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Placebo responses in Parkinson's disease
1Roger Gilbertson Endowed Chair in Neurology, Department of Neurology, University of North Dakota School of Medicine & Health Science, and Sanford Health, Fargo, ND, United States.
International Review of Neurobiology
|June 22, 2020
Summary
Parkinson's disease patients show significant placebo responses in trials, influenced by expectations and specific conditions. These genuine biological effects can be objectively measured and potentially managed in clinical settings.
Area of Science:
- Neuroscience
- Clinical Trials
- Pharmacology
Background:
- Parkinson's disease (PD) patients demonstrate substantial placebo responses in clinical trials.
- Patient factors like expectations, genetics, and personality influence these responses.
- Motor fluctuations and high baseline UPDRS motor scores are predictors of placebo response.
Purpose of the Study:
- To explore patient characteristics influencing placebo response in Parkinson's disease.
- To investigate the biological mechanisms underlying placebo effects in PD.
- To identify strategies for managing placebo and nocebo effects in clinical practice and trials.
Main Methods:
- Review of studies on patient characteristics and placebo response in Parkinson's disease.
- Neuroimaging (PET, fMRI) and neurophysiological techniques to measure placebo effects.
- Analysis of dopamine release and neuronal activity in basal ganglia circuits.
Main Results:
- Motor fluctuations and high baseline UPDRS scores predict placebo response; gender, age, and education do not.
- Preconditioning with active treatments like apomorphine enhances placebo effects.
- Placebo response is linked to dopamine release in striatal regions and neuronal activity changes.
Conclusions:
- Placebo effects in Parkinson's disease are genuine biological responses.
- Understanding these mechanisms can help minimize placebo effects in clinical trials.
- Harnessing placebo effects and minimizing nocebo effects can improve patient outcomes.
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