Environmental and Behavioral Interventions May Alleviate Nonmotor Symptoms of Parkinson’s Disease

WASHINGTON, DC—Nonmotor symptoms of Parkinson’s disease, including problems with vision, cognition, mood, and sleep, may be targeted with various behavioral and environmental interventions, according to a presentation at the 67th Annual Meeting of the American Academy of Neurology. Certain interventions for vision and cognition may also improve gait, said Alice Cronin-Golomb, PhD, Professor of Psychological and Brain Sciences and faculty with the Center of Neuroscience at Boston University.

Dopaminergic treatment of Parkinson’s disease generally does not improve nonmotor symptoms, which patients often cite as detrimental to quality of life. “There’s a great variety of interventions [for nonmotor symptoms] that we’re trying,” Dr. Cronin-Golomb said. “A lot of it’s very new, and we need to be careful about how we’re doing it, but I think there’s a lot of promise to it.”

A Range of Vision Problems
Contrast sensitivity is reduced in people with Parkinson’s disease and worsens as the disease progresses. Patients also may experience problems with motion perception, optic flow perception, and depth and distance perception. Dr. Cronin-Golomb and her research colleagues asked 81 members of Parkinson’s disease support groups in the Boston area to complete a questionnaire about vision and visuospatial function. About 80% of respondents endorsed at least one of the symptoms listed in the survey, such as bumping into objects and difficulty judging space.

Such problems with vision may be related to patients’ motor symptoms. In some samples, people with freezing of gait have reduced contrast sensitivity, compared with people who do not have freezing of gait. Reduced contrast sensitivity could explain why some patients freeze when they encounter visual changes, such as a doorway or a change in carpeting, Dr. Cronin-Golomb said.

Interventions for vision problems include increasing lighting and contrast and avoiding glare. Although the question has not been studied in people with Parkinson’s disease, contrast sensitivity training might be possible. Dr. Cronin-Golomb discussed a study published by DeLoss et al in the April 2015 issue of Psychological Science. After five days of perceptual training, healthy older adults’ contrast sensitivity improved so that their performance was indistinguishable from that of young adults. Participants also improved on some tasks for which they had not trained.

Visuospatial Dysfunction
Studies using line bisection have shown that some patients’ perceived center is biased to one side, typically opposite the side of symptom onset. Research shows that this visuospatial bias drives the direction in which patients veer when walking, Dr. Cronin-Golomb said. When blindfolded and relying on motor function, patients veer, as expected, to the side of symptom onset, which has a shorter stride. Without the blindfold, they veer to the side of their visuospatial bias.

Visual guides, such as striped floors, have been studied as interventions for problems of depth perception and optic flow. Dr. Cronin-Golomb and her research team found that a pattern of random squares is as effective as stripes in improving gait and direction walking. This finding implies that gait improvement “should occur under a broader array of environmental conditions than we used to think,” she said.

Ways to Improve Dual Tasking?
Researchers have found that people with Parkinson’s disease are more affected by dual tasking, such as walking while counting backward by seven, than healthy control participants. Traditionally, patients have been advised to focus solely on walking, but that is unrealistic, Dr. Cronin-Golomb said. “People are now going in a new direction toward enhancing cognition or doing some other kind of intervention to allow them to walk and do something else at the same time,” she said.

Speed of Processing Training is one such intervention. A study by Edwards et al asked participants to focus on a series of images that changed quickly. The intent was to build up participants’ processing speed. Compared with 42 no-contact control participants, 32 people with Parkinson’s disease who underwent 20 hours of Speed of Processing Training over three months improved on the Useful Field of View Test.

Aerobic exercise also may improve cognition. Uc et al had 49 people with mild to moderate Parkinson’s disease walk 45 minutes per day for three days per week for six months. Patients improved on one measure of executive function, the Eriksen flanker task. Subjective quality of life, motor function, depression, and fatigue scores also improved.

