Parkinson’s disease (PD) is the fastest-growing neurodegenerative disorder worldwide. It is characterized by a heterogeneous spectrum of motor and non-motor symptoms that lead to progressive disability, which is often insufficiently addressed by pharmacological or surgical treatments alone. Optimal management of individuals living with PD, therefore, requires a multidisciplinary team approach that integrates comprehensive functional assessment with both pharmacological and non-pharmacological strategies. A person-centered framework is essential to ensure continuity, coherence, and tailored rehabilitation across disease stages. Within this context, physiatrists (rehabilitation medicine physicians) may play a pivotal role; however, their specific contributions to PD care remain insufficiently defined. This position paper presents the rationale, reviews the supporting evidence, and provides practical recommendations to strengthen and clarify the role of physiatrists in the comprehensive management of PD. We illustrate the versatile contributions of physiatrists using the metaphor of an orchestra, in which the physiatrist can play a valuable role as a member and, depending on local circumstances and the availability of possible alternatives, also as the director.

OBJECTIVE:Increased Alzheimer's disease (AD) prevalence paired with improved ability to diagnose the disease at earlier stages now, more than ever, necessitates interventions that will support the AD population for extended periods of time. Even with the substantial body of literature available, the effectiveness of physical exercise (PE) on various cognitive domains and the optimal dosage of PE are yet to be confirmed. Therefore, our objectives were to determine 1) the effectiveness of PE on cognitive function in older adults with AD, and 2) the optimal PE dosage for targeted outcomes. DATA SOURCES:The search was carried out across Embase, PsycInfo, and Ovid Medline databases. STUDY SELECTION:Of an initial return of 1,001 articles, 142 remained after title and abstract review, and 21 after full text review. DATA EXTRACTION:Primary outcomes extracted from included articles spanned four cognitive domain outcomes (global cognition, memory, language, attention, and executive function). Data on secondary outcomes included activities of daily living, emotional well-being, quality of life, and caregiver burden. DATA SYNTHESIS:The 21 included studies were published between 1991 and 2020 and sample sizes ranged from 12 to 494. Results confirm significant improvement in 4 of 5 cognitive domains favoring PE versus control conditions. Similarly, results favored exercise over control conditions for activities of daily living, emotional well-being, and quality of life outcomes, but not caregiver burden. The optimal PE dose was determined to be less than 60 minutes at least 3 times per week as compared to fewer more intense bouts. CONCLUSIONS:The results of this systematic review and meta-analysis provide important insight into the effectiveness of exercise on cognitive outcomes and guidance on the most effective PE parameters for optimizing cognitive function in AD.

BACKGROUND:Modulation of artistic creativity has occasionally been reported in individuals with Parkinson's disease (PD) after dopamine replacement therapy. Who better to describe this phenomenon and experiences with artistic endeavors than professional artists living with PD? This study aimed to explore their personal experiences of creating art while living with the condition. CASES:We interviewed 5 professional artists with PD. Each artist responded sequentially to 6 questions focused on PD, dopamine, and creativity in the context of art making. Four themes were identified: (1) impact of PD: most reported negative effects on quality of life and daily function; (2) artistic changes: all noted changes in style or technique but not in creativity; (3) medications and on/off effects: artists adapted their work schedules around motor fluctuations; and (4) artistic representation: 3 created PD-related pieces, some of which were commercialized. LITERATURE REVIEW:This small qualitative case series and narrative review of the literature shows multiple instances of art and novelty facilitation among patients with PD, touching on interactions among PD symptoms, dopaminergic medications and other treatments, and their art. CONCLUSIONS:Exploring the artistic experiences of individuals with PD may provide insights relevant to managing both motor and nonmotor symptoms associated with the disease.

