Effectiveness of Cognitive Rehabilitation in Parkinson’s Disease: A Systematic Review and Meta-Analysis

Sanchez-Luengos, Itsasne; Balboa-Bandeira, Yolanda; Lucas‐Jiménez, Olaia; Ojeda, Natalia; Peña, Javier; Ibarretxe‐Bilbao, Naroa

doi:10.3390/jpm11050429

Cited by 15 publications

(8 citation statements)

References 58 publications

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“…Second, previous studies have suggested that cognitive levels of jobs correlate with better processing speed and that processing speed is one of the most frequently improved domains by cognitive rehabilitation in PD. 46,47 Therefore, although the PASE questionnaire quantifies only the working hours per week but not the cognitive levels of each job, we speculate that work-related cognitive tasks may be behind the observed association between work-related activities and slower decline in processing speed. Finally, the observed association between household activities and slower decline in ADL might possibly suggest that becoming familiar with household chores is important for maintaining high ADL over time.…”

Section: Discussionmentioning

confidence: 91%

Long-term Effect of Regular Physical Activity and Exercise Habits in Patients With Early Parkinson Disease

2022

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Objective:Owing to the lack of long-term observations and/or comprehensive adjustment for confounding factors, reliable conclusions regarding long-term effects of exercise and regular physical activity in Parkinson’s disease (PD) have yet to be drawn. Here, using data from the Parkinson’s Progression Markers Initiative study that includes longitudinal and comprehensive evaluations of many clinical parameters, we examined the long-term effects of regular physical activity and exercise habits on the course of PD.Methods:In this observational cohort study, we primarily used the multivariate linear mixed-effects models to analyze the interaction effects of their regular physical activity and moderate-to-vigorous exercise levels, measured through the Physical Activity Scale for the Elderly questionnaire, on the progression of clinical parameters, after adjusting for age, sex, levodopa-equivalent dose, and disease duration. We also calculated bootstrapping 95% confidence intervals (CIs), and conducted sensitivity analyses using the multiple imputation method and subgroup analyses using the propensity score matching to match for all baseline background factors.Results:237 early PD patients [median (interquartile range); age, 63.0 (56.0–70.0) years; Male, 69.2%; follow-up duration, 5.0 (4.0–6.0) years] were included. Regular physical activity and moderate-to-vigorous exercise levels at the baseline did not significantly affect the subsequent clinical progression of PD. However, average regular overall physical activity levels over time were significantly associated with slower deterioration of postural and gait stability [standardized fixed-effects coefficients of the interaction term (βinteraction) = -0.10 (95% CI, -0.14 to -0.06)], activities of daily living [βinteraction = 0.08 (95% CI, 0.04 to 0.12)], and processing speed [βinteraction = 0.05 (95% CI, 0.03 to 0.08)] in PD patients. Moderate-to-vigorous exercise levels were preferentially associated with slower decline of postural and gait stability [βinteraction = -0.09 (95% CI, -0.13 to -0.05)] and work-related activity levels were primarily associated with slower deterioration of processing speed [βinteraction = 0.07 (95% CI, 0.04 to 0.09)]. Multiple imputation and propensity score matching confirmed the robustness of our results.Conclusions:In the long-term, the maintenance of high regular physical activity levels and exercise habits was robustly associated with better clinical course of PD, with each type of physical activity having different effects.Trial Registration Information:Clinicaltrials.gov (NCT01176565). A link to trial registry page is https://clinicaltrials.gov/ct2/show/NCT01141023.Classification of Evidence:This study provides Class II evidence that sustained increase in overall regular physical activity levels in patients with early Parkinson disease was associated with slower decline of several clinical parameters.

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Section: Discussionmentioning

confidence: 91%

Long-term Effect of Regular Physical Activity and Exercise Habits in Patients With Early Parkinson Disease

2022

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“…Importantly, the improvements were not maintained after six months. These recent studies show positive but modest results as measured by 'laboratory' neuropsychological tests, as opposed to the self-measure of executive functioning, evaluating daily functioning, used in the present study [50][51][52].…”

Section: Plos Onementioning

confidence: 43%

Goal management training and psychoeducation / mindfulness for treatment of executive dysfunction in Parkinson’s disease: A feasibility pilot trial

