Focused and Sustained Attention Is Modified by a Goal-Based Rehabilitation in Parkinsonian Patients

Abstract

Rehabilitation for patients with Parkinson’s disease (PD) is based on cognitive strategies that exploit attention. Parkinsonians exhibit impairments in divided attention and interference control. Nevertheless, the effectiveness of specific rehabilitation treatments based on attention suggests that other attentional functions are preserved. Data about attention are conflicting in PD, and it is not clear whether rehabilitative treatments that entail attentional strategies affect attention itself. Reaction times (RTs) represent an instrument to explore attention and investigate whether changes in attentional performances parallel rehabilitation induced-gains. RTs of 103 parkinsonian patients in “on” state, without cognitive deficits, were compared with those of a population of 34 healthy controls. We studied those attentional networks that subtend the use of cognitive strategies in motor rehabilitation: alertness and focused and sustained attention, which is a component of the executive system. We used visual and auditory RTs to evaluate alertness and multiple choices RTs (MC RTs) to explore focused and sustained attention. Parkinsonian patients underwent these tasks before and after a 4-week multidisciplinary, intensive and goal-based rehabilitation treatment (MIRT). Unified Parkinson’s Disease Rating Scale (UPDRS) III and Timed Up and Go test (TUG) were assessed at the enrollment and at the end of MIRT to evaluate the motor-functional effectiveness of treatment. We did not find differences in RTs between parkinsonian patients and controls. Further, we found that improvements in motor-functional outcome measures after MIRT (p < 0.0001) paralleled a reduction in MC RTs (p = 0.014). No changes were found for visual and auditory RTs. Correlation analysis revealed no association between changes in MC RTs and improvements in UPDRS-III and TUG. These findings indicate that alertness, as well as focused and sustained attention, are preserved in “on” state. This explains why Parkinsonians benefit from a goal-based rehabilitation that entails the use of attention. The reduction in MC RTs suggests a positive effect of MIRT on the executive component of attention and indicates that this type of rehabilitation provides benefits by exploiting executive functions. This ensues from different training approaches aimed at bypassing the dysfunctional basal ganglia circuit, allowing the voluntary execution of the defective movements. These data suggest that the effectiveness of a motor rehabilitation tailored for PD lies on cognitive engagement.

Efficacy of intensive multidisciplinary rehabilitation in Parkinson’s disease: a randomised controlled study

“…Consistent with this evidence, we have have demonstrated that an intensive and aerobic rehabilitation treatment such as MIRT promotes a beneficial effect on the executive component of attention in patients with PD. 42 …”

Asymmetric Dopaminergic Degeneration and Attentional Resources in Parkinson’s Disease

“…Cognition is improved by specific motor trainings (David et al, 2015; Ferrazzoli et al, 2017), and it has been showed how the improvement in cognitive functioning may be considered as an index of neuroplasticity (Hötting and Röder, 2013).…”

Effectiveness of Rotigotine plus intensive and goal-based rehabilitation versus Rotigotine alone in “de-novo” Parkinsonian subjects: a randomized controlled trial with 18-month follow-up

“…The main feature of the disease is the impaired ability to learn and express habitual-automatic actions [ 43 – 45 ]: since DRT does not improve the expression of habitual-automatic actions in Parkinsonian subjects, the main goal of rehabilitation should be properly the re-learning of the lost habitual motor behaviours. In fact, even though their habitual scheduling is altered [ 43 ], the parkinsonian subjects can still express habitual skills by using the executive-volitional component of action [ 28 , 46 – 49 ]. For this reason, in the field of PD rehabilitation, external stimuli and specific techniques and strategies [ 28 , 34 – 36 , 50 ] have been properly developed in order to perform motor actions in a volitional and goal-directed manner [ 13 , 14 , 28 , 49 ].…”

“…Nevertheless, the improvements in motor performances after MIRT cannot be explained only by these “activity-dependent” processes. The goal-directed approach of this kind of multidisciplinary and intensive rehabilitation is another fundamental requirement for achieve motor-functional improvements [ 49 ]. The physical techniques, the devices and the cognitive strategies adopted in this rehabilitative protocol, exploit the functions of the frontal cortical regions (specifically the pre-frontal cortex) and allow: (i) to bypass the dysfunctional basal ganglia, (ii) to stimulate the re-learning of the lost automatic movements, (iii) to reinforce the cortical mechanisms involved in the execution of the commands to move and, finally, (iv) to improve the patients’ mobility, balance, gait and posture [ 46 , 49 , 50 , 56 , 57 ].…”