Computer assisted cognitive rehabilitation improves visuospatial and executive functions in Parkinson's disease: Preliminary results

Systematic review and meta-analysis of standalone digital interventions for cognitive symptoms in people without dementia

Cognitive symptoms are prevalent across neuropsychiatric disorders, increase distress and impair quality of life. Self-guided digital interventions offer accessibility, scalability, and may overcome the research-to-practice treatment gap. Seventy-six trials with 5214 participants were identified. A random-effects meta-analysis investigated the effects of all digital self-guided interventions, compared to controls, at post-treatment. We found a small-to-moderate positive pooled effect on cognition (k = 71; g = -0.51, 95%CI -0.64 to -0.37; p < 0.00001) and mental health (k = 30; g = -0.41, 95%CI -0.60 to -0.22; p < 0.0001). Positive treatment effects on fatigue (k = 8; g = -0.27, 95%CI -0.53 to -0.02; p = 0.03) and quality of life (k = 22; g = -0.17, 95%CI -0.34 to -0.00; p = 0.04) were only marginally significant. No significant benefit was found for performance on activities of daily living. Results were independent of control groups, treatment duration, risk of bias and delivery format. Self-guided digital transdiagnostic interventions may benefit at least a subset of patients in the short run, yet their impact on non-cognitive outcomes remains uncertain.

Efficacy of Computerized vs. Traditional Cognitive Interventions for the Treatment of Chronic mTBI Symptoms Among Service Members

INTRODUCTION

Military service members (SMs) with mild traumatic brain injury (mTBI or concussion) frequently report cognitive and behavioral difficulties. Currently, military clinical guidelines recommend clinician-run, manualized cognitive rehabilitation (CR) to treat these symptoms; however, it is unclear whether this approach adequately addresses the unique needs of warfighters. Computerized cognitive training (CCT) programs represent an innovative, promising approach to treating cognitive difficulties; however, whether these programs can effectively remediate cognitive impairment in individuals with mTBI remains unclear.

MATERIALS AND METHODS

A total of 65 SMs with a history of at least 1 diagnosed mTBI were recruited from a military hospital. Participants received 1 of 2 interventions: Clinician-run, manualized CR (Study of Cognitive Rehabilitation Effectiveness [SCORE]; n = 37), consisting of 60 total intervention hours over 6 weeks, or CCT (n = 28), in which participants trained with either a commercial CCT (n = 14) or noncommercial CCT (n = 14), for a total of 12 hours over 4 weeks. Participants were assessed pre- and postintervention, using a combination of self-report and objective outcome measures: Key Behaviors Change Inventory (KBCI), a self-report measure of functional difficulties; Paced Auditory Serial Addition Test (PASAT), an objective cognitive assessment that measures both information processing speed and sustained and divided attention; and Symbol Digit Modalities Test (SDMT), an objective cognitive assessment that measures information processing speed.

RESULTS

Mixed ANOVA revealed no interaction effect between intervention type and time (pre- and postassessment) on the PASAT (P = .643, ηp2 = 0.003), SDMT (P = .423, ηp2 = 0.010), or KBCI (P = .434, ηp2 = 0.010); however, there was a significant within-group main effect (time) on all 3 outcome measures (PASAT P < .001, ηp2 = 0.54; SDMT P < .001, ηp2 = 0.25; and KBCI P = .001, ηp2 = 0.15). On average, participants showed improvement over baseline on the PASAT (SCORE delta = 6.98, SD = 7.25, P < .001; CCT delta = 7.79, SD = 6.45, P < .001), SDMT (SCORE delta = 4.62, SD = 8.82, P = .003; CCT delta = 6.58, SD = 10.81, P = .003), and KBCI (SCORE delta = -3.22, SD = 7.09, P = .009; CCT delta = -2.00, SD = 4.72, P = .033). Additional analysis comparing the relative effectiveness of the 2 different CCTs revealed that while training with either program resulted in improved performance on the PASAT (P < .001, ηp2 = 0.627), SDMT (P = .003, ηp2 = 0.286), and KBCI (P = .036, ηp2 = 0.158), there was no interaction effect of CCT program type and change over time for any measure (PASAT P = .102, ηp2 = 1.00; SDMT P = .317, ηp2 = 0.038; and KBCI P = .719, ηp2 = 0.005).

