Abstract
Background While the efficacy of cognitive stimulation (CS) has been demonstrated in patients with dementia, no study has included patients with Parkinson's disease dementia (PDD). Objective For the first time, this randomized crossover pilot study examined the feasibility and potential effects of CS in PDD. Methods All residents of a PDD-specific long-term care unit in the Netherlands that were eligible for the study (n=12) were randomly allocated to group A (n=6) receiving CS (eight weeks, twice weekly for 60 minutes) or group B (n=6) receiving usual care (control group, CG). The CG participated in CS afterwards, resulting in an experimental group (EG), consisting of n=12. Pre- and postassessments and a six-week follow-up (FU) were conducted for cognition, neuropsychiatric symptoms, quality of life (QoL), and activities of daily living (ADL) outcomes. Results Between-group analysis with difference scores from pre- to posttest revealed a group difference for global cognition (CERAD total score) favoring the EG, with a moderate effect size and a p value just failing to reach statistical significance (p=0.067; r = 0.43). A further statistical trend was observed for neuropsychiatric symptoms, again with a moderate effect size (p=0.075; r = 0.42). Within-group analyses indicated improvement only in the EG with large effects also just failing to reach significance for global cognition (short term, p=0.060; r = 0.70) as well as for depression (long term, p=0.072; r = 0.61). ADL deteriorated significantly at FU in the EG (p=0.014; r = 0.71). Conclusions Although our data are preliminary due to the small sample size, this study shows that CS is feasible and potentially effective for cognitive and noncognitive outcomes in PDD patients. Randomized controlled trials with larger sample sizes are needed to confirm these promising results.
Highlights
Parkinson’s disease dementia (PDD) is highly prevalent [1] and impacts patients, caregivers, and the health-care system [2]
We hypothesized that cognitive stimulation (CS) is feasible in this context and that the PDD patients participating in a CS program would show benefits in cognition, neuropsychiatric symptoms, and quality of life (QoL)
At the beginning of the study, 21 PD patients lived in the unit. e aim was to include as many patients as possible from the care unit. erefore, the inclusion criteria were defined rather broadly as (i) being a resident in the PD care unit, (ii) idiopathic PD diagnosed by a neurologist or psychiatrist, (iii) cognitive dysfunction operationalized by the Mini-Mental State Examination (MMSE; 10 to 25 points) [15], (iv) Dutch as the native language or very good Dutch language skills, (v) only slightly restricted or corrected-to-normal vision and hearing, and (vi) the provision of written consent from a legal representative to participate in the study
Summary
Parkinson’s disease dementia (PDD) is highly prevalent [1] and impacts patients, caregivers, and the health-care system [2]. Us, we conducted a pilot randomized crossover trial of CS in PDD patients to examine the feasibility and potential effects. We hypothesized that CS is feasible in this context and that the PDD patients participating in a CS program would show benefits in cognition, neuropsychiatric symptoms, and QoL. This randomized crossover pilot study examined the feasibility and potential effects of CS in PDD. Pre- and postassessments and a six-week follow-up (FU) were conducted for cognition, neuropsychiatric symptoms, quality of life (QoL), and activities of daily living (ADL) outcomes. Our data are preliminary due to the small sample size, this study shows that CS is feasible and potentially effective for cognitive and noncognitive outcomes in PDD patients. Randomized controlled trials with larger sample sizes are needed to confirm these promising results
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