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Ortelli P, Versace V, Saltuari L, Randi A, Stolz J, Dezi S, Maestri R, Buechner S, Giladi N, Oliviero A, Sebastianelli L, Ferrazzoli D. Looking deeper: does a connection exist between fatigue and attentional deficits in Parkinson's disease? A conceptual framework. Front Neurol 2023; 14:1212876. [PMID: 37638176 PMCID: PMC10457007 DOI: 10.3389/fneur.2023.1212876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/13/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Paola Ortelli
- Psychology Service, Hospital of Bressanone (SABES-ASDAA) - Teaching Hospital of the Paracelsus Medical Private University (PMU), Bressanone-Brixen, Italy
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy - Teaching Hospital of the Paracelsus Medical Private University (PMU), Salzburg, Austria
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy - Teaching Hospital of the Paracelsus Medical Private University (PMU), Salzburg, Austria
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy - Teaching Hospital of the Paracelsus Medical Private University (PMU), Salzburg, Austria
| | - Anna Randi
- Psychology Service, Hospital of Bressanone (SABES-ASDAA) - Teaching Hospital of the Paracelsus Medical Private University (PMU), Bressanone-Brixen, Italy
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy - Teaching Hospital of the Paracelsus Medical Private University (PMU), Salzburg, Austria
| | - Jakob Stolz
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy - Teaching Hospital of the Paracelsus Medical Private University (PMU), Salzburg, Austria
| | - Sabrina Dezi
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy - Teaching Hospital of the Paracelsus Medical Private University (PMU), Salzburg, Austria
| | - Roberto Maestri
- Istituti Clinici Scientifici Maugeri, IRCCS, Department of Biomedical Engineering of Montescano Institute, Pavia, Italy
| | - Susanne Buechner
- Department of Neurology, Hospital of Bolzano (SABES-ASDAA) - Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Nir Giladi
- Brain Institute, Tel Aviv Soursky Medical Center, Tel Aviv, Israel
- Faculty of Medicine and Sagol School of Neurosciences, Tel Aviv University, Tel Aviv, Israel
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy - Teaching Hospital of the Paracelsus Medical Private University (PMU), Salzburg, Austria
| | - Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy - Teaching Hospital of the Paracelsus Medical Private University (PMU), Salzburg, Austria
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Fournet M, Chiuvé SC, Laganaro M. Attentional Demand of Motor Speech Encoding: Evidence From Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3758-3775. [PMID: 36201164 DOI: 10.1044/2022_jslhr-22-00096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE While the involvement of attention in utterance planning is well established at the conceptual and lexical levels, the attentional demands of postlexical processes are still debated. This study investigates the involvement of attentional resources on motor speech encoding during utterance production in the context of Parkinson's disease (PD), a population allowing to assess if the attentional demands observed in a dual-task paradigm (the dual-task costs [DTCs]) are explained by postlexical difficulties and not solely by executive impairment. METHOD Speech production was analyzed in a dual-task paradigm with 30 participants presenting with motor speech disorders due to hypokinetic dysarthria in the context of PD. The dual-task comprised an automatic speech task in which participants recited the days of the week and two nonverbal tasks evaluating processing speed and inhibition. The severity of dysarthria and performance in several executive tests (inhibition, verbal fluency, and cognitive shifting) were used as potential predictors of the DTCs. RESULTS Individuals with PD exhibited a DTC on the nonverbal tasks and on the speech task when the secondary task was inhibition (the most difficult one). Additionally, the severity of dysarthria and a poorer performance in cognitive shifting predicted a more severe DTC on speech rate. Finally, modulation of the magnitude of the DTCs was observed, depending on the difficulty of the nonverbal secondary task. CONCLUSION The results suggest that, in PD, postlexical processes require attentional resources and cognitive shifting is related to dual-task performance in speech. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21265893.
