Table 1.
Characteristics of included trails in this network meta-analysis.
| References (country) | Sample (I/C) (Mean age) | Duration of disease, years | Hoehn-Yahr | Gender (M/F) | Intervention | Details of interventions | Measured outcomes |
|---|---|---|---|---|---|---|---|
| Aftanas et al. (2021) (Russia) |
23/23 (63.3) |
I: 7.0 ± 4.0 C: 5.6 ± 4.0 |
NA | 21/25 | I:10-Hz rhythmic TMS C: Placebo |
M1: 100% MT, 4,000 pulses/day; lDLPFC: 110% MT, 3,000 pulses/ day; 20 consecutive days |
HDRS |
| Bega et al. (2016) (America) |
7/7 (67.3) |
NA | I: 2.3 ± 0.4 C: 2.4 ± 0.5 |
11/3 | I: Yoga C: Resistance exercise |
60 min each, twice/week, 12 weeks | BDI |
| Bogosian et al. (2022) (Britain) |
30/30 (60.9) |
I: 5.22 ± 3.55 C: 6.43 ± 3.85 |
NA | 30/30 | I: Mindfulne- ss interven- tion C: waitlist |
60min each, once /week 8 weeks | HDRS |
| Brys et al. (2016) (America) |
20/15 (64.5) |
I: 7.30 ± 5.60 C: 4.50 ± 2.20 |
NA | 22/13 | I:10-Hz rTMS C: Placebo |
Bilateral M1: 2000 (1,000 each side) pulses/day; lDLPFC: 2,000 pulses/ day; 10 consecutive days |
HDRS |
| Calleo et al. (2015) (America) |
7/4 (62.9) |
NA | NA | NA | I: CBT C: TAU |
30–40 min each, 8 sessions, 12 weeks | HDRS |
| Cohen et al. (2018) (Israel) |
21/21 (65.6) |
I: 4.70 ± 3.40 C: 5.60 ± 3.70 |
I: 2.0 (2.0–2.5) C: 2.0 (2.0–2.5) [Median (range)] |
32/10 | I: 1-Hz rTMS (M1) 10-Hz (PFC) C: Placebo |
M1: 110% MT, 900 pulses/ day; Bilateral PFC: 100 MT, 800 pulses/ day; 90 consecutive days |
BDI |
| Cheung et al. (2018) (Australia) |
10/10 (64.7) |
NA | I: 1.8 ± 1.0 C: 1.3 ± 0.5 |
NA | I: Yoga C: Waitlist |
60 min each, twice/week, 12 weeks | BDI |
| Craig et al. (2006) (America) |
18/14 (63.3) |
NA | I: 1.8 ± 1.0 C: 1.3 ± 0.5 |
23/9 | I: Massage therapy C: Music therapy |
45 min each, twice/week, 4 weeks | BDI |
| Dashtipour et al. (2015) (America) |
6/5 (63.3) |
I: 2.9 ± 1.5 C: 4.5 ± 3.3 |
I: 1.8 ± 0.5 C: 1.3 ± 0.5 |
NA | I: LSVT BIG therapy C: Aerobic exercise |
60min each, 4 times/week, 4 weeks | BDI |
| Dobkin et al. (2011) (America) |
41/39 (64.6) |
I: 6.53 ± 5.53 C: 6.13 ± 5.56 |
NA | 48/32 | I: CBT C: Clinical monitoring |
60–75 min each, once/ week, 10 weeks |
BDI |
| Dobkin et al. (2021) (America) |
45/45 (66.8) |
I: 5.4 ± 5.01 C: 5.24 ± 5.13 |
NA | 90/0 | I: CBT C: TAU |
60 min each, once/week 10 weeks |
HDRS |
| Edwards et al. (2013) (America) |
44/43 (68.8) |
I: 7.25 ± 6.14 C: 6.63 ± 4.89 |
I: 2 (1–3) C: 2 (1–3) [Median (range)] |
54/33 | I: SPOT C: Waitlist |
