Cognitive Therapy for Parkinson’s Patients
Cognitive training is “a promising tool for dealing with cognitive impairment in PD,” according to researchers who conducted a program among patients with Parkinson’s disease (PD) aimed at improving their processing speed, visual learning and memory, theory of mind (TOM), and functional disability, all of which impair activities of daily living. The study demonstrates the success of nonpharmacologic intervention for PD, which to date is a limited area of study, say researchers.
What is Parkinson’s Disease? Parkinson’s disease is a progressive disorder of the nervous system that affects movement. It develops gradually, sometimes starting with a barely noticeable tremor in just one hand. But the disorder also commonly causes stiffness or slowing of movement.
In addition, posture may become stooped, or balance problems may arise. There may be decreased ability to perform unconscious movements, like blinking, smiling or swinging arms when walking. Patients may no longer gesture when talking, or have speech problems, such as speaking softly, quickly, slurring, or hesitating before talking. Speech may be more of a monotone, and writing may appear small and become difficult.
How the Study Worked. The program included up to 300 different tasks, hierarchically organized into at least three levels of complexity and subtypes of abilities, including several timed tasks, such as viewing a photo, memorizing as much detail as possible, and writing down the detail in a timed minute. The study comprised three 60-minute weekly sessions over a three-month period, with a gradual buildup in cognitive effort and demand.
Functional Disability. The major finding of this study was the improvement in functional disability, attributed by researchers to the emphasis on strategic learning and transfer techniques—that is, the ability to extend what patients had learned in one context to a new context.
Patients with PD are impaired in social cognitive abilities. The PD patients in this program showed significant improvement in TOM—the ability, or cognitive capacity, to attribute mental states, such as beliefs, desires, hopes, and intent, to oneself and to others.
Bottom Line. The research originally was devised for treating schizophrenia and adapted for an elderly population. Javier Pena, PhD, lecturer-faculty of Psychology and Education, University of Deusto, Bilbao, Spain, led the study. Researchers recommend integrating cognitive training into standard care for patients with PD, and also suggested that future studies consider analyzing biomarkers of the resulting improvements, including cerebral changes associated with cognitive rehabilitation.
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