The multimodal effect of circadian interventions in Parkinson's disease: A narrative review.
Study Goal
The researchers aimed to evaluate the role of the circadian system and the effectiveness of light therapy, melatonin, and melatonin agonists in improving motor and non-motor symptoms in persons with Parkinson's disease.
Results Summary
Most studies showed that light therapy improved sleep, depression, motor function, and some cognitive and non-motor symptoms, with level 2B evidence for certain outcomes like daytime sleepiness and depressive symptoms. However, the small sample sizes and heterogeneous outcome measures were noted as limitations.
Population
Persons with Parkinson's disease (PwP)
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
melatonin | increase | measures of sleep | persons with Parkinson's disease (PwP) | - | induced improvements | #1 |
melatonin | increase | depression | persons with Parkinson's disease (PwP) | - | induced improvements | #2 |
melatonin | increase | motor function | persons with Parkinson's disease (PwP) | - | induced improvements | #3 |
melatonin | increase | cognitive function | persons with Parkinson's disease (PwP) | - | induced improvements | #4 |
melatonin | increase | other non-motor symptoms | persons with Parkinson's disease (PwP) | - | induced improvements | #5 |
melatonin agonists | increase | measures of sleep | persons with Parkinson's disease (PwP) | - | induced improvements | #6 |
melatonin agonists | increase | depression | persons with Parkinson's disease (PwP) | - | induced improvements | #7 |
melatonin agonists | increase | motor function | persons with Parkinson's disease (PwP) | - | induced improvements | #8 |
melatonin agonists | increase | cognitive function | persons with Parkinson's disease (PwP) | - | induced improvements | #9 |
melatonin agonists | increase | other non-motor symptoms | persons with Parkinson's disease (PwP) | - | induced improvements | #10 |
light therapy | increase | measures of sleep | persons with Parkinson's disease (PwP) | - | induced improvements | #11 |
light therapy | increase | depression | persons with Parkinson's disease (PwP) | - | induced improvements | #12 |
light therapy | increase | motor function | persons with Parkinson's disease (PwP) | - | induced improvements | #13 |
light therapy | increase | cognitive function | persons with Parkinson's disease (PwP) | - | induced improvements | #14 |
light therapy | increase | other non-motor symptoms | persons with Parkinson's disease (PwP) | - | induced improvements | #15 |
circadian treatments | increase | daytime sleepiness | persons with Parkinson's disease (PwP) | level 2 B evidence | evidence for the use | #16 |
circadian treatments | increase | depressive symptoms | persons with Parkinson's disease (PwP) | level 2 B evidence | evidence for the use | #17 |
circadian treatments | increase | some motor symptoms | persons with Parkinson's disease (PwP) | level 2 B evidence | evidence for the use | #18 |
bright light therapy | increase | sleep quality | persons with Parkinson's disease (PwP) | - | positive effects | #19 |
bright light therapy | increase | depression | persons with Parkinson's disease (PwP) | - | positive effects | #20 |
bright light therapy | increase | motor function | persons with Parkinson's disease (PwP) | - | positive effects | #21 |
exogenous melatonin | increase | sleep quality | persons with Parkinson's disease (PwP) | - | positive effects | #22 |
exogenous melatonin | increase | depression | persons with Parkinson's disease (PwP) | - | positive effects | #23 |
exogenous melatonin | increase | motor function | persons with Parkinson's disease (PwP) | - | positive effects | #24 |
melatonin agonists | increase | sleep quality | persons with Parkinson's disease (PwP) | - | positive effects | #25 |
melatonin agonists | increase | depression | persons with Parkinson's disease (PwP) | - | positive effects | #26 |
melatonin agonists | increase | motor function | persons with Parkinson's disease (PwP) | - | positive effects | #27 |
BACKGROUND: The circadian system and its dysfunction in persons with Parkinson's disease (PwP) has a clear impact on both motor and non-motor symptoms. Examples include circadian patterns in motor disability, with worsening of symptoms throughout the day, but also the existence of similar patterns in non-motor symptoms. OBJECTIVE: In this narrative review, we discuss the role of the circadian system, we address the role of dopamine in this system, and we summarise the evidence that supports the use of circadian system treatments for motor and non-motor symptoms in PwP. METHODS: A systematic search in PubMed and Web of Science database was performed and the final search was performed in November 2021. We included articles whose primary aim was to investigate the effect of melatonin, melatonin agonists, and light therapy in PwP. RESULTS: In total 25 articles were retrieved. Of these, 12 were related to bright light therapy and 13 to melatonin or/and melatonin agonists. Most, but not all, studies showed that melatonin and melatonin agonists and light therapy induced improvements in measures of sleep, depression, motor function, and some also cognitive function and other non-motor symptoms. For some of these outcomes, including daytime sleepiness, depressive symptoms, and some motor symptoms, there is level 2 B evidence for the use of circadian treatments in PwP. CONCLUSIONS: Treatment with bright light therapy, exogenous melatonin and melatonin agonists seems to have not only positive effects on sleep quality and depression but also on motor function in PwP. Drawbacks in earlier work include the relatively small number of participants and the heterogeneity of outcome measures. Further large and well-designed trials are needed to address these shortcomings and to confirm or refute the possible merits of the circadian system as a treatment target in PwP.