Dual-Task-Based Drum Playing with Rhythmic Cueing on Motor and Attention Control in Patients with Parkinson's Disease: A Preliminary Randomized Study

Combinations of physical and cognitive training for subcortical neurodegenerative diseases with physical, cognitive and behavioral symptoms: a systematic review

BACKGROUND

The onset of the symptoms of subcortical NDs is due to a unique part of the brain which strengthens the idea of reciprocal influence of physical activity and cognitive training in improving clinical symptoms. Consequently, protocols combining the two stimulations are becoming increasingly popular in NDs. Our threefold aim was to (A) describe the different combinations of physical and cognitive training used to alleviate the motor and cognitive symptoms of patients with subcortical neurodegenerative disorders, (B) compare the effects of these different combinations (sequential, dual tasking, synergical) on symptoms, and (C) recommend approaches for further studies.

METHODS

We conducted literature searches of PubMed, BASE and ACM, to carry out a systematic review of randomized controlled trials and controlled trials of combined physical and cognitive training among patients with Huntington's disease, Parkinson's disease, amyotrophic lateral sclerosis, Lewy body dementia, spinocerebellar ataxia, Friedreich's ataxia, and progressive supranuclear palsy. Physical, neuropsychological, behavioral outcomes were considered. The Cochrane risk-of-bias tool was used to verify the critical appraisal.

RESULTS

Twenty-one studies focused on Parkinson's disease with 940 participants were included. Despites promising benefits on cognitive and physical function, our results revealed discrepant findings for research on combined training.

DISCUSSION

Inconsistencies were linked to the choice of tests, the functions that were targeted, disease progression, and trainings. There was a dearth of follow-up data.

CONCLUSIONS

Differences between combined training are unclear, particularly regarding the role of cognitive load. Future studies should focus on comparing the feasibility, tolerability, and effectiveness of different combinations of motor-cognitive training.

Association between cognitive performance and manual dexterity in patients with Parkinson's disease

INTRODUCTION

Parkinson's disease (PD) is a progressive neurological condition resulting from the degeneration of dopaminergic neurons in the substantia nigra. Impaired manual dexterity and cognitive impairment are common symptoms and are often associated with recurrent adverse events in this population.

OBJECTIVE

To verify the association between cognitive performance and manual dexterity in people with PD.

METHODS

This is a cross-sectional observational study, with 29 participants, who underwent cognitive and manual dexterity assessments, and the following tools were used: Trail Making Test, box and block test (BBT), Learning Test of Rey and Nine Hole Peg Test. Descriptive statistics for clinical and demographic data were performed using mean and standard deviation, and data normality was assessed using the Shapiro-Wilk test. Spearman's nonparametric test was used to determine the correlation between variables.

RESULTS

Our findings revealed significant associations between cognitive performance and manual dexterity. The nine-hole peg test positively correlated with TMT-Part A and Part B, establishing a relationship between manual dexterity and cognitive functions such as attention and mental flexibility. On the other hand, BBT showed an inverse relationship with TMT-Part B, indicating that longer time on this task was associated with lower manual dexterity.

CONCLUSION

Fine manual dexterity had a significant correlation with visual search skills and motor speed, while gross motor dexterity had a negative correlation with cognitive skills. No significant results were demonstrated regarding the interaction between manual dexterity and memory.

Cognitive Stimulation with Music in Older Adults with Cognitive Impairment: A Scoping Review

BACKGROUND

The use of music in cognitive interventions represents a possibility with potential worthy of further investigation in the field of aging, both in terms of prevention from dementia, in the phase of mild cognitive impairment, and in the treatment of overt dementia.

OBJECTIVES

Currently, the types of music-based interventions proposed in the literature are characterized by wide heterogeneity, which is why it is necessary to clarify which interventions present more evidence of effectiveness in stimulating different cognitive domains.

METHOD

The study was conducted in accordance with PRISMA guidelines for scoping reviews. By searching two different databases, PubMed and the Web of Science, all studies evaluating the cognitive effects of music-based interventions on people at early stages of cognitive decline (MCI or mild-to-moderate dementia) were selected.

RESULTS

The study selection included a total of 28 studies involving n = 1612 participants (mean age ranged from 69.45 to 85.3 years old). Most of the studies analyzed agree with the observation of an improvement, or at least maintenance, of global cognitive conditions (mainly represented by the results of the MMSE test) following music-based interventions, together with a series of other positive effects on verbal fluency, memory, and executive processes.

