doi:10.1111/psyg.
12834
REVIEW ARTICLE
Spiritual care for the management of Parkinson’s disease:
Where we are and how far can we go
Jia GAO,1 Qunjuan WANG,2 Qin WU,2 Yu WENG,2 Huamei LU3 and Jingzhi XU
1
Science and Research Office, 2Neurology Depart-
ment and 3Nursing Department, Changshu Hospi-
tal Affiliated to Nanjing University of Chinese
Medicine, Changshu, China
C o r r e s p o n d e n ce : J i n g z h i X u , N e u r o lo gy
Department, Changshu Hospital Affiliated to
Nanjing University of Chinese Medicine,
Changshu, China. Email: jingzhi_xu@hotmail.com
Disclosure: The authors declare that they have no
conflicts of interest in the research.
Received 24 November 2021; revision received 24 January
2022; accepted 24 March 2022.
Key words: neurodegenerative diseases, Parkinson’s
disease, spiritual care.
INTRODUCTION
In recent decades, several studies have delved at the
neural pathways and brain areas involved in various
features of spiritual devotion or spiritual practice.1–5
Another technique is to examine if neurological
abnormalities induced by stroke, tumour, brain dam-
age, or degenerative disease are followed by a shift
in religion or spirituality, in addition to studying
healthy persons.6–9 For example, Urgesi et al. discov-
ered that, following the excision of brain cancers by
neurosurgery, damage to the posterior parietal areas
was linked to a higher level of religious embrace.7 In
traumatic brain injury patients, a connection between
right parietal damage and growing spirituality scores
has been acknowledged,8 and dorsomedial prefrontal
cortex injuries caused by tumours or strokes were
linked to enhancement of authoritarian tendencies,
© 2022 Japanese Psychogeriatric Society.
PSYCHOGERIATRICS 2022; 22: 521–529
2
Abstract
An increasing number of studies have investigated the neural networks and
brain regions activated by different aspects of religious faith or spiritual
practice. The extent to which religiousness and spirituality are dependent
on the integrity of neural circuits is a question unique to neurological ill-
nesses. Several studies have reported that neural networks and brain areas
represent the various components of religious faith or spiritual activity in
recent decades. In addition to research in healthy people, another strategy
is to observe if neurological abnormalities caused by stroke, tumour, brain
damage, or degenerative sickness are accompanied by an alteration in reli-
giosity or spirituality. Similarly, Parkinson’s disease (PD), an ailment charac-
terized by dopaminergic neuron malfunction, has been utilized to explore
the role of dopaminergic networks in the practice, experience, and mainte-
nance of religious or spiritual beliefs. Case–control and priming studies have
demonstrated a decline in spirituality and religion in people with PD due to
dopaminergic degeneration. These studies could not adequately control for
confounding variables and lacked methodological rigour. Using qualitative
and quantitative assessments, a mixed-method approach might shed addi-
tional light on putative religious beliefs alterations in PD. In the current
review paper, we discussed the recent research on the impact of PD on
spiritual beliefs and spirituality.
particularly spiritual authoritarianism.6 Seizures in the
temporal lobe have also been linked to spiritual con-
version and numinous experiences.9 The World
Health Assembly resolution 37.13 made the spiritual
dimension part and parcel of World Health Organiza-
tion (WHO) Member States’ strategies for health in
1984.10,11 According to the WHO, ‘The spiritual
dimension [is understood] to imply a phenomenon
that is not material in nature, but belongs to the realm
of ideas, beliefs, values and ethics that have arisen in
the minds and conscience of human beings, particu-
larly ennobling ideas. … The spiritual dimension plays
a great role in motivating people’s achievement in all
aspects of life’.10(pp. 5 6) Case–control and priming
studies have demonstrated a decline in spirituality
and religion in people with Parkinson’s disease
(PD) due to dopaminergic degeneration. These
521

J. Gao et al.
studies could not adequately control for confounding
variables and lacked methodological rigour. A mixed-
method approach using qualitative and quantitative
assessments might shed additional light on putative
religious beliefs alterations in PD.11 Spiritual care is
not synonymous with chaplaincy in healthcare. It is
an obtrusive addition to routine care; spiritual care
is an awareness of the spiritual dimension and an
acceptance of patients’ and caregivers’ needs,
options, resources, civil rights, and possible spiritual
or religious limitations. Spiritual care is accepting a
patient’s or caregiver’s desire to avoid discussing
spiritual needs and concerns with healthcare practi-
tioners.12 In palliative care, spiritual care emphasizes
spirituality via presence, empowerment, and provid-
ing calm.13
Correspondingly, PD, a disease characterized by a
dysfunction of dopaminergic neurons, has been used
to investigate the role of dopaminergic networks in
religious or spiritual belief, practice, experience, and
maintenance. A few case–control studies have been
conducted with non-demented PD patients, disease
control, and healthy people of the same age, using
standardized questionnaires14–17 or further objective
implicit methods18–21 to assess religiousness and
spirituality. The interpretation of such studies, on the
other hand, is not simple. The physical, cognitive,
and emotional impacts of PD are typically exacer-
bated by the unpredictability of therapeutic
approaches and symptoms.22,23 Such confounds
must be carefully controlled to claim a disease’s
selective effect on spirituality. In this review, we
examine this research and argue that the findings
have been misinterpreted to show that religious faith
is less important for patients with PD.