3 months | CES-D |
| Fan et al. (2017) (China) |
18/18 (64.1) |
NA | NA | 15/21 | I: Qigong C: TAU |
60 min each, 5 times/week, 8 weeks | POMS-D |
| Fellman et al. (2020) (Finland) |
26/26 (65.2) |
I: 5.2 ± 3.2 C: 6.0 ± 6.1 |
NA | 18/34 | I: Working memory train- ing C: Active quiz task |
45 min each, 3 times/week, 7 weeks | GDS-30 |
| Ghielen et al. (2017) (Netherlands) |
19/19 (63.1) |
I: 10.5 ± 5.7 C: 12.3 ± 4.3 |
NA | 7/31 | I: Body awar- eness training C: AU |
60 min each, twice/week, 6 weeks | BDI |
| Han et al. (2021) (China) |
50/50 (68.2) |
I: 36 (24–120) C: 36 (24-111) [Median (range)] (months) |
I: 2.56 ± 0.78 C: 2.80 ± 1.04 |
49/51 | I: VR + Wuqinxi C: TAU |
VR: 20–30 min each, 3 times/week, 2 weeks Wuqinxi: 40 min each, 3 times/week, 6 weeks |
HDRS |
| Kalbe et al. (2020) (Germany) |
33/31 (67.6) |
G1: 13 (2-20) G2: 12 (9-20) |
NA | 40/24 | I: Multidoma- in group cognitive training C: Streching exercise |
90 min each, twice/week, 6 weeks | BDI-II |
| Kong et al. (2018) (Singapore) |
20/20 (64.6) |
I: 68.8 ± 45.5 C: 87.2 ± 53.2 (months) |
NA | 13/27 | I: Acupunctu- re C: Placebo |
70 min each, twice/week, 5 weeks | GDS |
| Kraepelien et al. (2020) (Sweden) |
38/39 (66.0) |
I: 8.3 ± 4.4 C: 9.6 ± 5.7 |
NA | 30/47 | I: ICBT C: Waiting list |
10 weeks | HADS |
| Kwok et al. (2019) (China) |
71/67 (63.6) |
NA | NA | 65/73 | I: Yoga C: Streching exercise |
90 min each, once/week, 8 weeks | HDRS |
| Lee et al. (2015) (Korea) |
10/10 (69.3) |
NA | NA | 10/10 | I: VR C: Balance training |
Dance exerci- se using Nintendo Wii TM fit game, 45 min each, 5 times/week 6 weeks |
BDI |
| Lee et al. (2018) (Korea) |
25/16 (65.8) |
I: 4.5 ± 3.3 C: 4.4 ± 3.0 |
NA | 17/24 | I: Qi dance C: waitlist |
60 min each, twice/week, 8 weeks | BDI |
| Li et al. (2020) (China) |
24/24 (61.6) |
I: 5.48 ± 3.69 C: 6.46 ± 5.17 |
I: 1.85 ± 0.63 C: 1.83 ± 0.64 |
16/32 | I: rTMS C: Placebo |
Bilateral M1: 80% RMT, 2,000 pulses/ day, 5 consecutive days |
HDRS |
| Michels et al. (2018) (America) |
9/4 (69.2) |
NA | I: 2.11 ± 0.33 C: 2.50 ± 1.00 |
NA | I: Dance C: Health ed- ucation |
60 min each, twice/week, 10 weeks | BDI |
| Modugno et al. (2010) (Italy) |
10/10 (62.6) |
I: 3.0 ± 0.22 C: 3.5 ± 0.17 |
I: 10 ± 1.8 C: 9.4 ± 1.1 |
10/10 | I: Active theater C: Physiothe- rapy |
6 h each, 18 h/month, 3 years | HDRS |
| Moon et al. (2020) (America) |
8/9 (66.1) |
I: 4.25 ± 2.1 C: 5.33 ± 3.3 |
I: 2 (2–2) C: 2 (2–2) |
10/7 | I: Qigong C: Placebo |