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Affiliation(s)
- Maryll Fournet
- Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland
- Department of Neurorehabilitation, Geneva University Hospitals, Switzerland
| | | | - Marina Laganaro
- Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland
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Droby A, Varangis E, Habeck C, Hausdorff JM, Stern Y, Mirelman A, Maidan I. Effects of aging on cognitive and brain inter-network integration patterns underlying usual and dual-task gait performance. Front Aging Neurosci 2022; 14:956744. [PMID: 36247996 PMCID: PMC9557358 DOI: 10.3389/fnagi.2022.956744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Aging affects the interplay between cognition and gait performance. Neuroimaging studies reported associations between gait performance and structural measures; however, functional connectivity (FC) analysis of imaging data can help to identify dynamic neural mechanisms underlying optimal performance. Here, we investigated the effects on divergent cognitive and inter-network FC patterns underlying gait performance during usual (UW) and dual-task (DT) walking. Methods A total of 115 community-dwelling, healthy participants between 20 and 80 years were enrolled. All participants underwent comprehensive cognitive and gait assessments in two conditions and resting state functional MRI (fMRI) scans. Inter-network FC from motor-related to 6 primary cognitive networks were estimated. Step-wise regression models tested the relationships between gait parameters, inter-network FC, neuropsychological scores, and demographic variables. A threshold of p < 0.05 was adopted for all statistical analyses. Results UW was largely associated with FC levels between motor and sustained attention networks. DT performance was associated with inter-network FC between motor and divided attention, and processing speed in the overall group. In young adults, UW was associated with inter-network FC between motor and sustained attention networks. On the other hand, DT performance was associated with cognitive performance, as well as inter-network connectivity between motor and divided attention networks (VAN and SAL). In contrast, the older age group (> 65 years) showed increased integration between motor, dorsal, and ventral attention, as well as default-mode networks, which was negatively associated with UW gait performance. Inverse associations between motor and sustained attention inter-network connectivity and DT performance were observed. Conclusion While UW relies on inter-network FC between motor and sustained attention networks, DT performance relies on additional cognitive capacities, increased motor, and executive control network integration. FC analyses demonstrate that the decline in cognitive performance with aging leads to the reliance on additional neural resources to maintain routine walking tasks.
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Affiliation(s)
- Amgad Droby
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility (CMCM), Tel Aviv Sourasky Medical Center, Neurological Institute, Tel Aviv, Israel
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Eleanna Varangis
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY, United States
| | - Christian Habeck
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY, United States
| | - Jeffrey M. Hausdorff
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility (CMCM), Tel Aviv Sourasky Medical Center, Neurological Institute, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
- Department of Orthopedic Surgery, Rush Alzheimer’s Disease Center, Rush University, Chicago, IL, United States
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY, United States
| | - Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility (CMCM), Tel Aviv Sourasky Medical Center, Neurological Institute, Tel Aviv, Israel
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Inbal Maidan
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility (CMCM), Tel Aviv Sourasky Medical Center, Neurological Institute, Tel Aviv, Israel
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
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Ferrazzoli D, Ortelli P, Iansek R, Volpe D. Rehabilitation in movement disorders: From basic mechanisms to clinical strategies. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:341-355. [PMID: 35034747 DOI: 10.1016/b978-0-12-819410-2.00019-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Movement disorders encompass a variety of conditions affecting the nervous system at multiple levels. The pathologic processes underlying movement disorders alter the normal neural functions and could lead to aberrant neuroplastic changes and to clinical phenomenology that is not expressed only through mere motor symptoms. Given this complexity, the responsiveness to pharmacologic and surgical therapies is often disappointing. Growing evidence supports the efficacy of neurorehabilitation for the treatment of movement disorders. Specific form of training involving both goal-based practice and aerobic training could drive and modulate neuroplasticity in order to restore the circuitries dysfunctions and to achieve behavioral gains. This chapter provides an overview of the alterations expressed in some movement disorders in terms of clinical signs and symptoms and plasticity, and suggests which ones and why tailored rehabilitation strategies should be adopted for the management of the different movement disorders.
