Action Observation With Dual Task for Improving Cognitive Abilities in Parkinson’s Disease: A Pilot Study

Abstract

Action observation therapy (AOT) has been recently proposed as a new rehabilitation approach for treatment of motor deficits in Parkinson’s disease. To date, this approach has never been used to deal with cognitive deficits (e.g., deficits in working memory, attention), which are impairments that are increasingly recognized in Parkinsonian patients. Typically, patients affected by these dysfunctions have difficulty filtering out irrelevant information and tend to lose track of the task goal. In this paper, we propose that AOT may also be used to improve cognitive abilities of Parkinsonian patients if it is used within a dual task framework. We articulate our hypothesis by pivoting on recent findings and on preliminary results that were obtained through a pilot study that was designed to test the efficacy of a long-term rehabilitation program that, for the first time, uses AOT within a dual task framework for treating cognitive deficits in patients with Parkinson’s disease. Ten Parkinson’s disease patients underwent a 45-min treatment that consisted in watching a video of an actor performing a daily-life activity and then executing it while performing distractive tasks (AOT with dual task). The treatment was repeated three times per week for a total of 4 weeks. Patients’ cognitive/motor features were evaluated through standard tests four times: 1 month before treatment, the first and the last day of treatment and 1 month after treatment. The results show that this approach may provide relevant improvements in cognitive aspects related to working memory (verbal and visuospatial memory) and attention. We discuss these results by pivoting on literature on action observation and recent literature demonstrating that the dual task method can be used to stimulate cognition and concentration. In particular, we propose that using AOT together with a dual task may train the brain systems supporting executive functions through two mechanisms: (i) stimulation of goal setting within the mirror neuron system through action observation and (ii) working memory and persistent goal maintenance through dual task stimuli.

Functional and Cognitive Improvement After an Intensive Inpatient Multidisciplinary Rehabilitation Program in Mild to Severe Parkinson's Disease: A Retrospective and Observational Study

“…Interestingly, action observation therapy has been demonstrated effective in improving cognitive abilities of PwPD if it is used within a dual task framework ( 21 ).…”

Effects of Exergaming on Attentional Deficits and Dual-Tasking in Parkinson's Disease

“…As there is a limited effect of pharmacological therapy or deep brain stimulation on dual-tasking (9), other strategies are sought to positively influence these deficits. Previous studies showed that both, attentional cognitive performance and dual-tasking are responsive to training interventions and have a reciprocal impact on each other (10–12).…”

Action observation combined with gait training to improve gait and cognition in elderly with mild cognitive impairment A randomized controlled trial

“…27 AO is recognized as one of the cognitive training approaches 9,12 that can activate the MNS which is partially damaged in MCI. 6 A recent study of Caligiore et al 15 found improved cognitive domains (working memory and attention) after AO combined with dual-task training for 4 weeks in Parkinson's disease. They proposed an explanation of cognitive improvement through the mechanism of stimulating goal-setting within the MNS by AO and the mechanisms of working memory and goal maintaining by dual-task training.…”

“…However, cognitive ability can be gained more through observing complicated tasks or using cues in patients with Parkinson's disease. 15,19 Given the points outlined, AO might be more suitable for use in the elderly with MCI. Therefore, the study aimed to investigate the effect of AO combined with gait training on gait and cognition in elderly with MCI.…”