Improving functional disability and cognition in Parkinson disease

Abstract

Objectives:To examine the efficacy of an integrative cognitive training program (REHACOP) to improve cognition, clinical symptoms, and functional disability of patients with Parkinson disease (PD).Methods:Forty-two patients diagnosed with PD in Hoehn & Yahr stages 1 to 3 were randomly assigned to either the cognitive training group (REHACOP) or the control group (occupational activities) for 3 months (3 sessions, 60 min/wk). Primary outcomes were change on processing speed, verbal memory, visual memory, executive functioning, and theory of mind. Secondary outcomes included changes on neuropsychiatric symptoms, depression, apathy, and functional disability. The trial was registered with clinicaltrials.gov (NCT02118480).Results:No baseline group differences were found. Bootstrapped analysis of variance results showed significant differences in the mean change scores between the REHACOP group and control group in processing speed (0.13 [SE = 0.07] vs −0.15 [SE = 0.09], p = 0.025), visual memory (0.10 [SE = 0.10] vs −0.24 [SE = 0.09], p = 0.011), theory of mind (1.00 [SE = 0.37] vs −0.27 [SE = 0.29], p = 0.013), and functional disability (−5.15 [SE = 1.35] vs 0.53 [SE = 1.49], p = 0.012).Conclusions:Patients with PD receiving cognitive training with REHACOP demonstrated statistically significant and clinically meaningful changes in processing speed, visual memory, theory of mind, and functional disability. Future studies should consider the long-term effect of this type of intervention. These findings support the integration of cognitive training into the standard of care for patients with PD.Classification of evidence:This study provides Class II evidence that for patients with PD, an integrative cognitive training program improves processing speed, visual memory, theory of mind, and functional disability.

Long‐term effects of cognitive rehabilitation on brain, functional outcome and cognition in Parkinson's disease

“…This study aimed to investigate the long‐term (18‐month) effects of an integrative cognitive rehabilitation programme in PD, assessing cognitive, behavioural and neuroimaging changes. Results showed that the improvements found from baseline to post‐treatment in cognition and functional disability , and the increased FC and activation , were still present after an 18‐month follow‐up.…”

“…Findings revealed increased cognitive performance in most cognitive domains in the long‐term compared with baseline, which supports the long‐term effects of cognitive rehabilitation. In the previous study, after attending a 3‐month cognitive rehabilitation programme, patients with PD improved in PS, VIM, ToM and tendency to change in VM . In the present study, patients with PD showed maintenance of these cognitive improvements in the long term.…”

“…Patients with PD underwent the same neuropsychological battery at T 0 , T 1 and T 2 as previously described , which included the assessment of five cognitive domains: (i) processing speed (PS), including the Trail Making Test–A and Salthouse Letter Comparison Test; (ii) verbal memory (VM), using the Hopkins Verbal Learning Test (learning and recall) (version 3); (iii) visual memory (VIM), using the Brief Visual Memory Test (learning and recall) (version 5); (iv) executive functions (EFs), using the Stroop test (word‐colour and interference scores); and (v) theory of mind (ToM), using the Happé test. The following behavioural aspects were also evaluated: (i) apathy, using the Lille Apathy Rating Scale; (ii) depression, using the Geriatric Depression Scale; and (iii) functional disability, using the World Health Organization Disability Assessment Schedule II.…”

“…Previous PD studies have also shown functional brain changes after cognitive rehabilitation in the short term . Recently, in a previous study from our group, patients with PD, after attending a 3‐month cognitive rehabilitation programme, demonstrated improvements in cognition and functional disability , which were accompanied by increased brain functional connectivity (FC) and activation .…”

Combining social cognitive treatment, cognitive remediation, and functional skills training in schizophrenia: a randomized controlled trial

“…10 In fact, a similar finding was also previously reported using the same method in patients suffering from Parkinson’s disease with ToM deficits. 20 These generally positive results suggest that this domain is likely to be improved through cognitive interventions.…”