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Affiliation(s)
- Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Department of Parkinson's Disease, Fresco Parkinson Center, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Gravedona ed Uniti, Como, Italy
| | - Paola Ortelli
- Department of Parkinson's Disease, Fresco Parkinson Center, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Gravedona ed Uniti, Como, Italy; Department of Parkinson's Disease, Fresco Parkinson Center, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Gravedona ed Uniti, Como, Italy
| | - Robert Iansek
- Clinical Research Centre for Movement Disorders and Gait, National Parkinson Foundation Center of Excellence, Monash Health, Cheltenham, VIC, Australia; School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Daniele Volpe
- Department of Rehabilitation, Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
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Yu Q, Li Q, Fang W, Wang Y, Zhu Y, Wang J, Shen Y, Han Y, Zou D, Cheng O. Disorganized resting-state functional connectivity between the dorsal attention network and intrinsic networks in Parkinson's disease with freezing of gait. Eur J Neurosci 2021; 54:6633-6645. [PMID: 34479401 DOI: 10.1111/ejn.15439] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/28/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
Freezing of gait (FOG) is a common and complex manifestation of Parkinson's disease (PD) and is associated with impairment of attention. The purpose of this study was to evaluate the functional network connectivity (FNc) changes between the dorsal attention network (DAN) and the other seven intrinsic networks relevant to attention, visual-spatial, executive and motor functions in PD with or without FOG. Forty-three idiopathic PD patients (21 with FOG [FOG+] versus 22 without FOG [FOG-]) and 18 healthy controls (HC) were recruited in this study. The data-driven independent component analysis (ICA) method was used to extract and analyze the above-mentioned resting-state networks (RSNs). Compared with FOG-, FOG+ displayed decreased positive connectivity between the DAN and medial visual network (mVN) and sensory-motor network (SMN) and increased negative connectivity between the DAN and default mode network (DMN). The within-network connectivity in the SMN and visual networks were decreased, whereas the connectivity within DMN was increased significantly in FOG+. Correlation analysis showed that the clock drawing test (CDT) scores were positively correlated with the functional connectivity of mVN (r = 0.573, p = 0.008) and lateral visual network (lVN) (r = 0.510, p = 0.022), the Timed Up and Go Test (TUG) duration were negatively correlated with the connectivity of SMN (r = -0.629, p = 0.003), and the Frontal Assessment Battery (FAB) scores were negatively correlated with the connectivity of DMN in FOG+. Functional connectivity was changed in multiple intra-networks in patients with FOG. Inordinate inter-network connectivity between the DAN and other intrinsic networks may partly contribute to the mechanism of freezing.
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Affiliation(s)
- Qian Yu
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Qun Li
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Weidong Fang
- Department of Radiology, the First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yuchan Wang
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yingcheng Zhu
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Juan Wang
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yalian Shen
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yu Han
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Dezhi Zou
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Oumei Cheng
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Hommel ALAJ, Meinders MJ, Weerkamp NJ, Richinger C, Schmotz C, Lorenzl S, Dodel R, Coelho M, Ferreira JJ, Tison F, Boraud T, Meissner WG, Rosqvist K, Timpka J, Odin P, Wittenberg M, Bloem BR, Koopmans RT, Schragand A. Optimizing Treatment in Undertreated Late-Stage Parkinsonism: A Pragmatic Randomized Trial. JOURNAL OF PARKINSONS DISEASE 2020; 10:1171-1184. [PMID: 32568111 DOI: 10.3233/jpd-202033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Treatment of patients with late-stage parkinsonism is often sub-optimal. OBJECTIVE To test the effectiveness of recommendations by a movement disorder specialist with expertise in late-stage parkinsonism. METHODS Ninety-one patients with late-stage parkinsonism considered undertreated were included in apragmatic a pragmatic multi-center randomized-controlled trial with six-month follow-up. The intervention group received a letter with treatment recommendations to their primary clinician based on an extensive clinical assessment. Controls received care as usual. The primary outcome was the Unified Parkinson Disease Rating Scale (UPDRS)part-II (Activities of Daily Living). Other outcomes included quality-of-life (PDQ-8), mental health (UPDRS-I), motor function (UPDRS-III), treatment complications (UPDRS-IV), cognition (Mini-mental-state-examination), non-motor symptoms (Non-Motor-Symptoms-scale), health status (EQ-5D-5L) and levodopa-equivalent-daily-dose (LEDD). We also assessed adherence to recommendations. In addition to intention-to-treat analyses, a per-protocol analysis was conducted. RESULTS Sample size calculation required 288 patients, but only 91 patients could be included. Treating physicians followed recommendations fully in 16 (28%) and partially in 21 (36%) patients. The intention-to-treat analysis showed no difference in primary outcome (between-group difference = -1.2, p = 0.45), but there was greater improvement for PDQ-8 in the intervention group (between-group difference = -3.7, p = 0.02). The per-protocol analysis confirmed these findings, and showed less deterioration in UPDRS-part I, greater improvement on UPDRS-total score and greater increase in LEDD in the intervention group. CONCLUSIONS The findings suggest that therapeutic gains may be reached even in this vulnerable group of patients with late-stage parkinsonism, but also emphasize that specialist recommendations need to be accompanied by better strategies to implement these to further improve outcomes.