et al. 2022

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Introduction As there is currently no pharmacological treatment for Parkinson’s Disease Mild Cognitive Impairment (PD-MCI) with executive dysfunctions, specific cognitive interventions must be investigated. Most previous studies have tested bottom-up cognitive training programs but have not shown very good results. Objectives The aim of this study was to test ease of implementation, differential safety and preliminary efficacy of two top-down (strategy-learning) home-based, individualized, cognitive interventions: Goal Management Training (GMT), adapted for PD-MCI (Adapted-GMT), and a psychoeducation program combined with mindfulness exercises (PSYCH-Mind). Methods This was a single-blind block-randomized between-group comparative study. Twelve PD-MCI with mild executive dysfunctions were divided in four blocks and randomly assigned to any of the two interventions. The participants were included if they had PD-MCI diagnosis (no dementia), with stabilized medication. Both groups (Adapted-GMT and PSYCH-mind) received five intervention sessions each lasting 60–90 minutes for five weeks. Measures were collected at baseline, mid-point, one-week, four-week and 12-week follow-ups. Executive functions were assessed with the Dysexecutive questionnaire (DEX) and the Zoo Map Test (ZMT). Quality of life (QoL) and psychiatric symptoms were also evaluated. Repeated measures ANCOVAs (mixed linear analysis) were applied to all outcomes. Results There was one drop out, and both interventions were feasible and acceptable. Despite the small sample size limiting statistical power, patients of both groups significantly improved executive functions per the DEX-patient (Time: F(4,36) = 2.96, p = 0.033, CI95%: 10.75–15.23) and DEX-caregiver scores (Time: F(4,36) = 6.02, p = 0.017, CI95%: 9.63–17.23). Both groups significantly made fewer errors between measurement times on the ZMT (Time: F(3,36) = 16.66, p = 0.001, CI95%: 1.07–2.93). However, QoL significantly increased only in PSYCH-Mind patients at four-week follow-up (interaction Time*Group: F(4,36) = 5.31, p = 0.002, CI95%: 15.33–25.61). Conclusion Both interventions were easily implemented and proved to be safe. Because both interventions are arguably cost-effective, these pilot findings, although promising, need to be replicated in large samples. ClinicalTrials.gov Identifier NCT04636541.

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“…Considering that PD is a physically and psychologically debilitating disorder, health care professionals should adopt a holistic approach to PD rehabilitation [ 65 ]. Treatment objectives vary among individuals, highlighting the need for personalized intervention; so, a variety of non-pharmacological therapies should also be taken into account [ 66 ], such as, mindfulness yoga [ 65 ], psychological interventions [ 67 ], spiritual resilience [ 68 ], physical therapy [ 69 ], cognitive training [ 70 ], and speech therapies [ 71 ]. These therapies could be included in the clinical manage of PD patients.…”

Section: Discussionmentioning

confidence: 99%

Predictors of health-related quality of life in Parkinson’s disease: the impact of overlap between health-related quality of life and clinical measures

et al. 2022

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Purpose This study aimed to determine predictors of health-related quality of life (HRQoL) in Parkinson's disease (PD) and to explore their predictive value before and after controlling overlapping items between HRQoL and clinical variables. Methods One hundred and eight PD patients underwent motor, anxiety, depression, apathy, fatigue, and neurocognition assessment. HRQoL was assessed by the Parkinson’s Disease Questionnaire-39 (PDQ-39). In order to determine predictors of HRQoL in PD, stepwise multiple regression analyses were performed in two ways: before and after removing the emotional well-being dimension from PDQ-39 to control the overlap between depression and anxiety, and HRQoL. Results HRQoL total index was predicted by anxiety, fatigue, motor symptoms, and depression, explaining 26.9%, 7.2%, 2.8%, and 1.9% of the variance. However, after removing overlapping items, HRQoL total index was predicted by fatigue (16.5%), anxiety (6.1%), motor symptoms (3.9%), and neurocognition (2.5%), but not depression. Regarding HRQoL dimensions, mobility and activities of daily living were predicted by fatigue (19.7% and 5%) and UPDRS-III (4% and 10.2%); emotional well-being by fatigue (7.9%); social support by anxiety (12.2%) and UPDRS-III (8.6%); communication by neurocognition (5.3%) and UPDRS-III (3.4%); cognition by anxiety (10.6%) and bodily discomfort by anxiety (23%) and fatigue (4.1%). Conclusion These findings showed the importance of identifying and controlling overlapping items of HRQoL and clinical measures to perform an accurate interpretation. HRQoL dimensions showed different predictors before and after controlling the overlap. Based on these results fatigue, anxiety, motor symptoms, and neurocognition, but not depression are the main predictors of HRQoL in PD patients.

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Effectiveness of Cognitive Rehabilitation in Parkinson’s Disease: A Systematic Review and Meta-Analysis

Cited by 15 publications

References 58 publications

Long-term Effect of Regular Physical Activity and Exercise Habits in Patients With Early Parkinson Disease

Long-term Effect of Regular Physical Activity and Exercise Habits in Patients With Early Parkinson Disease

Goal management training and psychoeducation / mindfulness for treatment of executive dysfunction in Parkinson’s disease: A feasibility pilot trial

Predictors of health-related quality of life in Parkinson’s disease: the impact of overlap between health-related quality of life and clinical measures

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