15–20 min each, twice/day, 12 weeks | GDS |
| Naismith et al. (2013) (Britain) |
35/15 (67.4) |
I: 6.0 ± 5.5 C: 8.1 ± 5.6 |
I: 2.1 ± 0.5 C: 2.1 ± 0.5 |
36/14 | I: Cognitive training C: Waitlist |
120 min each, twice/day, 7 weeks | BDI-II |
| Okai et al. (2013) (Britain) |
28/17 (58.8) |
I: 10.5 ± 6.0 C: 8.8 ± 5.6 |
NA | 31/14 | I: CBT C: waitlist |
12 sessions, 12 weeks |
BDI |
| Pal et al. (2010) (Hungary) |
12/10 (68.5) |
I: 6 (3-9.5) C: 6.5 (3.75–10.5) [Median (range)] |
NA | 11/11 | I: 5-Hz rTMS C: Placebo |
lDLPFC: 90% RMT, 600 pulses/day; 10 consecutive days |
BDI |
| Patel et al. (2016) (America) |
14/14 (63.9) |
NA | NA | 16/12 | I: CBT C: sleep hygi- ene advice |
6 weeks | PHQ-9 |
| Paus et al. (2007) (Germany) | 18/18 (63.5) |
I: 7.4 ± 4.3 C: 7.9 ± 4.7 |
I: 2.7 ± 0.6 C: 2.5 ± 0.4 |
23/13 | I: BLT C: Placebo |
7,500 lux for 30 min daily for 14 days | BDI |
| Peña et al. (2014) (Spain) |
22/22 (67.8) |
I: 5.6 ± 4.6 C: 7.4 ± 5.7 |
NA | 27/17 | I: Cognitive training C: Occupatio- nal group activities |
60 min each, 3 times/week, 12 weeks | GDS |
| Pérez-de la Cruz (2018) (Spain) | 15/15 (65.1) |
I: 7.1 ± 2.042 C: 7.7 ± 3.025 |
I: 2.81 ± 0.22 C: 2.76 ± 1.02 |
15/15 | I: Aquatic Ai chi C: Stretching exercise |
45 min each, twice/week, 10 weeks | GDS |
| Petrelli et al. (2014) (Germany) |
22/21 (69.0) |
I: 66.2 ± 39.5 C: 65.0 ± 52.8 (months) |
NA | 22/21 | I: NEUROvit- alis C: Waiting list |
90 min each, twice/week, 6 weeks | BDI-II |
| Picelli et al. (2016) (Italy) |
9/8 (71.4) |
I: 11.2 ± 5.6 C: 10.8 ± 4.1 |
NA | 9/8 | I: Treadmill training C: Regular social interactions |
45 min each, 3 times/week, 4 weeks | BDI |
| Rodgers et al. (2019) (Australia) |
18/18 (63.7) |
NA | NA | 16/20 | I: Mindfulne- ss interven- tion C: waitlist |
120 min each, 6 sessions, 8 weeks |
GDS-15 |
| Rios Romenets et al. (2013) (Canada) |
6/6 (67) |
I: 5.2 ± 1.8 C: 5.2 ± 4.4 |
NA | 11/1 | I: CBT+BLT C: Placebo |
CBT: 90 min each, once/week, 6 weeks BLT: 10,000 lux for 30 min daily |
BDI |
| Rios Romenets et al., 2013 (Canada) |
18/15 (63.7) |
I: 7.7 ± 4.6 C: 5.5 ± 4.4 |
NA | 19/14 | I: Dance C: waitlist |
60 min each, twice/week, 12 weeks | BDI |
| Rutten et al. (2019) (Netherlands) |
35/37 (62.5) |
NA | I: 2.1 ± 0.6 C: 2.4 ± 0.7 |
40/32 | I: BLT C: Placebo |
10,000 lux for 30 min twice/day for 3 months |
HDRS |
| Sacheli et al. (2019) (Britain) |
20/15 (67.2) |
I: 3.91 ± 2.85 C: 5.17 ± 4.26 |
NA | 22/13 | I: Aerobic exercise C: Stretching exercise |
