Traditional Chinese Medicine for non-motor symptoms in Parkinson disease: A systematic review and meta-analysis of RCTs

Parkinson disease (PD) is the second most common neurodegenerative disease, which has impacts on the patient’s quality of life due to non-motor symptoms such as sleep disorders, anxiety, and depression. Traditional Chinese medicine (TCM) has gained increasing attention in the diagnosis and treatment of PD with the concept of “overall concepts and dialectical treatment.” Therefore, exploring the characteristics of TCM in the treatment of PD can improve the level of diagnosis and treatment of PD. METHODS: A comprehensive literature search was conducted using the following electronic databases: PubMed, Web of Science, Embase, Scopus, Cochrane Library, and China National Knowledge Infrastructure. The inclusion criteria were randomized controlled trials (RCTs) that compared TCM intervention with conventional treatments or placebo for non-motor symptoms in PD. The quality of the included RCTs was assessed using the Cochrane risk of bias tool. RESULTS: A total of 9 RCTs involving 1714 participants with PD were included in this systematic review and meta-analysis. The meta-analysis showed that TCM was effective in improving non-motor symptoms, including depression (Hamilton depression rating scale [HAMD], weighted mean difference [WMD] = 4.24, 95% CI = 2.84–5.65, P < .0001), anxiety (HAMA, WMD = 4.03, 95% CI = 2.64–5.41, P < .0001), autonomic dysfunction (Scales for Outcomes in Parkinson’s disease–Autonomic, WMD = 4.57, 95% CI = 1.69–7.45, P = .002), non-motor symptoms (Movement Disorder Society-Unified Parkinson’s Disease Rating Scale-part 1, WMD = 0.66, 95% CI = 0.20–1011, P = .004), and quality of life (PDQ-39, WMD = 6.72, 95% CI = 0.87–12.58, P < .05), compared with baseline. Zishen Pingchan granules was particularly effective for depression (HAMD, WMD = −1.94, 95% CI = −3.07 to −0.81, P < .001, compared to placebo; HAMD, WMD = 3.40, 95% CI = 0.52–6.28, P < .05, after treatment). Pingchan granules was particularly effective for quality of life after treatment (PDQ-39, WMD = 10.20, 95% CI = 1.87−18.53, P < .05). CONCLUSIONS: TCM is effective and safety for improvement of depression, anxiety, autonomic dysfunctions, and quality of life in PD. Zishen Pingchan granules was particularly effective for depression; and Pingchan granules was particularly effective for quality of life.