CONCLUSIONS

The results of this review suggest the introduction of music-based interventions as complementary approaches to usual cognitive treatments. Also, the use of standardized and well-defined protocols, in addition to strong methodological research approaches, is suggested. Music-based interventions are recommended in the early stages of dementia, in MCI, and in a preventive sense in healthy older adults.

Effects of Upper Limb Exercise or Training on Hand Dexterity and Function in People With Parkinson Disease: A Systematic Review and Meta-analysis

OBJECTIVE

This systematic review investigated the effects of exercise and training on hand dexterity and function outcomes in people with Parkinson disease (PD).

DATA SOURCES

We searched 5 databases (MEDLINE Ovid, CINAHL, PEDro, PubMed, Cochrane Database) from inception to October 2022.

STUDY SELECTION

Included studies were randomized controlled trials delivering upper limb exercise or training interventions to people with PD and evaluating 1 or more upper limb activity outcomes. Two independent reviewers screened 668 articles for inclusion.

DATA EXTRACTION

Two reviewers independently extracted data relating to study participants, intervention characteristics, and key outcomes. Cochrane Risk of Bias and GRADE tools assessed methodological quality of included studies, and strength of evidence for 3 outcomes: hand dexterity, self-reported hand function, and handwriting performance. Meta-analyses synthesized results for within-hand dexterity and self-reported function.

RESULTS

Eighteen randomized controlled trials (n=704) with low to unclear risk of bias were identified. Experimental interventions varied considerably in their approach and treatment dose, and 3 studies focused on training handwriting. Meta-analysis showed moderate quality evidence of a small positive effect on within-hand dexterity (SMD=0.26; 95% CI 0.07, 0.44). Very low-quality evidence pointed toward a nonsignificant effect on self-reported hand function (SMD=0.67; 95% CI -0.40, 1.75). A narrative review of handwriting interventions showed low quality evidence for improved performance after training.

CONCLUSIONS

There is moderate certainty of evidence supporting the use of exercise and training to address dexterity problems, but evidence remains unclear for self-reported hand function and handwriting. Our findings suggest that training could employ task-related approaches. Future research should interrogate aspects of clinical practice such as optimal dose and key ingredients for effective interventions.

[Effects on cognitive processes of dual-task training in people with Parkinson's disease: a systematic review]

INTRODUCTION

Dual-tasking is a non-pharmacological intervention in people with neurodegenerative conditions, and is used in Parkinson's disease (PD), primarily to enhance motor performance. The aim of this review is to compile the current evidence on how dual-task training affects cognitive processes in people with PD.

MATERIAL AND METHODS

A systematic review was undertaken, applying PRISMA guidelines, which included articles obtained from the PubMed, Web of Science, Science Direct and Springer Link databases. Methodological quality was assessed using PEDro and ROBINS-I.

RESULTS

Twelve articles met the inclusion and exclusion criteria: nine of them were randomized controlled trials, and the remaining three were non-randomized studies. Improvements in attention and executive functions were identified, although the diversity of approaches and duration means that reaching definitive conclusions is difficult.

CONCLUSIONS

Increased research and standardized intervention programmes are essential. Longitudinal and randomized controlled studies in representative samples which provide conclusions that are applicable to other contexts are also important.

Effects of movement training based on rhythmic auditory stimulation in cognitive impairment: a meta-analysis of randomized controlled clinical trial

Objective

According to the World Alzheimer's Disease Report in 2015,there were 9.9 million new cases of dementia in the world every year. At present, the number of patients suffering from dementia in China has exceeded 8 million, and it may exceed 26 million by 2040.Mild cognitive impairment (MCI) refers to the pathological state of pre-dementia with the manifestation of the progressive decline of memory or other cognitive functions but without decline of activities of daily life. It is particularly important to prevent or prolong the development of MCI into dementia. Research showing effects of rhythmic auditory stimulation based-movement training(RASMT) interventions on cognitive function is also emerging. Therefore, the present meta-analysis briefly summarize findings regarding the impacts of RASMT programs on cognitive impairment.

Methods

Data from Pubmed, Embase, and Cochrane Library were utilized. The impact of RASMT on cognitive functions was evaluated using indicators such as overall cognitive status, memory, attention, and executive functions. The REVMAN5.3 software was employed to analyze bias risks integrated into the study and the meta-analysis results for each indicator.

