Objective: To determine the feasibility and impact of remote cognitive remediation therapy (CRT) on cognitive function and quality of life (QOL) in patients with Parkinson’s disease (PD) participating in Rock Steady Boxing (RSB).

Background: Non-motor symptoms of PD such as cognitive impairment decrease QOL and daily functioning [1]. To date, no pharmacological interventions have been effective in reducing cognitive deficits in PD [2]. CRT, however, has been effective in enhancing cognition in many disease populations, and can be made accessible through remote administration [3]. Much like physical exercise, CRT has been demonstrated to improve cognitive functioning in PD, but a remote option for these patients has yet to be fully explored [4-5].

Method: After IRB approval, 25 PD patients recruited from NYIT RSB, a non-contact group exercise program, consented to participate; 24 subjects met inclusion criteria, Montreal Cognitive Assessment (MoCA) ≥ 20, and were randomized to two groups (control and intervention). The intervention group attended virtual CRT sessions for one hour, twice a week for 10 weeks. Subjects completed exercises targeting attention, brain speed, and memory, followed by a 15-minute group discussion. Both groups were assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and PD Questionnaire (PDQ-39) before and after the intervention.

Results: Twenty-one subjects completed the study; preliminary data analysis using mixed ANOVA included 11 intervention (6 male, 69.1y ± 6.3) and eight control (4 male, 65.6y ± 9.2) subjects. Comparing groups, changes in mean MoCA (control: 24.6 to 25.0, intervention: 26.1 to 26.5, p=0.91), RBANS (control: 95.0 to 90.8, intervention: 102.1 to 99.9, p=0.61), and PDQ-39 (control: 20.7 to 25.6, intervention: 18.5 to 18.3, p=0.15) scores failed to demonstrate statistical significance. However, intervention subjects enjoyed the CRT sessions (81.8%), would recommend them to another person with PD (81.8%), and saw improvements in their daily lives (72.7%), specifically in attention (n=8), visuospatial perception (n=6), and memory (n=5).

Conclusion: This study suggests that remote CRT for PD patients is feasible, enjoyable, and subjectively improves daily life, yet the objective impact on cognition and QOL remains unclear. Limitations of this study include a small sample size and a highly motivated, educated, and health-conscious cohort.

References: [1] Díez-Cirarda M, Ibarretxe-Bilbao N, Peña J, Ojeda N. Efficacy of cognitive rehabilitation in Parkinson’s disease. Neural Regen Res. 2018;13(2):226-227. doi:10.4103/1673-5374.226390
[2] Seppi K, Ray Chaudhuri K, Coelho M, Fox, SH, Katzenschlager, R, Perez Lloret, S, Weintraub, D, Sampaio, C, et al. Update on treatments for nonmotor symptoms of Parkinson’s disease-an evidence-based medicine review. Mov Disord. 2019;34(2):180-198. doi:10.1002/mds.27602
[3] Gough N, Brkan L, Subramaniam P, Chiuccariello, L, De Petrillo, A, Mulsant, BH, Bowie, CR, Rajji, T. K. Feasibility of remotely supervised transcranial direct current stimulation and cognitive remediation: A systematic review. PLoS One. 2020;15(2):e0223029. doi:10.1371/journal.pone.0223029
[4] da Silva FC, Iop RDR, de Oliveira, LC, Boll, AM, de Alvarenga, J, Gutierres Filho, P, de Melo, L, Xavier, AJ, da Silva, R. Effects of physical exercise programs on cognitive function in Parkinson’s disease patients: A systematic review of randomized controlled trials of the last 10 years. PLoS One. 2018;13(2):e0193113. doi:10.1371/journal.pone.0193113
[5] Nousia A, Martzoukou M, Tsouris Z, Siokas V, Aloizou AM, Liampas I, Nasios G, Dardiotis E. The Beneficial Effects of Computer-Based Cognitive Training in Parkinson’s Disease: A Systematic Review. Arch Clin Neuropsychol. 2020;35(4):434-447. doi:10.1093/arclin/acz080

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-efficacy-of-a-remote-cognitive-remediation-therapy-crt-program-on-parkinsons-disease/