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Cognitive Training Improves Memory in People with PD and Mild Cognitive Impairment

Researchers have found a possible tool for boosting memory in people with Parkinson’s disease (PD), according to a report in the April 29 edition of Movement Disorders. The two-part intervention called the “healthy brain aging cognitive training program,” could prove to be an important strategy for people with the disease who experience mild cognitive impairment (MCI).

About a third of people with PD may experience mild cognitive impairment, which means that they might notice some cognitive symptoms, but those symptoms are not severe enough to interfere with daily activities. A percentage of these people may go on to develop dementia. Researchers wondered whether cognitive training programs – helpful in other disease areas – could help ease MCI or stave off the dementia. In cognitive training, a person learns practical strategies, such as using mnemonic devices or diaries, for coping with their symptoms.

Sharon Naismith, M.Clin.Psych., D.Psych., and her colleagues at the University of Sidney in Camperdown, Australia, worked with fifty participants. Half of the participants received an hour of cognitive training and hour of psychoeducation (lessons about how the brain ages) twice a week, for seven weeks. Participants were 67 years of age, on average, and had been on levodopa or another PD therapy prior to the trial. At the start and end of the study, Dr. Naismith’s team tested the participants for memory, mental flexibility, verbal fluency and other aspects of cognition.

Results

  • Participants receiving the cognitive training /psychoeducation showed significant better memory retention by the end of the study.
  • Participants receiving the cognitive training /psychoeducation showed improvement in knowledge at the end of the study, but the result was not statistically significant.
  • The two groups showed no differences in terms of psychomotor speed, mental flexibility, verbal fluency or depressive symptoms by the end of the study.

What Does It Mean?

Many people with PD complain of cognitive changes as PD advances. Many others are concerned about potential cognitive implications of PD. Unfortunately, medications are available only in more advanced stages of cognitive impairment in PD, and their effect is only modest.

Doctors often recommend “brain activity” to people who are concerned about cognitive impairment. However, it is very difficult to scientifically challenge the “use it or lose it” theory, that practice may improve brain function.

This study showed success in improving memory and is the largest cognitive training trial in PD to date.  It suggests that at least one aspect of MCI – memory loss – might be eased with the “healthy brain aging cognitive training program.”

More research is needed before the program is used in doctor’s offices. For example, Dr. Naismith and her colleagues were not able to tease out which part of the two-part program - the cognitive training, the psychoeducation or the combination of the two  - accounts for the boost in memory. There is some evidence to suggest psychoeducation alone is of limited effectiveness.

Despite the study’s success, more research is needed. First, people in the study’s intervention group might have received some benefits from placebo effect, or positive thinking, in contrast to people in the control group who were given no intervention. A sham intervention would have reduced the risk of this possibility. Additionally, research is needed to understand how long the effect of this therapy persists. Finally, while this therapy focused on memory loss, it could be structured to include strategies that might improve general cognition like mental flexibility and speed as well as verbal fluency, i.e., the ability to use language easily.

This study may eventually provide a tool for people with PD and their doctors; and may help to advance our understanding of cognitive issues in PD. In the meantime we recommend maintaining as cognitively and socially stimulating routine as possible.

Reference: Naismith SL, Mowszowski L, Diamond K, Lewis SJG (2013) Improving memory in Parkinson's disease: A healthy brain ageing cognitive training program. Mov Disord. DOI: 10.1002/mds.25457 http://dx.doi.org/10.1002/mds.25457

Source Date: May 31 2013