We bring this up because these few studies which
have been done pose the risk of producing a stereo-
typical perspective of PD as causing a loss of reli-
gious faith. Indeed, in the United States, if not yet in
Europe, this viewpoint is circulating in patient infor-
mation publications.24 These studies, on the other
hand, may contribute to a broader discussion of the
plausible ways in which PD neuropathology and ther-
apy can influence spiritual belief differences, even
after controlling for physical and psychosocial factors
and addressing the importance of religious coping in
adjusting to life with a chronic condition.25 We also
make annotations about observational research on
522
14798301, 2022, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/psyg.12834 by UFPI - Universidade Federal do Piaui, Wiley Online Library on [11/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
spiritual and worldwide managing in PD, highlighting
the role of religious coping.26–30
Spirituality and religious beliefs are a significant
resource for patients with a chronic sickness, offering
emotional consolation, helping to sustain self-esteem
and greater tolerance of discomfort and further indi-
cations, even in more secularized European coun-
tries.31–36 The procedure of adaptation following a
change in one’s lifestyle, objectives, and prospects
can lead to a period of contemplation, generating
observational uncertainties about life’s meaning and
determination. This could indicate a rising interest in
spirituality and religion, as well as a dependency
on it.37
A specific study of religious faith in PD patients
should differentiate between an intrinsic loss of reli-
giousness due to neurological degeneration, a predi-
cated loss of spirituality due to the disease’s
practical, social, and cognitive challenges, and any
sensitive response to an ailment that may strengthen
or weaken spiritual belief.
Describing and Evaluating Religion and
Spirituality
It is difficult to describe religious faith and spirituality
because there is no consensus on a concept or mea-
surement method. Religiousness encompasses many
psychological, social, cultural, cognitive, and behav-
ioural traits. The alignment of domains is not always
consistent—for example, a person can have religious
views but not practice religion. Spirituality has also
been described as a ‘nebulous notion’ encom-
passing a wide range of individual meanings.38 Disil-
lusionment with institutional religion has led to a
growing emphasis on personal meaning and auton-
omy in spirituality, with many people now identifying
as ‘spiritual but not religious’.38 Certain standardized
procedures have been established to designate how
important religious belief and spirituality components
are to individuals. Table 1 shows a brief description
of those used in the studies reviewed.
HEALTH-RELATED SPIRITUALITY
BENCHMARKS
The hospice movement in the United Kingdom in the
1960s improved medicine by emphasizing spirituality
as an important component of the overall pain
© 2022 Japanese Psychogeriatric Society.
 14798301, 2022, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/psyg.12834 by UFPI - Universidade Federal do Piaui, Wiley Online Library on [11/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Spiritual care for Parkinson’s disease

Table 1 Various standardized procedures for assessing the importance of religious belief and spirituality, of relevance to the management
of Parkinson’s disease
Scale Description
Brief Multidimensional The BMMRS is a confirmed self-report questionnaire that contains approximately 35 items about the
Measure of participant’s beliefs, religion’s public and private aspects, practices, and commitments. It comes in a
Religiousness and variety of formats. In a recent factor analysis, the most closely associated variables to differences in
Spirituality (BMMRS)39,40 personal belief were positive spiritual experiences, negative spiritual experiences, religious practices,
forgiveness, religious support, and two basic questions about general religious and spiritual belief. Due to
mobility limitations and a lack of energy, lesser scores for religious activities and spiritual support may be
the outcome. In private religious beliefs, concentration concerns may interfere with prayer or analyse
religious literature difficult.
Gorsuch Intrinsic/Extrinsic In this short quiz, individuals assess their agreement with 14 statements identifying features of religious
Religious Orientation activity. These declarations may imply an ‘intrinsic’ religious commitment based on intense private
Scale41 devotion (e.g. ‘My entire approach to life is founded on my religion’, or ‘It is crucial for me to spend time in
private thinking and prayer’). On the other hand, extrinsic commitment refers to actions taken to benefit
others or improve one’s mood. (e.g. ‘I attend church largely to spend time with my friends’).
Religious and Spiritual This was created as a comprehensive measure to avoid Judaeo-Christian bias, and it comprises public and
Beliefs: A Royal Free private religious, spiritual, and philosophical components of belief. The participant is asked the following
Interview (RFI)42,43 questions on ‘religious practice’: ‘How important is the actual practice of your faith to you?’ ‘What form
does it take?’ and ‘How often do you practice?’ The term ‘spiritual practice’ represents the belief in an
exterior spiritual power and how it affects daily life, managing and analysing world events and natural
calamities. A section on philosophical belief poses similar questions about philosophical stances like
existential, atheist, etc.
The Freiburg A 35-item coping measure with five subscales: depressive response; dynamic, problem-solving coping;
Questionnaire of Coping diversion; religiosity and the search for meaning; understatement and ambitious thinking.
with sickness44

paradigm. Dame Cecily Saunders, a nurse, social
worker, and physician, campaigned for the integrity
of cancer patients by combining the best nursing and
medical practices and devising an ars moriendi para-
digm that maintained pain alleviation with adequate
morphine doses.45
According to the WHO definition, spiritual require-
ments are felt by healthcare professionals, patients,
and caregivers worldwide, especially during pivotal
and significant life circumstances. As a result, all
healthcare personnel, patients, and caregivers are
concerned about spiritual requirements. International
efforts have been made since 1991 to promote spiri-
tual care in all aspects of healthcare, not just pallia-
tive care.46,47 In 1996, the NANDA nursing diagnosis
standards were expanded to include spiritual anguish
and suffering.48 In 2006, the WHO recognized reli-
giousness as part of its health-related quality of life
scale.49
In 2012, the International Council of Nurses (ICN)
stated that ‘in providing care, the nurse promotes an
environment in which the human rights, values, cus-
toms and spiritual beliefs of the individual, family and
community are respected’.50(p. 2) Despite their best
efforts, healthcare professionals struggle to cope
with defining spirituality and spiritual care, and as a
consequence, they often fail to address the religious
beliefs of patients and caregivers.51,52 Gijsberts et al.
