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Acupuncture may help improve sleep in Parkinson’s disease patients

Dr. Joseph Delano Fule Robles
21 Mar 2019

A recent study by the Hong Kong Polytechnic University (HKPU) indicates that acupuncture may be effective for treating sleep problems in patients with Parkinson’s disease. Meanwhile, investigators from the Chinese University of Hong Kong (CUHK) have uncovered a possible explanation for the cognitive impairment experienced by patients with Parkinson’s disease.

In the systematic review performed by HKPU, 12 studies with 722 participants (age range, 42–86 years) were analyzed. Results showed that acupuncture, alone or in combination with antiparkinsonian medications, might have some positive effects in the management of sleep problems in patients with Parkinson’s disease. [Pang KW, et al, 14th International Symposium on Healthy Aging 2019, poster P10]

However, no significant improvements in depression were noted with the use of acupuncture.

The review included randomized controlled trials (RCTs), quasi-experimental studies and pilot studies evaluating the use of acupuncture alone or in combination with antiparkinsonian medications in treating depression and sleep problems in patients with Parkinson’s disease.

No restrictions were applied on gender, age, race, disease duration and drug therapy. There were also no restrictions on frequency, intensity or duration of treatment. Databases in English (n=7) and Chinese (n=3) were included in the review.

“Our analysis showed significant improvement in sleep problems with acupuncture with or without drugs, compared with drugs alone. Methodological flaws and risks of bias in the studies may, however, affect the quality of evidence. Therefore, well-designed placebo-controlled RCTs with sufficient randomization, blinding and concealed allocation are needed,” commented the investigators.

In another study, researchers from CUHK found that strategy-switching inflexibility, which may stem from dopaminergic dysregulation in the cortico-limbic system, was a possible mechanism for cognitive impairment in patients with Parkinson’s disease. [Ke Y, 14th International Symposium on Healthy Aging 2019]

“The nucleus accumbens receives signals from various regions of the brain, such as the hippocampus, amygdala, prefrontal cortex and the ventral tegmental area. These brain regions are responsible for emotional responses and behavioural flexibility,” explained investigator Professor Ya Ke of the School of Biomedical Sciences, CUHK.

“Inhibition of the pathway from the prelimbic cortex to the D2-medium spiny neurons of the nucleus accumbens causes decreased task-switching flexibility, which is usually associated with neurodegenerative disorders such as Parkinson’s disease,” Ke added. [PNAS 2018;115:E4890-E4899]

Ke’s group demonstrated in mouse models of Parkinson’s disease by tyrosine hydroxylase immunostaining that dopamine loss is present in the nucleus accumbens. They also demonstrated that presynaptic D1 and D2 dopamine receptors modulate the prelimbic cortex-nucleus accumbens pathway by making viral knockdown constructs of D1 dopamine receptors. The knockdown of D1 dopamine receptors resulted in impaired task-switching ability in mice.

Strategy acquisition and switching in goal-directed behaviour were evaluated in mice using response-direction tasks (RDT) and visual cue tasks (VCT). In the RDT, mice were required to always turn in the opposite direction of their turn bias to receive a food pellet, regardless of the location of the visual cue. In the VCT, mice were trained to enter the arm indicated by the visual cue. [PNAS 2018;115:E4890-E4899]

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