Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
Dement Geriatr Cogn Disord. 2023;52(1):16-31. doi: 10.1159/000529256. Epub 2023 Mar 28.
Lewy body disease (LBD) is the second most common neurodegenerative disorder in patients older than 65 years. LBD is characterized by heterogeneous symptoms like fluctuation in attention, visual hallucinations, Parkinsonism, and REM sleep behaviour disorders. Considering the relevant social impact of the disease, identifying effective non-pharmacological treatments is becoming a priority. The aim of this systematic review was to provide an up-to-date literature review of the most effective non-pharmacological treatments in patients with LBD, focussing on evidence-based interventions.
Following PRISMA criteria, we carried out a systematic search through three databases (PubMed, Cochrane Libraries, and PEDro) including physical therapy (PT), cognitive rehabilitation (CR), light therapy (LT), transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), deep brain stimulation (DBS). All studies were qualitatively assessed using standardized tools (CARE and EPHPP).
We obtained a total of 1,220 studies of which 23 original articles met eligibility criteria for inclusion. The total number of LBD patients included was 231; mean age was 69.98, predominantly men (68%). Some PT studies highlighted improvements in motor deficits. CR produced significant improvements in mood, cognition, and patient's quality of life and satisfaction. LT outlined a partial trend of improvements in mood and sleep quality. DBS, ECT, and TMS showed some partial improvements mainly on neuropsychiatric symptoms, whereas tDCS provided partial improvements in attention.
This review highlights the efficacy of some evidence-based rehabilitation studies in LBD; however, further randomized controlled trials with larger samples are needed to provide definitive recommendations.
路易体病（LBD）是 65 岁以上患者中第二常见的神经退行性疾病。LBD 的特征是注意力波动、视幻觉、帕金森病和 REM 睡眠行为障碍等异质症状。考虑到该疾病的相关社会影响，确定有效的非药物治疗方法已成为当务之急。本系统评价的目的是提供 LBD 患者最有效非药物治疗的最新文献综述，重点关注基于证据的干预措施。
根据 PRISMA 标准，我们通过三个数据库（PubMed、Cochrane 图书馆和 PEDro）进行了系统搜索，包括物理治疗（PT）、认知康复（CR）、光照疗法（LT）、经颅直流电刺激（tDCS）、经颅磁刺激（TMS）、电惊厥疗法（ECT）和深部脑刺激（DBS）。所有研究均使用标准化工具（CARE 和 EPHPP）进行定性评估。
我们共获得了 1220 项研究，其中 23 项原始文章符合纳入标准。纳入的 LBD 患者总数为 231 人；平均年龄为 69.98 岁，主要为男性（68%）。一些 PT 研究强调了运动缺陷的改善。CR 显著改善了情绪、认知和患者的生活质量和满意度。LT 概述了情绪和睡眠质量改善的部分趋势。DBS、ECT 和 TMS 显示出一些对神经精神症状的部分改善，而 tDCS 则对注意力提供了部分改善。
本综述强调了一些基于证据的康复研究在 LBD 中的疗效；然而，需要进一步的随机对照试验来提供明确的建议。