discovered that spiritual care in palliative care was
defined as ‘attention for spirituality, presence,
empowerment, and bringing peace’ in a study of
European literature.13,53 Religiousness is infrequently
encouraged as an important part of health and well-
being in public health and/or patient education, leav-
ing patients and caregivers bewildered when
healthcare practitioners (unexpectedly) discuss spiri-
tual subjects in the secularized context of technical
medicine.54–56
Potential mechanisms for a relationship
between Parkinson’s disease (PD) and religion
Some broad assumptions can be made regarding
how neuropathological alterations and therapy
effects in PD might contribute to changes in religios-
ity. Recent research in healthy persons suggests that
the basal ganglia play a role in religious belief mainte-
nance and motivation and rituals like prayer and
meditation.2,57 Given the cortico-striatal-thalamic’s
significance this is predictable in the management of
cognitive and emotional functions as well as motor
control.58–60

© 2022 Japanese Psychogeriatric Society. 523


J. Gao et al.
Dopamine’s significance in motivation and goal-
directed conduct has long been known,61–63 and
reward circuit blunting in the ventromedial prefrontal
cortex, amygdala, striatum, and midbrain has been
associated to PD-related lethargy.64 As a result, apa-
thy in PD may involve a loss of interest in religious
practices. In a functional magnetic resonance imag-
ing (fMRI) study with healthy volunteers, activation
patterns were analysed when individuals rated
whether religious affirmations, ethical attitudes, and a
fundamental, propositional statement such as ‘Most
people have ten toes’, were true or untrue.65,66 When
compared to uncertainty, both belief and scepticism
showed stronger activation, showing a corticostriatal
network regulating anticipatory, reward-related deci-
sion making, involving the ventromedial prefrontal
cortex, limbic regions, and caudate.
Despite its shortcomings, the study shows that
sacred belief is controlled via brain links similar to
those that drive general beliefs. In a group of devoted
Christians, an fMRI study of prayer revealed an
extremely substantial district rise in the blood oxygen
level-dependent response in the head of the caudate
nucleus while they were praying quietly.67 The impor-
tance of the connections between the dorsal caudate
and the dorsolateral prefrontal cortex in habitual
reward processing has been well demonstrated.68
Similar brain pathways were activated in investiga-
tions of economic exchange games, including trust,
collaboration, and expectation of forthcoming benefit
in exchange for commitment, and parallels were dis-
covered in this prayer study.69 In the spiritual econ-
omy, prayer appears to be the medium of exchange
for commitment.
Certain neurobiological interpretations of religious
practices have emphasized the significance of dopa-
mine and serotonergic disturbances in delusional
beliefs and obsessions in psychiatric illnesses, indicat-
ing that dopamine provides a unique function in modi-
fying religious experience within a ‘religious circuit’.70
This has seemed to be misrepresentative, in part since
routine spiritual behaviour and attitude and belief have
less in common with the severe anxiety, grandiosity,
or fearfulness based on religious psychoses; further-
more, the neural connections engaged in these abnor-
malities and those associated in PD seem to have
little correlation.71,72 On this premise, no firm link can
be drawn between dopaminergic superfluous in these
524
14798301, 2022, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/psyg.12834 by UFPI - Universidade Federal do Piaui, Wiley Online Library on [11/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
circumstances and dopamine deficiency in PD, lead-
ing to a decline in religious devotion.
Treatment with dopamine agonists, and to a
slighter degree, with levodopa, has been associated
with impulsive, compulsive disorders (ICDs), irrational
gambling, excessive purchasing, eating disorders,
and hypersexuality are few examples.73,74
Dopamine neurotransmission in the mesocor-
ticolimbic pathway is affected by dopamine agonist
actions acting through D3 receptors in the ventral
striatum. Excessive praying or other religious prac-
tices were not mentioned in the ICD, whether or not
they were related to PD.75
Religious alterations could result from degenera-
tive changes in Parkinson’s illness that reach beyond
the nigrostriatal circuit. In individuals with PD, there
have been findings of abnormalities in the theory of
mind, particularly cognitive elements, linked to frontal
executive deficiencies.76,77 Personal extemporary
praying has been observed to recruit areas involved
in social cognition, including a traditional theory of
mind, in devout Christians but not in atheist controls.
Talking to God appears to be similar to talking to a
friend. Indeed, anthropologists have hypothesized
that religion evolved due to a well-developed con-
ception of mind that permitted the supernatural
agentic intent to be attached to natural
happenings.78
Other cognitive deficits associated with PD, such
as difficulties with focus, concentration, and memory,
are likely to block religious practice in some ways.
However, we only identified one short qualitative
study that mentioned concentration impacting
prayer.79 Some believe that frontal lobe executive
function and working memory are required for ‘tran-
scendence’, or the ability to ascend above the cur-
rent moment in contemplation of an alternate
world.29 Though there is no evidence that this occurs
in a religious context, frontal lobe impairments in a
nondemented PD group have been linked to difficul-
ties conceptualizing hypothetical future
occurrences.80
Personality changes might also have a role:
Increased impulsivity, for example, could make it
more difficult to stick to past religious convictions.81
A more stoic, cautious, and inflexible attitude has
also been seen in people with PD. However, this is
no longer considered a risk factor but rather a
© 2022 Japanese Psychogeriatric Society.

