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Mantovani E, Bressan MM, Tinazzi M, Tamburin S. Towards multimodal cognition-based treatment for cognitive impairment in Parkinson's disease: drugs, exercise, non-invasive brain stimulation and technologies. Curr Opin Neurol 2024:00019052-990000000-00188. [PMID: 39132779 DOI: 10.1097/wco.0000000000001310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
PURPOSE OF REVIEW Cognitive impairment is one of the most challenging non-motor symptoms of Parkinson's disease (PD) and may occur during all PD stages. There are no established pharmacological treatments for PD-related cognitive impairment, which may be improved by cognition-based interventions (i.e., cognitive stimulation, cognitive training, cognitive rehabilitation). Multimodal cognition-based interventions by adjunctive drugs, exercise, non-invasive brain stimulation and technologies may be effective in PD. RECENT FINDINGS Exercise combined with cognitive training may enhance global, memory, visuospatial and executive functioning, transcranial direct current stimulation delivered alongside cognitive training may improve attention and executive functioning, and exergames, semi-immersive virtual reality (VR) and telerehabilitation plus non-immersive VR combined with cognitive training may ameliorate global and executive functioning in PD patients. SUMMARY The evidence reviewed here, despite preliminary, is very encouraging and suggests strong rationale for combining pharmacological and non-pharmacological interventions with cognition-based treatments in PD. To overcome limitations of current studies, we propose some recommendations for future trials on drugs, exercise, non-invasive brain stimulation and technologies combined with cognition-based treatments for cognitive impairment in PD.
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Affiliation(s)
- Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Zhao L, Guo Y, Zhou X, Mao W, Zhu H, Chen L, Liu X, Zhang L, Xie Y, Li L. The research progress of perioperative non-pharmacological interventions on postoperative cognitive dysfunction: a narrative review. Front Neurol 2024; 15:1369821. [PMID: 38751891 PMCID: PMC11094646 DOI: 10.3389/fneur.2024.1369821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Postoperative cognitive dysfunction (POCD) is a common neurological complication in elderly patients after surgery and general anesthesia. The occurrence of POCD seriously affects the postoperative recovery of patients, and leads to prolonged hospital stay, reduced quality of life, increased medical costs, and even higher mortality. There is no definite and effective drug treatment for POCD. More evidence shows that perioperative non-pharmacological intervention can improve postoperative cognitive function and reduce the incidence of POCD. Therefore, our studies summarize the current non-pharmacological interventions of POCD from the aspects of cognitive training, physical activity, transcutaneous electrical acupoint stimulation, noninvasive brain stimulation, non-pharmacological sleep improvement, music therapy, environment, and multimodal combination Interventions, to provide more data for clinical application and research.
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Affiliation(s)
- Li Zhao
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Yiping Guo
- School of Humanities and Management, Key Laboratory for Quality of Life and Psychological Assessment and Intervention, Guangdong Medical University, Dongguan, China
- Nanchong Center for Disease Control and Prevention, Nanchong, China
| | - Xuelei Zhou
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Wei Mao
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Hongyu Zhu
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Linlin Chen
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Xianchun Liu
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Longyi Zhang
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Ying Xie
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Linji Li
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
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Zhao L, Guo Y, Zhou X, Mao W, Li L. Preoperative cognitive training improves postoperative cognitive function: a meta-analysis and systematic review of randomized controlled trials. Front Neurol 2024; 14:1293153. [PMID: 38259656 PMCID: PMC10800879 DOI: 10.3389/fneur.2023.1293153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Background Postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) are common post-surgical complications that often lead to prolonged hospitalization, reduced quality of life, increased healthcare costs, and increased patient mortality. We conducted a meta-analysis to evaluate the effects of preoperative cognitive function training on postoperative cognitive function. Methods PubMed, Cochrane Library, Embase, Web of Science, ClinicalTrials, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and Chinese Biomedical Literature Database were searched for randomized controlled trials comparing the effects of preoperative cognitive function training and conventional preoperative measures on postoperative cognitive function. The search period spanned from the establishment of the databases to March 31, 2023. The primary outcomes were the incidence of POCD and POD. Results Eleven randomized controlled trials involving 1,045 patients were included. The results of the meta-analysis showed that, compared to the control group, preoperative cognitive function training significantly reduced the incidence of POCD (RR = 0.38, P < 0.00001), and there was no statistically significant difference in the incidence of POD (P = 0.3). Cognitive function training significantly improved postoperative cognitive function scores compared with the control group (MD = 1.92, P = 0.001). In addition, two studies reported that 10% of the patients in the cognitive training group completed a pre-set training duration. Conclusion Cognitive function training significantly reduced the incidence of POCD; however, there was no significant difference in the incidence of POD. Preoperative cognitive function training should be promoted and emphasized as a simple, economical, and practical method of improving postoperative cognitive function. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=396154.
