How Cognitive Reserve should Influence Rehabilitation Choices using Virtual Reality in Parkinson’s Disease

Abstract

Virtual reality (VR) is used in the rehabilitation of patients with Parkinson's disease (PD) in several studies. In VR trials, the motor, physical characteristics, and the degree of the disease are often well de ned, while PD cognitive reserve is not. is systematic review was performed to de ne a cognitive pro le for patients with PD who could best bene t from using VR to enhance functional motor aspects during rehabilitation. PubMed, Cochrane Library, Scopus, and Web of Sciences databases were analysed to identify randomized clinical trials (RCT) and randomized pilot trials that addressed the rehabilitation of motor symptoms in subjects with PD using VR. e included studies used Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA) to evaluate the cognitive aspect. Only articles written in English and with full texts were considered. e risk of bias from all included studies was assessed based on the Cochrane risk-of-bias tool and the PRISMA guideline was considered. Eighteen articles were eligible for review, including three randomized pilot trials. All studies aimed to evaluate the e ect of VR on the motor aspects typically a ected by PD (balance, postural control, risk of falls, walking, and reaching). e most widely adopted approach has been nonimmersive VR, except for one study that used immersive VR. Both the bene ts of physical activity on the motor symptoms of patients with PD and the impact of cognitive reserve during the rehabilitation of these patients were highlighted. e analysis of the results allowed us to outline the ideal cognitive pro le of patients with PD who can bene t from the e ects of rehabilitation using VR.

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