Efficacy of cognitive behavioral therapy on non-motor symptoms and quality of life in Parkinson’s disease: A systematic review and meta-analysis

Objective The aim of this study was to perform a quantitative analysis to evaluate the efficacy of cognitive behavioral therapy (CBT) on non-motor symptoms and its impact on quality of life (QOL) in Parkinson’s disease (PD). Methods We searched for randomized controlled trials in three electronic databases. Twelve studies, including 358 patients with PD, met the inclusion criteria. We determined the pooled efficacy by standard mean differences and 95% confidence intervals, using I 2 to reveal heterogeneity. Results The result showed CBT had a significant effect on depression [-0.94 (95% CI, -1.25 to -0.64, P < 0.001)] and anxiety [-0.78 (95% CI, -1.05 to -0.50, P < 0.001)]. Moderate effect sizes were noted with stress [-0.60 (95% CI, -1.06 to -0.14, P = 0.01)] and sleep disorders [-0.44 (95% CI, -0.74 to -0.15, P = 0.003)]. There was no evident impact of CBT on fatigue or QOL. We found an intervention period > 8 weeks was advantageous compared with < 8 weeks, and CBT intervention was more effective than CBT developmental therapy. Conclusion We found that CBT in patients with PD was an efficacious therapy for some non-motor symptoms in PD, but not efficacious for fatigue and QOL. These results suggest that CBT results in significant improvement in PD and should be used as a conventional clinical intervention.