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Affiliation(s)
- Adrianus L A J Hommel
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands; Groenhuysen Organisation, Roosendaal, the Netherlands
| | - Marjan J Meinders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientici Center for Quality of Healthcare, Nijmegen, the Netherlands
| | - Nico J Weerkamp
- Department of Neurology, Bronovo Medical Center, The Hague, The Netherlands
| | - Carmen Richinger
- Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München - Klinikum Großhadern, Munich, Germany. Institute of Nursing Science and -Practice, Paracelsus Medical University Salzburg, Austria
| | - Christian Schmotz
- Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München - Klinikum Großhadern, Munich, Germany. Institute of Nursing Science and -Practice, Paracelsus Medical University Salzburg, Austria
| | - Stefan Lorenzl
- Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München - Klinikum Großhadern, Munich, Germany. Institute of Nursing Science and -Practice, Paracelsus Medical University Salzburg, Austria
| | - Richard Dodel
- Department of Geriatric Medicine, University Hospital Essen, Essen, Germany
| | - Miguel Coelho
- Instituto de Medicina Molecular Universidad di Lisboa, Lisbon, Portugal
| | | | - Francois Tison
- Service de Neurologie, CHU de Bordeaux, Bordeaux, France and Univ. de Bordeaux, Institut des Maladies Neurodégénératives, CNRS, UMR 5293, Bordeaux, France
| | - Thomas Boraud
- Service de Neurologie, CHU de Bordeaux, Bordeaux, France and Univ. de Bordeaux, Institut des Maladies Neurodégénératives, CNRS, UMR 5293, Bordeaux, France
| | - Wassilios G Meissner
- Service de Neurologie, CHU de Bordeaux, Bordeaux, France and Univ. de Bordeaux, Institut des Maladies Neurodégénératives, CNRS, UMR 5293, Bordeaux, France.,Department of Medicine, University of Otago, Christchurch, New Zealand and New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Kristina Rosqvist
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Jonathan Timpka
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Per Odin
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Michael Wittenberg
- Coordinating Centre for Clinical Trials (KKS), Philipps-University Marburg, Marburg, Germany
| | - Bas R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands
| | - Raymond T Koopmans
- Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands; Joachim en Anna, Center for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Anette Schragand
- UCL Queen Square Institute of Neurology, University College London, Royal Free Campus, Rowland Hill Street, London, UK
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Ferrazzoli D, Ortelli P, Cucca A, Bakdounes L, Canesi M, Volpe D. Motor-cognitive approach and aerobic training: a synergism for rehabilitative intervention in Parkinson's disease. Neurodegener Dis Manag 2020; 10:41-55. [PMID: 32039653 DOI: 10.2217/nmt-2019-0025] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Parkinson's disease (PD) results in a complex deterioration of motor behavior. Effective pharmacological or surgical treatments addressing the whole spectrum of both motor and cognitive symptoms are lacking. The cumulative functional impairment may have devastating socio-economic consequences on both patients and caregivers. Comprehensive models of care based on multidisciplinary approaches may succeed in better addressing the overall complexity of PD. Neurorehabilitation is a highly promising non-pharmacological intervention for managing PD. The scientific rationale beyond rehabilitation and its practical applicability remain to be established. In the present perspective, we aim to discuss the current evidence supporting integrated motor-cognitive and aerobic rehabilitation approaches for patients with PD while suggesting a practical framework to optimize this intervention in the next future.