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Affiliation(s)
- Li Zhao
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Yiping Guo
- School of Humanities and Management, Key Laboratory for Quality of Life and Psychological Assessment and Intervention, Guangdong Medical University, Dongguan, China
- Nanchong Center for Disease Control and Prevention, Nanchong, China
| | - Xuelei Zhou
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Wei Mao
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Linji Li
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
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Cai X, Chen F, Wang S, Pan P, Mu T, Dong C, Dai Z, Chen Z. Knowledge, attitude, and practice of healthcare professionals toward cognitive dysfunction in Parkinson's disease and cognitive rehabilitation. BMC MEDICAL EDUCATION 2024; 24:26. [PMID: 38178059 PMCID: PMC10768106 DOI: 10.1186/s12909-023-04989-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND To investigate the knowledge, attitude, and practice (KAP) of healthcare professionals regarding cognitive dysfunction and cognitive rehabilitation in Parkinson's disease (PD). METHODS This multicenter, cross-sectional survey enrolled physicians and nurses in 10 hospitals between October 2022 and November 2022. A self-administered questionnaire was developed to collect the demographic information of the participants and their knowledge, attitude, and practice toward cognitive dysfunction in PD and cognitive rehabilitation. RESULTS This study enrolled 224 physicians and 229 nurses. The knowledge, attitude, and practice scores were 12.57 ± 3.76 (total score: 22), 29.10 ± 3.71 (total score: 32), and 21.07 ± 8.03 (total score: 28) among physicians, and 9.97 ± 4.70 (total score: 22), 25.27 ± 8.96 (total score: 32), and 25.27 ± 8.96 (total score: 28) among nurses. Among physicians, the knowledge scores (OR = 4.23, 95%CI: 2.36-7.58, P < 0.001) and attitude scores (OR = 3.00, 95%CI: 1.67-5.37, P < 0.001) were independently associated with good practice. Among nurses, the knowledge scores (OR = 4.31, 95%CI: 2.31-8.05, P < 0.001), attitude scores (OR = 5.18, 95%CI: 2.82-9.53, P < 0.001), working department (Ref: rehabilitation; neurology: OR = 2.26, 95%CI: 1.01-5.08, P = 0.048; public health service/chronic disease follow-up center: OR = 2.98, 95%CI: 1.12-7.92, P = 0.028) were independently associated with good practice. CONCLUSIONS Physicians and nurses have insufficient knowledge, favorable attitudes, and active practice regarding cognitive dysfunction and cognitive rehabilitation in PD. This study identified gaps in KAP and suggested education activities to improve the KAP toward cognitive dysfunction in PD.
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Affiliation(s)
- Xia Cai
- Department of Public Health Management and Preventive Care, The Yancheng School of Clinical Medicine of Nanjing Medical University (Yancheng Third People's Hospital), 224008, Yancheng, China
| | - Fei Chen
- Department of Academic Research, The Yancheng School of Clinical Medicine of Nanjing Medical University (Yancheng Third People's Hospital), 224008, Yancheng, China
- Department of Radiology, The Yancheng School of Clinical Medicine of Nanjing Medical University (Yancheng Third People's Hospital), 224008, Yancheng, China
| | - Shufang Wang
- Department of Neurology, The Yancheng School of Clinical Medicine of Nanjing Medical University (Yancheng Third People's Hospital), 224008, Yancheng, China
| | - Pinglei Pan
- Department of Academic Research, The Yancheng School of Clinical Medicine of Nanjing Medical University (Yancheng Third People's Hospital), 224008, Yancheng, China
- Department of Neurology, The Yancheng School of Clinical Medicine of Nanjing Medical University (Yancheng Third People's Hospital), 224008, Yancheng, China
| | - Tianchi Mu
- Department of Radiology, The Yancheng School of Clinical Medicine of Nanjing Medical University (Yancheng Third People's Hospital), 224008, Yancheng, China
| | - Congsong Dong
- Department of Radiology, The Yancheng School of Clinical Medicine of Nanjing Medical University (Yancheng Third People's Hospital), 224008, Yancheng, China.
| | - Zhenyu Dai
- Department of Radiology, The Yancheng School of Clinical Medicine of Nanjing Medical University (Yancheng Third People's Hospital), 224008, Yancheng, China.
| | - Zhipeng Chen
- Department of Neurology, The Yancheng School of Clinical Medicine of Nanjing Medical University (Yancheng Third People's Hospital), 224008, Yancheng, China.
