Abstract
ABSTRACTPatients with Parkinson's disease (PD) are very vulnerable to the negative effects of psychological distress: neuropsychiatric symptoms, such as anxiety and depression, are highly prevalent in PD; motor symptoms (such as tremor) typically worsen in stressful situations; and dopaminergic medication is less effective. Furthermore, animal studies of PD suggest that chronic stress may accelerate disease progression. Adequate self‐management strategies are therefore essential to reduce the detrimental effects of chronic stress on PD. Mindfulness‐based interventions encourage individuals to independently self‐manage and adapt to the challenges created by their condition. In PD, emerging clinical evidence suggests that mindfulness‐based interventions may reduce psychological distress and improve clinical symptoms, but insight into the underlying mechanisms is lacking. In this viewpoint, we provide a systematic overview of existing mindfulness trials in PD. Furthermore, we discuss the cerebral mechanisms involved in acute and chronic stress, and the impact of mindfulness‐based interventions on these networks. In addition, we delineate a hypothetical mechanistic framework of how chronic stress may increase the susceptibility for neuropsychiatric symptoms in PD and may potentially even influence disease progression. We end with offering recommendations for future research. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
Highlights
The increased sensitivity of patients with Parkinson’s disease (PD) to stress may be related to dopaminergic dysfunction of the striatum: dopamine-dependent adaptation is a requirement for successful coping that, when deficient, leads to a sense of loss of control and increased psychological distress.[8]
We discuss the detrimental effect of chronic stress on PD and how mindfulness-based interventions may mitigate this effect, both from a clinical and a mechanistic standpoint
Absolute changes between baseline and postintervention for measures relating to motor symptoms, depression, anxiety, and quality of life are listed
Summary
The following full text is a publisher's version. For additional information about this publication click this link. https://repository.ubn.ru.nl/handle/2066/232519. PD that coronavirus disease (COVID)-related stress was associated with increased (self-reported) severity of motor and neuropsychiatric symptoms (anxiety and depression), and of nonmotor symptoms, such as pain, constipation, and sleeping difficulties.[6] Third, dopaminergic medication can be less effective in reducing motor symptoms during stress, as has been shown for tremor.[7] The increased sensitivity of patients with PD to stress may be related to dopaminergic dysfunction of the striatum: dopamine-dependent adaptation (or flexibility) is a requirement for successful coping that, when deficient, leads to a sense of loss of control and increased psychological distress.[8] In this viewpoint, we discuss the detrimental effect of chronic stress on PD and how mindfulness-based interventions may mitigate this effect, both from a clinical and a mechanistic standpoint. All trials used Movement Disorder Society Unified Parkinson’s Disease Rating Scale Part III (MDS-UPDRS III) scores as an outcome measure, for which the MCID threshold was estimated to be 3.25 points.[20] Only one of three studies showed a significant improvement of 13.8 points in the intervention group. For QoL questionnaires, the estimated MCID in patients with PD for the Parkinson’s Disease Questionnaire (PDQ)-39 is −4.7
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