Physical Therapy and Cognitive Decline
Condition: Parkinson Disease; Cognitive Impairment
MeSH terms: Parkinson Disease; Cognitive Dysfunction
Study type: Interventional

Summary: 
      Background: Mild Cognitive Impairment in Parkinson's disease (PD-MCI) is considered a
      predictor for the development of dementia, a major source of eventual treatment-refractory
      disability. Physical activity, which has proved effective in improving motor symptom, has
      also been proposed as a possible non-pharmacological intervention for preventing/delaying the
      onset of cognitive impairment in Parkinson's disease (PD).

      Objectives: This study evaluates the effect of a 4-week rehabilitation therapy on cognitive
      functions in mid-stage PD-MCI patients.

      Methods: 40 PD-MCI patients were randomized to receive physical therapy (PT) or no physical
      therapy (CT) according to a controlled single-blind design. Subjects in the PT group (n. 17)
      attended a rehabilitation program with 6 sessions/week, each lasting 60 minutes, for 4 weeks
      in addition to their usual pharmacological therapy; subjects in CT group (n. 22) received
      only pharmacological therapy. Cognitive and motor functions were assessed at baseline (T0)
      and at the end of the intervention period (T1) in both groups.
    

Detailed description: 
      Non-pharmacological intervention may represent adjunctive therapy to medications in order to
      delay the onset of the cognitive deficits or dementia.

      Previous studies observed a positive effect of cognitive training on cognition both in
      healthy elderly people and patients in the early stage of neurodegenerative diseases such as
      PD-MCI.

      Several exercise interventions have proved to be effective on cognition in PD: tango, aerobic
      exercises and resistance exercise training. Physical activity may reduce dementia risk has
      not been established and issues regarding type, frequency and duration of exercises, as well
      as the best timing in which operate (disease stage and level of cognitive deterioration)
      remain unresolved.

      Given the well-established irreversibility of cognitive impairment in neurodegenerative
      disorders, the scientific attention has shifted more and more on the identification of early
      interventions that, applied before the onset of deficits, may delay their full development.
      In this frame, the aim of the present study was to assess the effect of 4-week intensive
      physical training (6 session/week, 60 minutes/day) on both motor and cognitive impairments in
      patients with mid-stage PD-MCI.

      Patients with idiopathic PD and MCI were recruited from the Neurorehabilitation Unit and
      Parkinson and Movement Disorders Unit of IRCCS Mondino Foundation.

      All patients were treated with dopamine agonists or L-DOPA and had been on a stable therapy
      schedule for at least 3 months. No variations were allowed during the training and follow-up
      period. All groups were sex and age-matched.

      The PD-MCI diagnosis was formulated on the basis of a comprehensive neuropsychological
      evaluation (baseline cognitive assessment - T0) according to the guidelines (level II
      criteria).

      The following standardized tests assessing different domains were used:

        -  global cognitive function: Mini-Mental State Examination (MMSE) and Montreal Montreal
           Overall Cognitive Assessment (MoCA);

        -  memory: verbal (Verbal Span, Digit Span) and spatial (Corsi's block-tapping test - CBTT)
           span; verbal long-term memory (Logical Memory Test immediate and delayed recall) (Rey's
           15-word test immediate and delayed recall); spatial long-term memory (Rey Complex Figure
           delayed recall - RCF-dr);

        -  logical-executive functions: non-verbal reasoning (Raven's Matrices 1947 - RM47) ;
           categorical abstract reasoning (Weigl's Sorting test); frontal functionality (Frontal
           Assessment Battery - FAB); semantic fluency (animals, fruits, car brands), phonological
           fluency (FAS);

        -  attention: visual selective attention (Attentive Matrices) (Carlesimo et al., 1995);
           simple speed processing and complex attention (Trail Making Test parts A - TMT A and
           part B - TMT B);

        -  visuospatial abilities: constructive apraxia Rey Complex Figure copy - RCF-copy.

      At follow-up evaluation, we used a selection of previous tests in order to selectively
      investigate various features of executive functions. All the test scores were corrected for
      age, sex, and education and compared with the values available for the Italian population.

      Motor performances were also assessed by means of MDS-Unified Parkinson's Disease Rating
      Scale, part III, Tinetti balance and gait score (Tinetti, 1986) and Hauser Index both at the
      baseline the follow-up evaluation.

      This study is a prospective controlled, parallel-group randomized study. At baseline (T0) all
      the PD patients recruited underwent both cognitive and motor assessments. Patients enrolled
      were randomized to receive physical therapy (PT) or no physical therapy (CT). The physical
      therapy program consisted of 6 individual sessions/week, each lasting 60 minutes for 4 weeks
      in addition to their usual pharmacological therapy; while subjects in CT group received only
      pharmacological therapy. Cognitive and motor performances were evaluated after 4 weeks (T1)
      by means of the above-mentioned tests to detect the effect of physical therapy on both motor
      and cognitive performances (T0 vs T1).

      Our physical therapy program included a variety of different exercise modalities (aerobic
      exercises, treadmill training and exercise intervention program) performed under the
      supervision of a physiotherapist, in order to facilitate goal-directed learning through
      cognitive engagement (learning through verbal feedback, cues, maintaining motivation and
      attention, improving awareness).
    

Intervention name(s): Physical therapy
Intervention type(s): Other
Intervention description(s): Our physical therapy program included a variety of different exercise modalities (aerobic exercises, treadmill training and exercise intervention program) performed under the supervision of a physiotherapist
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Prospective controlled, parallel-group randomized study
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Cognitive decline; Physical therapy; Parkinson's Disease