If the first maxim of a doctor is “First do no harm”, a close runner up
should be “Use only treatments that work”. The bookshops and app-stores are
full of brain training methods. For the most part, these are not evidence based
and while entertaining, are unlikely to be the reason why someone is awarded a
Nobel prize.
Targeted cognitive training however is perhaps a different kettle of
fish. This study assessed the effects of a multi-domain cognitive training regime
over three months, and then the residual effects after 18 months. Participants
underwent a series of cognitive and behavioural tasks at each assessment. Some
of the participants then went on to have MRI imaging at the later time point to
see the effects.
The authors report increased cognitive function in several (alhtough
not all) domains that was preserved even after a delay despite there overall
Parkinson’s condition getting worse.
The imaging findings they report are very hard to interpret. In an
earlier report of this study, 44 participants were randomised to either the
REHACOP cognitive training programme that formed the intervention, and 19 were
randomised to occupational therapy as a control. There was a high drop out rate
(7/22 in the intervention group, 4/19 in the control group) which creates a
high risk of bias. In this paper, only the participants in the brain training
group had repeat imaging at 18 months. Therefore, the findings do not compare
the intervention and controls, but just the intervention group to themselves 15
months later. Furthermore, the two of the authors hold copyright for the
training programme, and this could create a financial conflict of interest.
While I hope that there can be evidence based treatments that can
improve the thinking and behaviour of people with Parkinson’s disease, I think
this paper has some significant issues such that it doesn’t provide the
evidence that would make me change my practice.
The search continues
DOI: 10.1111/ene.13472
Long-term effects of cognitive rehabilitation on brain,
functional outcome and cognition in Parkinson's disease
Abstract
Background
Cognitive rehabilitation has demonstrated efficacy in
producing short-term cognitive and brain changes in Parkinson's disease (PD)
patients. To date, no study has assessed the long-term effects of cognitive
rehabilitation using neuroimaging techniques in PD. The aim was to assess the
longitudinal effects of a 3-month cognitive rehabilitation program evaluating
the cognitive, behavioural and neuroimaging changes after 18 months.
Methods
Fifteen PD patients underwent a cognitive, behavioural and
neuroimaging assessment at pre-treatment (T0), post-treatment (T1)
and after 18-months (T2). This study examined the long-term effects
(from T0 to T2) and the maintenance of the changes
(from T1 to T2). T1-weighted, diffusion-weighted,
functional magnetic resonance imaging (fMRI) during both a resting-state and a
memory paradigm were acquired. Voxel-based-morphometry and
tract-based-spatial-statistics were used for grey and white matter analyses. A
ROI-to-ROI approach was used for resting-state functional connectivity (FC),
and model-based for brain activation during the memory paradigm.
Results
PD patients showed increased cognitive performance,
decreased functional disability, increased brain FC and activation at T2 compared
with T0 (p<.05-FDR).
Moreover, patients showed the maintenance of the improvements in cognition and
functionality and the maintenance of the increased brain FC and activation at T2 compared
with T1. However, significant grey matter reduction and alterations
of white matter integrity were found at T2 (p<.05-FWE).
Conclusions
Findings suggest that the improved cognitive performance and
the increased brain FC and activation after cognitive rehabilitation were
significantly maintained after 18 months in PD patients, despite the structural
brain changes, consistent with a progression of neurodegenerative processes.
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