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J Cent Nerv Syst Dis. 2020 Jan 16;12:1179573519899469. doi: 10.1177/1179573519899469. eCollection 2020.

Effects of Home-Based Working Memory Training on Visuo-Spatial Working Memory in Parkinson's Disease: A Randomized Controlled Trial.

Author information

1
Multimodal Neuroimaging Group, Department of Nuclear Medicine, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany.
2
Department of Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany.
3
Department of Neurology, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany.
4
Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, UK.
5
Department of Neurology, University Hospital of Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.
6
Center for Mind, Brain and Behavior, Philipps-University of Marburg and Justus Liebig University Giessen, Marburg, Germany.
7
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
8
Department of Experimental Psychology, University of Oxford, Oxford, UK.
9
German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.

Abstract

Background:

Cognitive impairment is a very frequent and severe nonmotor symptom of Parkinson's disease (PD). Early intervention in this at-risk group for cognitive decline may be crucial for long-term preservation of cognitive functions. Computerized working memory training (WMT) has been proven beneficial in non-PD patient populations, but such evidence is still needed for patients with PD.

Objective:

This study aimed to evaluate the effect of WMT on visuo-spatial working memory (WM) in cognitively unimpaired patients with PD.

Methods:

A single-blind randomized controlled trial encompassing 76 patients with PD but no cognitive impairment according to level II diagnostic criteria was conducted. Thirty-seven patients engaged in home-based adaptive WMT 5 times per week for a period of 5 weeks, whereas the remaining patients were in the waiting list arm of the study (control group [CG]). Working memory performance was evaluated using a computerized task before and after intervention and at 14-week follow-up, allowing to quantify the precision of WM on a continuous scale, ie, to test not only if an item was remembered but also how well the location of this item was retained.

Results:

Coincidently, the WMT group showed slightly worse WM performance compared with the CG at baseline, which was ameliorated after WMT. This training-induced effect remained stable until follow-up.

Conclusion:

Patients showing relatively low WM performance, despite not formally diagnosable as Parkinson's disease with mild cognitive impairment (PD-MCI), seem to benefit from home-based WMT. Thus, WMT could potentially be implemented in future trials as a time- and cost-efficient route to counteract subtle cognitive changes in early disease stages.

Trial registration:

German Clinical Trial Register (drks.de, DRKS00009379).

KEYWORDS:

Idiopathic Parkinson’s disease; executive function; nonpharmacologic intervention; randomized controlled trial; working memory; working memory training

Conflict of interest statement

Declaration of Conflicting Interests:The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: KG.reports no disclosures. AO reports no disclosures. PR received a travel grant from AbbVie. SR reports no disclosures. JH reports no disclosures. MTB reports personal fees from SOP Neurologie, GE Medical, Bial, UCB, Abbott, and Boston Scientific, in addition, reports grants and personal fees from Medtronic. NZ has received grants from the British Academy. CE has received grants from the German Research Foundation (KFO219, TP 10), the Medical Faculty of the Philipps University Marburg, Germany, and the German Ministry of Education and Research and received honoraria from AbbVie, Wiesbaden, Germany; UCB, Monheim, Germany; Daiichi Sankyo, Munich, Germany; Medtronic, Meerbusch, Germany; Bayer Vital, Leverkusen, Germany; and Bial, Mörfelden-Walldorf, Germany. MH has received grants from the Wellcome Trust, London, UK, the European Union, and the Velux Foundation and personal fees from Lilly Pharma. EK has received grants from the German Ministry of Education and Research, Parkinson Fonds Deutschland gGmbH, and the German Parkinson Society and honoraria from Oticon GmbH, Hamburg, Germany; Lilly Pharma GmbH, Bad Homburg, Germany; Bernafon AG, Bern, Switzerland; and Desitin GmbH, Hamburg, Germany. T.v.E. reports having received grants from the German Research Foundation, the EU Joint Programme—Neurodegenerative Disease Research (JPND) and the Leibniz Association; received consulting and speaker honoraria from Lilly, Shire Germany, and CHDI; and received support for a symposium from Siemens Healthcare, Piramal (now Life Molecular Imaging), and GE Healthcare as well as nonfinancial support from Piramal and AVID Radiopharmaceuticals. He is a stock owner of Allianz SE and NVIDIA.

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