Department of Psychology, Umeå University, Umeå, Sweden.
Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden.
BMC Neurol. 2020 Sep 7;20(1):337. doi: 10.1186/s12883-020-01893-z.
Cognitive decline and dementia are common in Parkinson's disease (PD). Cognitive deficits have been linked to the depletion of dopamine in the nigrostriatal pathway, but pharmacological treatments for PD have little evidence of improving or delaying cognitive decline. Therefore, exploring non-pharmacological treatment options is important. There have been some promising results of cognitive training interventions in PD, especially for improvements in working memory and executive functions. Yet, existing studies are often underpowered, lacking appropriate control condition, long term follow-up, a thorough description of the intervention and characteristics of the participants. Working memory updating training has previously shown to increase striatal activation in healthy young and old participants as well as dopaminergic neurotransmission in healthy young participants. In the light of dopamine dysfunction in PD, with negative effects on both motor and cognitive functions it is of interest to study if an impaired striatal system can be responsive to a non-invasive, non-pharmacological intervention.
The iPARK trial is a double-blinded, randomized controlled trial with a parallel-group design that aims to recruit 80 patients with PD (during the period 02/2017-02/2023). Included patients need to have PD, Hoehn and Yahr staging I-III, be between 45 to 75 years of age and not have a diagnosis of dementia. All patients will undergo 30 sessions (6-8 weeks) of web-based cognitive training performed from home. The target intervention is a process-based training program targeting working memory updating. The placebo program is a low dose short-term memory program. A battery of neuropsychological tests and questionnaires will be performed before training, directly after training, and 16 weeks after training.
We expect that the iPARK trial will provide novel and clinically useful information on whether updating training is an effective cognitive training paradigm in PD. Further, it will hopefully contribute to a better understanding of cognitive function in PD and provide answers regarding cognitive plasticity as well as determining critical factors for a responsive striatal system.
Clinicaltrials.gov registry number: NCT03680170 , registry name: "Cognitive Training in Parkinson's Disease: the iPARK study", retrospectively registered on the 21st of September 2018. The inclusion of the first participant was the 1st of February 2017.
认知能力下降和痴呆在帕金森病（PD）中很常见。认知缺陷与黑质纹状体通路中多巴胺的耗竭有关，但 PD 的药物治疗在改善或延缓认知能力下降方面证据很少。因此，探索非药物治疗选择很重要。认知训练干预在 PD 中取得了一些有希望的结果，尤其是在改善工作记忆和执行功能方面。然而，现有的研究往往力度不够，缺乏适当的对照条件、长期随访、对干预措施的全面描述以及参与者的特征。工作记忆更新训练以前已经表明，它可以增加健康的年轻和老年参与者的纹状体激活以及健康年轻参与者的多巴胺能神经传递。鉴于 PD 中的多巴胺功能障碍对运动和认知功能都有负面影响，研究受损的纹状体系统是否可以对非侵入性、非药物干预做出反应是很有意义的。
iPARK 试验是一项双盲、随机对照试验，采用平行组设计，旨在招募 80 名 PD 患者（招募时间为 2017 年 2 月至 2023 年 2 月）。入组患者需要患有 PD、Hoehn 和 Yahr 分期 I-III 期、年龄在 45 至 75 岁之间，且没有痴呆症诊断。所有患者都将在家中进行 30 次（6-8 周）的基于网络的认知训练。目标干预是针对工作记忆更新的基于过程的训练计划。安慰剂方案是一个低剂量的短期记忆方案。在训练前、训练后直接和训练后 16 周，将进行一系列神经心理学测试和问卷调查。
我们预计 iPARK 试验将提供关于更新训练是否是 PD 中一种有效的认知训练模式的新的和临床有用的信息。此外，它还有望有助于更好地了解 PD 中的认知功能，并提供关于认知可塑性的答案以及确定对纹状体系统有反应的关键因素。
Clinicaltrials.gov 注册号：NCT03680170，注册名称：“帕金森病的认知训练：iPARK 研究”，于 2018 年 9 月 21 日回顾性注册。第一个参与者的纳入时间是 2017 年 2 月 1 日。