probable preclinical development.82 This type of shift
might contribute to a preference for a certain type of
religious devotion, such as a more traditional rather
than a more modern form of worship.
Finally, degenerative alterations in PD may impact
a variety of brain networks and cognitive circuits that
underpin religious beliefs and practices. They must,
however, be evaluated in light of observational stud-
ies (described below), which suggest that religion
plays an important coping role in PD.24
Conceptualization attempts
The phrase ‘otherworldliness’ is rarely used by
patients and guardians to describe their interests
and demands. When the most established of elderly
(85+) from Sweden received some information
regarding otherworldliness, he described it as ‘some-
thing magnificent and unimaginable.’83,84 The chal-
lenge in appreciating what otherworldliness implies is
accepting and respecting its multiplicity and individu-
ality. According to the United States’ agreement-
based definition, ‘the part of humankind that refers to
the manner in which people look for and express sig-
nificance and reason, and the manner in which they
experience their connectedness to the occasion, to
self, to other people, to nature, and to the huge or
sacrosanct’.47,85 The working definition of European
palliative consideration is as follows:
Spirituality is the dynamic dimension of human life
that relates to the way people (individual and com-
munity) experience, express and/or seek meaning,
purpose and transcendence, and the way they con-
nect to the moment, to self, to others, to nature, to
the significant and/or the sacred. Spirituality is multi-
dimensional, consisting of
1 Existential challenges (e.g. questions concerning
personality, which means enduring and demise,
blame and disgrace, compromise and absolution,
opportunity and obligation, expectation and mis-
ery, love and delight).
2 Attitudes and values are founded on values (what is
most important for each person, such as relations
to oneself, family, friends, work, things nature, art
and culture, ethics and morals, and life itself).
3 Religious grounds and concerns (faith, beliefs and
practices, the relationship with God or the ulti-
mate). It is important to remember, though, that in
care circumstances, the patient is the one who
tells us what form their spirituality takes.
© 2022 Japanese Psychogeriatric Society.
14798301, 2022, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/psyg.12834 by UFPI - Universidade Federal do Piaui, Wiley Online Library on [11/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Spiritual care for Parkinson’s disease
In therapeutic practice, spiritual care is wholly con-
structed on connection. ‘The activity of “spiritual
care” or responding to “spiritual need” becomes a
matter of recognizing what people fail to receive in
healthcare contexts and trying to ensure that they
are, as far as possible, assisted on their multiple que-
sts to make that which may be absent present’, write
Swinton and Pattison.86(p. 233)
CONNECTIVITY IS NOT A REMEDIAL
MEASURE
Since the whole of human existence is more than
the sum of its parts, human perception cannot be
divided into physical, social, psychological, or spiri-
tual domains. It is vital to comprehend the interre-
lated nature of spirituality in all parts of healthcare
regarding disease-induced deficits in the perception
of ourselves, others, and the world. Individuals will
try to pursue meaning, negotiate life events, and
build social lives even though their general percep-
tion and sense-making are challenged.87 Atul
Gawande criticizes the one-dimensionality in medi-
cine as follows: ‘of people’s minute-by-minute levels
of pleasure and pain miss this fundamental aspect
of human existence. A seemingly happy life may be
empty. A seemingly difficult life may be devoted to a
great cause. We have purposes larger than our-
selves. Unlike your experiencing self—which is
absorbed in the moment—your remembering self is
attempting to recognize not only the peaks of joy
and valleys of misery but also how the story works
out as a whole.’ As a result, it is critical to establish
and sustain relationships to address and support
people in acquiring what they lack.
Spiritual care is defined as a non-discipline-
specific healthcare function analogous to emo-
tional or physical care.88 As a result, it is the obli-
gation of all healthcare providers to give spiritual
care and maintain connectivity. Even though medi-
cal professionals recognize the need for spiritual
care, how it is administered is uncertain.89 As
sources of help, the creation of evaluation instru-
ments90 and the instrumentalization of spiritual
care are also pursued. Instead of emphasizing the
need for specific spiritual therapies, patients
express gratitude for being acknowledged as a
‘whole person’.91
525

J. Gao et al.
The spirituality of patients with Parkinson’s
disease (PD)
Prizer et al.92 found that PD patients with a caregiver
reported significantly advanced spiritual well-being
(106.90, SD =316.00) compared to those without
caregivers (78.49, SD =316.00). Advanced Functional
Assessment of Chronic Illness Therapy-Spiritual
Well-being scores were linked with lower quality of
life, fewer non-motor symptoms, and less palliative
care symptoms in these individuals. As a result, the
authors conclude. “spiritual counselling may be a
crucial emphasis in the management of Parkinson’s
disease and must be examined when a patient and
caregiver visit our department.”92 This is one of the
first studies to look into this crucial human fac-
tor in PD.
According to the findings of Prizer et al.’s study,
spirituality has an important role in PD management.92
Due to the extreme connections between meaning,
peace, faith, mood, palliative symptoms, and quality
of life, spirituality should be included in the clinical his-
tory recorded by the doctor. According to Boersma
et al, patients with PD do not believe palliative care is
enough at the time of diagnosis. Palliative care, they
believe, is associated with hospice, advanced cancer,
and death. On the other hand, many PD patients
believe that faith and spirituality are critical in helping
them accept their diagnosis and go forward with their
new lives with the disease.93
For PD patients, spirituality is regularly incorpo-
rated into palliative care plans.90 We discovered PD
patients in a tranquil state near the end of their lives
through our own94 research, which addressed the
spirituality of the caretakers as well as ourselves.95
(In a nutshell, all physicians who treat individuals with
’PD should consider spirituality in their practice and
deliver access to professional spiritual care. The ben-
efits of healthcare teams delivering complete, multi-
disciplinary treatment to PD patients are supported
by this study.