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Affiliation(s)
- Davide Ferrazzoli
- Fresco Parkinson Center, Department of Parkinson's disease, Movement Disorders & Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital - Gravedona ed Uniti, Como, 22015, Italy
| | - Paola Ortelli
- Fresco Parkinson Center, Department of Parkinson's disease, Movement Disorders & Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital - Gravedona ed Uniti, Como, 22015, Italy
| | - Alberto Cucca
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, 36057, Italy.,The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, Department of Neurology, NYU School of Medicine, New York, NY 10017, USA
| | - Leila Bakdounes
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, 36057, Italy
| | - Margherita Canesi
- Fresco Parkinson Center, Department of Parkinson's disease, Movement Disorders & Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital - Gravedona ed Uniti, Como, 22015, Italy
| | - Daniele Volpe
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, 36057, Italy
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Spencer KA, Paul J, Brown KA, Ellerbrock T, Sohlberg MM. Cognitive Rehabilitation for Individuals With Parkinson's Disease: Developing and Piloting an External Aids Treatment Program. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1-19. [PMID: 31697899 DOI: 10.1044/2019_ajslp-19-0078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Cognitive deficits are common in Parkinson's disease (PD) and can have a detrimental effect on daily activities. To date, most cognitive treatments have had an impairment-based focus with primary outcome measures of formal neuropsychological test scores. Few, if any, studies have focused on functional improvement or patient-centered goals. Method Three individuals with idiopathic PD participated in an 8-week pilot treatment program to train for the use of compensatory external aids to achieve personalized goals. Goal attainment scaling was the primary outcome measure, which was independently judged by multiple raters at baseline, postintervention, and 1 month posttreatment and analyzed via T-score analysis. Descriptive measures, including self-report and spouse-report rating scales of cognitive functioning, were employed. Results All 3 participants improved in the majority of their laboratory and home goals posttreatment, as measured by goal attainment scaling, and maintained gains for the majority of goals 1 month posttreatment. Conclusions This is the 1st known study to implement an external aids treatment program with patient-centered goals for individuals with cognitive deficits from PD. Positive outcomes were likely influenced by 3 factors: (a) a theoretically motivated focus on external aids; (b) a well-documented, systematic approach to instruction; and (c) the personalization of goals. Supplemental Material https://doi.org/10.23641/asha.10093493.
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Affiliation(s)
- Kristie A Spencer
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Jennifer Paul
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Katherine A Brown
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Taylor Ellerbrock
- Department of Speech and Hearing Sciences, University of Washington, Seattle
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Maidan I, Jacob Y, Giladi N, Hausdorff JM, Mirelman A. Altered organization of the dorsal attention network is associated with freezing of gait in Parkinson's disease. Parkinsonism Relat Disord 2019; 63:77-82. [DOI: 10.1016/j.parkreldis.2019.02.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 02/20/2019] [Accepted: 02/22/2019] [Indexed: 01/29/2023]
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Clerici I, Maestri R, Bonetti F, Ortelli P, Volpe D, Ferrazzoli D, Frazzitta G. Land Plus Aquatic Therapy Versus Land-Based Rehabilitation Alone for the Treatment of Freezing of Gait in Parkinson Disease: A Randomized Controlled Trial. Phys Ther 2019; 99:591-600. [PMID: 30657995 DOI: 10.1093/ptj/pzz003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 10/14/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Freezing of gait (FOG) is one of the most disabling symptoms of Parkinson disease (PD). Different land-based rehabilitation approaches based on motor and cognitive strategies can be effective in treating FOG. Although there are data about the efficacy of aquatic therapy in ameliorating this phenomenon, no study has explored the combined effect of land-based therapies plus aquatic therapy in patients with PD who have FOG. OBJECTIVE The objective was to investigate the effectiveness of a multidisciplinary, intensive, motor-cognitive rehabilitation treatment (MIRT) in improving FOG and whether implementation with aquatic therapy (MIRT-AT) adds further benefits. DESIGN The design consisted of a single-blind, parallel-group, 1:1 allocation ratio, randomized trial. SETTING The Department of Parkinson Disease, Movement Disorders and Brain Injury Rehabilitation at "Moriggia-Pelascini" Hospital (Gravedona ed Uniti, Como, Italy) was used as the setting. PARTICIPANTS Sixty hospitalized patients with PD who had FOG in Hoehn and Yahr stage 2 or 5-3 were included. INTERVENTION Sixty patients with PD + FOG were randomly assigned to 2 groups: 30 underwent a 4-week MIRT and 30 underwent a 4-week MIRT-AT. MEASUREMENTS The primary outcome measure was the Freezing of Gait Questionnaire; secondary outcome measures were total Unified Parkinson Disease Rating Scale (UPDRS), UPDRS II, UPDRS III, Berg Balance Scale, Timed Up and Go Test, and 6-Minute Walk Test. These measures were assessed both at admission and discharge. RESULTS Participants in the 2 groups had similar age, sex distribution, Hoehn and Yahr stage, and most-affected side. At baseline, no difference in outcome measures was observed between the 2 groups. After treatment, a significant time effect was observed for all variables in both groups. No significant time × group interaction was observed. A between-group analysis showed nonsignificant differences between values at T1 and values at T0 for all variables. LIMITATIONS The limitations were the lack of a control group and follow-up. CONCLUSIONS We showed that a multidisciplinary, intensive, and goal-based rehabilitation treatment, such as MIRT, improves FOG in patients with PD. Although aquatic therapy could be considered a useful approach for treating FOG, it does not add further benefits to this kind of motor-cognitive rehabilitation.
