Complex Exercises Improve Cognition in People With Parkinson's Disease and Freezing of Gait

Overview

Journal Neurorehabil Neural Repair

Publisher Sage Publications

Specialties Neurology
Rehabilitation Medicine

Date 2024 Oct 15

PMID 39403970

Authors

Carla Silva-Batista

Filipe Oliveira de Almeida

Alana Batista

Egberto Reis Barbosa

Fay B Horak

Carlos Ugrinowitsch

Affiliations

Soon will be listed here.

Abstract

Background: Evidence has suggested that cognitive decline may be a risk factor for freezing of gait (FOG) in Parkinson's disease (PD). Complex and challenging exercises have been suggested as potential rehabilitation strategies to decrease FOG severity and improve cognition; however, it is unknown whether improvement in cognition would explain decreased FOG severity following exercise.

Objective: In this secondary analysis, we evaluated the effects of the adapted resistance training with instability (ARTI-complex and challenging exercises) compared with traditional motor rehabilitation (TMR-without challenging exercises) on cognitive function in people with FOG of PD. We also verified whether cognitive improvement explains the decrease in FOG previously published.

Methods: Participants were randomized to either the experimental group (ARTI, n = 17) or the active control group (TMR, n = 15). Both training groups exercised 3 times a week for 12 weeks (80-90 minute each session). FOG severity (FOG ratio from inertial sensors during a 360° turning-in-place task), frontal lobe function (Frontal Assessment Battery [FAB]), global cognition (Montreal Cognitive Assessment [MoCA]), and attention and psychomotor speed (Digit Symbol Substitution Test [DSST]) were evaluated before and after interventions.

Results: Only the ARTI group improved FAB, MoCA, and DSST scores at posttraining. In addition, ARTI was more effective than TMR in improving FAB scores at posttraining. The changes in FAB scores explained the changes in FOG ratio following ARTI ( = .43, < .01).

Conclusions: This pilot study suggests that ARTI, a complex and challenging training, improves cognition in people with FOG of PD. Improvements in frontal lobe function with ARTI help explain decreased FOG severity.

References

Carey J, Bhatt E, Nagpal A . Neuroplasticity promoted by task complexity. Exerc Sport Sci Rev. 2005; 33(1):24-31. View

Fortaleza A, Mancini M, Carlson-Kuhta P, King L, Nutt J, Chagas E . Dual task interference on postural sway, postural transitions and gait in people with Parkinson's disease and freezing of gait. Gait Posture. 2017; 56:76-81. PMC: 5714292. DOI: 10.1016/j.gaitpost.2017.05.006. View

Silva-Batista C, de Lima-Pardini A, Penteado Nucci M, Coelho D, Batista A, Pimentel Piemonte M . A Randomized, Controlled Trial of Exercise for Parkinsonian Individuals With Freezing of Gait. Mov Disord. 2020; 35(9):1607-1617. PMC: 7722148. DOI: 10.1002/mds.28128. View

Gul A, Yousaf J . L-Dopa response to Cortical Dysfunctions, health related quality of life and Fatigue Severity in Idiopathic Parkinson's disease. Pak J Med Sci. 2018; 34(4):1014-1018. PMC: 6115581. DOI: 10.12669/pjms.344.14753. View

Silva-Batista C, Corcos D, Kanegusuku H, Pimentel Piemonte M, Gobbi L, de Lima-Pardini A . Balance and fear of falling in subjects with Parkinson's disease is improved after exercises with motor complexity. Gait Posture. 2018; 61:90-97. DOI: 10.1016/j.gaitpost.2017.12.027. View

Fengler S, Liepelt-Scarfone I, Brockmann K, Schaffer E, Berg D, Kalbe E . Cognitive changes in prodromal Parkinson's disease: A review. Mov Disord. 2017; 32(12):1655-1666. DOI: 10.1002/mds.27135. View

