Abstract
The principal feature of Parkinson’s disease (PD) is the impaired ability to acquire and express habitual-automatic actions due to the loss of dopamine in the dorsolateral striatum, the region of the basal ganglia associated with the control of habitual behavior. Dopamine replacement therapy (DRT) compensates for the lack of dopamine, representing the standard treatment for different motor symptoms of PD (such as rigidity, bradykinesia and resting tremor). On the other hand, rehabilitation treatments, exploiting the use of cognitive strategies, feedbacks and external cues, permit to “learn to bypass” the defective basal ganglia (using the dorsolateral area of the prefrontal cortex) allowing the patients to perform correct movements under executive-volitional control. Therefore, DRT and rehabilitation seem to be two complementary and synergistic approaches. Learning and reward are central in rehabilitation: both of these mechanisms are the basis for the success of any rehabilitative treatment. Anyway, it is known that “learning resources” and reward could be negatively influenced from dopaminergic drugs. Furthermore, DRT causes different well-known complications: among these, dyskinesias, motor fluctuations, and dopamine dysregulation syndrome (DDS) are intimately linked with the alteration in the learning and reward mechanisms and could impact seriously on the rehabilitative outcomes. These considerations highlight the need for careful titration of DRT to produce the desired improvement in motor symptoms while minimizing the associated detrimental effects. This is important in order to maximize the motor re-learning based on repetition, reward and practice during rehabilitation. In this scenario, we review the knowledge concerning the interactions between DRT, learning and reward, examine the most impactful DRT side effects and provide suggestions for optimizing rehabilitation in PD.
Highlights
Parkinson’s disease (PD) is a progressive neurodegenerative disorder clinically dominated by bradykinesia, rigidity and resting tremor
The great value of rehabilitation is the possibility to treat many disabling PD disturbances that do not respond to Dopamine replacement therapy (DRT) as they result from the involvement of systems outside the dopaminergic structures
Rehabilitation exploiting the use of cognitive strategies, feedbacks and external cues, permits to bypass the defective basal ganglia using the dorsolateral area of the prefrontal cortex and allowing the execution of correct movements under executive-volitional control (Morris, 2006; Morris et al, 2009)
Summary
Parkinson’s disease (PD) is a progressive neurodegenerative disorder clinically dominated by bradykinesia, rigidity and resting tremor. Motor learning in PD is negatively affected throughout the automatization phase (Doyon et al, 2009; Nieuwboer et al, 2009) Given that, the main purpose of rehabilitation in PD should be the re-acquisition of the lost automatic movements through executive-volitional control that is the ability to initiate habits using goal-directed triggers On these bases, Morris et al (2010) showed that external cues, such as lines on the floor, visualizing the walk with long steps, imagining the movement pattern before the action is performed, breaking down long or complex motor sequences into parts, enabled people with PD to walk with longer steps and at a more normal stepping rate, reducing move and balance difficulty (Morris et al, 1994, 1996, 2009; Morris, 2006). We will explore the impact of DRT on learning and reward
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