Ferrazzoli Davide, Ortelli Paola, Maestri Roberto, Bera Rossana, Giladi Nir, Ghilardi Maria Felice, Pezzoli Gianni, Frazzitta Giuseppe
Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital Gravedona ed Uniti, Italy.
Department of Biomedical Engineering, Scientific Institute of Montescano, S. Maugeri Foundation IRCCS Montescano, Italy.
Front Aging Neurosci. 2016 Aug 11;8:192. doi: 10.3389/fnagi.2016.00192. eCollection 2016.
The cognitive status is generally considered as a major determinant of rehabilitation outcome in Parkinson's disease (PD). No studies about the effect of cognitive impairment on motor rehabilitation outcomes in PD have been performed before.
This study is aimed to evaluate the impact of cognitive decline on rehabilitation outcomes in patients with PD.
We retrospectively identified 485 patients with PD hospitalized for a 4-week Multidisciplinary Intensive Rehabilitation Treatment (MIRT) between January 2014 and September 2015. According to Mini Mental State Examination (MMSE), patients were divided into: group 1-normal cognition (score 27-30), group 2-mild cognitive impairment (score 21-26), group 3-moderate or severe cognitive impairment (score ≤ 20). According to Frontal Assessment Battery (FAB), subjects were divided into patients with normal (score ≥13.8) and pathological (score <13.8) executive functions. The outcome measures were: Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Disability Scale (PDDS), Six Minutes Walking Test (6MWT), Timed Up and Go Test (TUG) and Berg Balance Scale (BBS).
All scales had worse values with the increase of cognitive impairment and passing from normal to pathological executive functions. After rehabilitation, all the outcome measures improved in all groups (p < 0.0001). Between groups, the percentage of improvement was significantly different for total UPDRS (p = 0.0009, best improvement in normal MMSE group; p = 0.019, best improvement in normal FAB group), and BBS (p < 0.0001, all pairwise comparisons significant, best improvement in patients with worse MMSE score; p < 0.0001, best improvement in patients with pathological FAB). TUG (p = 0.006) and BBS (p < 0.0001) improved in patients with pathological FAB score, more than in those with normal FAB score.
Patients gain benefit in the rehabilitative outcomes, regardless of cognition. Our data suggest that rehabilitation could be effective also in Parkinsonian subjects with cognitive impairment, as well as with dysexecutive syndrome.
认知状态通常被认为是帕金森病（PD）康复结局的主要决定因素。此前尚无关于认知障碍对PD患者运动康复结局影响的研究。
本研究旨在评估认知功能下降对PD患者康复结局的影响。
我们回顾性纳入了2014年1月至2015年9月期间因4周多学科强化康复治疗（MIRT）而住院的485例PD患者。根据简易精神状态检查表（MMSE），患者被分为：第1组——认知正常（评分27 - 30分），第2组——轻度认知障碍（评分21 - 26分），第3组——中度或重度认知障碍（评分≤20分）。根据额叶评估量表（FAB），受试者被分为执行功能正常（评分≥13.8）和异常（评分<13.8）的患者。结局指标包括：统一帕金森病评定量表（UPDRS）、帕金森病残疾量表（PDDS）、6分钟步行试验（6MWT）、起立行走试验（TUG）和伯格平衡量表（BBS）。
随着认知障碍的加重以及从正常执行功能转变为异常执行功能，所有量表的值均变差。康复后，所有组的所有结局指标均有所改善（p < 0.0001）。在各亚组之间，UPDRS总分（p = 0.0009，MMSE正常组改善最佳；p = 0.019，FAB正常组改善最佳）和BBS（p < 0.0001，所有两两比较均有显著差异，MMSE评分较差的患者改善最佳；p < 0.0001，FAB异常的患者改善最佳）的改善百分比有显著差异。FAB评分异常的患者TUG（p = 0.006）和BBS（p < 0.0001）的改善程度大于FAB评分正常的患者。
无论认知情况如何，患者都能从康复结局中获益。我们的数据表明，康复治疗对伴有认知障碍以及执行功能障碍综合征的帕金森病患者同样有效。
