Parkinson’s disease is widely recognised and understood as a movement disorder which affects motor control, balance, speed and coordination. Features include tremor, rigidity, slowness in movements (bradykinesia), freezing episodes, uncontrollable movements (dyskinesia), postural instability and gait changes. There is increasing attention to the non-pharmacological treatments available such as physiotherapy and even brain surgery designed to reduce the impact of the motor symptoms. However, the non-motor consequences- namely changes in thinking and emotion are less known and understood, and treatments for these aspects of the condition remain elusive.
For many people living with Parkinson’s, changes in thinking skills can accompany motor changes, underpinned by many of the same dopamine-dependent neural processes. The changes in cognitive function can include reductions in mental flexibility, problem solving and speed of processing, as well as visual spatial deficits and short term memory problems. These can all contribute to reduced quality of life and function (including ability to work, manage finances and drive), as well as carer strain and burnout.
It is important to note that not all people with Parkinson’s disease will experience changes in their thinking skills, and like with motor symptoms, the nature and degree of these changes varies widely from person to person and can be related to age, length of illness, medication and many other factors. Parkinson’s Disease Dementia (PDD) is defined only in the context of significant decline in cognition impacting on function. PDD is estimated to affect around 20-30% of people with Parkinson’s over time.
In a neuro-rehab setting, cognitive rehabilitation programs provided by the rehabilitation therapist aim to assist a person in the use of internal or ‘restorative’ techniques and external or ‘compensatory’ techniques to reduce the impact of cognitive deficits or decline.
Restorative techniques focus on strategies to improve cognitive functioning and can include computerized drills and repeated prompting to improve memory, spaced retrieval or vanishing cues. Compensatory techniques provide strategies that organise information to improve recall and learning and provide instruction in self-management. Examples may include the effective use of dairies, calendars and external cues or aide memoirs, procedural training to learn increasingly more complex behaviors.
A very recent article in the journal Parkinson’s Disease, 2012 by Calleo, Burrows, Levin, Marsh, Lai and York reviews the literature to date and asks the question: How effective are cognitive rehabilitation programs for Parkinson’s? The review narrowed its search to one main area of cognition; executive function (higher-order thinking skills encompassing ability to plan, organise, sequence, abstract and think flexibly). Reviewing the four best studies to date which have employed a mixture of computerised and manual cognitive training exercises, study participants with Parkinson’s demonstrated improvement in their executive function (and in some cases attention and speed) test scores following the cognitive rehabilitation intervention. In one study, improvement was maintained over six months without further training. However, the authors caution that the studies were limited by their small sample size and did not address the question whether the improvements would translate to functional improvement in day-to-day life.
Further research is needed. Taking into consideration the variability of symptoms people with Parkinson’s experience which impact on physical, emotional and cognitive function, the authors conclude that future cognitive rehabilitation programs should aim for ﬂexibility and individualisation, considering in particular each person’s cognitive strengths and weaknesses. The full text article is freely available and can be found here: http://www.hindawi.com/journals/pd/2012/512892/
Reference: Calleo, J., Burrows, C., Levin, H., Marsh, M., Lai, E. & York, M. K. (2012). Review Article. Cognitive Rehabilitation for Executive Dysfunction in Parkinson’s Disease: Application and Current Directions. Parkinson’s Disease, Article ID 512892, 6 pages.
Follow this blog for further information on the role cognitive rehabilitation for Parkinson’s and other neurological conditions. – Helga Hemberger