Thinking of future benchmarks
Integrating spiritual care into a religiously diverse set-
ting like healthcare is challenging, according to
Liefbroer et al.96 There are a variety of viewpoints on
how to integrate spirituality with healthcare and medi-
cine. Three questions are essential here: (i) Who
should provide spiritual support? (ii) What kind of
526
14798301, 2022, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/psyg.12834 by UFPI - Universidade Federal do Piaui, Wiley Online Library on [11/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
spiritual care should be provided? and (iii) What role
does spirituality play in caregivers’ spiritual care?96
According to Gijsberts et al.,13 There appears to be a
split between North American scholars who advocate
hypothesis-driven outcome research based on vali-
dated instruments and the assessment of potential
confounding variables, and those who advocate
hypothesis-driven outcome research based on vali-
dated instruments and the assessment of potential
confounding factors.97 Furthermore, European
researchers believe that the impacts of spiritual care
offered through creative, storytelling, or ritual prac-
tices may not be reflected entirely in health-related
quality of life. As a result, the creation of (instruments
to quantify) narrative outcomes are recommended as
a future direction.13 Finally, doctors and researchers
struggle to address and attend to spirituality in
patients with persistent neurological illnesses. To be
understandable, seek purpose, and feel allied,
patients with PD and their caregivers require spiritual
care. On the other hand, appropriate spiritual care
models have yet to be devised.
CONCLUSION
In PD, the relationship of religion and spirituality has
received little attention. The literature is limited to a
few investigators who employed diverse methodolo-
gies and assumptions, all of whom worked in
Westernized contexts with predominantly Judaeo-
Christian faith backgrounds among their partici-
pants. Decreased movement and possibly cognitive
impairment, combined with social and emotional
considerations, can have an unspecified impact
on religious or spiritual life in persons with
PD. Meanwhile, case–control studies have been
interpreted to show a selective religiosity deficit in
PD, showing that dopamine is involved in normal
spirituality, and these findings have been widely
published in books and papers.28 However, these
claims could only be confirmed by comparing PD
cases to carefully chosen controls with identical
mobility, cognitive, emotional regulation, and sociali-
zation difficulties.
On the other hand, small-scale qualitative research
has emphasized the potential positive effects of a
disease like PD on the growth of spirituality, as well
as the prospective advantages of religious faith in
coping with illness. A diverse process approach
© 2022 Japanese Psychogeriatric Society.

integrating both quantitative and qualitative data-
gathering approaches will likely yield a more
nuanced, comprehensive portrayal of developments.
Future research might benefit from fine-tuning inter-
view questions to emphasize probable changes in
theory of mind or personality that impact religious
practice style. This complicated image will require
more investigation.
DATA AVAILABILITY STATEMENT
Data sharing is not applicable to this article as no
new data were created or analyzed in this study.
REFERENCES
1 Seitz RJ, Angel HF. Processes of believing – a review and con-
ceptual account. Rev Neurosci 2012; 23: 303–309.
2 Azari NP, Missimer J, Seitz RJ. Religious experience and emo-
tion: evidence for distinctive cognitive neural patterns. Int J
Psychol Relig 2005; 15: 263–281.
3 Cahn BR, Polich J. Meditation states and traits: EEG, ERP, and
neuroimaging studies. Psychol Bull 2006; 132: 180–211.
4 Schjoedt U, Stødkilde-Jørgensen H, Geertz AW, Roepstorff A.
Highly religious participants recruit areas of social cognition in
personal prayer. Soc Cogn Affect Neurosci 2009; 4: 199–207.
5 Kapogiannis D, Barbey AK, Su M, Zamboni G, Krueger F,
Grafman J. Cognitive and neural foundations of religious belief.
Proc Natl Acad Sci U S A 2009; 106: 4876–4881.
6 Asp E, Ramchandran K, Tranel D. Authoritarianism, religious
fundamentalism, and the human prefrontal cortex. Neuropsy-
chology 2012; 26: 414–421.
7 Urgesi C, Aglioti SM, Skrap M, Fabbro F. The spiritual brain:
selective cortical lesions modulate human self-transcendence.
Neuron 2010; 65: 309–319.
8 Johnstone B, Bodling A, Cohen D, Christ SE, Wegrzyn A. Right
parietal lobe-related “selflessness” as the neuropsychological
basis of spiritual transcendence. Int J Psychol Relig 2012; 22:
267–284.
9 Devinsky O, Lai G. Spirituality and religion in epilepsy. Epilepsy
Behav 2008; 12: 636–643.
10 WHO. Handbook of resolutions and decisions. In: WHA, ed.
The Determinants of Health, Vol. II. Geneva: World Health
Organization, 1985; 5: 1985–62.
11 Paal P, Lorenzl S. Patients with Parkinson’s disease need spiri-
tual care. Ann Palliat Med 2020; 9: 144–148.
12 Best M, Leget C, Goodhead A, Paal P. An EAPC white paper
on multi-disciplinary education for spiritual care in palliative
care. BMC Palliat Care 2020; 19: 9.
13 Gijsberts MHE, Liefbroer AI, Otten R, Olsman E. Spiritual care
in palliative care: A systematic review of the recent european
literature. Med Sci (Basel) 2019; 7: 25.
14 McNamara P, Durso R, Brown A. Religiosity in patients with
Parkinson’s disease. Neuropsychiatr Dis Treat 2006; 2:
341–348.