Mood and Emotion
In addition to traditional exercise, interventions for mood disturbance can include alternative physical activities like tai chi, yoga, and dance therapy. The social components of those interventions may contribute to their effectiveness, Dr. Cronin-Golomb said. Cognitive behavioral therapy (CBT) also may improve emotional problems in people with Parkinson’s disease. The psychotherapy has been used to treat depression and impulse control disorders in Parkinson’s disease.

Some studies show emotion recognition deficits in people with Parksinon’s disease. Buxton et al found that people with Parkinson’s disease were significantly different in their ability to detect subtle expressions of facial emotion and emotions conveyed by voices, compared with control participants. As an intervention, caregivers might try amplifying their expressions to help patients pick up emotional cues, said Dr. Cronin-Golomb.

Interventions for Sleep
Exercise interventions may improve sleep, although few studies of exercise interventions use sleep as an outcome measure. Nascimento et al showed a trend for improved sleep among patients who completed aerobic and conditioning exercise. Patients also had improved subjective quality of life.

CBT for insomnia is an effective treatment for primary insomnia and for insomnia related to many other conditions, but it probably is not an appropriate intervention for people with Parkinson’s disease because of its sleep restriction component. “For somebody at risk for falls, this is probably not something you want to be doing,” said Dr. Cronin-Golomb. Some evidence suggests that bright-light therapy might improve sleep, mood, and motor function, and that melatonin may improve subjective sleep quality, Dr. Cronin-Golomb said.

—Jake Remaly

WASHINGTON, DC—Nonmotor symptoms of Parkinson’s disease, including problems with vision, cognition, mood, and sleep, may be targeted with various behavioral and environmental interventions, according to a presentation at the 67th Annual Meeting of the American Academy of Neurology. Certain interventions for vision and cognition may also improve gait, said Alice Cronin-Golomb, PhD, Professor of Psychological and Brain Sciences and faculty with the Center of Neuroscience at Boston University.

Dopaminergic treatment of Parkinson’s disease generally does not improve nonmotor symptoms, which patients often cite as detrimental to quality of life. “There’s a great variety of interventions [for nonmotor symptoms] that we’re trying,” Dr. Cronin-Golomb said. “A lot of it’s very new, and we need to be careful about how we’re doing it, but I think there’s a lot of promise to it.”

A Range of Vision Problems
Contrast sensitivity is reduced in people with Parkinson’s disease and worsens as the disease progresses. Patients also may experience problems with motion perception, optic flow perception, and depth and distance perception. Dr. Cronin-Golomb and her research colleagues asked 81 members of Parkinson’s disease support groups in the Boston area to complete a questionnaire about vision and visuospatial function. About 80% of respondents endorsed at least one of the symptoms listed in the survey, such as bumping into objects and difficulty judging space.

Such problems with vision may be related to patients’ motor symptoms. In some samples, people with freezing of gait have reduced contrast sensitivity, compared with people who do not have freezing of gait. Reduced contrast sensitivity could explain why some patients freeze when they encounter visual changes, such as a doorway or a change in carpeting, Dr. Cronin-Golomb said.

Interventions for vision problems include increasing lighting and contrast and avoiding glare. Although the question has not been studied in people with Parkinson’s disease, contrast sensitivity training might be possible. Dr. Cronin-Golomb discussed a study published by DeLoss et al in the April 2015 issue of Psychological Science. After five days of perceptual training, healthy older adults’ contrast sensitivity improved so that their performance was indistinguishable from that of young adults. Participants also improved on some tasks for which they had not trained.

Visuospatial Dysfunction
Studies using line bisection have shown that some patients’ perceived center is biased to one side, typically opposite the side of symptom onset. Research shows that this visuospatial bias drives the direction in which patients veer when walking, Dr. Cronin-Golomb said. When blindfolded and relying on motor function, patients veer, as expected, to the side of symptom onset, which has a shorter stride. Without the blindfold, they veer to the side of their visuospatial bias.

