Cognitive Rehabilitation In Parkinson’s Disease: Evidence From Neuroimaging

Dr. Cristina Nombela-Otero, Brain Repair Centre, Department of Clinical Neurosciences, Cambridge university, UK.

Victoria Murphy:

My guest today is Dr. Cristina Nombela-Otero from the Brain Repair Centre, Department of Clinical Neurosciences, Cambridge university, UK. Dr. Nombela, a very warm welcome to you, thank you for joining us.

Dr. Nombela:

Thank you very much for inviting me.

Victoria Murphy:

Today we are here to discuss a paper you authored in Frontiers in Neurology in December 2011. The title of your paper was, cognitive rehabilitation in parkinson’s disease: evidence from neuroimaging. Dr. Nombela, what were the objectives of your study?

Dr. Nombela:

In this study we tested the effectiveness of a medium-term cognitive training in Parkinson’s disease (PD) population. The cognitive program was based on a set of Sudoku exercises(easy level) to do every day.

Victoria Murphy:

How was it designed?

Dr. Nombela:

We counted with two groups:
1) PD patients
2) Healthy age-matched controls.

We conducted a complete assessment (cognitive and clinical evaluation plus fMRI scan -running a standard Stroop task-) in two phases:

1) BASELINE (before the training programme). After the baseline
assessment, PD group was split in two subgroups:
a) Subgroup that was going to follow the cognitive training
program (Trained)
b) Subgroup that was NOT going to follow the cognitive training
program (untrained)

2) FOLLOW-UP (after the training programme)

Victoria Murphy:

What types of patients were included?

Dr. Nombela:

Inclusion criteria were non-demented patients diagnosed with idiopathic Parkinson’s disease.
H{cf2c27d335602139ec9071daca508545599ba8f9ca09b366fd00e5c28736f208}Y stage: II and III.
MMSE score < 24.

Victoria Murphy:

What were the study endpoints?

Dr. Nombela:

Our interest was to verify if cognitive training could be effective in the elderly, especially under diagnosed neurodegenerative conditions.

Victoria Murphy:

What were the results?

Dr. Nombela:

According to our hypothesis, trained patients showed a significant improvement in Stroop task performance during the fMRI scan. Subsequent analysis showed that the brain activation pattern in trained patients were significantly reduced respect to untrained patients, keeping an equivalent efficacy (measured in RT and correct answers).

Victoria Murphy:

Are there any limitations to the study?

Dr. Nombela:

This study was conducted within a small sample of PD patients (n=10). Furthermore, patients decided themselves whether to join or not the “training team” what includes a motivation/cognitive bias.

Victoria Murphy:

What conclusions can be drawn from these results?

Dr. Nombela:

Results indicated that cognitive training has a positive effect under elderly neurodegenerative conditions, supporting the use of cognitive rehabilitation in PD.

Victoria Murphy:

Can these results be considered conclusive?

Dr. Nombela:

Although results look strongly positive, it would be necessary to conduct additional experiments to establish general conclusive statements.

Victoria Murphy:

Could we talk about dementia implications in Parkinsonism?

Dr. Nombela:

25{cf2c27d335602139ec9071daca508545599ba8f9ca09b366fd00e5c28736f208} of PD patients develop dementia. This group of patients has worse prognosis, experiences lower quality of life and generates more stress in relatives and careers. From an economical point of view, dementia costs £23Bn/year (twice the cost of cancer) to the National Health System in Britain.
The incidence and prevalence of neurodegenerative diseases and dementia increase with life expectancy.
These elements justify the urgent need of preventive measures and non-pharmacological treatments for cognitive impairments.

Victoria Murphy:

Dr. Nombela, thank you very much for joining us today, it has been a pleasure.

Dr. Nombela:

Thank you very much, I hope this study will be interesting for several people, not just neurologists or psychologists but for other medical professionals that are interested in dementia and the elderly.

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