Enriched Rehabilitation Improves Gait Disorder and Cognitive Function in Parkinson's Disease: A Randomized Clinical Trial.

Xin Wang,Yao Xu,Junya Wang,Yuan Peng,Ping Yan,Wenrui Yang,Hongying Zhang,Yichen Lv,Hongyu Zhou,Xiaojia Tang,Lanlan Chen

doi:10.3389/fnins.2021.733311

Abstract

Background: Studies on non-pharmacological strategies for improving gait performance and cognition in Parkinson’s disease (PD) are of great significance. We aimed to investigate the effect of and mechanism underlying enriched rehabilitation as a potentially effective strategy for improving gait performance and cognition in early-stage PD.Methods: Forty participants with early-stage PD were randomly assigned to receive 12 weeks (2 h/day, 6 days/week) of enriched rehabilitation (ER; n = 20; mean age, 66.14 ± 4.15 years; 45% men) or conventional rehabilitation (CR; n = 20; mean age 65.32 ± 4.23 years; 50% men). In addition, 20 age-matched healthy volunteers were enrolled as a control (HC) group. We assessed the general motor function using the Unified PD Rating Scale—Part III (UPDRS-III) and gait performance during single-task (ST) and dual-task (DT) conditions pre- and post-intervention. Cognitive function assessments included the Montreal Cognitive Assessment (MoCA), the Symbol Digit Modalities Test (SDMT), and the Trail Making Test (TMT), which were conducted pre- and post-intervention. We also investigated alteration in positive resting-state functional connectivity (RSFC) of the left dorsolateral prefrontal cortex (DLPFC) in participants with PD, mediated by ER, using functional magnetic resonance imaging (fMRI).Results: Compared with the HC group, PD participants in both ER and CR groups performed consistently poorer on cognitive and motor assessments. Significant improvements were observed in general motor function as assessed by the UPDRS-III in both ER and CR groups post-intervention. However, only the ER group showed improvements in gait parameters under ST and DT conditions post-intervention. Moreover, ER had a significant effect on cognition, which was reflected in increased MoCA, SDMT, and TMT scores post-intervention. MoCA, SDMT, and TMT scores were significantly different between ER and CR groups post-intervention. The RSFC analysis showed strengthened positive functional connectivity between the left DLPFC and other brain areas including the left insula and left inferior frontal gyrus (LIFG) post-ER.Conclusion: Our findings indicated that ER could serve as a potentially effective therapy for early-stage PD for improving gait performance and cognitive function. The underlying mechanism based on fMRI involved strengthened RSFC between the left DLPFC and other brain areas (e.g., the left insula and LIFG).

Highlights

Parkinson’s disease (PD) is the second most common neurodegenerative disorder in older adults, which is typically characterized by motor and non-motor impairments that lead to increasingly serious physical disability (Homayoun, 2018; Armstrong and Okun, 2020)
There were no significant differences in baseline characteristics between the healthy control (HC) group and the PD groups, including age, sex, and length of lower limbs (Table 1, p > 0.05)
Gait Parameters in the Single-Task and Dual-Task Conditions As shown in Table 2, there were no significant differences in gait speed or stride length between the PD groups and the HC group pre-intervention under the ST condition (p > 0.05), whereas coefficients of variation (CV) of gait speed and stride length were significantly different (p < 0.05)

Summary

Introduction

Parkinson’s disease (PD) is the second most common neurodegenerative disorder in older adults, which is typically characterized by motor and non-motor impairments that lead to increasingly serious physical disability (Homayoun, 2018; Armstrong and Okun, 2020). Clinical evidence has shown that gait deficits in PD patients are more obvious during dual-task (DT) conditions, which are more cognitively demanding owing to the simultaneous performance of cognitive and motor tasks, than during single-task (ST) conditions (Salazar et al, 2017). Despite emerging clinical targets for enhancing motor and cognitive functions simultaneously, pharmacological strategies, such as dopamine replacement therapy, usually only resolve motor symptoms while barely improving cognitive function (Armstrong and Okun, 2020). Studies on non-pharmacological strategies for improving gait performance and cognition in Parkinson’s disease (PD) are of great significance.

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