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The multimodal effect of circadian interventions in Parkinson's disease: A narrative review.

Parkinsonism & related disorders
May 1, 2023
Katarzyna Smilowska et al. (3 authors)
Journal ArticleReviewHuman Study
Study Details

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

Extracted Claims (27)
InterventionDirectionEndpointPopulationDosageImpactClaim #
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
Abstract

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.

Medical Subject Headings (MeSH)
HumansParkinson DiseaseMelatoninPersons with DisabilitiesMotor DisordersSleepCircadian Rhythm
Study Links
Quality Scores
SafetyNot Assessed
Efficacy75/10
Quality65/10
Citation Metrics
Total Citations3
Citations/Year1.5
Relative Citation Ratio0.89
NIH Percentile46.1%
Research Impact Scores
APT Score0.25
Weight Score2.29
Normalized Score0.63
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