van Balkom Tim D, Berendse Henk W, van der Werf Ysbrand D, Twisk Jos W R, Peeters Carel F W, Hoogendoorn Adriaan W, Hagen Rob H, Berk Tanja, van den Heuvel Odile A, Vriend Chris
Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, PO Box 7057, Amsterdam, Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Amsterdam Neuroscience, PO Box 7057, Amsterdam, Netherlands.
Amsterdam UMC, Vrije Universiteit Amsterdam, Neurology, Amsterdam Neuroscience, PO Box 7057, Amsterdam, Netherlands.
Parkinsonism Relat Disord. 2022 Mar;96:80-87. doi: 10.1016/j.parkreldis.2022.02.018. Epub 2022 Feb 28.
INTRODUCTION: Cognitive training (CT) has been proposed as a treatment option for cognitive impairment in Parkinson's disease (PD). We aimed to assess the efficacy of adaptive, computerized CT on cognitive function in PD. METHODS: In this double-blind, randomized controlled trial we enrolled PD patients that experienced substantial subjective cognitive complaints. Over a period of eight weeks, participants underwent 24 sessions of computerized multi-domain CT or an active control intervention for 45 min each (randomized 1:1). The primary outcome was the accuracy on the Tower of London task; secondary outcomes included effects on other neuropsychological outcomes and subjective cognitive complaints. Outcomes were assessed before and after training and at six-months follow-up, and analyzed with multivariate mixed-model analyses. RESULTS: The intention-to-treat population consisted of 136 participants (n = 68 vs. n = 68, age M: 62.9y, female: 39.7%). Multivariate mixed-model analyses showed no group difference on the Tower of London accuracy corrected for baseline performance (n = 130): B: -0.06, 95% CI: -0.27 to 0.15, p = 0.562. Participants in the CT group were on average 0.30 SD (i.e., 1.5 s) faster on difficulty load 4 of this task (secondary outcome): 95% CI: -0.55 to -0.06, p = 0.015. CT did not reduce subjective cognitive complaints. At follow-up, no group differences were found. CONCLUSIONS: This study shows no beneficial effect of eight-week computerized CT on the primary outcome (i.e., planning accuracy) and only minor improvements on secondary outcomes (i.e., processing speed) with limited clinical impact. Personalized or ecologically valid multi-modal intervention methods could be considered to achieve clinically meaningful and lasting effects.
引言:认知训练(CT)已被提议作为帕金森病(PD)认知障碍的一种治疗选择。我们旨在评估适应性计算机化CT对PD患者认知功能的疗效。 方法:在这项双盲随机对照试验中,我们纳入了有明显主观认知主诉的PD患者。在八周的时间里,参与者接受了24节计算机化多领域CT或积极对照干预,每次45分钟(随机分配,比例为1:1)。主要结局是伦敦塔任务的准确性;次要结局包括对其他神经心理学结局和主观认知主诉的影响。在训练前后以及六个月随访时评估结局,并采用多变量混合模型分析。 结果:意向性分析人群包括136名参与者(n = 68对n = 68,年龄中位数:62.9岁,女性:39.7%)。多变量混合模型分析显示,在根据基线表现校正后的伦敦塔准确性方面,两组没有差异(n = 130):B:-0.06,95%置信区间:-0.27至0.15,p = 0.562。CT组的参与者在该任务的难度等级4上平均快0.30标准差(即1.5秒)(次要结局):95%置信区间:-0.55至-0.06,p = 0.015。CT并没有减少主观认知主诉。在随访时,未发现组间差异。 结论:本研究表明,为期八周的计算机化CT对主要结局(即计划准确性)没有有益影响,对次要结局(即处理速度)只有轻微改善,临床影响有限。可以考虑采用个性化或生态有效的多模式干预方法来取得具有临床意义和持久的效果。
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