Results

A total of 1,596 studies were retrieved, of which 1,385 non-randomized controlled studies and 48 repetitive studies were excluded. After reviewing titles and abstracts of the remaining 163 articles, 133 irrelevant studies were excluded, 30 studies were downloaded and read the full text. Among 30 articles, 18 articles that did not meet the inclusion criteria were excluded, the other 12 studies were included in this meta-analysis. Utilizing the Cochrane Collaborative Network Bias Risk Assessment Scale, it was found that 11 studies explained the method of random sequence generation, nine studies did not describe allocation concealment, four were single-blinded to all researchers, and eight reported single-blinding in the evaluation of experimental results. In the meta-analysis, the main outcomes showed statistically significant differences in overall cognitive status [MD = 1.19, 95%CI (0.09, 2.29), (p < 0.05)], attention [MD = -1.86, 95%CI (-3.53, -0.19), (p < 0.05)], memory [MD = 0.71, 95%CI (0.33, 1.09), (p < 0.01)], and executive function [MD = -0.23, 95% CI (-0.44, -0.02), (p < 0.05)]. Secondary outcomes indicated no statistically significant differences in verbal fluency [MD = -0.51, 95%CI (-1.30, 0.27), (p = 0.20)], while depression [MD = -0.29, 95% CI (-0.42, -0.16), (p < 0.01)] and anxiety [MD = 0.19, 95% CI (0.06, 0.32), (p < 0.01)] exhibited statistically significant differences. The GRADEpro GDT online tool assessed the quality of evidence for the outcome measures, revealing one low-quality outcome, two moderate-quality outcomes, and one high-quality outcome in this review.

Conclusion

This study shows that RASMT can improve the general cognitive status, memory, attention and executive function of patients with cognitive impairment. The quality of evidence revealed that MMSE was low, attention and memory were moderate, and executive function was high. The RAMST program (type of exercise: play percussion instruments; time of exercise: 30-60 min; frequency of exercise: 2-3 times/week; duration of exercise: more than 12 weeks) was proved to be more effective in improving cognitive function. However, the sample size is relatively insufficient, the future needs further study.

Systematic review registration

PROSPERO, identifier: CRD42023483561.

The transformative power of music: Insights into neuroplasticity, health, and disease

Music is a universal language that can elicit profound emotional and cognitive responses. In this literature review, we explore the intricate relationship between music and the brain, from how it is decoded by the nervous system to its therapeutic potential in various disorders. Music engages a diverse network of brain regions and circuits, including sensory-motor processing, cognitive, memory, and emotional components. Music-induced brain network oscillations occur in specific frequency bands, and listening to one's preferred music can grant easier access to these brain functions. Moreover, music training can bring about structural and functional changes in the brain, and studies have shown its positive effects on social bonding, cognitive abilities, and language processing. We also discuss how music therapy can be used to retrain impaired brain circuits in different disorders. Understanding how music affects the brain can open up new avenues for music-based interventions in healthcare, education, and wellbeing.

Acupuncture therapy for Parkinson's disease: a case report demonstrating symptomatic improvement without medication

Background

Parkinson's disease (PD) often necessitates immediate medical intervention following diagnosis. In recent years, there has been a noticeable increase in clinical investigations assessing the efficacy of acupuncture in PD, with many studies reporting positive outcomes. Ethical guidelines commonly endorse pharmaceutical therapies for PD, leading ongoing research to combine acupuncture with standard drug-based treatments. At present, there is a conspicuous absence of dedicated clinical research exclusively examining the independent impact of acupuncture on PD treatment.

Case

In a clinical observation, we documented a case involving a 75-year-old male displaying progressive, characteristic PD symptoms, including evident limb tremors, rigidity, bradykinesia, fatigue, and additional non-motor symptoms. The patient received a confirmed diagnosis of PD. Due to the refusal of the patient to take medication, we exclusively administered acupuncture therapy. The outcomes indicated a noteworthy enhancement in the clinical symptoms of the patient solely through acupuncture intervention.

Conclusion

This case affirms that using acupuncture in isolation significantly improved both the motor and non-motor symptoms in the patient. Acupuncture could potentially serve as an alternative therapy for patients who decline or are intolerant to anti-Parkinson drugs. However, further studies are needed to assess its long-term efficacy. This case report obtained approval from the Ethics Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine (Ethics number: K-2023-127).