40–60 min each, 3 times/week, 12 weeks | BDI |
| Schmidt et al. (2021) (Germany) |
28/26 (67.3) |
I: 13.34 ± 3.84 C: 13.96 ± 3.33 |
NA | 36/18 | I: NEUROvit- alis C: Stretching exercise |
90 min each, twice/week, 6 weeks | BDI-II |
| Smania et al. (2010) (Italy) |
28/27 (67.5) |
I: 10.39 ± 4.76 C: 8.63 ± 5.39 |
I: 3.0 ± 0.1 C: 3.1 ± 0.3 |
29/26 | I: Balance training C: Stretching exercise |
50 min each, 3 times/week, 7 weeks | GDS |
| Shirota et al. (2013) (Japan) |
34/36 (66.8) |
I: 7.8 ± 6.6 C: 7.6 ± 4.4 |
NA | 31/39 | I:10-Hz rTMS C: Placebo |
SMA: 110% RMT, 1,000 pulses/day, 8 weeks | HDRS |
| Stallibrass et al. (2002) (Britain) |
29/29/30 (65.0) |
G1: 4.8 ± 4.3 G2: 4.7 ± 3.7 G3: 4.9 ± 3.5 |
NA | 61/27 | G1: Alexand- er technique G2: Massage G3: TAU | 40 min each, twice/week, 12 weeks | BDI |
| Solla et al. (2019) (Italy) |
10/10 (67.5) |
I: 4.4 ± 4.5 C: 5.0 ± 2.9 |
I: 2.1 ± 0.6 C: 2.3 ± 0.4 |
13/7 | I: Dance C: TAU |
90 min each, twice/week, 12 weeks | BDI-II |
| Sproesser et al. (2010) (Brazil) |
8/8 (59.0) |
I: 9.0 ± 4.0 C: 7.0 ± 4.0 |
I: 2.4 ± 0.2 C: 2.2 ± 0.4 |
9/7 | I: Psychother- apeutic intervention, C: Waiting list |
90 min each, twice/month, 12 months | BDI |
| Tollár et al. (2018) (Netherlands) |
35/20 (67.4) |
I: 6.7 ± 2.3 C: 7.1 ± 2.8 |
NA | 29/26 | I: VR C: TAU |
The Xbox virtual reality exergame: 60 min each, 15 sessions over 3 weeks | BDI |
| Troeung et al. (2014) (Australia) |
11/7 (66.0) |
I: 5.7 ± 5.5 C: 4.29 ± 3.25 |
NA | 12/6 | I: CBT C: waitlist |
120 min each, once/week, 8 weeks | DASS-D |
| Tröster et al. (2017) (America) |
131/35 (60.3) |
I: 12.1 ± 4.9 C: 11.7 ± 4.1 |
NA | 84/52 | I: DBS C: waitlist |
Receive stim-ulation imme- diately (7 days) after device impla- ntation was completed | HDRS |
| Veazey et al. (2009) (America) |
4/4 (71.0) |
NA | NA | 8/0 | I: Telephone CBT C: Phone calls about the patients' general wellbeing |
Average 41 min each, once/week, 8 weeks |
PHQ-9 |
| Videnovic et al. (2017) (America) |
16/15 (63.1) |
I: 5.94 ± 3.57 C: 8.38 ± 3.71 |
I: 2.1 ± 0.3 C: 2.3 ± 0.5 |
13/18 | I: BLT C: Placebo |
10,000 lux for 60 min twice/ day for 14 days |
BDI |
| Wade et al. (2003) (Britain) |
53/41 (70.9) |
NA | NA | 56/38 | I: Multidisci- plenary reha- bilitation C: Waiting list |
120 min each, once/week, 24 weeks | HDRS |
| Willis et al. (2018) (Australia) |
10/10 (68.9) |
NA | NA | 17/13 | I: Polychrom- atic light C: Placebo |
3,000 lux for 1 h for 2 weeks |
BDI-II |