Stuss D, Alexander M . Executive functions and the frontal lobes: a conceptual view. Psychol Res. 2000; 63(3-4):289-98. DOI: 10.1007/s004269900007. View

Fling B, Cohen R, Mancini M, Nutt J, Fair D, Horak F . Asymmetric pedunculopontine network connectivity in parkinsonian patients with freezing of gait. Brain. 2013; 136(Pt 8):2405-18. PMC: 3722352. DOI: 10.1093/brain/awt172. View

Kostic V, Agosta F, Pievani M, Stefanova E, Jecmenica-Lukic M, Scarale A . Pattern of brain tissue loss associated with freezing of gait in Parkinson disease. Neurology. 2012; 78(6):409-16. DOI: 10.1212/WNL.0b013e318245d23c. View

10.

Ehgoetz Martens K, Hall J, Georgiades M, Gilat M, Walton C, Matar E . The functional network signature of heterogeneity in freezing of gait. Brain. 2018; 141(4):1145-1160. DOI: 10.1093/brain/awy019. View

11.

Silva-Batista C, Corcos D, Roschel H, Kanegusuku H, Gobbi L, Pimentel Piemonte M . Resistance Training with Instability for Patients with Parkinson's Disease. Med Sci Sports Exerc. 2016; 48(9):1678-87. DOI: 10.1249/MSS.0000000000000945. View

12.

Oshima E, Terada S, Sato S, Ikeda C, Nagao S, Takeda N . Frontal assessment battery and brain perfusion imaging in Alzheimer's disease. Int Psychogeriatr. 2012; 24(6):994-1001. DOI: 10.1017/S1041610211002481. View

13.

Varjacic A, Mantini D, Demeyere N, Gillebert C . Neural signatures of Trail Making Test performance: Evidence from lesion-mapping and neuroimaging studies. Neuropsychologia. 2018; 115:78-87. PMC: 6018614. DOI: 10.1016/j.neuropsychologia.2018.03.031. View

14.

Peterson D, King L, Cohen R, Horak F . Cognitive Contributions to Freezing of Gait in Parkinson Disease: Implications for Physical Rehabilitation. Phys Ther. 2015; 96(5):659-70. PMC: 4858659. DOI: 10.2522/ptj.20140603. View

15.

Pigott K, Rick J, Xie S, Hurtig H, Chen-Plotkin A, Duda J . Longitudinal study of normal cognition in Parkinson disease. Neurology. 2015; 85(15):1276-82. PMC: 4617168. DOI: 10.1212/WNL.0000000000002001. View

16.

Hely M, Morris J, Reid W, Trafficante R . Sydney Multicenter Study of Parkinson's disease: non-L-dopa-responsive problems dominate at 15 years. Mov Disord. 2004; 20(2):190-9. DOI: 10.1002/mds.20324. View

17.

Silva-Batista C, Ragothaman A, Mancini M, Carlson-Kuhta P, Harker G, Jung S . Cortical thickness as predictor of response to exercise in people with Parkinson's disease. Hum Brain Mapp. 2020; 42(1):139-153. PMC: 7721225. DOI: 10.1002/hbm.25211. View

18.

Kim R, Lee T, Lee H, Ko D, Lee J, Shin H . Effects of physical exercise interventions on cognitive function in Parkinson's disease: An updated systematic review and meta-analysis of randomized controlled trials. Parkinsonism Relat Disord. 2023; 117:105908. DOI: 10.1016/j.parkreldis.2023.105908. View

19.

Amboni M, Cozzolino A, Longo K, Picillo M, Barone P . Freezing of gait and executive functions in patients with Parkinson's disease. Mov Disord. 2007; 23(3):395-400. DOI: 10.1002/mds.21850. View

20.

Shine J, Moustafa A, Matar E, Frank M, Lewis S . The role of frontostriatal impairment in freezing of gait in Parkinson's disease. Front Syst Neurosci. 2013; 7:61. PMC: 3790147. DOI: 10.3389/fnsys.2013.00061. View