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Affiliation(s)
- Ilaria Clerici
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, Italy
| | - Roberto Maestri
- Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS, Pavia, Italy
| | - Francesca Bonetti
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital
| | - Paola Ortelli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital
| | - Daniele Volpe
- Center for Parkinson's Disease and Movement Disorders, "Villa Margherita" Healthcare Facility, Arcugnano, Vicenza, Italy
| | - Davide Ferrazzoli
- Department of Parkinson's disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, via Pelascini, 3, Gravedona ed Uniti (CO), 22015, Italy
| | - Giuseppe Frazzitta
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital
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11
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Ortelli P, Ferrazzoli D, Zarucchi M, Maestri R, Frazzitta G. Asymmetric Dopaminergic Degeneration and Attentional Resources in Parkinson's Disease. Front Neurosci 2018; 12:972. [PMID: 30618591 PMCID: PMC6304447 DOI: 10.3389/fnins.2018.00972] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 12/04/2018] [Indexed: 12/24/2022] Open
Abstract
Background: Attention is crucial to voluntary perform actions in Parkinson's disease (PD), allowing patients to bypass the impaired habitual motor control. The asymmetrical degeneration of the dopaminergic system could affect the attentional functions. Objective: To investigate the relationship between the asymmetric dopaminergic degeneration and the attentional resources in Parkinsonian patients with right-side (RPD) and left-side (LPD) motor symptoms predominance. Methods: 50 RPD, 50 LPD, and 34 healthy controls underwent visual (V), auditory (A), and multiple choices (MC) reaction time (RTs) tasks. For PD patients, these tasks were performed before and after a 4-week intensive, motor-cognitive rehabilitation treatment (MIRT). The effectiveness of treatment was evaluated assessing Unified Parkinson's disease Rating Scale (UPDRS) III and Timed-up and Go Test (TUG). Results: RTs did not differ between PD patients and healthy controls. Before MIRT, no differences between LPD and RPD patients were observed in RTs (p = 0.20), UPDRS III (p = 0.60), and TUG (p = 0.38). No differences in dopaminergic medication were found between groups (p = 0.44 and p = 0.66 before and after MIRT, respectively). After MIRT, LPD patients showed a significant reduction in MC RTs (p = 0.05), V RTs (p = 0.02), and MC-V RTs. A significant association between changes in RTs and improvements in UPDRS III and TUG was observed in LPD patients. Conclusion: attention does not differ among RPD patients, LPD patients and healthy controls. Only LPD patients improved their performances on attentional tasks after MIRT. We argue that the increased early susceptibility of the left nigrostriatal system to degeneration affects differently the cognitive modifiability and the neuroplastic potential. Our results could provide insight into new therapeutic approaches, highlighting the importance to design different treatments for RPD patients and LPD patients.