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Vaccaro MG, Pullano L, Canino S, Pastore M, Sarica A, Quattrone A, Fernandes SM, Migliorini F, Maestu F, Quattrone A. Assessing of the Italian version of the Memory Strategy Test (TMS) in people with Parkinson disease: a preliminary descriptive psychometric study. Neurol Sci 2023; 44:3895-3903. [PMID: 37354323 PMCID: PMC10570218 DOI: 10.1007/s10072-023-06906-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/08/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Previous literature has shown that executive functions (EF) are related to performance in memory (M) tasks. The Test of Memory strategies (TMS) is a psychometric test that examines EF and M simultaneously and it was recently validated on an Italian healthy cohort. The first aim of the study was to apply TMS, for the first time, on a sample of patients with Parkinson's disease (PD), who are characterized by mild cognitive impairment. The second aim is to investigate whether TMS scores can discriminate PD patients from healthy controls. METHOD Ninety-eight subjects were enrolled, including 68 patients with PD, and 30 Italian healthy controls (HC), who also underwent a memory evaluation through well-known tests. RESULTS Confirmatory factor analysis (CFA) demonstrated that TMS of PD patients had a bi-dimensional structure as previously found in healthy cohort. In detail, The TMS-1 and TMS-2 lists require greater involvement of the EF factor, while TMS-3, TMS-4 and TMS-5 the M factor. Receiver operating characteristic (ROC) curves and precision-recall (PR) curves showed that the M subscale can distinguish between HC and PD, while EF had poor discrimination power. CONCLUSION The hypothesized prediction model of TMS test seems to have adequate ability to discriminate PD from HC especially for the M function.
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Affiliation(s)
- Maria Grazia Vaccaro
- Neuroscience Research Centre, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, Germaneto, Catanzaro, 88100, Italy.
| | - Luca Pullano
- Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, 88100, Italy
| | - Silvia Canino
- Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, 88100, Italy
| | - Massimiliano Pastore
- Department of Developmental and Social Psychology, Padova University, Padua, Italy
| | - Alessia Sarica
- Neuroscience Research Centre, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, Germaneto, Catanzaro, 88100, Italy
| | - Andrea Quattrone
- Neuroscience Research Centre, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, Germaneto, Catanzaro, 88100, Italy
| | | | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
| | - Fernando Maestu
- Department of Experimental Psychology, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
- Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, Spain
| | - Aldo Quattrone
- Neuroscience Research Centre, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, Germaneto, Catanzaro, 88100, Italy
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Zhao L, Zhu H, Mao W, Zhou X, Xie Y, Li L. Effects of perioperative cognitive function training on postoperative cognitive dysfunction and postoperative delirium: a systematic review and meta-analysis. Front Neurol 2023; 14:1146164. [PMID: 37416309 PMCID: PMC10322196 DOI: 10.3389/fneur.2023.1146164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/25/2023] [Indexed: 07/08/2023] Open
Abstract
Background Randomized controlled trials (RCTs) have shown conflicting results regarding the effects of perioperative cognitive training (CT) on the incidence of postoperative cognitive dysfunction (POCD) and postoperative delirium (POD). We, therefore, performed a meta-analysis to assess the overall effects of studies on this topic. Methods We searched PubMed, Embase, the Cochrane Library, and Web of Science for all RCTs and cohort studies that investigated the effects of perioperative CT on the incidence of POCD and POD. Data extraction and quality assessment were conducted independently by two researchers. Results This study included nine clinical trials with a total of 975 patients. The results showed that perioperative CT significantly reduced the incidence of POCD compared with the control group [risk ratio (RR) = 0.5, 95% CI (confidence interval): 0.28-0.89, P = 0.02]. Nevertheless, for the incidence of POD, the difference between the two groups was not statistically significant (RR = 0.64; 95% CI: 0.29-1.43, P = 0.28). In addition, the CT group had less postoperative decline in the cognitive function scores compared with the control group [mean differences (MD): 1.58, 95% CI: 0.57-2.59, P = 0.002]. In addition, there were no statistically differences in length of hospital stay between the two groups (MD: -0.18, 95% CI: -0.93-0.57, P = 0.64). Regarding CT adherence, the proportion of patients in the cognitive training group who completed the planned duration of CT was 10% (95% CI: 0.05-0.14, P = 0.258). Conclusion Our meta-analysis revealed that perioperative cognitive training is possibly an effective measure to reduce the incidence of POCD, but not for the incidence of POD. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022371306, identifier: CRD42022371306.
