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      Memory enhancement by multidomain group cognitive training in patients with Parkinson’s disease and mild cognitive impairment: long-term effects of a multicenter randomized controlled trial

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          Abstract

          Background

          Meta-analyses indicate positive effects of cognitive training (CT) in patients with Parkinson’s disease (PD), however, most previous studies had small sample sizes and did not evaluate long-term follow-up. Therefore, a multicenter randomized controlled, single-blinded trial (Train-ParC study) was conducted to examine CT effects in PD patients with mild cognitive impairment (PD-MCI). Immediately after CT, an enhancement of executive functions was demonstrated. Here, we present the long-term results 6 and 12 months after CT.

          Methods

          At baseline, 64 PD-MCI patients were randomized to a multidomain CT group ( n = 33) or to a low-intensity physical activity training control group (PT) ( n = 31). Both interventions included 90 min training sessions twice a week for 6 weeks. 54 patients completed the 6 months (CT: n = 28, PT: n = 26) and 49 patients the 12 months follow-up assessment (CT: n = 25, PT: n = 24). Primary study outcomes were memory and executive functioning composite scores. Mixed repeated measures ANOVAs, post-hoc t tests and multiple regression analyses were conducted.

          Results

          We found a significant time x group interaction effect for the memory composite score ( p = 0.006, η 2 = 0.214), but not for the executive composite score ( p = 0.967, η 2 = 0.002). Post-hoc t tests revealed significant verbal and nonverbal memory improvements from pre-intervention to 6 months, but not to 12 months follow-up assessment in the CT group. No significant predictors were found for predicting memory improvement after CT.

          Conclusions

          This study provides Class 1 evidence that multidomain CT enhances memory functioning in PD-MCI after 6 months but not after 12 months, whereas executive functioning did not change in the long-term.

          Clinical trial registration

          German Clinical Trials Register (ID: DRKS00010186), 21.3.2016 (The study registration is outlined as retrospective due to an administrative delay. The first patient was enrolled three months after the registration process was started. A formal confirmation of this process from the German Clinical Trials Register can be obtained from the authors.)

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00415-021-10568-9.

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          Most cited references62

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          The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.

          To develop a 10-minute cognitive screening tool (Montreal Cognitive Assessment, MoCA) to assist first-line physicians in detection of mild cognitive impairment (MCI), a clinical state that often progresses to dementia. Validation study. A community clinic and an academic center. Ninety-four patients meeting MCI clinical criteria supported by psychometric measures, 93 patients with mild Alzheimer's disease (AD) (Mini-Mental State Examination (MMSE) score > or =17), and 90 healthy elderly controls (NC). The MoCA and MMSE were administered to all participants, and sensitivity and specificity of both measures were assessed for detection of MCI and mild AD. Using a cutoff score 26, the MMSE had a sensitivity of 18% to detect MCI, whereas the MoCA detected 90% of MCI subjects. In the mild AD group, the MMSE had a sensitivity of 78%, whereas the MoCA detected 100%. Specificity was excellent for both MMSE and MoCA (100% and 87%, respectively). MCI as an entity is evolving and somewhat controversial. The MoCA is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in patients performing in the normal range on the MMSE.
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            Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases.

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              Diagnostic criteria for mild cognitive impairment in Parkinson's disease: Movement Disorder Society Task Force guidelines.

              Mild cognitive impairment is common in nondemented Parkinson's disease (PD) patients and may be a harbinger of dementia. In view of its importance, the Movement Disorder Society commissioned a task force to delineate diagnostic criteria for mild cognitive impairment in PD. The proposed diagnostic criteria are based on a literature review and expert consensus. This article provides guidelines to characterize the clinical syndrome and methods for its diagnosis. The criteria will require validation, and possibly refinement, as additional research improves our understanding of the epidemiology, presentation, neurobiology, assessment, and long-term course of this clinical syndrome. These diagnostic criteria will support future research efforts to identify at the earliest stage those PD patients at increased risk of progressive cognitive decline and dementia who may benefit from clinical interventions at a predementia stage. Copyright © 2012 Movement Disorder Society.
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                Author and article information

                Contributors
                karsten.witt@uni-oldenburg.de
                Journal
                J Neurol
                J Neurol
                Journal of Neurology
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0340-5354
                1432-1459
                27 April 2021
                27 April 2021
                2021
                : 268
                : 12
                : 4655-4666
                Affiliations
                [1 ]GRID grid.5560.6, ISNI 0000 0001 1009 3608, Department of Neurology, , University Oldenburg, ; Steinweg 13-17, 26122 Oldenburg, Germany
                [2 ]GRID grid.9764.c, ISNI 0000 0001 2153 9986, Department of Neurology, , University Hospital Schleswig-Holstein, Christian-Albrechts-University, ; Kiel, Germany
                [3 ]GRID grid.6190.e, ISNI 0000 0000 8580 3777, Medical Psychology, Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Interventions (CeNDI), , Faculty of Medicine and University Hospital Cologne, University of Cologne, ; Cologne, Germany
                [4 ]GRID grid.411327.2, ISNI 0000 0001 2176 9917, Department of Neurology, Center for Movement Disorders and Neuromodulation and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, , Heinrich-Heine-University Duesseldorf, ; Duesseldorf, Germany
                [5 ]GRID grid.10392.39, ISNI 0000 0001 2190 1447, Department of Neurodegenerative Diseases, , German Center for Neurodegenerative Diseases (DZNE) and Hertie Institute for Clinical Brain Research, University of Tuebingen, ; Tuebingen, Germany
                [6 ]IB Hochschule Für Gesundheit Und Soziales, Stuttgart, Germany
                [7 ]GRID grid.411067.5, ISNI 0000 0000 8584 9230, Department of Neurology, , University Hospital of Marburg, Center for Mind, Brain and Behavior (CMBB), Universities Marburg and Giessen, ; Marburg, Germany
                [8 ]GRID grid.6190.e, ISNI 0000 0000 8580 3777, Department of Neurology, , Faculty of Medicine and University Hospital Cologne, University of Cologne, ; Cologne, Germany
                [9 ]GRID grid.5560.6, ISNI 0000 0001 1009 3608, Research Center Neurosensory Science, Carl von Ossietzky University Oldenburg, ; Oldenburg, Germany
                Article
                10568
                10.1007/s00415-021-10568-9
                8563628
                33904966
                85db995a-5bf0-4912-a678-fe4104734bc8
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 11 March 2021
                : 12 April 2021
                : 15 April 2021
                Funding
                Funded by: ParkinsonFonds Germany
                Funded by: German Centre for Neurodegenerative diseases (DZNE) e.V.
                Funded by: Carl von Ossietzky Universität Oldenburg (3092)
                Categories
                Original Communication
                Custom metadata
                © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2021

                Neurology
                parkinson’s disease,mild cognitive impairment,cognition,cognitive training,non-pharmacological intervention,long-term effects

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