Nonpharmacologic management of Parkinson disease
- Daniel Tarsy, MD
Daniel Tarsy, MD
- Professor of Neurology
- Harvard Medical School
Parkinson disease (PD) is a chronic disorder that requires broad-based management including patient and family education, support group services, general wellness maintenance, exercise, and nutrition. Treatment of PD can be divided into nonpharmacologic, pharmacologic, and surgical therapy. A useful algorithm for the management of PD has been published by the American Academy of Neurology (AAN) .
This topic will review the nonpharmacologic management of PD. The pharmacologic treatment of PD and the treatment of comorbid problems associated with it are discussed separately. (See "Pharmacologic treatment of Parkinson disease" and "Management of comorbid problems associated with Parkinson disease".)
The prospect of having a chronic and progressive neurologic disease is frightening. Many individuals are familiar with Parkinson disease (PD) and may even have had first-hand acquaintance with its disabling effects in an affected family member or friend. Education is essential in order to provide the patient and family with some understanding and control over the disorder.
However, caution should be exercised in newly diagnosed patients with mild symptoms and an uncertain future with regard to progression; early overexposure to potentially disturbing material may be counterproductive. Focused education surrounding particular symptoms may be more effective and is available through books and other materials (see 'Information for patients' below) written for the lay audience, through national and regional Parkinson disease organizations (table 1), which publish educational pamphlets and organize symposia for patients and families, and through the internet.
The emotional and psychologic needs of the patient with PD and family should be addressed. Normal reactions of anger, depression, anxiety, and social and economic concerns often begin with the onset of the disease and evolve as it progresses. Support for the caregiver is particularly important as he or she learns to cope with the increasing needs of the spouse or parent, or more rarely, a son or daughter . Support groups are especially valuable for allowing interactions with other patients or families with similar experiences and for providing access to useful educational information .
- Olanow CW, Watts RL, Koller WC. An algorithm (decision tree) for the management of Parkinson's disease (2001): treatment guidelines. Neurology 2001; 56:S1.
- Carter JH, Stewart BJ, Archbold PG, et al. Living with a person who has Parkinson's disease: the spouse's perspective by stage of disease. Parkinson's Study Group. Mov Disord 1998; 13:20.
- Mittelman MS, Ferris SH, Shulman E, et al. A comprehensive support program: effect on depression in spouse-caregivers of AD patients. Gerontologist 1995; 35:792.
- Young Parkinson's Handbook, Mark MH, Sage JI (Eds), The American Parkinson Disease Association, Inc, New York 2000. www.stlapda.org/content/pdfs/Young%20Parkinson%20Handbook.pdf (Accessed on February 14, 2012).
- Comella CL, Stebbins GT, Brown-Toms N, Goetz CG. Physical therapy and Parkinson's disease: a controlled clinical trial. Neurology 1994; 44:376.
- Suchowersky O, Gronseth G, Perlmutter J, et al. Practice Parameter: neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006; 66:976.
- Shulman LM, Katzel LI, Ivey FM, et al. Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease. JAMA Neurol 2013; 70:183.
- Ridgel AL, Vitek JL, Alberts JL. Forced, not voluntary, exercise improves motor function in Parkinson's disease patients. Neurorehabil Neural Repair 2009; 23:600.
- Ahlskog JE. Does vigorous exercise have a neuroprotective effect in Parkinson disease? Neurology 2011; 77:288.
- Uc EY, Doerschug KC, Magnotta V, et al. Phase I/II randomized trial of aerobic exercise in Parkinson disease in a community setting. Neurology 2014; 83:413.
- Reynolds GO, Otto MW, Ellis TD, Cronin-Golomb A. The Therapeutic Potential of Exercise to Improve Mood, Cognition, and Sleep in Parkinson's Disease. Mov Disord 2016; 31:23.
- Li F, Harmer P, Fitzgerald K, et al. Tai chi and postural stability in patients with Parkinson's disease. N Engl J Med 2012; 366:511.
- Tomlinson CL, Herd CP, Clarke CE, et al. Physiotherapy for Parkinson's disease: a comparison of techniques. Cochrane Database Syst Rev 2014; :CD002815.
- Wade DT, Gage H, Owen C, et al. Multidisciplinary rehabilitation for people with Parkinson's disease: a randomised controlled study. J Neurol Neurosurg Psychiatry 2003; 74:158.
- Monticone M, Ambrosini E, Laurini A, et al. In-patient multidisciplinary rehabilitation for Parkinson's disease: A randomized controlled trial. Mov Disord 2015; 30:1050.
- Miyai I, Fujimoto Y, Ueda Y, et al. Treadmill training with body weight support: its effect on Parkinson's disease. Arch Phys Med Rehabil 2000; 81:849.
- Miyai I, Fujimoto Y, Yamamoto H, et al. Long-term effect of body weight-supported treadmill training in Parkinson's disease: a randomized controlled trial. Arch Phys Med Rehabil 2002; 83:1370.
- Mehrholz J, Kugler J, Storch A, et al. Treadmill training for patients with Parkinson's disease. Cochrane Database Syst Rev 2015; :CD007830.
- Hirsch MA, Toole T, Maitland CG, Rider RA. The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson's disease. Arch Phys Med Rehabil 2003; 84:1109.
- Silva-Batista C, Corcos DM, Roschel H, et al. Resistance Training with Instability for Patients with Parkinson's Disease. Med Sci Sports Exerc 2016; 48:1678.
- Marchese R, Diverio M, Zucchi F, et al. The role of sensory cues in the rehabilitation of parkinsonian patients: a comparison of two physical therapy protocols. Mov Disord 2000; 15:879.
- Pacchetti C, Mancini F, Aglieri R, et al. Active music therapy in Parkinson's disease: an integrative method for motor and emotional rehabilitation. Psychosom Med 2000; 62:386.
- Tomlinson CL, Patel S, Meek C, et al. Physiotherapy versus placebo or no intervention in Parkinson's disease. Cochrane Database Syst Rev 2013; :CD002817.
- Johnson JA, Pring TR. Speech therapy and Parkinson's disease: a review and further data. Br J Disord Commun 1990; 25:183.
- Ramig LO, Sapir S, Fox C, Countryman S. Changes in vocal loudness following intensive voice treatment (LSVT) in individuals with Parkinson's disease: a comparison with untreated patients and normal age-matched controls. Mov Disord 2001; 16:79.
- Herd CP, Tomlinson CL, Deane KH, et al. Speech and language therapy versus placebo or no intervention for speech problems in Parkinson's disease. Cochrane Database Syst Rev 2012; :CD002812.
- Nutt, JG, Carter, JH. Dietary issues in the treatment of Parkinson's disease. In: Therapy of Parkinson's Disease, Koller, WC, Paulson, G (Eds), Marcel Dekker, New York, 1990. p.531.