MOOD SYMPTOMS IN PARKINSON’S DISEASE AND THEIR IMPACT ON A QIGONG EXERCISE’S EFFICACY FOR TREATING SLEEP QUALITY AND GAIT PERFORMANCE
Schmidt, Marshall Alan
University of Kansas
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The purpose of this study was to investigate both the non-motor features associated with Parkinson's disease (PD), i.e. anxiety and depression, and these features impact the efficacy of a mild exercise intervention treating sleep dysfunction and other non-motor symptoms, as well as a gait impairment. To determine the prevalence and comorbidity of depression and anxiety symptoms and their relationship with disease progression, a retrospective database analysis was performed using data collected during the routine evaluations of 1221 patients diagnosed with PD performed during the initial visit to a PD clinic. Given the discrepancy in previous estimates of mood symptoms in PD, it was hypothesized that 50% of the population would demonstrate anxiety or depression symptoms and that severity of these symptoms would correlate with overall disease severity. Anxiety and depression symptom severity was measured with respective Beck scales, while disease duration (years since PD diagnosis), Hoehn and Yahr (HY) stage, and Unified Parkinson's Disease Rating Scale (UPDRS) scores assessed modes of disease progression. Anxiety and depression were analyzed in categories of severity, prevalence, and strength of relationship with respect to disease progression markers using correlational analysis and chi-square tests. Results of the database analysis confirm previous findings that anxiety and depression are relevant non-motor symptoms of PD as well as the hypothesis, where more nearly half the sample population was determined to have significant depression while two-thirds reported anxiety symptoms. While the severity of mood symptoms was found to be worse in patients with greater disease progression, this relationship was found to be non-linear. A randomized controlled pilot clinical trial was then completed to assess the impact of mood disorders on the efficacy of a mild exercise intervention- Qigong meditation- on the non-motor symptoms of PD especially sleep quality, fatigue, and cognitive impairment, as well as gait performance. Previous studies have found that mood symptoms negatively affect adherence with interventions for treating symptoms of PD. In a previous pilot study conducted in our research laboratory the practice of Qigong meditation improved sleep, fatigue, cognition, as well as gait performance in PD; however, there was no control group and the sample size was small. We hypothesized that the current pilot study would find significant improvements in the experimental group compared to the control group and in terms of non-motor symptoms, especially sleep quality, and gait performance compared to the control groups, and that mood disorders in participants might decrease efficacy of the intervention. During six weeks of intervention, both a control and experimental group performed the mild/Qigong exercise twice daily in addition to a weekly group session. While both groups performed the same body motions of the exercise, only the experimental group synchronized their breathing, sounds, and meditation with the movements. Non-motor symptoms in PD were assessed using standard evaluations. The effect of mood symptoms on efficacy of the intervention was primarily measured by the rate of compliance demonstrated by study participants reporting a history of anxiety/depression. Based on a thorough examination of potential technologies for measuring gait pattern, A Gaitmat II device was selected and used to quantify gait velocity, stride time, stride and step length. As hypothesized, participants in the experimental group reporting a history of anxiety/depression reported lower overall compliance with the exercise program than fellow participants. Further, patients in the experimental group demonstrated significant improvement in sleep quality compared to the control group while both groups improved gait performance and some autonomic symptoms including urinary and sexual functioning. Fatigue also improved in the experimental group, though not comparatively significant. The study findings suggest the Qigong exercise may be a viable complementary therapy for treating both non-motor symptoms (NMS) and gait impairment of PD, especially sleep dysfunction. Further, mechanisms associated with the practice of Qigong may specifically slow, halt, or even reverse neurological damage associated with PD, given the neurodegenerative association with the PD symptoms improved in the study. Both the database analysis and pilot clinical trial suggest mood disorders are prevalent non-motor symptoms in PD, and that addressing these aspects is integral for providing adequate care to persons with PD and optimize the benefit of alternative therapies such as Qigong exercise in treating non-motor and motor features of the disease.
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