CONCLUSIONS

We showed that CCT programs do not differ in efficacy compared to clinician-run, manualized CR for treating symptoms associated with mTBI; however, exploratory analyses suggest that each approach may have distinct advantages for treating specific symptoms. Additionally, we showed that the improvement in the CCT intervention did not differ between those who trained using the commercial program vs. those who trained with the noncommercial program.

German Society of Neurology guidelines for the diagnosis and treatment of cognitive impairment and affective disorders in people with Parkinson's disease: new spotlights on diagnostic procedures and non-pharmacological interventions

BACKGROUND AND OBJECTIVE

Cognitive impairment and dementia as well as affective disorders are common and debilitating syndromes that develop in people with Parkinson's disease (PwPD). The authors summarized recommendations for the 2023 updated German guidelines on "Parkinson's disease" from the German Neurological Society (DGN), focusing on the diagnosis and treatment of these disorders.

METHODS

The recommendations were based on literature reviews, other relevant guidelines, and expert opinions.

RESULTS

Measurements to assess cognitive and affective states were reviewed for psychometric properties, use in routine clinical practice, and availability in German. To improve mild cognitive impairment, cognitive training and physical aerobic training are recommended. To treat Parkinson's disease (PD)-related dementia, cognitive stimulation (as a non-pharmacological intervention) and acetylcholinesterase inhibitors (AChEIs, i.e., rivastigmine) are recommended. Cognitive behavioral therapy is recommended to treat depression, anxiety, and fear of progression. Physical interventions are recommended to treat depression, fatigue, and apathy. Optimized dopaminergic treatment is the first-line pharmacological strategy recommended to manage depression, apathy, anhedonia, fatigue, and mood swings. Major depression can be additionally treated using venlafaxine or desipramine, while moderate depression can be treated pharmacologically according to its clinical phenotype (psychomotor retardation or agitation) and comorbidities (e.g., sleep disturbances, pain). Venlafaxine and nortriptyline can be used to treat anhedonia, while citalopram can be used for anxiety.

CONCLUSIONS

In addition to the updated pharmacological treatment options, new insights into recommendations for standardized diagnostics and non-pharmacological interventions were provided for the German health care system. However, more studies are needed to explore the full potential of non-pharmacological interventions to treat and prevent cognitive impairment and affective disorders.

Computer-assisted cognitive rehabilitation in neurological patients: state-of-art and future perspectives

Background and aim

Advances in computing technology enabled researchers and clinicians to exploit technological devices for cognitive training and rehabilitation interventions. This expert review aims to describe the available software and device used for cognitive training or rehabilitation interventions of patients with neurological disorders.

Methods

A scoping review was carried out to analyze commercial devices/software for computerized cognitive training (CCT) in terms of feasibility and efficacy in both clinical and home settings. Several cognitive domains responding to the different patients' needs are covered.

Results

This review showed that cognitive training for patients with neurological diseases is largely covered by several devices that are widely used and validated in the hospital setting but with few translations to remote/home applications. It has been demonstrated that technology and software-based devices are potential and valuable tools to administer remotely cognitive rehabilitation with accessible costs.

Conclusion

According to our results, CCT entails the possibility to continue cognitive training also in different settings, such as home, which is a significant breakthrough for the improvement of community care. Other possible areas of use should be the increase in the amount of cognitive therapy in the free time during the hospital stay.

The Role of Telemedicine in the Treatment of Cognitive and Psychological Disorders in Parkinson’s Disease: An Overview

Background: This literature review evaluates the use and efficacy of telemedicine in cognitive and psychological treatment in Parkinson’s disease. Methods: Studies performed between 2016 and 2021 that fulfilled inclusion criteria were selected from PubMed, Scopus, Cochrane, and Web of Science databases. All articles were evaluated by title, abstract, and text. All studies that examined the cognitive and psychological/psychotherapy treatment of patients with Parkinson’s disease by telemedicine were included. Results: Telehealth improved cognitive status and emotional/behavioral disorders in this population, and had positive effects on the patients’ and caregivers’ quality of life. Conclusions: Our literature review supports the development and efficacy of cognitive and psychological treatment with telemedicine, but the methodology of the study must be reviewed considering its limitations so as to highlight the benefits and risks of treatment via telemedicine.