Side of motor symptom onset predicts sustained attention deficits and motor improvements after attention training in Parkinson's disease

OBJECTIVE

Parkinson's disease (PD) side of motor symptom onset has been associated with distinct cognitive deficits; individuals with left-side onset (LPD) show more visuospatial impairments, whereas those with right-side onset (RPD) show more verbal impairments. Non-spatial attention is a critical cognitive ability associated with motor functioning that is right hemisphere lateralized but has not been characterized with regard to PD side of onset. We compared individuals with LPD and RPD on non-spatial attention tasks and examined differential responses to a 4-week sustained attention training program.

METHOD

Participants included 9 with LPD and 12 with RPD, who performed both brief and extended go/no-go continuous performance tasks and an attentional blink task. Participants also engaged in an at-home sustained attention training program, Tonic and Phasic Alertness Training (TAPAT), 5 days/week for 4 weeks. We assessed cognitive and motor symptoms before and after training, and after a 4-week no-contact period.

RESULTS

At baseline, participants with LPD exhibited worse performance than those with RPD on the extended continuous performance task, indicating specific deficits in sustaining attention. Poorer attention was associated with worse clinical motor scores. Notably, side of onset had a significant effect on clinical motor changes after sustained attention training, with only LPD participants improving after training, and 4/9 showing clinically meaningful improvements.

CONCLUSIONS

Compared to RPD, participants with LPD had poorer sustained attention pre-training and were more likely to improve on clinical motor functioning after sustained attention training. These findings support mechanistic differences between LPD and RPD and suggest potential differential treatment approaches.

Clinical assessment of upper limb impairments and functional capacity in Parkinson's disease: a systematic review

BACKGROUND

 Parkinson's disease (PD) may progressively reduce the upper limb's functionality. Currently, there is no standardized upper limb functional capacity assessment in PD in the rehabilitation field.

OBJECTIVE

 To identify specific outcome measurements to assess upper limbs in PD and access functional capacity.

METHODS

 We systematically reviewed and analyzed the literature in English published from August/2012 to August/2022 according to PRISMA. The following keywords were used in our search: "upper limbs" OR "upper extremity" and "Parkinson's disease." Two researchers searched independently, including studies accordingly to our inclusion and exclusion criteria. Registered at PROSPERO CRD42021254486.

RESULTS

 We found 797 studies, and 50 were included in this review (n = 2.239 participants in H&Y stage 1-4). The most common upper limbs outcome measures found in the studies were: (i) UPDRS-III and MDS-UPDRS to assess the severity and progression of PD motor symptoms (tremor, bradykinesia, and rigidity) (ii) Nine Hole Peg Test and Purdue Pegboard Test to assess manual dexterity; (iii) Spiral test and Funnel test to provoke and assess freezing of upper limbs; (iv) Technology assessment such as wearables sensors, apps, and other device were also found.

CONCLUSION

 We found evidence to support upper limb impairments assessments in PD. However, there is still a large shortage of specific tests to assess the functional capacity of the upper limbs. The upper limbs' functional capacity is insufficiently investigated during the clinical and rehabilitation examination due to a lack of specific outcome measures to assess functionality.

Updates in Parkinson's Disease Integrative Therapies: an Evidence-Based Review

PURPOSE OF REVIEW

This review summarizes recent evidence-based integrative therapies for Parkinson's disease (PD) that may improve motor and non-motor symptoms, enhance quality of life, and alter disease progression.

RECENT FINDINGS

Imaging studies have demonstrated that aerobic exercise changes brain structure and function, while strength training improves posture and balance. Loneliness is associated with worsening PD severity, but social prescribing and cognitive behavioral therapy may effectively foster connections. Ayurvedic and traditional Chinese medicine practices including yoga, meditation, tai chi, and acupuncture may help improve mobility, mood, sleep, and quality of life. Art therapy enhances visuospatial skills, whereas music and dance therapy can alleviate freezing of gait. Several studies demonstrate successful use of these integrative strategies virtually, thereby improving patient accessibility and participation. PD management has broadened to include integrative approaches combining conventional and complementary therapies. Potential benefits of movement, nutrition, sleep, socialization, and mind-body practices have been confirmed with several recent randomized controlled trials.

