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. 2024 Feb 15;10(4):e26107.
doi: 10.1016/j.heliyon.2024.e26107. eCollection 2024 Feb 29.

Treatment of apathy in Parkinson's disease: A bayesian network meta-analysis of randomised controlled trials

Aaron Shengting Mai  1 , Yi Siang Lee  1 , Jung Hahn Yong  1 , Dillon Christopher Yong Jie Teo  1 , Yi-Min Wan  2 , Eng-King Tan  3   4
Affiliations

Treatment of apathy in Parkinson's disease: A bayesian network meta-analysis of randomised controlled trials

Aaron Shengting Mai et al. Heliyon. .

Abstract

Background: Apathy is an important but unrecognised aspect of Parkinson's disease (PD). The optimal therapeutic options for apathy remain unclear. Early recognition and treatment of apathy can reduce the significant burden of disease for patients and their caregivers. Here we conducted a meta-analysis to evaluate the comparative efficacy of different treatment modalities of apathy in PD (CRD42021292099).

Methods: We screened Medline, Embase, and PsycINFO databases for articles on therapies for apathy in PD. The outcome of interest is the reduction in apathy scores post-intervention and is measured by standardised mean differences (SMD) with 95% credible intervals (CrI). We included only randomised controlled trials examining interventions targeted at reducing apathy.

Results: Nineteen studies involving 2372 patients were included in the quantitative analysis. The network meta-analysis found pharmacotherapy to be the most efficacious treatment, significantly better than brain stimulation (SMD -0.43, 95% CrI -0.78 to -0.07), exercise-based interventions (SMD -0.66, 95% CrI -1.25 to -0.08), supplements (SMD -0.33, 95% CrI -0.67 to 0), and placebo (SMD -0.38, 95% CrI -0.56 to -0.23). Subgroup analysis of pharmacotherapy versus placebo found similar efficacy of dopamine agonists (SMD -0.36, 95% CI -0.59 to -0.12, P = 0.003) and alternative medications (SMD -0.42, 95% CI -0.61 to -0.23, P < 0.001). The remaining comparisons and subgroup analyses did not demonstrate any significant treatment effects.

Conclusion: Our meta-analysis of randomised controlled trials showed that pharmacotherapy is the most efficacious treatment option, with dopamine agonists having similar efficacy as other medications. Further research is needed to determine the optimal management strategy.

Keywords: Interventions; Neuropsychiatric symptoms; Parkinson's disease; apathy.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Prisma Flow Diagram.
Fig. 2
Fig. 2
Forest plot for subgroup analysis of pharmacotherapy.
See this image and copyright information in PMC

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