Cognitive Training in Parkinson's disease

Mild cognitive impairment is experienced by 30% of Parkinson’s disease patients (PD-MCI), often affecting executive functions. There is currently no pharmacological treatment for PD-MCI. The aim of this study was to test preliminary effects of two home-based cognitive interventions: Goal Management Training, adapted for PD-MCI (Adapted-GMT), and a psychoeducation program combined with mindfulness exercises. Twelve PD-MCI persons with executive dysfunctions, measured by extensive neuropsychological evaluation, were randomly assigned to one group. Both groups received five sessions each lasting 60-90 minutes for five weeks, in presence of caregiver. Measures were collected at baseline, mid-point, one-week, four-week and 12-week follow-ups. Primary outcomes were executive functions assessed by subjective (DEX questionnaire) and objective (Zoo Map Test) measures. Secondary outcomes included quality of life (PDQ-39), and global cognition (DRS-II). Repeated measures ANCOVAs were applied to outcomes. Both groups improved in DEX-patient and DEX-caregiver scores. PDQ-39 scores decreased at four-week follow-up in Psychoeducation/Mindfulness group whereas they were maintained in Adapted-GMT group. All other measures were maintained in both groups. Adapted-GMT and Psychoeducation/Mindfulness groups improved executive functioning. This is one of the first studies to test home-based approaches, tailored to participant’s cognitive needs, and involving caregivers.

30%的帕金森病患者会罹患帕金森病轻度认知障碍（Parkinson’s Disease Mild Cognitive Impairment, PD-MCI），该病症常累及执行功能。目前针对PD-MCI尚无获批的药物治疗方案。本研究旨在评估两种居家认知干预手段的初步效果：一是针对PD-MCI适配的目标管理训练（Adapted Goal Management Training, Adapted-GMT），二是结合正念练习的心理教育项目。研究纳入12名经全面神经心理学评估确诊存在执行功能障碍的PD-MCI患者，将其随机分配至两个干预组中。两组均接受为期5周、共5次的干预，每次时长60至90分钟，且需有照料者陪同参与。研究分别在基线期、干预中期、干预结束后1周、4周及12周随访节点采集相关数据。主要结局指标为通过主观评估（DEX问卷）与客观评估（动物园地图测试，Zoo Map Test）量化的执行功能水平。次要结局指标包括生活质量（帕金森病生活质量问卷39项版，PDQ-39）与整体认知功能（德克萨斯痴呆评定量表第二版，DRS-II）。本研究采用重复测量协方差分析（Repeated Measures ANCOVAs）对结局指标进行统计检验。两组患者的DEX患者自评与DEX照料者他评得分均显著提升。心理教育/正念组在干预后4周随访时的PDQ-39得分显著降低，而适配版目标管理训练组的该得分则维持稳定。其余所有观测指标在两组中均保持稳定。适配版目标管理训练组与心理教育/正念组的执行功能均得到改善。本研究是首批针对患者个体认知需求定制、并纳入照料者参与的居家认知干预研究之一。