain, and insomnia and excessive sleepiness. Conclusion: Recent evidence suggests that targeted non-pharmacological treatments, as well as some other NMS management options may have a significant beneficial effect on quality of life and need to be considered in the pathways of treatment of PD.

Aging and aging-related diseases: from molecular mechanisms to interventions and treatments

“…529,530 Nondrug treatments for PD include surgical treatments that can relieve the clinical symptoms, such as deep brain stimulation and rehabilitation and exercise therapy. 531 At present, the drugs for the treatment of PD are divided into two main categories: anticholinergic drugs (such as Antan) and drugs related to the action of dopamine in the brain. 532,533 To improve PD pathology, attempts have been made to reduce α-syn expression.…”

Effects and Mechanisms of Exercise on Brain-Derived Neurotrophic Factor (BDNF) Levels and Clinical Outcomes in People with Parkinson’s Disease: A Systematic Review and Meta-Analysis

“…Parkinson’s disease causes a wide variety of non-motor features (NMF) and motor symptoms including tremor, dystonia, rigidity, bradykinesia, as well as problems with gait, motor coordination, and balance [ 5 ]. Non-motor features include behavioral changes, depression and anxiety, cognitive impairment (specifically relating to learning and memory), constipation, osteoporosis, pain, insomnia, and fatigue [ 6 ]. The medical management of these issues can be ameliorated to a certain extent pharmacologically with L-dopa or, in the later stages, with neurosurgical approaches such as deep brain stimulation.…”

Efficacy of non-pharmacological interventions on depressive symptoms in patients with Parkinson’s disease: a study protocol for a systematic review and network meta-analysis

“…Although the latter constitute the first-line intervention for the treatment of PD depression, they have not achieved satisfactory results with regard to efficacy, tolerability and patient acceptability. 22 Pharmacological treatments, such as dopamine agonists and monoamine oxidase inhibitors, fail to provide either adequate symptom control or a high quality of life. 23 Dopaminergic medications induce severe side effects such as serious dyskinesias.…”

“…Currently, there is no evidence-based evaluation in the field comparing the clinical efficacy of different non-pharmacological interventions for the treatment of PD depression. 22 For the current study, therefore, non-pharmacological interventions commonly used in clinical practice will be selected and relevant clinical evidence will be integrated using traditional meta and network meta-analysis (NMA) methods to compare the clinical efficacy and safety of various non-pharmacological interventions and thus identify the most effective non-pharmacological intervention for clinical treatment.…”

“…Currently, the most effective treatment approach for PD depression is considered to be a combination of anti-parkinsonism medications with antidepressants. Although the latter constitute the first-line intervention for the treatment of PD depression, they have not achieved satisfactory results with regard to efficacy, tolerability and patient acceptability 22. Pharmacological treatments, such as dopamine agonists and monoamine oxidase inhibitors, fail to provide either adequate symptom control or a high quality of life 23.…”