15 Butler PM, McNamara P, Ghofrani J, Durso R. Disease-
associated differences in religious cognition in patients with
Parkinson’s disease. J Clin Exp Neuropsychol 2011; 33:
917–928.
© 2022 Japanese Psychogeriatric Society.
14798301, 2022, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/psyg.12834 by UFPI - Universidade Federal do Piaui, Wiley Online Library on [11/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Spiritual care for Parkinson’s disease
16 Giaquinto S, Bruti L, Dall’Armi V, Palma E, Spiridigliozzi C. Reli-
gious and spiritual beliefs in outpatients suffering from
Parkinson disease. Int J Geriatr Psychiatry 2011; 26: 916–922.
17 Redfern C, Coles A. Parkinson’s disease, religion, and spiritual-
ity. Mov Disord Clin Pract 2015; 2: 341–346.
18 Butler PM, McNamara P, Durso R. Deficits in the automatic
activation of religious concepts in patients with Parkinson’s dis-
ease. J Int Neuropsychol Soc 2010; 16: 252–261.
19 Butler PM, McNamara P, Durso R. Side of onset in Parkinson’s
disease and alterations in religiosity: novel behavioral pheno-
types. Behav Neurol 2011; 24: 133–141.
20 Morgan J, Clark D, Tripodis Y et al. Impacts of religious seman-
tic priming on an intertemporal discounting task: response time
effects and neural correlates. Neuropsychologia 2016; 89:
403–413.
21 Angwin AJ, Chenery HJ, Copland DA, Murdoch BE, Silburn PA.
Summation of semantic priming and complex sentence com-
prehension in Parkinson’s disease. Brain Res Cogn Brain Res
2005; 25: 78–89.
22 Weintraub D, Burn DJ. Parkinson’s disease: the quintessen-
tial neuropsychiatric disorder. Mov Disord 2011; 26: 1022–
1031.
23 Williams-Gray CH, Foltynie T, Lewis SJG, Barker RA. Cognitive
deficits and psychosis in Parkinson’s disease: a review of path-
ophysiology and therapeutic options. CNS Drugs 2006; 20:
477–505.
24 Valeo T. Not just tremor: recognizing depression and other
non-motor symptoms of Parkinson’s disease. Neurol Now
2012; 8: 22–27.
25 McGrath JC. Posttraumatic growth and spirituality after brain
injury. Brain Impairment 2011; 12: 82–92.
26 Stanley-Hermanns M, Engebretson J. Sailing the stormy seas:
the illness experience of persons with Parkinson’s disease.
Qual Rep 2010; 15: 340–369.
27 Krakow K, Haltenhof H, Bühler KE. Coping with Parkinson’s
disease and refractory epilepsy. A comparative study. J Nerv
Ment Dis 1999; 187: 503–508.
28 Herrmann M, Curio N, Petz T et al. Coping with illness after
brain diseases – a comparison between patients with malignant
brain tumors, stroke, Parkinson’s disease and traumatic brain
injury. Disabil Rehabil 2000; 22: 539–546.
29 Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. Coping with
chronic neurological impairment: a contrastive analysis of
Parkinson’s disease and stroke. Disabil Rehabil 1997; 19: 6–12.
30 Hurt CS, Landau S, Burn DJ et al. Cognition, coping, and out-
come in Parkinson’s disease. Int Psychogeriatr 2012; 24: 1656–
1663.
31 Dezutter J, Wachholtz A, Corveleyn J. Prayer and pain: the
mediating role of positive re-appraisal. J Behav Med 2011; 34:
542–549.
32 Meints SM, Mosher C, Rand KL, Ashburn-Nardo L, Hirsh AT.
An experimental investigation of the relationships among race,
prayer, and pain. Scand J Pain 2018; 18: 545–553.
33 Wiech K, Farias M, Kahane G, Shackel N, Tiede W, Tracey I. An
fMRI study measuring analgesia enhanced by religion as a
belief system. Pain 2008; 139: 467–476.
34 Petrovic P, Kalso E, Petersson KM, Andersson J, Fransson P,
Ingvar M. A prefrontal non-opioid mechanism in placebo anal-
gesia. Pain 2010; 150: 59–65.
35 Thuné-Boyle IC, Stygall JA, Keshtgar MR, Newman SP. Do
religious/spiritual coping strategies affect illness adjustment in
patients with cancer? A systematic review of the literature. Soc
Sci Med 2006; 63: 151–164.
527

J. Gao et al.
36 Thuné-Boyle IC, Stygall J, Keshtgar MRS, Davidson TI,
Newman SP. Religious/spiritual coping resources and their
relationship with adjustment in patients newly diagnosed with
breast cancer in the UK. Psychooncology 2013; 22: 646–658.
37 Shaw A, Joseph S, Linley PA. Religion, spirituality, and post-
traumatic growth: a systematic review. Mental Health Relig Cult
2005; 8: 1–11.
38 Zinnbauer BJ, Pargament KI, Cole B et al. Religion and spiritu-
ality: Unfuzzying the fuzzy. J Sci Study Relig 1997; 36:
549–564.
39 Traphagan JW. Multidimensional measurement of religiousness/
spirituality for use in health research in cross-cultural perspective.
Res Aging 2005; 27: 387–419.
40 Johnstone B, Yoon DP, Franklin KL, Schopp L, Hinkebein J.
Re-conceptualizing the factor structure of the brief multi-
dimensional measure of religiousness/spirituality. J Relig Health
2009; 48: 146–163.
41 Gorsuch RL, Venable GD. Development of an" age universal" IE
scale. J Sci Study Relig 1983; 22: 181–187.
