Non-pharmacological treatment challenges in early Parkinson's disease for axial and cognitive symptoms : A mini review

Journal article


Constantinescu-Sharpe, Gabriella, Macerollo, Antonella, Fabbri, Margherita and Tripoliti, Elina. (2020). Non-pharmacological treatment challenges in early Parkinson's disease for axial and cognitive symptoms : A mini review. Frontiers in Neurology. 11, p. 576569. https://doi.org/10.3389/fneur.2020.576569
AuthorsConstantinescu-Sharpe, Gabriella, Macerollo, Antonella, Fabbri, Margherita and Tripoliti, Elina
Abstract

Background: Parkinson's disease (PD) is now known to be a multisystemic heterogeneous neurodegenerative disease, including a wide spectrum of both motor and non-motor symptoms. PD patients' management must encompass a multidisciplinary approach to effectively address its complex nature. There are still challenges in terms of treating axial (gait, balance, posture, speech, and swallowing) and cognitive symptoms that typically arise with disease progression becoming poorly responsive to dopaminergic or surgical treatments.

Objective: The objectives of the study are to further establish the presentation of axial and cognitive symptoms in early PD [Hoehn and Yahr (H&Y) scale ≤ 2] and to discuss the evidence for non-pharmacological approaches in early PD.

Results: Mild and subtle changes in the investigated domains can be present even in early PD. Over the last 15 years, a few randomized clinical trials have been focused on these areas. Due to the low number of studies and the heterogeneity of the results, no definitive recommendations are possible. However, positive results have been obtained, with effective treatments being high-intensity treadmill and cueing for gait disturbances, high-intensity voice treatment, video-assisted swallowing therapy for dysphagia, and warm-up exercises and Wii FitTM training for cognition.

Conclusions: Considering the association of motor, speech, and cognitive function, future trials should focus on multidisciplinary approaches to combined non-pharmacological management. We highlight the need for a more unified approach in managing these “orphan” symptoms, from the very beginning of the disease. The concept “the sooner the better” should be applied to multidisciplinary non-pharmacological management in PD.

Keywordsearly Parkinson’s disease; speech; swallowing; axial symptoms; cognition; multidisciplinary care
Year2020
JournalFrontiers in Neurology
Journal citation11, p. 576569
PublisherFrontiers Research Foundation
ISSN1664-2295
Digital Object Identifier (DOI)https://doi.org/10.3389/fneur.2020.576569
Scopus EID2-s2.0-85092523447
Research or scholarlyResearch
Page range1-11
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online25 Sep 2020
Publication process dates
Accepted17 Aug 2020
Deposited12 Jul 2021
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