Enhancement of Executive Functions but Not Memory by Multidomain Group Cognitive Training in Patients with Parkinson's Disease and Mild Cognitive Impairment: A Multicenter Randomized Controlled Trial.
Elke Kalbe, Ann-Kristin Folkerts, Anja Ophey, Carsten Eggers, Saskia Elben, Karina Dimenshteyn, Patricia Sulzer, Claudia Schulte, Nele Schmidt, Christian Schlenstedt, Daniela Berg, Karsten Witt, Lars Wojtecki, Inga Liepelt-Scarfone
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引用次数: 10
Abstract
Background: Meta-analyses have demonstrated cognitive training (CT) benefits in Parkinson's disease (PD) patients. However, the patients' cognitive status has only rarely been based on established criteria. Also, prediction analyses of CT success have only sparsely been conducted.
Objective: To determine CT effects in PD patients with mild cognitive impairment (PD-MCI) on cognitive and noncognitive outcomes compared to an active control group (CG) and to analyze CT success predictors.
Methods: Sixty-four PD-MCI patients (age: 67.61 ± 7.70; UPDRS-III: 26.58 ± 13.54; MoCA: 24.47 ± 2.78) were randomized to either a CT group or a low-intensity physical activity CG for six weeks (twice weekly, 90 minutes). Outcomes were assessed before and after training. MANOVAs with follow-up ANOVAs and multiple regression analyses were computed.
Results: Both interventions were highly feasible (participation, motivation, and evaluation); the overall dropout rate was 4.7%. Time × group interaction effects favoring CT were observed for phonemic fluency as a specific executive test (p=0.018, ηp2=0.092) and a statistical trend for overall executive functions (p=0.095, ηp2=0.132). A statistical trend for a time × group interaction effect favoring CG was shown for the digit span backward as a working memory test (p=0.098, ηp2=0.043). Regression analyses revealed cognitive baseline levels, education, levodopa equivalent daily dose, motor scores, and ApoE status as significant predictors for CT success.
Conclusions: CT is a safe and feasible therapy option in PD-MCI, yielding executive functions improvement. Data indicate that vulnerable individuals may show the largest cognitive gains. Longitudinal studies are required to determine whether CT may also attenuate cognitive decline in the long term. This trial is registered with DRKS00010186.
背景:荟萃分析表明认知训练(CT)对帕金森病(PD)患者有益。然而，很少有患者的认知状态是基于既定的标准。此外，对CT成功的预测分析也很少进行。目的:探讨PD合并轻度认知障碍(PD- mci)患者的CT对认知和非认知预后的影响，并分析CT成功的预测因素。方法:64例PD-MCI患者(年龄:67.61±7.70;Updrs-iii: 26.58±13.54;MoCA: 24.47±2.78)随机分为CT组和低强度体力活动CG组，为期6周(每周2次，90分钟)。在训练前后对结果进行评估。计算方差分析、随访方差分析和多元回归分析。结果:两种干预措施(参与、动机和评估)都是高度可行的;总体辍学率为4.7%。在特定的执行测试中，观察到有利于CT的时间×组交互效应(p=0.018， η p 2=0.092)和整体执行功能的统计趋势(p=0.095， η p 2=0.132)。在工作记忆测试中，数字广度反向呈现时间×组交互效应(p=0.098， η p 2=0.043)。回归分析显示，认知基线水平、教育程度、左旋多巴当量日剂量、运动评分和ApoE状态是CT成功的重要预测因素。结论:CT是一种安全可行的PD-MCI治疗方法，可改善执行功能。数据表明，脆弱的个体可能表现出最大的认知收益。需要进行纵向研究来确定CT是否也可能在长期内减轻认知能力下降。该试验注册号为DRKS00010186。
期刊介绍：
Parkinson’s Disease is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies related to the epidemiology, etiology, pathogenesis, genetics, cellular, molecular and neurophysiology, as well as the diagnosis and treatment of Parkinson’s disease.
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