42 King M, Speck P, Thomas A. The Royal Free interview for reli-
gious and spiritual beliefs: development and standardization.
Psychol Med 1995; 25: 1125–1134.
43 King M, Speck P, Thomas A. The royal free interview for spiri-
tual and religious beliefs: development and validation of a self-
report version. Psychol Med 2001; 31: 1015–1023.
44 Muthny FA. Freiburger Fragebogen zur Krankheitsverarbeitung:
FKV. Washington: Beltz Weinheim, 1989.
45 Risse GB. The greatest benefit to mankind: a medical history of
humanity from antiquity to the present. Med Hist 1999; 43:
396–397.
46 Puchalski CM, Vitillo R, Hull SK, Reller N. Improving the spiri-
tual dimension of whole person care: reaching national and
international consensus. J Palliat Med 2014; 17: 642–656.
47 Puchalski C, Ferrell B, Virani R et al. Improving the quality of
spiritual care as a dimension of palliative care: the report of the
consensus conference. J Palliat Med 2009; 12: 885–904.
48 Available from: http://www.nandanursingdiagnosislist.
org/functional-health-patterns/spiritual-suffering/. Accessed
February 3, 2022
49 A cross-cultural study of spirituality, religion, and personal
beliefs as components of quality of life. Soc Sci Med 2006; 62:
1486–1497.
50 Nurses., I.C.o., The ICN code of ethics for nurses. In: Geneva
ICoN 2012.
51 van der Weegen K, Hoondert M, Timmermann M, van der
Heide A. Ritualization as alternative approach to the spiritual
dimension of palliative care: a concept analysis. J Relig Health
2019; 58: 2036–2046.
52 Appleby A, Wilson P, Swinton J. Spiritual Care in General Prac-
tice: rushing in or fearing to tread? An integrative review of
qualitative literature. J Relig Health 2018; 57: 1108–1124.
53 Puchalski CM, Kilpatrick SD, McCullough ME, Larson DB. A
systematic review of spiritual and religious variables in palliative
medicine, American journal of hospice and palliative care, hos-
pice journal, journal of palliative care, and journal of pain and
symptom management. Palliat Support Care 2003; 1: 7–13.
54 Paal P, Frick E, Roser T, Jobin G. Expert discussion on taking a
spiritual history. J Palliat Care 2017; 32: 19–25.
55 Soroka JT, Collins LA, Creech G, Kutcher GR, Menne KR,
Petzel BL. Spiritual Care at the end of life: does educational
intervention focused on a broad definition of spirituality
increase utilization of chaplain spiritual support in hospice?
J Palliat Med 2019; 22: 939–944.
528
14798301, 2022, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/psyg.12834 by UFPI - Universidade Federal do Piaui, Wiley Online Library on [11/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
56 Balboni TA, Balboni M, Enzinger AC et al. Provision of spiritual
support to patients with advanced cancer by religious commu-
nities and associations with medical care at the end of life.
JAMA Intern Med 2013; 173: 1109–1117.
57 Schjødt U, Stødkilde-Jørgensen H, Geertz AW, Roepstorff A.
Rewarding prayers. Neurosci Lett 2008; 443: 165–168.
58 Cools R. Dopaminergic control of the striatum for high-level
cognition. Curr Opin Neurobiol 2011; 21: 402–407.
59 Obeso JA, Marin C, Rodriguez-Oroz C et al. The basal ganglia
in Parkinson’s disease: current concepts and unexplained
observations. Ann Neurol 2008; 64: S30–S46.
60 Gonza lez-Burgos I, Feria-Velasco A. Serotonin/dopamine inter-
action in memory formation. Prog Brain Res 2008; 172: 603–623.
61 Lawrence AD, Goerendt IK, Brooks DJ. Apathy blunts neural
response to money in Parkinson’s disease. Soc Neurosci 2011;
6: 653–662.
62 Harris S, Sheth SA, Cohen MS. Functional neuroimaging of
belief, disbelief, and uncertainty. Ann Neurol 2008; 63:
141–147.
63 Sacks O, Hirsch J. A neurology of belief. Ann Neurol 2008; 63:
129–130.
64 Martinez-Horta S, Sampedro F, Pagonabarraga J et al. Non-
demented Parkinson’s disease patients with apathy show
decreased grey matter volume in key executive and reward-
related nodes. Brain Imaging Behav 2017; 11: 1334–1342.
65 Lucas-Jiménez O, Ojeda N, Peña J et al. Apathy and brain alter-
ations in Parkinson’s disease: a multimodal imaging study.
Annals of clinical and translational neurology. 2018; 5: 803–814.
https://doi.org/10.1002/acn3.578
66 Koçak OM, Ciçek M, Yag  murlu B, Atbasog  lu C. How is cogni-
tive control of a simple mental image achieved? An fMRI Study.
Int J Neurosci 2008; 118: 1781–1796.
67 Marcangione C, Rompré PP. Topographical Fos induction
within the ventral midbrain and projection sites following self-
stimulation of the posterior mesencephalon. Neuroscience
2008; 154: 1227–1241.
68 Everitt BJ, Robbins TW. From the ventral to the dorsal striatum:
devolving views of their roles in drug addiction. Neurosci Bio-
behav Rev 2013; 37: 1946–1954.
69 King-Casas B, Tomlin D, Anen C, Camerer CF, Quartz SR,
Montague PR. Getting to know you: reputation and trust in a
two-person economic exchange. Science 2005; 308: 78–83.
70 McNamara P. The Neuroscience of Religious Experience: Cam-
bridge: Cambridge University Press, 2009.
