Background: Parkinson's disease is a complex neurodegenerative disorder characterized by motor and non-motor symptoms. Non-motor issues, such as sleep disorders, depression, and autonomic dysfunction, often appear years before motor symptoms, significantly affecting daily life. However, their overall impact on the disease's burden is still debated.
The aim of the work: This study aimed to compare airway pressure release ventilation [APRV] mode and synchronized intermittent mandatory ventilation [SIMV] mode with lung protective strategy protocol.
Patients and Methods: A randomized, case-controlled trial was conducted on 40 PD patients enrolled from Al- Zahraa University Hospital. Patients were randomly assigned to receive either ten consecutive LF-TMS sessions [n=20] or sham sessions [n=20]. Cognitive function, depressive symptoms, sleep quality, and daytime sleepiness were assessed before, immediately after and after one- month of TMS sessions using the Montreal Cognitive Assessment [MOCA], Hamilton Depression Rating Scale [HDRS], Pittsburgh Sleep Quality Index [PSQI], and Epsworth Sleepiness Scale [ESS], respectively. In addition, the motor threshold was determined for the right first dorsal interosseous muscle, and patients received ten consecutive days of LF-TMS over the right dorsolateral prefrontal cortex [DLPFC].
Results: Compared to the sham group, the patient group showed significantly higher MOCA scores improvement [p<0.001] and significantly improvement in depressive symptoms evaluated by the HDRS. In addition, a statistically significant higher improvement percentage of PSQI and ESS in the patients group than in the sham group, with a p-value [p<0.001], and this improvement present immediately after LF-TMS sessions and remained for one month later. The improvement in MOCA showed a negative correlation with age in years with a p-value [p<0.05].
Conclusions: LF-TMS improved cognition, depression, and EDS in PD patients, supporting its potential as a non-invasive treatment for non-motor symptoms.