Supplementary Material for: Non-pharmacological treatments in Lewy body disease: a systematic review

Introduction: Lewy body disease (LBD) is the second most common neurodegenerative disorder in patients older than 65 years. LBD is characterized by heterogeneous symptoms like fluctuation in attention, visual hallucinations, parkinsonism and REM sleep behavior disorders. Considering the relevant social impact of the disease, identifying effective non-pharmacological treatments is becoming a priority. The aim of this systematic review was to provide an up-to-date literature review of the most effective non-pharmacological treatments in patients with LBD, focusing on evidence-based interventions. Methods: Following PRISMA criteria, we carried out a systematic search through three databases (PubMed, Cochrane Libraries, PEDro) including physical therapy (PT), cognitive rehabilitation (CR), light therapy (LT), transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), deep brain stimulation (DBS). All studies were qualitatively assessed using standardized tools (CARE and EPHPP). Results: We obtained a total of 1220 studies of which 23 original articles met eligibility criteria for inclusion. The total number of LBD patients included was 231, mean age 69.98, predominantly men (68%). Some physical therapy studies highlighted improvements in motor deficits. Cognitive rehabilitation produced significant improvements in mood, cognition and patient’s quality of life and satisfaction. Light therapy outlined a partial trend of improvements in mood and sleep quality. DBS, ECT and TMS showed some partial improvements mainly on neuropsychiatric symptoms whereas tDCS provided partial improvements in attention. Conclusion: This review highlights the efficacy of some evidence-based rehabilitation studies in LBD, however, further randomized controlled trials with larger samples are needed to provide definitive recommendations.