Visual guides, such as striped floors, have been studied as interventions for problems of depth perception and optic flow. Dr. Cronin-Golomb and her research team found that a pattern of random squares is as effective as stripes in improving gait and direction walking. This finding implies that gait improvement “should occur under a broader array of environmental conditions than we used to think,” she said.

Ways to Improve Dual Tasking?
Researchers have found that people with Parkinson’s disease are more affected by dual tasking, such as walking while counting backward by seven, than healthy control participants. Traditionally, patients have been advised to focus solely on walking, but that is unrealistic, Dr. Cronin-Golomb said. “People are now going in a new direction toward enhancing cognition or doing some other kind of intervention to allow them to walk and do something else at the same time,” she said.

Speed of Processing Training is one such intervention. A study by Edwards et al asked participants to focus on a series of images that changed quickly. The intent was to build up participants’ processing speed. Compared with 42 no-contact control participants, 32 people with Parkinson’s disease who underwent 20 hours of Speed of Processing Training over three months improved on the Useful Field of View Test.

Aerobic exercise also may improve cognition. Uc et al had 49 people with mild to moderate Parkinson’s disease walk 45 minutes per day for three days per week for six months. Patients improved on one measure of executive function, the Eriksen flanker task. Subjective quality of life, motor function, depression, and fatigue scores also improved.

Mood and Emotion
In addition to traditional exercise, interventions for mood disturbance can include alternative physical activities like tai chi, yoga, and dance therapy. The social components of those interventions may contribute to their effectiveness, Dr. Cronin-Golomb said. Cognitive behavioral therapy (CBT) also may improve emotional problems in people with Parkinson’s disease. The psychotherapy has been used to treat depression and impulse control disorders in Parkinson’s disease.

Some studies show emotion recognition deficits in people with Parksinon’s disease. Buxton et al found that people with Parkinson’s disease were significantly different in their ability to detect subtle expressions of facial emotion and emotions conveyed by voices, compared with control participants. As an intervention, caregivers might try amplifying their expressions to help patients pick up emotional cues, said Dr. Cronin-Golomb.

Interventions for Sleep
Exercise interventions may improve sleep, although few studies of exercise interventions use sleep as an outcome measure. Nascimento et al showed a trend for improved sleep among patients who completed aerobic and conditioning exercise. Patients also had improved subjective quality of life.

CBT for insomnia is an effective treatment for primary insomnia and for insomnia related to many other conditions, but it probably is not an appropriate intervention for people with Parkinson’s disease because of its sleep restriction component. “For somebody at risk for falls, this is probably not something you want to be doing,” said Dr. Cronin-Golomb. Some evidence suggests that bright-light therapy might improve sleep, mood, and motor function, and that melatonin may improve subjective sleep quality, Dr. Cronin-Golomb said.

—Jake Remaly

WASHINGTON, DC—Nonmotor symptoms of Parkinson’s disease, including problems with vision, cognition, mood, and sleep, may be targeted with various behavioral and environmental interventions, according to a presentation at the 67th Annual Meeting of the American Academy of Neurology. Certain interventions for vision and cognition may also improve gait, said Alice Cronin-Golomb, PhD, Professor of Psychological and Brain Sciences and faculty with the Center of Neuroscience at Boston University.

Dopaminergic treatment of Parkinson’s disease generally does not improve nonmotor symptoms, which patients often cite as detrimental to quality of life. “There’s a great variety of interventions [for nonmotor symptoms] that we’re trying,” Dr. Cronin-Golomb said. “A lot of it’s very new, and we need to be careful about how we’re doing it, but I think there’s a lot of promise to it.”

A Range of Vision Problems
Contrast sensitivity is reduced in people with Parkinson’s disease and worsens as the disease progresses. Patients also may experience problems with motion perception, optic flow perception, and depth and distance perception. Dr. Cronin-Golomb and her research colleagues asked 81 members of Parkinson’s disease support groups in the Boston area to complete a questionnaire about vision and visuospatial function. About 80% of respondents endorsed at least one of the symptoms listed in the survey, such as bumping into objects and difficulty judging space.

