Training of executive functions in Parkinson's disease

Department of Psychology, Justus-Liebig-University of Giessen, Germany.
Journal of the Neurological Sciences (Impact Factor: 2.47). 11/2006; 248(1-2):115-9. DOI: 10.1016/j.jns.2006.05.028
Source: PubMed


Cognitive disturbances are common in Parkinson's disease (PD). Examination of cognitive function often reveals deficits in executive functions, including maintenance and inhibition of attention, flexibility in thinking, and planning. The involvement of the dopaminergic system in cognitive executive functions has been suggested by numerous studies. The aim of the present study was to analyze the effect of cognitive training on cognitive performance of PD-patients (N=26). Half of the patients participated in a cognitive training regimen, while the other patients only received standard treatment. The outcome showed improved performance of the group with cognitive treatment in two executive tasks after the training period, while no improvement was seen in the standard-treatment group. The results indicate that specific training is required for improvement of executive functions, while general rehabilitation is not sufficient. Thus, PD-patients might benefit from a short-term cognitive executive function training program that is tailored to the individual patient's needs.

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Available from: Gebhard Sammer, Aug 28, 2014
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    • "The use of ambulatory aids, though beneficial in preventing falls, may instead increase the number of freezing episodes (Cubo et al. 2003). Cognitive training could be useful in ameliorating FOG (Sammer et al. 2006) (Table 2). Second, pharmacological treatment poses complex issues, but accurate observation of the response of FOG to various drugs is recommended (Giladi 2008). "
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    ABSTRACT: In recent years, the management of Parkinson's disease (PD) has come a long way, leading to an increase in therapeutic options that now include oral and transdermal drug delivery, infusion as well as surgical treatments. Nonetheless, in the evolution of this complex neurodegenerative disorder, several symptoms remain refractory to dopaminergic therapy. It is our aim to review the literature to date and to bring them into focus, as well as emphasizing on pathophysiological mechanisms, profile of risk factors in their development, and therapeutic options. We will focus on freezing of gait, camptocormia, dysphagia and dysphonia, as well as cognitive impairment and dementia because they represent the far end of therapy-resistant symptoms, encompassing poor health-related quality of life and often a more reserved prognosis with either a rapid evolution of the disease, and/or merely a more severe clinical picture. Pathophysiological mechanisms and brain neurotransmitter abnormalities behind these symptoms seem to overlap to some extent, and a better understanding of these correlations is desirable. We believe that further research is paramount to expand our knowledge of the dopamine-resistant symptoms and, consequently, to develop specific therapeutic strategies.
    Journal of Neural Transmission 09/2015; DOI:10.1007/s00702-015-1463-8 · 2.40 Impact Factor
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    • "Moreover, these findings support experimental studies documenting improvements in cognitive performance in rodent models of HD after environmental enrichment (Wood et al. 2010, 2011). While evidence is limited in HD, an increasing number of studies are showing that motor and cognitive interventions positively impact on cognitive function in the elderly (Liu-Ambrose et al. 2010; Erickson et al. 2011; Bherer et al. 2013) and those suffering with MCI (Hampstead et al. 2011, 2012; Smith et al. 2013), MS (Solari et al. 2004; Flavia et al. 2010; Mattioli et al. 2010; Shatil et al. 2010) and PD (Sammer et al. 2006; Calleo et al. 2011; Par ıs et al. 2011). It is likely that the improvements in verbal learning and memory observed in this study resulted from the positive impact of multidisciplinary rehabilitation on caudate and DLPFC structures. "
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    ABSTRACT: Background There is a wealth of evidence detailing gray matter degeneration and loss of cognitive function over time in individuals with Huntington's disease (HD). Efforts to attenuate disease-related brain and cognitive changes have been unsuccessful to date. Multidisciplinary rehabilitation, comprising motor and cognitive intervention, has been shown to positively impact on functional capacity, depression, quality of life and some aspects of cognition in individuals with HD. This exploratory study aimed to evaluate, for the first time, whether multidisciplinary rehabilitation can slow further deterioration of disease-related brain changes and related cognitive deficits in individuals with manifest HD.Methods Fifteen participants who manifest HD undertook a multidisciplinary rehabilitation intervention spanning 9 months. The intervention consisted of once-weekly supervised clinical exercise, thrice-weekly self-directed home based exercise and fortnightly occupational therapy. Participants were assessed using MR imaging and validated cognitive measures at baseline and after 9 months.ResultsParticipants displayed significantly increased gray matter volume in the right caudate and bilaterally in the dorsolateral prefrontal cortex after 9 months of multidisciplinary rehabilitation. Volumetric increases in gray matter were accompanied by significant improvements in verbal learning and memory (Hopkins Verbal Learning-Test). A significant association was found between gray matter volume increases in the dorsolateral prefrontal cortex and performance on verbal learning and memory.Conclusions This study provides preliminary evidence that multidisciplinary rehabilitation positively impacts on gray matter changes and cognitive functions relating to verbal learning and memory in individuals with manifest HD. Larger controlled trials are required to confirm these preliminary findings.
    Brain and Behavior 01/2015; 5(2). DOI:10.1002/brb3.312 · 2.24 Impact Factor
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    • "While preexisting data on cognitive rehabilitation in PD is sparse, early findings are encouraging. Sinforiani et al. (2004) developed a training program aimed at improving general cognitive function and Sammer et al. (2006) targeted working memory abilities associated with executive function. Both groups showed improvement on some tasks which persisted six months after intervention. "
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    ABSTRACT: While Parkinson's disease (PD) is considered a motor disorder, motor signs of PD can be exacerbated by cognitive dysfunction. We evaluated the efficacy of a computer-based cognitive rehabilitation training program designed to improve motor-related executive function. Thirty people with PD and 21 controls participated in the 10-day training. Training consisted of a two-phase button press task. First, subjects produced an externally cued (EC) digit sequence, typing numbers displayed on the computer screen. Second, subjects were prompted to generate the same sequence in the absence of the number display (internally represented sequence, IR). Sequence length was automatically adjusted to maintain 87% correct performance. Participants were evaluated before and after training using a fixed version of the training task, and generalization of training was assessed using measures involving IR motor sequencing, switching and activities of daily living. PD participants were divided into two groups, those who showed impairment in IR motor sequence production prior to training (N=14) and those whose performance was similar to controls (N=16). Following training the impaired PD group showed significantly greater reduction in sequence initiation and completion time and in error rate for IR conditions compared to the unimpaired PD and control groups. All groups improved on Trails B-A, and pre-training Trails B was identified as a predictor of training-based improvement in IR sequence completion time and error rate. Our findings highlight the importance of neurorehabilitation tailored to the specific cognitive deficits of the PD patient.
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