Non-pharmacologic interventions to treat apathy in Parkinson’s disease: A realist review

Mele, Bria; Ismail, Zahinoor; Goodarzi, Zahra; Pringsheim, Tamara; Lew, Grace; Holroyd‐Leduc, Jayna

doi:10.1016/j.prdoa.2021.100096

Cited by 9 publications

(9 citation statements)

References 38 publications

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“…In patients whose striatal DAT SBR is particularly low, there is a scope to monitor apathy and anhedonia symptoms, or to intervene early with interventions such as behavioural activation therapy which has been shown to be potentially effective in treating these symptoms in PD. 43 However, further validation of striatal DAT SBR as a potential marker of apathy/anhedonia risk is needed, especially as the Robin-Hood algorithm used in the two-lines test primarily tests for the presence of a threshold effect and cannot precisely identify the true turning point value.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal decline in striatal dopamine transporter binding in Parkinson’s disease: associations with apathy and anhedonia

Costello

Yamamori

Reeves

et al. 2023

J Neurol Neurosurg Psychiatry

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BackgroundMotivational symptoms such as apathy and anhedonia are common in Parkinson’s disease (PD), respond poorly to treatment, and are hypothesised to share underlying neural mechanisms. Striatal dopaminergic dysfunction is considered central to motivational symptoms in PD but the association has never been examined longitudinally. We investigated whether progression of dopaminergic dysfunction was associated with emergent apathy and anhedonia symptoms in PD.MethodsLongitudinal cohort study of 412 newly diagnosed patients with PD followed over 5 years as part of the Parkinson’s Progression Markers Initiative cohort.Apathy and anhedonia were measured using a composite score derived from relevant items of the 15-item Geriatric Depression Scale (GDS-15) and part I of the MDS-Unified Parkinson’s Disease Rating Scale. Dopaminergic neurodegeneration was measured using repeated striatal dopamine transporter (DAT) imaging.ResultsLinear mixed-effects modelling across all contemporaneous data points identified a significant negative relationship between striatal DAT specific binding ratio (SBR) and apathy/anhedonia symptoms, which emerged as PD progressed (interaction:β=−0.09, 95% CI (−0.15 to 0.03), p=0.002). Appearance and subsequent worsening of apathy/anhedonia symptoms began on average 2 years after diagnosis and below a threshold striatal DAT SBR level. The interaction between striatal DAT SBR and time was specific to apathy/anhedonia symptoms, with no evidence of a similar interaction for general depressive symptoms from the GDS-15 (excluding apathy/anhedonia items) (β=−0.06, 95% CI (−0.13 to 0.01)) or motor symptoms (β=0.20, 95% CI (−0.25 to 0.65)).ConclusionsOur findings support a central role for dopaminergic dysfunction in motivational symptoms in PD. Striatal DAT imaging may be a useful indicator of apathy/anhedonia risk that could inform intervention strategies.

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Section: Discussionmentioning

confidence: 99%

Longitudinal decline in striatal dopamine transporter binding in Parkinson’s disease: associations with apathy and anhedonia

Costello

Yamamori

Reeves

et al. 2023

J Neurol Neurosurg Psychiatry

View full text Add to dashboard Cite

show abstract

“…In patients whose striatal DAT SBR is particularly low, there is scope to monitor apathy and anhedonia symptoms, or to intervene early with interventions such as behavioural activation therapy which has been shown to be potentially effective in treating these symptoms in PD. 38 However, further validation of striatal DAT SBR as a potential marker of apathy/anhedonia risk is needed, especially as the Robin-Hood algorithm used in the two-lines test primarily tests for the presence of a threshold effect and cannot precisely identify the true turning point value.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal decline in striatal dopamine transporter binding in Parkinson’s disease: Associations with apathy and anhedonia