| Wu et al. (2019) (China) |
50/50/50 (60.1) |
G1: 5.8 ± 1.6 G2: 5.5 ± 1.4 G3: 6.0 ± 1.7 |
NA | 89/61 | G1:1-Hz/5-Hz rTMS G2: Tradition- al rehabilita- tion G3: G1+G2 | lDLPFC: 80% MT, 1,600 pulses/day; 20 days in 4 weeks |
HDRS |
| Wu et al. (2020) (China) |
28/26 | I: 5.8 ± 2.6 C: 5.7 ± 3.5 |
I: 2.4 ± 0.8 C: 2.5 ± 3.6 |
30/24 | I: tDCS C: Placebo |
DLPFC: (F3, F4): 1.2 mA, 20 min, 24.75 cm2, 5 times/week, 4 weeks | HDRS |
| Wu et al. (2021) (China) |
49/49 (65.1) |
I: 4.97 ± 3.91 C: 5.66 ± 3.81 |
NA | 56/42 | I: Combined exercise C: TAU |
50 min each, 3 times/week, 8 weeks | GDS |
| Wuthrich and Rapee (2019) (Australia) |
6/5 NA | NA | NA | NA | I: Telephone CBT C: waitlist |
10 weeks | GDS |
| Xu and Xia (2017) (China) |
35/35 (72.5) |
I: 7.3± 2.2 C: 7.1 ± 2.1 |
NA | 42/28 | I: Auricular pressure + pointed psychological nursing C: TAU |
3–4 times/day, 1–3 min/time, 9 days |
SDS |
| You and She (2020) (China) |
35/35 (68.7) |
I: 4.17 ± 0.35 C: 4.21 ± 0.24 |
NA | 37/33 | I: Tai chi C: Stretching exercise |
60 min each, twice/week, 24 weeks | HDRS |
| Yu et al. (2017) (China) |
31/33 (67.6) |
I: 2.76 ± 1.56 C: 2.64 ± 1.49 |
NA | 30/34 | I: 5-Hz rTMS C: Placebo |
Bilateral DLPFC: 80% MEP, 1,600 pulses/ day, consecutive 10 days | HDRS |
| Zheng et al. (2020) (China) |
35/35 (72.9) |
I: 6.34 ± 0.27 C: 6.39 ± 0.25 |
NA | 41/29 | I: Resistance exercise C: TAU |
50 min each, 3 times/week, 4 weeks | HDRS |
| Zhuang et al. (2020) (China) |
19/14 (61.0) |
I: 70.37 ± 52.26 C: 68.57± 45.29 (month) |
I: 2 (1.5–2.5) C: 2.25 (1.75–3.0) [Median (range)] |
15/18 | I: 1-Hz rTMS C: Placebo |
rDLPFC: 110% RMT, 1,200 pulses/ day, consecu- tive 10 days | HDRS |
I, intervention; C; control; M, male; F, female; BLT, bright light therapy; CBT, cognitive behavioral therapy; DBS, deep brain stimulation; TAU, treatment as usual; TMS, transcranial magnetic stimulation; rTMS, repetitive transcranial magnetic stimulation; tDCS, transcranial direct current stimulation; VR, virtual reality; LSVT-BIG, Lee Silverman Voice Therapy BIG; lDLPFC or rDLPFC, left or right dorsolateral prefrontal cortex; MT, motor threshold; RMT, resting motor threshold; M1, primary motor cortex; SMA, supplementary motor area; MEP, motor evoked potential; BDI, Beck depression inventory; HDRS, Hamilton Depression Rating Scale; GDS, Geriatric Depression Scale; DASS-D, Depression, Anxiety, Stress Scale-depression; PHQ, Patient Health Questionnaire; SDS, Self-Rating Depression Scale.