Background/Objectives: Parkinson’s disease (PD) and multiple sclerosis (MS) are neurological conditions that result in debilitating non-motor symptoms, such as anxiety and depression, which significantly reduce quality of life and often persist despite pharmacological treatment. As a result, effective alternative treatment strategies are needed. Exercise therapy—particularly aerobic training—has shown promise in alleviating non-motor symptoms, potentially through neuroplastic adaptations. However, traditional aerobic exercise is often time-consuming and monotonous, limiting long-term adherence. High-intensity interval training (HIIT) offers a time-efficient and potentially more engaging alternative, though its effects on non-motor symptoms in PD and MS remain understudied. Methods: This transdiagnostic randomized controlled trial will enroll 48 participants (24 PD, 24 MS) with clinically significant affective symptoms (hospital anxiety and depression scale [HADS] ≥ 8). The participants will be randomly assigned to one of three 8-week interventions: (1) HIIT, 5–6 intervals of 45 s of high-intensity cycling; (2) continuous aerobic training (CAT), 50 min of low-intensity cycling; (3) movement advice (MA), step goals, and physical education. The primary (affective symptoms) and secondary outcomes (cognition, fatigue, sleep, motor function) will be assessed at four time points: 4 and 1 weeks pre intervention, and 1 and 4 weeks post intervention. Weekly blood samples and pre/post brain imaging will be collected to study biofluid and MRI measures for potential neuroplasticity. Linear mixed models will analyze the time and group effects. Discussion: This trial will assess whether HIIT can more effectively improve non-motor and motor symptoms in PD and MS than CAT or MA. A multimodal approach will explore both the clinical outcomes and underlying mechanisms, informing scalable and engaging rehabilitation strategies.

BACKGROUND:Community-based programs play a critical role in providing frail older adults with a safe environment to engage in physical activity. Satisfaction is a key indicator of such programs' acceptability while also playing a significant role in older adults' long-term participation in physical activity. Moreover, program leaders' satisfaction with training and confidence in program delivery are essential for ensuring the effectiveness and sustainability of community-based programs. The Walk On! program is a 12-week structured community-based program consisting of 24 sessions each lasting 60 min, designed for older adults with mobility challenges. Evaluating older adults' satisfaction with the Walk On program and program leaders' satisfaction with the training is crucial for informing strategies to facilitate broader dissemination and sustained implementation. OBJECTIVES:To evaluate older adults' (1) satisfaction with the Walk On! program, (2) perceived benefits on walking ability and overall well-being, and (3) program leaders' satisfaction with the Walk On! training. DESIGN:Pilot implementation trial. SETTING:Four community organization sites located in North Carolina, USA. PARTICIPANTS:42 older adult participants (mean age 79 years old; 87% female) and 9 all-female program leaders. MEASUREMENTS:Older adult participants' survey was completed at the end of the 12-week program cycle. Program leaders' survey was completed at the end of the training workshops. RESULTS:Older adult participants reported high satisfaction with the Walk On! program (n = 42, 100%), and perceived improvements across multiple domains: including strength and endurance, social support and enjoyment, walking confidence, self-efficacy and goal setting, and balance after program participation. All program leaders (n = 9) rated the training as either excellent (67%) or good (33%) and reported that the training was relevant and provided adequate preparation to lead the Walk On! PROGRAM: CONCLUSION:The Walk On! program was acceptable and perceived as impactful among older adult participants, and program leaders were highly satisfied with the Walk On! training. Together, these positive findings support the scaling and expansion of Walk On! into additional community settings.

BACKGROUND:Parkinson's disease (PD) is a complex neurodegenerative disorder impacting everyday function and quality of life. Rehabilitation plays a crucial role in improving symptoms, function, and quality of life and reducing disability, particularly given the lack of disease-modifying agents and limitations of medications and surgical therapies. However, rehabilitative care is under-recognized and under-utilized in PD and often only utilized in later disease stages, despite research and guidelines demonstrating its positive effects. Currently, there is a lack of consensus regarding fundamental topics related to rehabilitative services in PD. OBJECTIVE:The goal of the international Parkinson's Foundation Rehabilitation Medicine Task Force was to develop a consensus statement regarding the incorporation of rehabilitation in PD care. METHODS:The Task Force, comprised of international multidisciplinary experts in PD and rehabilitation and people directly affected by PD, met virtually to discuss topics such as rehabilitative services, existing therapy guidelines and rehabilitation literature in PD, and gaps and needs. A systematic, interactive, and iterative process was used to develop consensus-based statements on core components of PD rehabilitation and discipline-specific interventions. RESULTS:The expert-based consensus statement outlines key tenets of rehabilitative care including its multidisciplinary approach and discipline-specific guidance for occupational therapy, physical therapy, speech language pathology/therapy, and psychology/neuropsychology across all PD stages. CONCLUSIONS:Rehabilitative interventions should be an essential component in the comprehensive treatment of PD, from diagnosis to advanced disease. Greater education and awareness of the benefits of rehabilitative services for people with PD and their care partners, and further evidence-based and scientific study are encouraged.