Effectiveness of music-based interventions for cognitive rehabilitation in Parkinson's disease: a systematic review of randomized controlled clinical trials

BACKGROUND

Music-based interventions are promising for cognitive rehabilitation in Parkinson's disease; however, systematic reviews covering the topic are scarce.

OBJECTIVE

To analyze the effectiveness of music-based interventions for cognitive rehabilitation in PD.

METHOD

Systematic review study based on PRISMA criteria. The descriptors Parkinson's disease, Parkinson's disease, idiopathic Parkinson's disease, music-based interventions, music therapy, music training, auditory stimulation, music, rhythm, rhythmic, cognition, and cognitive were used. Five databases were searched PubMed/MEDLINE, PsycInfo, Scopus, Web of Science, and Cochrane in May 2022. Only randomized controlled trials with no limit on publication date or language were included. Risk of bias was assessed following Cochrane Collaboration criteria for development of systematic intervention reviews.

RESULTS

Nine hundred nineteen articles were found by the descriptors; 266 were excluded for being repeated; 650 for not meeting the inclusion criteria. The remaining three articles were included and analyzed. The interventions consisted of practices with emphasis on rhythm and were conducted in groups. Risks of important biases were observed, such as lack of blinding in the allocation of participants and in the assessment of outcomes, as well as incomplete data for some outcomes.

CONCLUSION

Overall, the results showed no evidence of efficacy of music-based interventions for cognitive outcomes in PD.

Effects of Music-Based Interventions on Motor and Non-Motor Symptoms in Patients with Parkinson's Disease: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis examined previous studies on music-based interventions for individuals with Parkinson’s disease (PD). The effectiveness of the interventions on various motor and non-motor outcomes was evaluated. This review was conducted by searching PubMed, CINAHL, PsycINFO, and Cochrane Library CENTRAL prior to June 2022 for randomized controlled trial (RCT) and controlled clinical trial (CCT) studies published in English. Data were expressed as weighted/standardized mean difference (MD/SMD) with 95% confidence intervals (CI). I2 index was used for heterogeneity. The initial search identified 745 studies, and 13 studies involving 417 participants with PD which met the inclusion criteria included in this review. The results of the meta-analysis revealed that music-based interventions can significantly improve walking velocity (MD = 0.12, 95% CI = 0.07~0.16, p < 0.00001), stride length (MD = 0.04, 95% CI = 0.02~0.07, p = 0.002), and mobility (MD = −1.05, 95% CI = −1.53~−0.57, p < 0.0001). However, the results did not support significant effects for music-based interventions on cadence (MD = 3.21, 95% CI = −4.15~10.57, p = 0.39), cognitive flexibility (MD = 20.91, 95% CI = −10.62~52.44, p = 0.19), inhibition (SMD = 0.07, 95% CI = −0.40~0.55, p = 0.76), and quality of life (SMD = −0.68, 95% CI= −1.68~0.32, p = 0.18). The findings suggest that music-based interventions are effective for the improvement of some motor symptoms, but evidence for non-motor symptoms is limited. Further high-quality studies with a larger sample size are required to obtain the robust effects of music-based interventions on various outcomes among patients with PD.

Dual-Task-Based Music Therapy to Improve Executive Functioning of Elderly Patients with Early Stage Alzheimer's Disease: A Multiple Case Study

Deficits in executive functioning are a common feature of Alzheimer's disease (AD) and result from impairment in the central executive system. As a result, elderly patients with early stage AD may require interventions that are more cognitively intense than traditional interventions. To address this need, in this multiple case study, we explored a dual-task-based music therapy intervention that involved drum playing and singing designed to induce attentional and motor controls. Three octogenarians diagnosed with early stage AD participated in 12 dual-task-based music therapy sessions over 6 weeks. Measures of executive functioning and the performance of a bimanual drum tapping task were evaluated before and after the intervention. Improvements in executive functioning were observed for participants A and C. After the intervention, reduced mean synchronization errors were found for the simultaneous tapping condition for all three participants. Although there was variability in the functional changes between participants, it is noteworthy that positive improvements in the elderly patients with early stage AD were obtained following dual-task-based music therapy. The results suggest that music therapy integrated into the dual-task paradigm can be an effective way to address degenerative cognitive deficits among elderly patients with early stage AD.