Feasibility and usability of a non-immersive virtual reality tele-cognitive app in cognitive rehabilitation of patients affected by Parkinson's disease

BACKGROUND

Cognitive impairment is one of the most common non-motor features of Parkinson's disease (PD). The aim of the present study was to evaluate the feasibility and acceptability/usability of a protocol using a non-immersive virtual reality tele-cognitive app, performed remotely in a sample of Italian patients with PD.

METHODS

Non-demented patients with mild PD were included in the study. Patients performed the cognitive rehabilitation in a remote way, at home (three training sessions lasting 20 min/week for 6 weeks) using the NeuroNation app, downloaded for free on the patients' smartphones. The usability and feasibility of the tele-cognitive rehabilitation program were assessed with the System Usability Scale (SUS) and the Goal Attainment Scaling (GAS).

RESULTS

Sixteen patients (9 men and 7 women; mean age 58.4 ± 8.3 years; mean disease duration 4.6 ± 2.1 years) were included in the study. At the end of the study, the mean SUS was 83.4 ± 11.5. The GAS score recorded at the end of the study (65.6 ± 4.2) was significantly higher than at baseline (38.5 ± 2.4; P-value <0.001).

CONCLUSION

In our sample, good feasibility and usability were observed for a 6-week cognitive rehabilitation protocol based on the non-immersive virtual reality tele-cognitive app NeuroNation. Our data support the usefulness of cognitive rehabilitation performed in a remote way in PD patients.

EEG Evaluation in a Neuropsychological Intervention Program Based on Virtual Reality in Adults with Parkinson's Disease

Nowadays, several strategies for treating neuropsychologic function loss in Parkinson’s disease (PD) have been proposed, such as physical activity performance and developing games to exercise the mind. However, few studies illustrate the incidence of these therapies in neuronal activity. This work aims to study the feasibility of a virtual reality-based program oriented to the cognitive functions’ rehabilitation of PD patients. For this, the study was divided into intervention with the program, acquisition of signals, data processing, and results analysis. The alpha and beta bands’ power behavior was determined by evaluating the electroencephalography (EEG) signals obtained during the execution of control tests and games of the “Hand Physics Lab” Software, from which five games related to attention, planning, and sequencing, concentration, and coordination were taken. Results showed the characteristic performance of the cerebral bands during resting states and activity states. In addition, it was determined that the beta band increased its activity in all the cerebral lobes in all the tested games (p-value < 0.05). On the contrary, just one game exhibited an adequate performance of the alpha band activity of the temporal and frontal lobes (p-value < 0.02). Furthermore, the visual attention and the capacity to process and interpret the information given by the surroundings was favored during the execution of trials (p-value < 0.05); thus, the efficacy of the virtual reality program to recover cognitive functions was verified. The study highlights implementing new technologies to rehabilitate people with neurodegenerative diseases.

Computerized Cognitive Training in Parkinson's Disease: A Systematic Review and Meta-Analysis

Cognitive impairment is a central non-motor symptom of Parkinson's disease (PD), and there are no established treatments. Computerized cognitive training (CCT) is a safe and efficacious strategy but its efficacy in PD is unclear. We aimed to investigate the efficacy of CCT on cognitive, psychosocial and daily function, and assess potential effect moderators in people with PD without dementia. Randomized controlled trials of CCT were included in multivariate meta-analyses and meta-regressions. Seventeen studies (16 trials) encompassing 679 participants were included. The pooled effect of CCT relative to control was small and statistically significant for overall cognitive function (g=0.16; 95% CI 0.02-0.29). There was robust evidence for benefit on clinical measures of global cognition across 10 trials (g=0.33; 95% CI 0.19-0.48), especially in PD with mild cognitive impairment (PD-MCI), as well as on individual cognitive domains. Greater CCT dose and PD-MCI population were associated with larger effect sizes, but no statistically significant differences were found between subgroups. There was no significant difference in the efficacy of home-based compared to supervised training. Our findings suggest that CCT is associated with cognitive benefits in PD, including when delivered remotely. Larger, well-powered trials are warranted to examine what specific CCT regimens are most likely to promote cognitive and everyday functioning in the long-term.

