Non-pharmacological Treatment Challenges in Early Parkinson's Disease for Axial and Cognitive Symptoms: A Mini Review.

Gabriella Sharpe,Elina Tripoliti,Margherita Fabbri,Antonella Macerollo

doi:10.3389/fneur.2020.576569

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.

Highlights

Parkinson’s disease (PD) is a neurodegenerative disease characterized by a spectrum of both motor and non-motor symptoms
Identifying the extent to which these symptoms are present in early PD and treating these symptoms early could help reduce their burden in later disease stages
This study explored the balance Berg scale as a secondary outcome among Hoehn and Yahr scale (H&Y) 1–2 patients finding an improvement in both groups [14] (Table 1)

Summary

Introduction

Parkinson’s disease (PD) is a neurodegenerative disease characterized by a spectrum of both motor and non-motor symptoms. Effective management of patients with PD (PwPD) must encompass a multidisciplinary individualized approach [1,2,3]. The same concept could be applied for non-pharmacological treatment for those troublesome symptoms that characterize the advanced PD stage; we need to elaborate and identify strategies that could prevent disabilities and act before their manifested appearance [10]. Parkinson’s disease (PD) is 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

Results

Discussion

Conclusion