Functional and Cognitive Improvement After an Intensive Inpatient Multidisciplinary Rehabilitation Program in Mild to Severe Parkinson's Disease: A Retrospective and Observational Study.

Mario Meloni,Francesca Lea Saibene,Monica Di Cesare,Francesca Baglio,Francesca Borgnis,Sonia Di Tella,Raffaello Nemni

doi:10.3389/fneur.2021.626041

Abstract

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor (resting tremor, rigidity, bradykinesia, postural instability, and gait disturbances) and nonmotor symptoms (cognitive, neuropsychiatric, and autonomic problems). In recent years, several studies demonstrated that neurorehabilitation therapy is an effective treatment in addition to pharmacological personalized interventions in persons with PD (PwPD). The main aim of this study was to explore the short-term changes in functional, cognitive, and geriatric domains after a multidimensional rehabilitation program in PwPD (as primary condition) in mild–moderate (M-Ms) to severe (Ss) stages. Our second aim was to compare the effects of multidimensional rehabilitation in M-Ms versus Ss of PD. Twenty-four PwPD in M-Ms to Ss [age (mean ± SD) = 76.25 ± 9.42 years; male/female = 10/14; Hoehn and Yahr (median; IQR) = 4.00; 1.75] were included in a retrospective, observational study. Motor, cognitive, functional, and neuropsychiatric aspects were collected in admission (T0) and in discharge (T1). PwPD were involved in a person-tailored (to individual's needs), inpatient, intensive (5–7 days per week), multidisciplinary (combining cognitive, physical, occupational, and speech therapies), comprehensive, and rehabilitative program. According to Movement Disorders Society Unified Parkinson's Disease Rating Scale III cutoff, PwPD were classified in M-Ms or Ss (M-Ms ≤59; Ss >59); 87.50% of our sample reported significant reduction of functional disability at Barthel Index (p < 0.001). A significant improvement in Token test (p = 0.021), semantic fluency (p = 0.036), Rey's Figure-Copy (p < 0.001), and Raven's Colored Progressive Matrices (p = 0.004) was observed. The pain intensity perception (p < 0.001) and the risk of developing pressure ulcers (p < 0.001) as assessed, respectively, by the Numeric Rating Scale and by the Norton Scale were improved. With regard to the second aim, in M-Ms group, we found a positive correlation between the number of neuromotor sessions and the change in functional disability and language comprehension; in the Ss group, on the other hand, despite a higher number of hospitalization days, the total number of completed sessions was positively associated with the change in visuoconstructional abilities. Our findings suggest that an intensive, inpatient, and multidisciplinary rehabilitation program may improve functional abilities, some strategic cognitive functions, and geriatric aspects in PwPD with mild–moderate motor impairment.

Highlights

Parkinson’s disease (PD) is considered a multiple system neurodegenerative disorder with early prominent death of dopaminergic neurons in the substantia nigra pars compacta.At time of diagnosis, the clinical hallmarks of the disease are represented by “the motor triad”: bradykinesia, rigidity, and resting tremor
The number of rehabilitative sessions, hospitalization days, and Mini-Mental State Examination (MMSE) at the baseline were used as covariates in order to explore the impact of potential confounding variables
A χ 2 test was calculated to compare proportions between patients that remained stable after the intervention with them who reported an increase in the functional assessment evaluated by the Barthel Index (BI)

Summary

Introduction

The clinical hallmarks of the disease are represented by “the motor triad”: bradykinesia, rigidity, and resting tremor. Psychiatric symptoms may be detected in de novo drug-naive patients, and they are not represented differently in the three main motor subtypes (akinetic-rigid, tremor-dominant, and mixed) [2]. Several drugs and surgical approaches are available for treating motor symptoms such as levodopa, dopamine agonists, monoamine oxidase B (MAO-B)/catechol-O-methyltransferase inhibitors, apomorphine infusion, levodopa–carbidopa intestinal gel infusion, and deep brain stimulation (DBS) [3]. The appearance over time of motor and non-motor complications induced by dopaminergic drugs (dyskinesias, motor fluctuations, dopamine dysregulation syndrome, impulse control disorders) results in detrimental impact on patients’ clinical conditions and their QoL, emphasizing the need for non-pharmacological therapies [4]

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