Costello

Yamamori

Reeves

et al. 2022

Preprint

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Background Motivational symptoms such as apathy and anhedonia are common in Parkinson's disease, respond poorly to treatment, and have been hypothesised to share underlying neural mechanisms. Striatal dopaminergic dysfunction is considered central to motivational symptoms in Parkinson's disease, but the association has never been examined longitudinally. We investigated whether the progression of dopaminergic neurodegeneration was associated with emergent apathy and anhedonia symptoms in Parkinson's disease. Methods Longitudinal cohort study of 412 newly diagnosed Parkinson's disease patients followed over five years as part of the Parkinson's Progression Markers Initiative (PPMI) cohort. Apathy and anhedonia were measured using a composite score derived from relevant items of the 15-item geriatric depression scale (GDS-15) and part I of the MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Dopaminergic neurodegeneration was measured using repeated ioflupane [123-I] single photon emission computed tomography imaging of striatal dopamine transporters (DAT). Results Linear mixed-effects modelling across all contemporaneous data points identified a significant negative relationship between striatal DAT specific binding ratio(SBR) and apathy/anhedonia symptoms, which emerged as Parkinson's disease progressed (interaction: β = -0.09, 95%CI[-0.15 -0.03], p=0.002). Appearance and subsequent worsening of apathy/anhedonia symptoms began on average two years after diagnosis and below a threshold striatal DAT SBR level. The interaction between striatal DAT SBR and time was specific to apathy/anhedonia symptoms, with no evidence of a similar interaction for general depressive symptoms from the GDS-15 (excluding apathy/anhedonia items) (β =-0.06, 95%CI[-0.13 0.01]) or motor symptoms indexed by the MDS-UPDRS part III (β =0.20, 95%CI[-0.25 0.65]). Conclusion The relationship between the progression of dopaminergic neurodegeneration and emergent apathy/anhedonia symptoms supports a central role for dopaminergic dysfunction in motivational symptoms in Parkinson's disease. Striatal DAT imaging may be a useful indicator of apathy/anhedonia risk that could inform intervention strategies.

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“…We assume that mindfulness has been a stabilizing factor preventing an increase of apathy in the training group. Previously, Mele et al (2021) concluded that mindfulness might indeed be useful to treat symptoms of apathy in PD especially in patients with higher motor impairment and mostly intact cognitive functioning.…”

Section: Discussionmentioning

confidence: 99%

Pilot Study of Mindfulness Training on the Self-Awareness of Motor Symptoms in Parkinson’s Disease – A Randomized Controlled Trial

et al. 2021

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Objective: This study aims to evaluate feasibility and effects of a newly developed mindfulness intervention tailored to specific needs of patients with Parkinson’s disease (PD).Background: The phenomenon of impaired self-awareness of motor symptoms (ISAm) in PD might be reduced by increasing patients’ mindfulness. A PD-specific mindfulness intervention has been developed and evaluated as a potential treatment option: IPSUM (“Insight into Parkinson’s Disease Symptoms by using Mindfulness”).Methods: IPSUM’s effectiveness is evaluated by comparing an intervention with a waitlist-control group. Applying a pre-post design, patients were assessed before, directly after and 8weeks after treatment. The primary outcome was the change in a quantitative ISAm score from baseline to post-assessment. Secondary outcome measures were PD-related affective changes and neuropsychological test performance. Feasibility was evaluated via feedback forms.Results: In total, 30 non-depressed and non-demented PD patients were included (intervention: n=14, waitlist-control: n=16). ISAm score did not change significantly, but the training group showed greater performance in sustained attention and language tasks over time. Additional changes included greater mindfulness as well as less sleeping problems and anxiety. Cognitive disturbances, apathy, and sleeping problems worsened only in the waitlist-control group. Patients’ feedback regarding the training concept and material was excellent.Conclusion: Insight into Parkinson’s Disease Symptoms by using Mindfulness has not been capable of reducing ISAm in PD patients but appears to be a feasible and effective concept to, among others, support mental health in the mid-term. It has to be noted though that the study was stopped beforehand because of the SARS CoV-2 pandemic. The lack of findings might therefore be caused by a lack of statistical power. The need for further research to better understand the mechanisms of ISAm and its connection to mindfulness in PD is highlighted.

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Non-pharmacologic interventions to treat apathy in Parkinson’s disease: A realist review

Abstract: Highlights Nine studies explore non-pharmacological treatment of apathy in Parkinson’s disease. Exercise targets goal-directed behaviour change and engagement in social interactions. Mindfulness targets emotional, cognitive, and goal-directed domains of apathy.

Cited by 9 publications

References 38 publications

Longitudinal decline in striatal dopamine transporter binding in Parkinson’s disease: associations with apathy and anhedonia

Longitudinal decline in striatal dopamine transporter binding in Parkinson’s disease: associations with apathy and anhedonia

Longitudinal decline in striatal dopamine transporter binding in Parkinson’s disease: Associations with apathy and anhedonia

Pilot Study of Mindfulness Training on the Self-Awareness of Motor Symptoms in Parkinson’s Disease – A Randomized Controlled Trial

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