71 Kimhy D, Goetz R, Yale S, Corcoran C, Malaspina D. Delusions
in individuals with schizophrenia: factor structure, clinical corre-
lates, and putative neurobiology. Psychopathology 2005; 38:
338–344.
72 Liddle PF, Friston KJ, Frith CD, Hirsch SR, Jones T,
Frackowiak RSJ. Patterns of cerebral blood flow in schizophre-
nia. Br J Psychiatry 1992; 160: 179–186.
73 Weintraub D, Koester J, Potenza MN et al. Impulse control dis-
orders in Parkinson disease: a cross-sectional study of 3090
patients. Arch Neurol 2010; 67: 589–595.
74 Raja M, Bentivoglio AR. Impulsive and compulsive behaviors
during dopamine replacement treatment in Parkinson’s disease
and other disorders. Curr Drug Saf 2012; 7: 63–75.
75 Wu K, Politis M, Piccini P. Parkinson disease and impulse con-
trol disorders: a review of clinical features, pathophysiology
and management. Postgrad Med J 2009; 85: 590–596.
76 Kemp J, Després O, Sellal F, Dufour A. Theory of mind in nor-
mal ageing and neurodegenerative pathologies. Ageing Res
Rev 2012; 11: 199–219.
© 2022 Japanese Psychogeriatric Society.

77 Poletti M, Enrici I, Adenzato M. Cognitive and affective theory
of mind in neurodegenerative diseases: neuropsychological,
neuroanatomical and neurochemical levels. Neurosci Biobehav
Rev 2012; 36: 2147–2164.
78 Boyer P. Religious thought and behaviour as by-products of
brain function. Trends Cogn Sci 2003; 7: 119–124.
79 Fitzpatrick L, Simpson J, Smith A. A qualitative analysis of
mindfulness-based cognitive therapy (MBCT) in Parkinson’s
disease. Psychol Psychother 2010; 83: 179–192.
80 de Vito S, Gamboz N, Brandimonte MA, Barone P, Amboni M,
Della Sala S. Future thinking in Parkinson’s disease: an execu-
tive function? Neuropsychologia 2012; 50: 1494–1501.
81 Nombela C, Rittman T, Robbins TW, Rowe JB. Multiple modes of
impulsivity in Parkinson’s disease. PLoS One 2014; 9: e85747.
82 Ishihara L, Brayne C. What is the evidence for a premorbid par-
kinsonian personality: a systematic review. Mov Disord 2006;
21: 1066–1072.
83 Norberg C, Santamäki Fischer R, Isaksson U, Lämås K. Some-
thing wonderful and incomprehensible: expressions and experi-
ences of spirituality among very old people. J Study Spirituality
2019; 9: 125–137.
84 Bingham V., Habermann B.. The influence of spirituality on family
management of Parkinson’s disease. Journal of Neuroscience
Nursing. 2006;38(6):42–7. https://doi.org/10.1097/01376517-
200612000-00006
85 Paal S, Lorenzl S. Patients with Parkinson’s disease need spiri-
tual care. Annals of Palliative Medicine. 2019; 9: 144–148.
86 Swinton J, Pattison S. Moving beyond clarity: towards a thin,
vague, and useful understanding of spirituality in nursing care.
Nurs Philos 2010; 11: 226–237.
87 Karnik S, Kanekar A. Ethical issues surrounding end-of-life care:
a narrative review. Healthcare (Basel, Switzerland) 2016; 4: 24.
© 2022 Japanese Psychogeriatric Society.
14798301, 2022, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/psyg.12834 by UFPI - Universidade Federal do Piaui, Wiley Online Library on [11/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Spiritual care for Parkinson’s disease
88 Handzo G. Spiritual care for palliative patients. Curr Probl Can-
cer 2011; 35: 365–371.
89 Bursell J, Mayers CA. Spirituality within dementia care: percep-
tions of health professionals. Br J Occup Ther 2010; 73:
144–151.
90 Monod S, Brennan M, Rochat E, Martin E, Rochat S, Büla CJ.
Instruments measuring spirituality in clinical research: a sys-
tematic review. J Gen Intern Med 2011; 26: 1345–1357.
91 Pujol N, Leboul D, Prodhomme C, Guirimand F. Is spiritual care
the Hospital’s business? A qualitative study on Patients’ prefer-
ences about the integration of spirituality in palliative care units
(PCU). J Pain Symptom Manage 2018; 56: e47–e48.
92 Prizer LP, Kluger BM, Sillau S, Katz M, Galifianakis N,
Miyasaki JM. Correlates of spiritual wellbeing in persons living
with Parkinson disease. Ann Palliat Med 2020; 9: S16–s23.
93 Boersma I, Jones J, Carter J et al. Parkinson disease patients’
perspectives on palliative care needs: what are they telling us?
Neurol Clin Pract 2016; 6: 209–219.
94 Kluger BM, Shattuck J, Berk J et al. Defining palliative care
needs in Parkinson’s disease. Mov Disord Clin Pract 2019; 6:
125–131.
95 Lex KM, Larkin P, Osterbrink J, Lorenzl S. A Pilgrim’s journey-
when Parkinson’s disease comes to an end in nursing homes.
Front Neurol 2018; 9: 1068.
96 Liefbroer AI, Ganzevoort RR, Olsman E. Addressing the spiritual
domain in a plural society: what is the best mode of integrating
spiritual care into healthcare? Mental Health Relig Cult 2019;
22: 244–260.
97 Balboni TA, Fitchett G, Handzo GF et al. State of the science of
spirituality and palliative care research part II: screening,
assessment, and interventions. J Pain Symptom Manage 2017;
54: 441–453.
529