Improvement in Language Function in Patients with Aphasia using Computer-Assisted Executive Function Training: A Controlled Clinical Trial

OBJECTIVE

Non-verbal cognitive training has gained popularity for the management of aphasia. The correlation between language function and cognitive control has been explored previously. Cognitive status affects language to a certain degree. In this study, we aimed to determine whether non-verbal computer-assisted executive control training (CAET) to improve cognitive status affects language performance in patients with aphasia (PWA).

DESIGN

A total of 73 participants were included in the study, and 5 subjects dropped out. A total of 68 individuals were randomly divided into two groups and underwent treatment. The experimental group was treated with traditional speech and language therapy (SLT) combined with CAET. The control group underwent SLT only.

RESULTS

Differences between pre- and post-treatment language outcomes expect oral naming (group × time, P = 0.236) were significantly greater in the experimental group compared with the control group: Spontaneous speech (group × time, P = 0.026), Auditory Comprehension (group × time, P < 0.001), Speech repetition (group × time, P = 0.001), AQ (group × time, P < 0.001). A similar effect was observed for cognitive function such as TMT-A (group × time, P = 0.006), TMT-B (group × time, P = 0.005) and VFT-V (group × time, P = 0.018).

CONCLUSION

Our study demonstrates that CAET combined with SLT can yield favorable language outcomes for PWA, especially improvements in auditory comprehension and AQ. CAET combined with SLT generates benefits in both cognitive function and language performance. Therefore, CAET may be applied as an adjuvant aphasia therapy in conjunction with traditional SLT. This article is protected by copyright. All rights reserved.

A double-blind randomized controlled trial of the efficacy of cognitive training delivered using two different methods in mild cognitive impairment in Parkinson's disease: preliminary report of benefits associated with the use of a computerized tool

BACKGROUND

The effectiveness of computer-based cognitive training (CCT) remains controversial, especially in older adults with neurodegenerative diseases.

AIMS

To evaluate the efficacy of CCT in patients with Parkinson's disease and mild cognitive impairment (PD-MCI).

METHODS

In this randomized controlled trial, 53 patients were randomized to receive CCT delivered by means of CoRe software, traditional paper-and-pencil cognitive training (PCT), or an unstructured activity intervention (CG). In each group, the intervention lasted 3 consecutive weeks (4 individual face-to-face sessions/week). Neuropsychological assessment was administered at baseline (T0) and post-intervention (T1). Outcome measures at T0 and T1 were compared within and between groups. The Montreal Overall Cognitive Assessment (MoCA) was taken as the primary outcome measure.

RESULTS

Unlike the PCT group and the CG, the patients receiving CCT showed significant medium/large effect size improvements in MoCA performance, global cognition, executive functions, and attention/processing speed. No baseline individual/demographic variables were associated with greater gains from the intervention, although a negative correlation with baseline MoCA performance was found.

CONCLUSION

CCT proved effective in PD-MCI patients when compared with traditional PCT. Further follow-up assessments are being conducted to verify the retention of the gains and the potential ability of the tool to delay conversion to PD-dementia. Trial registration number (ClinicalTrials.gov): NCT04111640 (30th September 2019).

Effects of domotics on cognitive, social and personal functioning in patients with Parkinson's disease: A pilot study

Home automation (HA) is either a "smart" house or a supportive environment, which enables the patients to regain an active role in daily life. HA could allow people affected by Parkinson Disease (PD) to better manage their daily lives. This study aims to evaluate the effects of domotics on quality of life, and personal/social autonomy in PD patients. We enrolled 40 with PD undergoing neurorehabilitation, who were randomized into either the control (CG) or the experimental group (EG). Two different rehabilitative approaches were used: the CG was submitted to a traditional training, whilst the EG underwent HA training, in which the activities were carried out through the use of assistive technologies. In both the training, the exercises were performed in small samples of 3-5 patients. Results showed that both CG and EG had a significant improvement in global cognitive functioning, executive functions, and instrumental autonomy. However, only in the EG, we observed a significant increase in social adaptation, activities of daily living and quality of life. This pilot study suggests that HA training could be a useful tool for the rehabilitation of patients with PD, improving social and cognitive functioning, personal autonomy and quality of life.