Understanding Parkinson's disease and its impact on mood

Parkinson's disease (PD) is a progressive neurodegenerative condition that typically affects individuals over the age of 50. It is characterised by a range of symptoms that impact both physical and mental well-being, significantly influencing quality of life.

Core symptoms of Parkinson's disease

• Motor symptoms - These include tremor (uncontrollable shaking), bradykinesia (slowness of movement), muscle rigidity (stiffness), and postural instability (difficulty maintaining balance).
• Non-motor symptoms - Beyond physical challenges, PD also leads to sleep disturbances, issues with executive functioning (such as planning and decision-making), and notable changes in mood.

Mood disturbances in Parkinson's disease

• Prevalence of depression - A significant number of individuals with PD experience depression, which can profoundly affect their daily lives.
• Impact on quality of life - Research indicates that depression may contribute to up to 60% of the reduction in quality of life scores for those with PD, often having a greater impact than motor symptoms alone.

The benefits of dance for motor and psychological symptoms

Dance has emerged as a valuable intervention for individuals with PD, offering benefits that address both physical limitations and emotional challenges. As a sociable form of exercise, it provides unique advantages for overall well-being.

Physical benefits of dance

• Improvement in motor symptoms - Regular dance sessions can help alleviate issues like tremor and bradykinesia by improving coordination and movement fluidity.
• Adapted formats - Dance activities can be tailored to suit varying levels of mobility, ensuring accessibility for those with mild to moderate PD symptoms.

Psychological and social benefits of dance

• Mental stimulation - Engaging in dance involves memory, learning new steps, and spatial awareness, providing a cognitive challenge that supports mental health.
• Mood regulation - Short dance sessions, lasting up to an hour, can increase positive emotions and reduce negative feelings. Longer interventions over several weeks also show sustained mood improvements.
• Social connection - Dance fosters a sense of community and belonging, which is crucial for combating loneliness and depression, particularly in older adults.
• Emotional uplift - Participants often describe dance as a way to escape daily struggles, reporting feelings of happiness and temporary relief from personal concerns.

Key research on mood changes after social dance sessions

A significant study by Lewis et al. (2014) investigated the effects of social dance sessions on mood in individuals with Parkinson's disease compared to those without the condition.

Method of the Lewis et al. (2014) study

• Participants - The study involved 37 individuals aged between 50 and 80 years, with an average age of 65.5. Of these, 22 had mild to moderate PD (12 males, 10 females), and 15 were age-matched controls without PD (7 males, 8 females). Participants were recruited through local advertisements and PD support groups.
• Design - A mixed experimental design was used, incorporating matched participants and repeated measures. Independent variables included group (PD sufferers versus non-PD controls) and time cycles (long cycle: week 1 versus week 12; short cycle: before versus after class). The dependent variable was participants' mood scores.
• Procedure - Dance classes lasted 50 minutes, structured as a 10-minute warm-up, 30 minutes of dancing, and a 5-minute cool-down, with a 5-minute break in between. Classes featured rhythmic dancing to a strong beat, with styles rotating every two weeks to include ballroom, cultural dances, and energetic rhythmic movements, adapted to participants' age and mobility levels.

Results of the Lewis et al. (2014) study

• Baseline comparison - There were no significant differences between the PD and control groups in terms of age, cognitive scores, or initial mood states. However, PD participants consistently showed higher total mood disturbance (TMD) scores compared to controls throughout the study.
• Long cycle outcomes (week 1 to week 12) - Over the 12-week period, all participants experienced a significant reduction in overall mood disturbance. Anger showed the most substantial decline, followed by a notable reduction in anxiety and tension. Vigour (energy levels) increased slightly but did not reach statistical significance.
• Short cycle outcomes (before versus after class) - Immediately following a single dance session, TMD scores improved significantly from baseline. Specific improvements were noted in tension-anxiety and vigour subscales, while other areas like depression showed positive changes but did not reach statistical significance.

Conclusions from the Lewis et al. (2014) study

• Mood enhancement - Dance interventions proved effective in improving mood states over both short-term (single session) and long-term (12 weeks) periods for both PD sufferers and controls.
• Specific benefits for PD - While PD participants started with higher mood disturbance levels, they experienced comparable improvements to the control group, suggesting dance as a powerful tool for emotional support in this population.

Evaluation of the Lewis et al. (2014) study

• Strengths - The use of a mixed design allowed for detailed comparisons across groups and time, providing robust evidence of dance benefits. The inclusion of age-matched controls strengthened the validity of findings specific to PD.
• Limitations - The self-selecting sample may introduce bias, as participants who volunteered might already have a positive inclination towards dance. The relatively small sample size limits generalisation to the broader PD population.
• Ethical considerations - The study ensured participant safety by adapting dance activities to mobility constraints, minimising physical risk during sessions.

Measurement tools for assessing mood states

In research on mood changes, specific scales are used to quantify emotional states accurately. Two key tools were employed in studies like Lewis et al. (2014) to evaluate the impact of dance on participants with and without PD.

Profile of Mood States (POMS)

• Structure - A comprehensive 64-item scale that measures mood across six sub-categories: Tension-Anxiety, Vigour-Activity, Depression-Dejection, Fatigue-Inertia, Anger-Hostility, and Confusion-Bewilderment.
• Scoring - Produces a Total Mood Disturbance (TMD) score by summing responses from all sub-categories and subtracting the Vigour score. Lower scores indicate a more positive mood state for all sub-scales except Vigour, where higher scores reflect increased energy and positive mood.

Brunel University Mood Scale (BRUMS)

• Structure - A shorter, 24-item scale adapted from POMS, assessing the same six mood states in a more concise format.
• Application - Used alongside or in place of POMS in studies requiring quicker assessments, maintaining reliability while reducing participant burden.

Implications of dance interventions for mood improvement

The findings from research on dance and mood, particularly in the context of Parkinson's disease, highlight broader applications and benefits for emotional and physical health in older adults.

Wider benefits of dance interventions

• Physical health gains - Beyond mood, dance supports physical fitness, balance, and coordination, which are critical for managing PD symptoms and maintaining independence in ageing populations.
• Emotional resilience - Regular participation in dance fosters a sustained sense of well-being, reducing feelings of anger, tension, and overall mood disturbance over time.
• Community and support - Social dance sessions create opportunities for connection, combating isolation and enhancing a sense of belonging, which is especially beneficial for those with chronic conditions like PD.

Potential for broader application

• Accessibility - Dance programmes can be adapted to various settings, including community centres and care facilities, making them a feasible intervention for diverse groups.
• Focus on vigour and fatigue - Dance not only lowers negative mood states but also boosts energy levels and reduces fatigue, contributing to an overall improved quality of life.
• Therapeutic integration - Incorporating dance into treatment plans for PD and other conditions could provide a holistic approach, addressing both motor and non-motor symptoms effectively.