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Affiliation(s)
- Paola Ortelli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, Moriggia-Pelascini Hospital, Como, Italy
| | - Davide Ferrazzoli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, Moriggia-Pelascini Hospital, Como, Italy
| | - Marianna Zarucchi
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, Moriggia-Pelascini Hospital, Como, Italy
| | - Roberto Maestri
- Istituti Clinici Scientifici Maugeri - Istituto di Ricovero e Cura a Carattere Scientifico, Biomedical Engineering Unit of Montescano Institute, Pavia, Italy
| | - Giuseppe Frazzitta
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, Moriggia-Pelascini Hospital, Como, Italy
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12
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Ferrazzoli D, Ortelli P, Zivi I, Cian V, Urso E, Ghilardi MF, Maestri R, Frazzitta G. Efficacy of intensive multidisciplinary rehabilitation in Parkinson's disease: a randomised controlled study. J Neurol Neurosurg Psychiatry 2018; 89:828-835. [PMID: 29321141 PMCID: PMC6204945 DOI: 10.1136/jnnp-2017-316437] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 11/21/2017] [Accepted: 12/11/2017] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To evaluate whether a 4-week multidisciplinary, aerobic, motor-cognitive and intensive rehabilitation treatment (MIRT) improves the quality of life (QoL) of patients with Parkinson's disease (PD), in the short-term and long-term period. METHODS This is a prospective, parallel-group, single-centre, single-blind, randomised clinical trial (ClinicalTrials.gov NCT02756676). 186 patients with PD, assigned to experimental group, underwent MIRT; conversely, 48 patients, assigned to control group, did not receive rehabilitation. Parkinson's Disease Questionnaire-39 was assessed 2 (T0), 10 (T1) and 18 (T2, only experimental group) weeks after the enrolment. We compared T1 versus T0 scores within subjects and delta scores (T1-T0) between subjects. To investigate the long-term effects, we compared T2 and T0 scores in the experimental group. RESULTS At T0, no between-group differences in the Global Index Score (GBI) were observed (experimental group: 43.6±21.4, controls: 41.6±22.9, P=0.50). At T1, we did not find significant changes in controls (delta score: 1.2±9.9, P=0.23), and we found an improvement in GBI in the experimental group (delta score: -8.3±18.0, P<0.0001), significant also between subjects (P<0.0001). Comparing T2 versus T0 in the experimental group, the GBI maintained a significant improvement (delta score: -4.8±17.5, P<0.0001). CONCLUSIONS A rehabilitation treatment such as MIRT could improve QoL in patients with PD in the short-term and long-term period. Even though the single-blind design and the possible role of the placebo effect on the conclusive results must be considered as limitations of this study, the improvement in outcome measure, also maintained after a 3-month follow-up period, suggests the effectiveness of MIRT on the QoL. CLINICAL TRIAL REGISTRATION NCT02756676: Pre-results.
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Affiliation(s)
- Davide Ferrazzoli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Italy
| | - Paola Ortelli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Italy
| | - Ilaria Zivi
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Italy
| | - Veronica Cian
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Italy
| | - Elisa Urso
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Italy
| | - Maria Felice Ghilardi
- Department of Physiology, Pharmacology and Neuroscience, CUNY Medical School, New York, New York, USA
| | - Roberto Maestri
- Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS, Montescano, Italy
| | - Giuseppe Frazzitta
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Italy
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13
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Ferrazzoli D, Ortelli P, Madeo G, Giladi N, Petzinger GM, Frazzitta G. Basal ganglia and beyond: The interplay between motor and cognitive aspects in Parkinson's disease rehabilitation. Neurosci Biobehav Rev 2018; 90:294-308. [PMID: 29733882 DOI: 10.1016/j.neubiorev.2018.05.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/28/2018] [Accepted: 05/03/2018] [Indexed: 02/08/2023]
Abstract
Parkinson's disease (PD) is characterized by motor and cognitive dysfunctions, affecting the motor behaviour. We summarize evidence that the interplay between motor and cognitive approaches is crucial in PD rehabilitation. Rehabilitation is complementary to pharmacological therapy and effective in reducing the PD disturbances, probably acting by inducing neuroplastic effects. The motor behaviour results from a complex integration between cortical and subcortical areas, underlying the motor, cognitive and motivational aspects of movement. The close interplay amongst these areas makes possible to learn, control and express habitual-automatic actions, which are dysfunctional in PD. The physiopathology of PD could be considered the base for the development of effective rehabilitation treatments. As the volitional action control is spared in early-medium stages of disease, rehabilitative approaches engaging cognition permit to achieve motor benefits and appear to be the most effective for PD. We will point out data supporting the relevance of targeting both motor and cognitive aspects in PD rehabilitation. Finally, we will discuss the role of cognitive engagement in motor rehabilitation for PD.