Such problems with vision may be related to patients’ motor symptoms. In some samples, people with freezing of gait have reduced contrast sensitivity, compared with people who do not have freezing of gait. Reduced contrast sensitivity could explain why some patients freeze when they encounter visual changes, such as a doorway or a change in carpeting, Dr. Cronin-Golomb said.

Interventions for vision problems include increasing lighting and contrast and avoiding glare. Although the question has not been studied in people with Parkinson’s disease, contrast sensitivity training might be possible. Dr. Cronin-Golomb discussed a study published by DeLoss et al in the April 2015 issue of Psychological Science. After five days of perceptual training, healthy older adults’ contrast sensitivity improved so that their performance was indistinguishable from that of young adults. Participants also improved on some tasks for which they had not trained.

Visuospatial Dysfunction
Studies using line bisection have shown that some patients’ perceived center is biased to one side, typically opposite the side of symptom onset. Research shows that this visuospatial bias drives the direction in which patients veer when walking, Dr. Cronin-Golomb said. When blindfolded and relying on motor function, patients veer, as expected, to the side of symptom onset, which has a shorter stride. Without the blindfold, they veer to the side of their visuospatial bias.

Visual guides, such as striped floors, have been studied as interventions for problems of depth perception and optic flow. Dr. Cronin-Golomb and her research team found that a pattern of random squares is as effective as stripes in improving gait and direction walking. This finding implies that gait improvement “should occur under a broader array of environmental conditions than we used to think,” she said.

Ways to Improve Dual Tasking?
Researchers have found that people with Parkinson’s disease are more affected by dual tasking, such as walking while counting backward by seven, than healthy control participants. Traditionally, patients have been advised to focus solely on walking, but that is unrealistic, Dr. Cronin-Golomb said. “People are now going in a new direction toward enhancing cognition or doing some other kind of intervention to allow them to walk and do something else at the same time,” she said.

Speed of Processing Training is one such intervention. A study by Edwards et al asked participants to focus on a series of images that changed quickly. The intent was to build up participants’ processing speed. Compared with 42 no-contact control participants, 32 people with Parkinson’s disease who underwent 20 hours of Speed of Processing Training over three months improved on the Useful Field of View Test.

Aerobic exercise also may improve cognition. Uc et al had 49 people with mild to moderate Parkinson’s disease walk 45 minutes per day for three days per week for six months. Patients improved on one measure of executive function, the Eriksen flanker task. Subjective quality of life, motor function, depression, and fatigue scores also improved.

Mood and Emotion
In addition to traditional exercise, interventions for mood disturbance can include alternative physical activities like tai chi, yoga, and dance therapy. The social components of those interventions may contribute to their effectiveness, Dr. Cronin-Golomb said. Cognitive behavioral therapy (CBT) also may improve emotional problems in people with Parkinson’s disease. The psychotherapy has been used to treat depression and impulse control disorders in Parkinson’s disease.

Some studies show emotion recognition deficits in people with Parksinon’s disease. Buxton et al found that people with Parkinson’s disease were significantly different in their ability to detect subtle expressions of facial emotion and emotions conveyed by voices, compared with control participants. As an intervention, caregivers might try amplifying their expressions to help patients pick up emotional cues, said Dr. Cronin-Golomb.

Interventions for Sleep
Exercise interventions may improve sleep, although few studies of exercise interventions use sleep as an outcome measure. Nascimento et al showed a trend for improved sleep among patients who completed aerobic and conditioning exercise. Patients also had improved subjective quality of life.

CBT for insomnia is an effective treatment for primary insomnia and for insomnia related to many other conditions, but it probably is not an appropriate intervention for people with Parkinson’s disease because of its sleep restriction component. “For somebody at risk for falls, this is probably not something you want to be doing,” said Dr. Cronin-Golomb. Some evidence suggests that bright-light therapy might improve sleep, mood, and motor function, and that melatonin may improve subjective sleep quality, Dr. Cronin-Golomb said.

—Jake Remaly