Objective: To establish whether home-based computerized attentional training would improve cognition, gait, and function in Parkinson’s disease (PD).

Background: Impairments in cognition and gait are common in PD and greatly affect everyday functioning and quality of life. Prior cognitive training studies have demonstrated selective improvements that do not transfer to other cognitive or functional domains. We targeted basic-level sustained attention and executive functions such as inhibitory control in order to broaden improvements [1].

Method: We conducted 4 weeks of Tonic and Phasic Attention Training (36 min/day, 4 days/week) with the goal of reducing cognitive, gait, motor, and functional symptoms. Performance was assessed pre- and post-training and after a 4-week no-contact period. Because this attentional training program is most effective in individuals with right-hemisphere brain injuries [2, 3], we predicted that those with left side of PD motor symptom onset (LPD; predominant right-hemisphere pathology) would improve more than those with right side onset (RPD; predominant left-hemisphere pathology).  We assessed 7 LPD and 9 RPD.

Results: Cognitive tests: The training group improved on near-transfer (e.g., span) and far-transfer cognitive tasks (e.g., learning and delayed recall) (no LPD-RPD difference). Gait and functional symptoms: On the UPDRS, there was significant improvement on Postural Instability and Gait Difficulty (PIGD), and trends for improvements on the Nontremor score and 10-meter walk cognitive dual-task (counting backwards by 3). There was no improvement in mood, sleep, or daytime sleepiness. Notably, only LPD improved on the UPDRS Motor score, Nontremor score and PIGD score. The 5-point improvement in LPD is nearly twice the threshold for clinically meaningful improvements on the UPDRS motor subscale.

Conclusion: The results suggest that training attention can potentially generalize to improvements in several domains of cognition and in gait (including dual-tasking) in PD in general, as well as reducing disease severity (motor symptoms, non-tremor symptoms, PIGD) specifically in LPD. The PIGD finding may reflect the “posture second” tendency of persons with PD at baseline [4], with enhanced post-training attention devoted to posture and gait.

References: [1] DeGutis J, Grosso M, VanVleet T, Esterman M, Pistorino L, Cronin-Golomb A (2016). Sustained attention training reduces spatial bias in Parkinson’s disease: A pilot case series. Neurocase, 22, 179-186. [2] DeGutis JM & Van Vleet TM (2010). Tonic and phasic alertness training: A novel behavioral therapy to improve spatial and non-spatial attention in patients with hemispatial neglect. Frontiers in Human Neuroscience, 4, pi:60. [3] Van Vleet TM et al. (2011). Modulation of non-spatial attention and the global/local processing bias. Neuropsychologia, 49, 352-359. [4] Bloem BR, Grimbergen YA, van Dijk JG, & Munneke M (2006). The “posture second” strategy: a review of wrong priorities in Parkinson’s disease. Journal of the Neurological Sciences, 248, 196-204.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/attentional-intervention-to-improve-cognition-and-gait-in-parkinsons-disease-side-of-onset-effects/