Introduction: Exercise therapy may increase brain-derived neurotrophic factor (BDNF) levels and improve clinical outcomes in people living with Parkinson’s disease (PD). This systematic review was performed to investigate the effect of exercise therapy on BDNF levels and clinical outcomes in human PD and to discuss mechanisms proposed by authors. Method: A search on the literature was performed on PubMed up to December 2023 using the following key words: Parkinson’s disease AND exercise, exercise therapy, neurological rehabilitation AND brain-derived neurotrophic factor, brain-derived neurotrophic factor/blood, brain-derived neurotrophic factor/cerebrospinal fluid AND randomized clinical trial, intervention study. Only randomized clinical trials comparing an exercise intervention to treatment as usual, usual care (UC), sham intervention, or no intervention were included. Results: A meta-analysis of BDNF outcomes with pooled data from five trials (N = 216 participants) resulted in a significant standardized mean difference (SMD) of 1.20 [95% CI 0.53 to 1.87; Z = 3.52, p = 0.0004, I2 = 77%], favoring exercise using motorized treadmill, Speedflex machine, rowing machine, and non-specified exercise. Significant improvements were found in Unified Parkinson’s Disease Rating Scale (UPDRS), UPDRS-III, 6 Minute Walk Test (6MWT), and Berg Balance Scale (BBS). Methodological quality of trials was categorized as “good” in three trials, “fair” in one trial, and “poor” in one trial. Conclusion: Key results of this systematic review are that exercise therapy is effective in raising serum BDNF levels and seems effective in alleviating PD motor symptoms. Exercise therapy confers neuroplastic effects on Parkinson brain, mediated, in part, by BDNF.

Non-pharmacological interventions, including cognitive-behavioral therapy (CBT), non-invasive brain stimulation (NIBS), electroconvulsive therapy (ECT), light therapy (LT), and physical rehabilitation/exercise, have shown promise as effective approaches to treat symptoms of depression and anxiety in individuals with Parkinson’s disease (PD). In this narrative literature overview, we discuss the state-of-the-art regarding these treatment options and address future perspectives for clinical practice and research. Non-pharmacological interventions hold promise to treat depression and anxiety in PD. There is meta-analytic evidence for the efficacy of CBT, NIBS, ECT, LT, and exercise on improving depressive symptoms. For the treatment of anxiety symptoms, CBT shows large effects but scientific evidence of other non-pharmacological interventions is limited. Importantly, these treatments are safe interventions with no or mild side-effects. More research is needed to tailor treatment to the individuals’ needs and combined interventions may provide synergistic effects.We conclude that non-pharmacological interventions should be considered as alternative or augmentative treatments to pharmacological and neurosurgical approaches for the treatment of depression and anxiety in individuals with PD.

Vitamin D is necessary for our body and brain to function. When the vitamin D level in our body is too low, it can cause health problems. A low vitamin D level is also called vitamin D deficiency or insufficiency. Low vitamin D is more common in older people, overweight individuals, and those who live in nursing homes or hospitals.1 People with Alzheimer (AD) and Parkinson disease (PD) have lower vitamin D levels than people of the same age without AD or PD.2,3

ABSTRACT Background Cognitive decline affects up to 50% of patients with Parkinson’s disease (PD) in the course of the disease and may be amenable to exercise interventions. To accurately set adequate training intensities, standardized exercise testing is required but such testing takes considerable time and effort. The aim of this pilot study was to investigate the feasibility of a graded peak cycle ergometer exercise test in cognitively impaired patients with Parkinson’s Disease (PD), and to define whether age-predicted maximal heart rate (HRmax) matched measured HRmax. Methods A convenience sample of seven patients with PD (Hoehn and Yahr: 2–4, and cognitive impairment (Montreal Cognitive Assessment (MoCA) ≤ 26) completed a graded peak cycle ergometer test to voluntary exhaustion. Borg Rating of Perceived Exertion was used to record the individual’s perception of exertion. Pre-defined age-predicted HRmax (calculated as 208-(0.7 × age) was compared with the measured HRmax using Bland-Altman plot and a two-one-sided test. Results All PD patients completed the graded exercise test between 8–12 minutes, showing therefore 100% compliance to the test protocol. No adverse events occurred. Predicted HRmax and measured HRmax did not differ. Conclusion We demonstrate feasibility of graded peak cycle ergometer testing in PD patients with cognitive impairment. The good correspondence of age-predicted HRmax equation with measured HRmax, in this small sample, may in the future provide clinicians with a tool to define training intensities in cognitively impaired PD, without cardiac disease. However, further research is needed to confirm these results.

