Improving functional disability and cognition in Parkinson disease

OBJECTIVES To examine the efficacy of an integrative cognitive training program (REHACOP) to improve cognition, clinical symptoms, and functional disability of patients with Parkinson disease (PD). METHODS Forty-two patients diagnosed with PD in Hoehn & Yahr stages 1 to 3 were randomly assigned to either the cognitive training group (REHACOP) or the control group (occupational activities) for 3 months (3 sessions, 60 min/wk). Primary outcomes were change on processing speed, verbal memory, visual memory, executive functioning, and theory of mind. Secondary outcomes included changes on neuropsychiatric symptoms, depression, apathy, and functional disability. The trial was registered with clinicaltrials.gov (NCT02118480). RESULTS No baseline group differences were found. Bootstrapped analysis of variance results showed significant differences in the mean change scores between the REHACOP group and control group in processing speed (0.13 [SE = 0.07] vs -0.15 [SE = 0.09], p = 0.025), visual memory (0.10 [SE = 0.10] vs -0.24 [SE = 0.09], p = 0.011), theory of mind (1.00 [SE = 0.37] vs -0.27 [SE = 0.29], p = 0.013), and functional disability (-5.15 [SE = 1.35] vs 0.53 [SE = 1.49], p = 0.012). CONCLUSIONS Patients with PD receiving cognitive training with REHACOP demonstrated statistically significant and clinically meaningful changes in processing speed, visual memory, theory of mind, and functional disability. Future studies should consider the long-term effect of this type of intervention. These findings support the integration of cognitive training into the standard of care for patients with PD. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with PD, an integrative cognitive training program improves processing speed, visual memory, theory of mind, and functional disability.