Mantovani Elisa, Bressan Miriana Maria, Tinazzi Michele, Tamburin Stefano
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Curr Opin Neurol. 2024 Dec 1;37(6):629-637. doi: 10.1097/WCO.0000000000001310. Epub 2024 Jul 30.
Cognitive impairment is one of the most challenging non-motor symptoms of Parkinson's disease (PD) and may occur during all PD stages. There are no established pharmacological treatments for PD-related cognitive impairment, which may be improved by cognition-based interventions (i.e., cognitive stimulation, cognitive training, cognitive rehabilitation). Multimodal cognition-based interventions by adjunctive drugs, exercise, non-invasive brain stimulation and technologies may be effective in PD.
Exercise combined with cognitive training may enhance global, memory, visuospatial and executive functioning, transcranial direct current stimulation delivered alongside cognitive training may improve attention and executive functioning, and exergames, semi-immersive virtual reality (VR) and telerehabilitation plus non-immersive VR combined with cognitive training may ameliorate global and executive functioning in PD patients.
The evidence reviewed here, despite preliminary, is very encouraging and suggests strong rationale for combining pharmacological and non-pharmacological interventions with cognition-based treatments in PD. To overcome limitations of current studies, we propose some recommendations for future trials on drugs, exercise, non-invasive brain stimulation and technologies combined with cognition-based treatments for cognitive impairment in PD.
认知障碍是帕金森病（PD）最具挑战性的非运动症状之一，可发生于PD的所有阶段。目前尚无针对PD相关认知障碍的确立的药物治疗方法，基于认知的干预措施（即认知刺激、认知训练、认知康复）可能会改善这种情况。通过辅助药物、运动、非侵入性脑刺激和技术进行的多模式基于认知的干预措施可能对PD有效。
运动与认知训练相结合可能会增强整体、记忆、视觉空间和执行功能，与认知训练同时进行的经颅直流电刺激可能会改善注意力和执行功能，电子游戏、半沉浸式虚拟现实（VR）以及远程康复加非沉浸式VR与认知训练相结合可能会改善PD患者的整体和执行功能。
尽管这里综述的证据是初步的，但非常令人鼓舞，并表明在PD中将药物和非药物干预与基于认知的治疗相结合具有充分的理由。为克服当前研究的局限性，我们针对未来关于药物、运动、非侵入性脑刺激和技术与基于认知的治疗相结合用于PD认知障碍的试验提出了一些建议。
