Cognitive stimulation in Parkinson's disease with mild cognitive impairment.

IF 4.6 2区医学 Q1 CLINICAL NEUROLOGY

Journal of Neurology Pub Date : 2025-09-27 DOI:10.1007/s00415-025-13374-9

Jolanda Buonocore, Noemi Iaccino, Giusi Torchia, Francesca Curcio, Fabio Michelangelo Pirrotta, Marianna Contrada, Caterina Pucci, Antonio Gambardella, Aldo Quattrone, Alberto Pilotto, Loris Pignolo, Gennarina Arabia

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引用次数: 0

Abstract

Background: Cognitive impairment is among the most frequent and disabling non-motor symptoms of Parkinson's disease (PD), often emerging early and substantially impacting autonomy and quality of life. While cognitive stimulation (CS) is supported in other neurodegenerative conditions, its role in PD is less explored. This study aimed to compare the efficacy of a therapist-guided, home-based CS program, delivered via a virtual reality rehabilitation system, with a conventional in-person CS intervention.

Methods: Of 123 individuals screened, 45 patients with PD and mild cognitive impairment (PD-MCI) were randomized to either the tele-rehabilitation group (TRG; n = 25) or the control group (CG; n = 20). Both groups received the same standardized 4-week CS program (20 multi-domain sessions, 5 days/week), targeting memory, attention, executive functions, language, and visuospatial skills. The TRG trained at home via the VRRS platform under remote supervision, while the CG attended outpatient sessions. Neuropsychological and clinical outcomes were assessed at baseline (T1), post-intervention (T2), and 6-month follow-up (T3). Analyses included repeated-measures ANOVA, multivariate linear regression, and categorical comparisons based on predefined clinical cut-offs.

Results: All participants completed the intervention with adherence exceeding 90% in both groups. At T2, the TRG showed greater improvements than the CG in global cognition, working memory, and delayed recall. These effects remained significant after adjusting for age, sex, baseline performance, and cognitive reserve index, and were robust to false discovery rate correction. Regression models confirmed these improvements. Categorical analyses also showed a marked reduction in pathological scores in the TRG in the same domains.

Conclusion: A short-term, therapist-guided CS program delivered via tele-rehabilitation effectively improved cognitive functioning in PD-MCI, with partial benefits maintained at 6 months, especially in memory and executive domains. The intervention was particularly beneficial for memory and executive functions, highlighting telemedicine as a promising and accessible option for cognitive care in PD.

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帕金森病伴轻度认知障碍的认知刺激。

背景：认知障碍是帕金森病（PD）最常见和致残性的非运动症状之一，通常出现较早，并严重影响自主性和生活质量。虽然认知刺激（CS）在其他神经退行性疾病中得到支持，但其在PD中的作用却很少被探索。本研究旨在比较治疗师指导下，通过虚拟现实康复系统提供的基于家庭的CS计划与传统的面对面CS干预的效果。方法：筛选123例PD合并轻度认知障碍（PD- mci）患者，将45例患者随机分为远程康复组（TRG, n = 25）和对照组（CG, n = 20）。两组都接受了同样的标准化的4周CS课程（20个多领域课程，每周5天），目标是记忆、注意力、执行功能、语言和视觉空间技能。TRG在远程监督下通过VRRS平台在家中接受培训，而CG参加门诊会议。在基线（T1）、干预后（T2）和6个月随访（T3）时评估神经心理学和临床结果。分析包括重复测量的方差分析、多元线性回归和基于预定义临床截止点的分类比较。结果：两组受试者均完成干预，依从性均超过90%。在T2时，TRG在整体认知、工作记忆和延迟回忆方面比CG有更大的改善。在调整了年龄、性别、基线表现和认知储备指数后，这些影响仍然显著，并且对错误发现率校正具有稳健性。回归模型证实了这些改进。分类分析还显示，在相同的领域，病理评分在TRG显著降低。结论：通过远程康复提供的短期治疗师指导的CS计划有效地改善了PD-MCI患者的认知功能，并在6个月后保持部分益处，特别是在记忆和执行领域。干预对记忆和执行功能特别有益，突出了远程医疗作为PD认知护理的一个有前途和可获得的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neurology 医学-临床神经学

CiteScore

10.00

自引率

5.00%

发文量

558

审稿时长

1 months

期刊介绍： The Journal of Neurology is an international peer-reviewed journal which provides a source for publishing original communications and reviews on clinical neurology covering the whole field. In addition, Letters to the Editors serve as a forum for clinical cases and the exchange of ideas which highlight important new findings. A section on Neurological progress serves to summarise the major findings in certain fields of neurology. Commentaries on new developments in clinical neuroscience, which may be commissioned or submitted, are published as editorials. Every neurologist interested in the current diagnosis and treatment of neurological disorders needs access to the information contained in this valuable journal.