Abstract
BackgroundParkinson’s disease (PD) is a chronic neurodegenerative disorder with limited knowledge about the normal function and effects of non-pharmacological therapies on the hypothalamic-pituitary-adrenal (HPA) axis. The aim of the study was to analyse the basal diurnal and total secretion of salivary cortisol in short- and long-term aspects of tactile massage (TM).MethodsDesign: Prospective, Controlled and Randomised Multicentre Trial.Setting and interventions: Forty-five women and men, aged 50–79 years, were recruited. Twenty-nine of them were blindly randomised to tactile massage (TM) and 16 of them to the control group, rest to music (RTM). Ten interventions were given during 8 weeks followed by a 26 weeks of follow up. Salivary cortisol was collected at 8 am, 1 pm, 8 pm, and 8 am the next day, on five occasions. With the first and eighth interventions, it was collected immediately before and after intervention.Main outcome measures: The primary aim was to assess and compare cortisol concentrations before and immediately after intervention and also during the follow-up period. The secondary aim was to assess the impact of age, gender, body mass index (BMI), duration and severity of PD, effects of interventional time-point of the day, and levodopa doses on cortisol concentration.ResultsThe median cortisol concentrations for all participants were 16.0, 5.8, 2.8, and 14.0 nmol/L at baseline, later reproduced four times without significant differences. Cortisol concentrations decreased significantly after TM intervention but no change in diurnal salivary cortisol pattern was found. The findings of reduced salivary cortisol concentrations immediately after the interventions are in agreement with previous studies. However, there was no significant difference between the TM and control groups. There were no significant correlations between cortisol concentrations and age, gender, BMI, time-point for intervention, time interval between anti-parkinson pharmacy intake and sampling, levodopa doses, duration, or severity of PD.ConclusionsDiurnal salivary cortisol rhythm was normal. Salivary cortisol concentrations were significantly reduced after the TM intervention and after RTM, but there were no significant differences between the groups and no sustained long-term effect. No associations were seen between salivary cortisol concentration and clinical and/or pharmacological characteristics.Trial registrationClinicalTrial.gov, NCT01734876 and FoU Sweden 108881.
Highlights
Parkinson’s disease (PD) is a chronic neurodegenerative disorder with limited knowledge about the normal function and effects of non-pharmacological therapies on the hypothalamic-pituitary-adrenal (HPA) axis
In a previous study by our group, we found that median morning salivary cortisol concentrations and total cortisol secretion during the day were higher in PD than in an age- and sex-matched healthy reference group [8]
We found higher morning cortisol in both PD groups compared with the reference group
Summary
Parkinson’s disease (PD) is a chronic neurodegenerative disorder with limited knowledge about the normal function and effects of non-pharmacological therapies on the hypothalamic-pituitary-adrenal (HPA) axis. Many PD patients suffer from sleep disorders, apathy, tiredness, anorexia, and instability (hypotension) These symptoms can mimic reduced adrenal cortisol activity. Several studies have shown salivary cortisol concentration to be an excellent mirror of hypothalamic-pituitary axis function [11], with fast reactions to changes in the surroundings [12]. We hypothesised that this would be a natural biomarker for stress in our study. In a previous study by Hartmann [13], total serum cortisol was analysed every 15 min for 24 h They found a higher diurnal cortisol secretion in PD compared with a healthy reference group. Could these results be a consequence of stress in the sampling situation?
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