Abstract
Objective: The aim of this study was to perform a quantitative analysis to evaluate the efficacy of cognitive behavioral therapy (CBT) on mood disorders, sleep, fatigue, and its impact on quality of life (QOL) in Parkinson's Disease (PD).Methods: We searched for randomized controlled trials in three electronic databases. Fourteen studies, including 507 patients with PD, met the inclusion criteria. We determined the pooled efficacy by standard mean differences and 95% confidence intervals, using I2 to reveal heterogeneity.Results: The result showed CBT had a significant effect on depression [−0.93 (95%CI, −1.19 to −0.67, P < 0.001)] and anxiety [−0.76 (95%CI, −0.97 to −0.55, P < 0.001)]. Moderate effect sizes were noted with sleep disorders [−0.45 (95% CI, −0.70 to −0.20, P = 0.0004)]. There was no evident impact of CBT on fatigue or QOL. We found an intervention period >8 weeks was advantageous compared with <8 weeks, and CBT implemented in non-group was more effective than in group. Between the delivery methods, no significant difference was found.Conclusion: We found that CBT in patients with PD was an efficacious therapy for some non-motor symptoms in PD, but not efficacious for fatigue and QOL. These results suggest that CBT results in significant improvement in PD and should be used as a conventional clinical intervention.
Highlights
Parkinson’s Disease (PD), a common neurodegenerative disorder with motor and non-motor symptoms that is second in prevalence to Alzheimer’s disease, affects more than 1% of the world’s population [1]
The inclusion criteria were as follows: [1] The study designed as a RCT (Random methods can be a computer-based random number generator, sealed envelopes including numbers and others); [2] participants had PD with any kind of nonmotor symptoms without limiting the severity of the symptoms; [3] the intervention was Cognitive behavioral therapy (CBT) and its derivative therapy and [4] the outcome was evaluated by clinically approved scales
We analyzed the scales used and found moderate effects were reported using scales other than the PDQ (0.42, 95%CI −0.01 to 0.84, P = 0.05, I2 = 0%), while we found small change score of CBT in enhancing quality of life (QOL) when measured with the PDQ (Figure 8)
Summary
Parkinson’s Disease (PD), a common neurodegenerative disorder with motor and non-motor symptoms that is second in prevalence to Alzheimer’s disease, affects more than 1% of the world’s population [1]. Compared with motor symptoms (resting tremor, bradykinesia, rigidity, and gait disturbances), non-motor symptoms (mood disturbances, fatigue, apathy, and sleep disorders) are often clinically underappreciated [2, 3]. Of these non-motor symptoms, the prevalence of mixed depression and anxiety reaches 50% and is more commonly found in patients with PD than in the general population [4]. Administration of regular sessions of CBT, which incorporates tailored interventions of relaxation training, thought monitoring and restructuring, sleep hygiene, worry control, and others, has resulted in symptom improvements in patients with PD [13]
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