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.
Highlights
In Parkinson’s disease (PD) the loss of the physiological dopaminergic modulation transforms the basal ganglia into a disruptive filter (Beeler et al, 2013) that impairs the ability to express habitual-automatic actions (Redgrave et al, 2010)
While it is known that functions such as the divided attention and the interference control might be impaired in PD (Sharpe, 1996; Wylie et al, 2009), the existing evidences about the effectiveness of rehabilitation approaches based on explicit learning strategies (Nieuwboer et al, 2009; Morris et al, 2010) suggest that other attentional functions are preserved or, at least, exploitable in PD patients
The integrity of these attentional functions could partially explain why PD patients benefit from a goal-based and intensive rehabilitation treatment, such as multidisciplinary intensive rehabilitation treatment (MIRT), which entails the use of attentional, explicit learning strategies
Summary
In Parkinson’s disease (PD) the loss of the physiological dopaminergic modulation transforms the basal ganglia into a disruptive filter (Beeler et al, 2013) that impairs the ability to express habitual-automatic actions (Redgrave et al, 2010). Even if implicit learning is defective in parkinsonian subjects, motor learning is feasible in PD (Nieuwboer et al, 2009) In this regard, it has been demonstrated that specific rehabilitation techniques provide benefits by using explicit cognitive strategies (Nieuwboer et al, 2009). It has been demonstrated that specific rehabilitation techniques provide benefits by using explicit cognitive strategies (Nieuwboer et al, 2009) These are bottom-up strategies, which use external cues, and/or top-down strategies, which exploit feedbacks or verbal instructions. While it is known that functions such as the divided attention and the interference control might be impaired in PD (Sharpe, 1996; Wylie et al, 2009), the existing evidences about the effectiveness of rehabilitation approaches based on explicit learning strategies (Nieuwboer et al, 2009; Morris et al, 2010) suggest that other attentional functions are preserved or, at least, exploitable in PD patients
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