Abstract
ABSTRACT.Pharmacological treatments for mild cognitive impairment (MCI), are lacking, and alternative approaches have been implemented, including cognitive training (CT).Objective:To determine the impact of CT on cognitive and quality of life measures in patients with Parkinson’s disease (PD) who were seen a hospital neurorehabilitation program.Methods:Thirty-nine individuals with MCI-PD, according to the Movement Disorder Society, were randomly distributed into two groups: experimental and control group, matched for demographic and clinical characteristics. Both groups were assessed for cognition and quality of life at the beginning of the study and at the end of the intervention protocol. The following instruments were used to assess cognition and quality of life: Addenbrooke’s Cognitive Examination III, Digit Span, Trail Making Test (TMT, A and B) and Parkinson disease quality of life questionnaire. The experimental group (EG) engaged in CT, whereas the control group (CG) underwent activities of the general rehabilitation program.Results:No baseline evaluation differences were found. Intergroup analysis showed differences in measures, such as total score (1.977, p=0.0480) and visuospatial domain (-2.636, p=0.0084) of the ACE-III, with the EG performing better, in addition to better performance in TMT-B mistakes (-1.928, p=0.0439). Intragroup analysis revealed that the EG showed significant improvement in almost all the cognitive variables, well as in self-reported quality of life (total score and mobility, activities of daily living, body discomfort dimensions).Conclusions:Engagement in cognitive activities was associated with better cognitive abilities in PD-MCI. Future studies should consider the long-term effect of this type of intervention and impact on functional activities.
Highlights
The original description by James Parkinson mentioned a condition characterized by motor features, which included bradykinesia, tremor and gait impairment, but he described other symptoms, without the same accuracy, such as bowel dysfunction, somnolence, delirium and constipation, which constitute the spectrum of nonmotor symptoms (NMS) associated with Parkinson’s disease (PD).[1,2]
Routine cognitive screening is important for the optimal management of patients with PD, to assess cognition functions, and to define the diagnosis of Mild cognitive impairment (MCI) or Parkinson’s disease dementia (PDD)
We evaluated the therapeutic effects of non-pharmacological interventions (CT) on cognitive symptoms in PD, including control group (CG) and randomization
Summary
The original description by James Parkinson mentioned a condition characterized by motor features, which included bradykinesia, tremor and gait impairment, but he described other symptoms, without the same accuracy, such as bowel dysfunction, somnolence, delirium and constipation, which constitute the spectrum of nonmotor symptoms (NMS) associated with Parkinson’s disease (PD).[1,2] Such symptoms were neglected for many years but in many cases, especially in more advanced stages, may dominate the clinical picture and impair functional performance and quality of life. The DSM 5 recognized the clinical entity of minor neurocognitive disorder (NCD) for different disorders including PD.[4] In contrast to amnestic MCI as a prodrome to Alzheimer’s disease (AD), the Parkinson’s disease-mild cognitive impairment (PD-MCI) is more heterogeneous and may affect diverse cognitive domains This heterogeneous clinical presentation is related to a great variety of available tests to assess cognitive functions in PD patients. There was an increase in publications on this topic in PD but in healthy elderly people and those with other neurological conditions.[16] Neuroimaging studies have shown changes in activation in brain regions,[17,18,19] and a systematic review study showed that there was an improvement in global cognition and ability for planning.[20] The studies used different assessment and intervention protocols (format of interventions and assessment instruments, sample size, follow-up time and therapeutic dose), which can interfere in the comparative and homogeneous analysis of the results. Our main objective was to determine the effectiveness of a 4-week, randomized and controlled CT program in improving cognition performance and quality of life of individuals with PD
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