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Qu M, Xing F, Xing N. Mesenchymal stem cells for the treatment of cognitive impairment caused by neurological diseases. Biotechnol Lett 2022; 44:903-916. [PMID: 35809141 DOI: 10.1007/s10529-022-03274-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/17/2022] [Indexed: 11/02/2022]
Abstract
Patients with neurological diseases often have cognitive impairment, which creates a substantial emotional and economic burden for patients and their families. This issue urgently needs to be addressed. The pathological mechanism of this cognitive impairment is a complicated process that involves a variety of cells and molecules, central nervous system inflammatory reactions, oxidative stress, free radical damage and nerve protection factor-related metabolic disorders. Traditional treatments include neuroprotective agents and analgesic therapy. However, analgesic therapy cannot improve cognitive function, and the blood-brain barrier (BBB) largely blocks neuroprotective agents from entering the central nervous system; therefore, it is very important to find a more effective treatment. Mesenchymal stem cells (MSCs) have anti-inflammatory, anti-apoptotic and immunomodulatory properties and have been proven to play an important role in the treatment of many neurodegenerative diseases. Most importantly, MSCs are likely to cross the BBB. Therefore, MSC therapy is regarded as an important means of ameliorating neurological impairment. The purpose of this review is to summarize recent researches on the treatment of cognitive dysfunction caused by neurological diseases with MSCs.
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Affiliation(s)
- Mingcui Qu
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, China
| | - Fei Xing
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, China
| | - Na Xing
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, China.
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Guglietti B, Hobbs DA, Wesson B, Ellul B, McNamara A, Drum S, Collins-Praino LE. Development and Co-design of NeuroOrb: A Novel “Serious Gaming” System Targeting Cognitive Impairment in Parkinson’s Disease. Front Aging Neurosci 2022; 14:728212. [PMID: 35422697 PMCID: PMC9002613 DOI: 10.3389/fnagi.2022.728212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/04/2022] [Indexed: 12/25/2022] Open
Abstract
Whilst Parkinson’s disease (PD) is typically thought of as a motor disease, a significant number of individuals also experience cognitive impairment (CI), ranging from mild-CI to dementia. One technique that may prove effective in delaying the onset of CI in PD is cognitive training (CT); however, evidence to date is variable. This may be due to the implementation of CT in this population, with the motor impairments of PD potentially hampering the ability to use standard equipment, such as pen-and-paper or a computer mouse. This may, in turn, promote negative attitudes toward the CT paradigm, which may correlate with poorer outcomes. Consequently, optimizing a system for the delivery of CT in the PD population may improve the accessibility of and engagement with the CT paradigm, subsequently leading to better outcomes. To achieve this, the NeuroOrb Gaming System was designed, coupling a novel accessible controller, specifically developed for use with people with motor impairments, with a “Serious Games” software suite, custom-designed to target the cognitive domains typically affected in PD. The aim of the current study was to evaluate the usability of the NeuroOrb through a reiterative co-design process, in order to optimize the system for future use in clinical trials of CT in individuals with PD. Individuals with PD (n = 13; mean age = 68.15 years; mean disease duration = 8 years) were recruited from the community and participated in three co-design loops. After implementation of key stakeholder feedback to make significant modifications to the system, system usability was improved and participant attitudes toward the NeuroOrb were very positive. Taken together, this provides rationale for moving forward with a future clinical trial investigating the utility of the NeuroOrb as a tool to deliver CT in PD.
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Affiliation(s)
- Bianca Guglietti
- Cognition, Ageing and Neurodegenerative Disease Laboratory, School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - David A. Hobbs
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Tonsley, SA, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Bradley Wesson
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Tonsley, SA, Australia
| | - Benjamin Ellul
- Cognition, Ageing and Neurodegenerative Disease Laboratory, School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Angus McNamara
- Cognition, Ageing and Neurodegenerative Disease Laboratory, School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Simon Drum
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Lyndsey E. Collins-Praino
- Cognition, Ageing and Neurodegenerative Disease Laboratory, School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- *Correspondence: Lyndsey E. Collins-Praino,
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