People with Parkinson disease (PD) can experience changes in the ways they move and the way they think.1 Some people with PD experience changes in their thinking while others might not experience any change.2 There are many components to our thinking that can be affected by PD (fig 1).2 All these components of thinking work together and influence how we understand and act in the world.3 One area of thinking that affects activities of daily living for individuals with PD is memory.2 The purpose of this educational page is to review how memory works and strategies you can use to address changes to your memory at different stages of the disease progression.

INTRODUCTION:Physical exercise is receiving increasing interest as an augmentative non-pharmacological intervention in Parkinson's disease (PD). This pilot study primarily aimed to quantify individual response patterns of motor symptoms to alternating exercise modalities, along with non-motor functioning and blood biomarkers of neuroplasticity and neurodegeneration.MATERIALS & METHODS:People with PD performed high-intensity interval training (HIIT) and continuous aerobic exercise (CAE) using a crossover single-case experimental design. A repeated assessment of outcome measures was conducted. The trajectories of outcome measures were visualized in time series plots and interpreted relative to the minimal clinically important difference (MCID) and smallest detectable change (SDC) or as a change in the positive or negative direction using trend lines.RESULTS:Data of three participants were analyzed and engaging in physical exercise seemed beneficial for reducing motor symptoms. Participant 1 demonstrated improvement in motor function, independent of exercise modality; while for participant 2, such a clinically relevant (positive) change in motor function was only observed in response to CAE. Participant 3 showed improved motor function after HIIT, but no comparison could be made with CAE because of drop-out. Heterogeneous responses on secondary outcome measures were found, not only between exercise modalities but also among participants.CONCLUSION:Though this study underpins the positive impact of physical exercise in the management of PD, large variability in individual response patterns to the interventions among participants makes it difficult to identify clear exercise-induced adaptations in functioning and blood biomarkers. Further research is needed to overcome methodological challenges in measuring individual response patterns.

Parkinson disease (PD) is a brain disease that affects a person's ability to move and perform daily activities. 1 Owen CL Ibrahim K Dennison L Roberts HC. Falls self-management interventions for people with Parkinson's disease: a systematic review. J Parkinson Dis. 2019; 9: 283-299 Crossref PubMed Scopus (9) Google Scholar As the disease progresses, loss of balance and falls are the leading cause of injuries and disability. 1 Owen CL Ibrahim K Dennison L Roberts HC. Falls self-management interventions for people with Parkinson's disease: a systematic review. J Parkinson Dis. 2019; 9: 283-299 Crossref PubMed Scopus (9) Google Scholar People with Parkinson disease (PwPD) have a much higher risk of falling and getting hurt compared with the general population. 1 Owen CL Ibrahim K Dennison L Roberts HC. Falls self-management interventions for people with Parkinson's disease: a systematic review. J Parkinson Dis. 2019; 9: 283-299 Crossref PubMed Scopus (9) Google Scholar ,2 Paul SS Sherrington C Canning CG Fung VS Close JC Lord SR. The relative contribution of physical and cognitive fall risk factors in people with Parkinson's disease: a large prospective cohort study. Neurorehabil Neural Repair. 2013; 28: 282-290 Crossref PubMed Scopus (86) Google Scholar

Abstract This presentation demonstrates the high degree of satisfaction with Walk On! from qualitative survey data from both clients and program leaders. As part of the curriculum, each attendee completes a survey asking about satisfaction around location, day/time, length of program, and changes in walking abilities. The survey also includes an opportunity for open-ended responses and suggestions for improvement. Overall, surveys showed a very high degree of satisfaction with the program with 80-100% of clients indicating they are “Very Much” satisfied with the program components. All open-ended responses were positive and examples include: “Very pleased with the instruction and environment”; “Encouraged me to walk at home and neighborhood”; “This program gave me energy to walk better and has changed my life”; “Enjoyed the fellowship with others”; and “I now walk with more confidence”. Leaders also complete a satisfaction survey upon completion of their Leader Training program and after leading a Walk On! program. A majority of the leaders “Strongly Agreed” or “Agreed “that: The length of the training was appropriate (83%); Course materials were explained well (100%); Course materials were easy to use (100%); I feel prepared to lead Walk On! (67%). Leader statements include: “I loved everything about this program. It was not just a walking program to me. I had social, cognitive and physical growth” and “This program afforded me the opportunity to have a real collaborative, immersive experience with elders.” Together, these positive findings support the need to scale and spread WalkOn! into additional community settings.