Cognitive training interventions for dementia and mild cognitive impairment in Parkinson’s disease

Orgeta, Vasiliki; McDonald, Kathryn; Poliakoff, Ellen; Hindle, John V.; Clare, Linda; Leroi, Iracema

doi:10.1002/14651858.cd011961.pub2

Cited by 77 publications

(83 citation statements)

References 166 publications

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“…Two meta-analyses have demonstrated CT benefits in PD patients, particularly with respect to executive functions, working memory, memory, and processing speed [9,10]. However, a recent Cochrane review and metaanalysis [11] found that studies on CT in PD patients so far do not give evidence for "important cognitive improvements." e authors point out that reliable conclusions cannot be drawn yet due to a small number of studies with few participants, limitations of study design and execution, and imprecise results.…”

Section: Introductionmentioning

confidence: 99%

“…In fact, in CT studies, the patients' cognitive status has only rarely been assessed based on established criteria. erefore, its efficacy in PD, PD-MCI, and PD dementia (PDD) cannot be derived [11,12]. Also, noncognitive outcomes (e.g., quality of life and neuropsychiatric symptoms) have only scarcely been examined in existing randomized controlled trials (RCTs) [9,11].…”

Section: Introductionmentioning

confidence: 99%

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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

Kalbe

Folkerts

Ophey

et al. 2020

Parkinson's Disease

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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 , η p 2 = 0.092 ) and a statistical trend for overall executive functions ( p = 0.095 , η p 2 = 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 , η p 2 = 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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Kalbe

Folkerts

Ophey

et al. 2020

Parkinson's Disease

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“…Therefore, it is more likely that individuals early in the disease will have a more responsive striatal system. Also, a recent meta-analysis from the Cochrane Library found no evidence for any important cognitive improvement after 4 to 8 weeks of cognitive training in PD-MCI and PDD [53]. This indicates that cognitive interventions might be more suitable early in the disease when the cognitive decline is less pronounced.…”

Section: Discussionmentioning

confidence: 99%

Evaluating a frontostriatal working-memory updating-training paradigm in Parkinson’s disease: the iPARK trial, a double-blinded randomized controlled trial

et al. 2020

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Background Cognitive decline and dementia are common in Parkinson’s disease (PD). Cognitive deficits have been linked to the depletion of dopamine in the nigrostriatal pathway, but pharmacological treatments for PD have little evidence of improving or delaying cognitive decline. Therefore, exploring non-pharmacological treatment options is important. There have been some promising results of cognitive training interventions in PD, especially for improvements in working memory and executive functions. Yet, existing studies are often underpowered, lacking appropriate control condition, long term follow-up, a thorough description of the intervention and characteristics of the participants. Working memory updating training has previously shown to increase striatal activation in healthy young and old participants as well as dopaminergic neurotransmission in healthy young participants. In the light of dopamine dysfunction in PD, with negative effects on both motor and cognitive functions it is of interest to study if an impaired striatal system can be responsive to a non-invasive, non-pharmacological intervention. Methods and design The iPARK trial is a double-blinded, randomized controlled trial with a parallel-group design that aims to recruit 80 patients with PD (during the period 02/2017–02/2023). Included patients need to have PD, Hoehn and Yahr staging I-III, be between 45 to 75 years of age and not have a diagnosis of dementia. All patients will undergo 30 sessions (6–8 weeks) of web-based cognitive training performed from home. The target intervention is a process-based training program targeting working memory updating. The placebo program is a low dose short-term memory program. A battery of neuropsychological tests and questionnaires will be performed before training, directly after training, and 16 weeks after training. Discussion We expect that the iPARK trial will provide novel and clinically useful information on whether updating training is an effective cognitive training paradigm in PD. Further, it will hopefully contribute to a better understanding of cognitive function in PD and provide answers regarding cognitive plasticity as well as determining critical factors for a responsive striatal system. Trial registration Clinicaltrials.gov registry number: NCT03680170, registry name: “Cognitive Training in Parkinson’s Disease: the iPARK study”, retrospectively registered on the 21st of September 2018. The inclusion of the first participant was the 1st of February 2017.

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“…To date, several systematic reviews and meta-analyses have investigated the efficacy of cognitive training on cognitive function in PD. [5][6][7][8] Leung and colleagues identified seven randomised controlled trials (RCTs) and concluded that cognitive training showed modest efficacy for overall cognition in PD, with larger effect sizes observed within individual cognitive domains. 5 Similar results were reported by Lawrence and colleagues, 6 who combined 11 randomised and non-randomised cognitive training trials.…”

Section: Introductionmentioning

confidence: 99%

“…More recently, a Cochrane review identified seven RCTs investigating the effects of cognitive training in patients with PD with MCI or dementia, reporting imprecise and uncertain evidence for efficacy on global cognition. 7 Approaches for estimating effect sizes across studies varied across reviews, and none conducted investigations of heterogeneity. Finally, a recent systematic review focusing specifically on CCT reported evidence for cognitive benefits based on seven RCTs; however, no meta-analysis was performed and potential effect modifiers were not explored.…”

Section: Introductionmentioning

confidence: 99%

Computerised cognitive training in Parkinson’s disease: a protocol for a systematic review and updated meta-analysis

et al. 2020

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IntroductionCognitive impairment is recognised as an important non-motor symptom in Parkinson’s disease (PD) and there is a need for evidence-based non-pharmacological interventions that may prevent or slow cognitive decline in this patient group. One such intervention is computerised cognitive training (CCT), which has shown efficacious for cognition across older adult populations. This systematic review aims to investigate the efficacy of CCT across cognitive, psychosocial and functional domains for people with PD and examine study and intervention design factors that could moderate CCT effects on cognition.Methods and analysisRandomised controlled trials investigating the effects of CCT in patients with PD without dementia, on cognitive, psychosocial or functional outcomes, will be included. The primary outcome is overall cognitive function. Secondary outcomes are domain-specific cognitive function, psychosocial functioning and functional abilities. We systematically searched MEDLINE, Embase and PsycINFO through 14 May 2020 to identify relevant literature. Risk of bias will be assessed using the revised Cochrane Risk of Bias tool. Effect sizes will be calculated as standardised mean difference of baseline to postintervention change (Hedges’ g) with 95% CI for each eligible outcome measure. Pooling of outcomes across studies will be conducted using random-effects models, accounting for dependency structure of effect sizes within studies. Heterogeneity will be assessed using τ2 and I2 statistic. Potential moderators, based on key study and intervention design factors, will be investigated using mixed-effects meta-regression models.Ethics and disseminationNo ethical approval is required. The findings will be disseminated in a peer-reviewed scientific journal.PROSPERO registration numberCRD42020185386.

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Cognitive training interventions for dementia and mild cognitive impairment in Parkinson’s disease

Abstract: What we foundCognitive training interventions for dementia and mild cognitive impairment in Parkinson's disease (Review)

Cited by 77 publications

References 166 publications

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

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

Evaluating a frontostriatal working-memory updating-training paradigm in Parkinson’s disease: the iPARK trial, a double-blinded randomized controlled trial

Computerised cognitive training in Parkinson’s disease: a protocol for a systematic review and updated meta-analysis

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