Non-pharmacological and non-surgical therapies in advanced Parkinson's disease: a narrative review and call to action.
Non-pharmacological and non-surgical therapies in advanced Parkinson's disease: a narrative review and call to action.
Where did the research take place?
The study site has not been established. Author addresses may differ from where the research occurred.
Dublin, IE · Author affiliation
Dublin Neurological Institute, Mater Misericordiae University Hospital, Dublin, Ireland. cfearon@tcd.ie.Location evidence
DE · Author affiliation · country only
Parkinson-Klinik Ortenau, 77709, Wolfach, Germany.Location evidence
Prague, CZ · Author affiliation
Department of Neurology, Center of Clinical Neuroscience First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.Location evidence
Zagreb, HR · Author affiliation
Department of Neurology, University Hospital Dubrava, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia.Location evidence
London, GB · Author affiliation
Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, UCL, London, UK.Location evidence
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Original abstract
Non-pharmacological and non-surgical interventions are increasingly recognised as essential components of management of Parkinson's disease (PD). However, as PD progresses to its advanced stages, limited mobility, cognitive impairment, treatment-refractory symptoms, and increasing dependence on care partners dominate. However, the evidence base for therapies in this stage becomes scarce. Most clinical practice guidelines and systematic reviews address PD as a whole, without highlighting specific recommendations tailored to advanced disease stage. This narrative review examines the current evidence for non-pharmacological and non-surgical therapies specifically in the context of advanced PD. This includes physiotherapy and exercise, freezing of gait management, dysphagia rehabilitation, nutrition and dietetics, neuropsychiatric care, autonomic dysfunction, pain management, and palliative care. We synthesised evidence from recent systematic reviews of clinical practice guidelines, scoping reviews of rehabilitation interventions in advanced PD, systematic reviews and meta-analyses of non-pharmacological treatments for specific symptom domains, the published literature on advanced PD management, and expert consensus. A recent systematic review identified 40 summary statements for non-pharmacological interventions in PD, yet these were developed without stage-specific differentiation. A scoping review of rehabilitation interventions specifically targeting advanced PD identified only 13 studies, predominantly focused on physical functioning. On the other hand, while interventions for freezing of gait, swallowing therapies, cognitive behavioural therapy for neuropsychiatric symptoms, non-invasive brain stimulation, non-pharmacological autonomic management, and multimodal exercise have demonstrated promise in PD, robust evidence for advanced PD remains largely absent. People with advanced PD represent a neglected population in non-pharmacological therapy research. There is a clear need for inclusion of people with advanced PD in guideline development and a holistic approach addressing factors such as demoralisation, caregiver strain, autonomic dysfunction, and spiritual wellbeing alongside physical rehabilitation.