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Affiliation(s)
- Davide Ferrazzoli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Via Pelascini, 3, Gravedona ed Uniti, 22015, Como, Italy.
| | - Paola Ortelli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Via Pelascini, 3, Gravedona ed Uniti, 22015, Como, Italy.
| | - Graziella Madeo
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Via Pelascini, 3, Gravedona ed Uniti, 22015, Como, Italy.
| | - Nir Giladi
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Centre, Sieratzki Chair in Neurology, Sackler School of Medicine, Sagol School for Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.
| | - Giselle M Petzinger
- Department of Neurology, University of Southern California, Los Angeles, CA, 90033, United States; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, 90033, United States.
| | - Giuseppe Frazzitta
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Via Pelascini, 3, Gravedona ed Uniti, 22015, Como, Italy.
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14
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Ferrazzoli D, Ortelli P, Riboldazzi G, Maestri R, Frazzitta G. Effectiveness of Rotigotine plus intensive and goal-based rehabilitation versus Rotigotine alone in "de-novo" Parkinsonian subjects: a randomized controlled trial with 18-month follow-up. J Neurol 2018; 265:906-916. [PMID: 29442177 PMCID: PMC5878188 DOI: 10.1007/s00415-018-8792-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 01/20/2023]
Abstract
Background Dopamine Replacement Therapy (DRT) represents the most effective treatment for Parkinson’s disease (PD). Nevertheless, several symptoms are unresponsive to treatment and its long-term use leads to serious side effects. To optimize the pharmacological management of PD, dopamine-agonists are often prescribed to “de-novo” patients. Moreover, several studies have shown the effectiveness and the synergic effect of rehabilitation in treating PD. Objective To evaluate the synergism between DRT and rehabilitation in treating PD, by investigating the short and the long-term effectiveness of a multidisciplinary, intensive and goal-based rehabilitation treatment (MIRT) in a group of patients treated with Rotigotine. Materials and methods In this multicenter, single blinded, parallel-group, 1:1 allocation ratio, randomized, non-inferiority trial, 36 “de-novo” PD patients were evaluated along 18 months: 17 were treated with Rotigotine plus MIRT; 19 were treated with Rotigotine alone (R). The primary outcome measure was the total score of Unified Parkinson’s Disease Rating Scale (UPDRS). The secondary outcomes included the UPDRS sub-sections II and III (UPDRS II-III), the 6-Minute Walk Test (6MWT), the Timed Up and Go Test (TUG) and the amount of Rotigotine. Patients were evaluated at baseline (T0), 6 months (T1), 1 year (T2), and at 18 months (T3). Results No differences in UPDRS scores in the two groups (total score, III part and II part, p = 0.48, p = 0.90 and p = 0.40, respectively) were found in the time course. Conversely, a greater improvement in Rotigotine + MIRT group was observed for 6MWT (p < 0.0001) and TUG (p = 0.03). Along time, the dosage of Rotigotine was higher in patients who did not undergo MIRT, at all observation times following T0. Conclusions Over the course of 18 months, the effectiveness of the combined treatment (Rotigotine + MIRT) on the patients’ global clinical status, evaluated with total UPDRS, was not inferior to that of the pharmacological treatment with Rotigotine alone. Importantly, rehabilitation allowed patients to gain better motor performances with lower DRT dosage.
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Affiliation(s)
- D Ferrazzoli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Via Pelascini 3, Gravedona ed Uniti (CO), 22015, Como, Italy.
| | - P Ortelli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Via Pelascini 3, Gravedona ed Uniti (CO), 22015, Como, Italy
| | - G Riboldazzi
- Parkinson's Disease and Movement Disorders Center, ASST dei Sette Laghi, Varese, Italy
- Parkinson's disease Rehabilitation Center, Fondazione Borghi, Brebbia, Varese, Italy
| | - R Maestri
- Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS, Via per Montescano 3, Montescano, 27040, Pavia, Italy
| | - G Frazzitta
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Via Pelascini 3, Gravedona ed Uniti (CO), 22015, Como, Italy
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15
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Promising non-pharmacological therapies in PD: Targeting late stage disease and the role of computer based cognitive training. Parkinsonism Relat Disord 2018; 46 Suppl 1:S42-S46. [DOI: 10.1016/j.parkreldis.2017.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/31/2017] [Accepted: 09/02/2017] [Indexed: 01/15/2023]
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