ABSTRACT
BACKGROUND AND PURPOSE: Patients with Parkinson's disease (PD) are at high risk for cognitive dysfunction. Non-pharmacological interventions have attracted increasing interest for enhancing PD patients' cognitive functions. METHODS: One-year follow-up data (T2 ) of a randomized controlled trial evaluating two 6-week cognitive trainings - a structured (NEUROvitalis, NV) and an unstructured (mentally fit, MF) program - compared with a waiting list control group (CG) in non-demented PD patients (Hoehn and Yahr I-III) are presented. Forty-seven PD patients were examined at T2 . Effects on overall cognitive functions (Mini-Mental State Examination and DemTect) were compared between all groups with repeated measurement analyses of variance. A combined score of the percentage change value from baseline (T0 ) to T2 was calculated to identify patients who retained or improved their cognitive state (responders). The risk of developing mild cognitive impairment (MCI) was analyzed. RESULTS: Significant time × treatment effects on overall cognitive functions were found for both training groups, each compared separately to the CG (DemTect, P < 0.05). Nine patients (56.3%) of the NV group, seven (41.2%) of the MF group and three (21.4%) of the CG were responders. Comparing NV to CG the odds ratio was 4.7 [95% confidence interval (0.8; 33.3)], and comparing MF to CG it was 2.6 [95% confidence interval (0.4; 17.4)]. MCI risk for patients without prior MCI was 40.0% in CG, 18.2% in MF and 18.2% in NV. The odds ratio was 3 comparing NV to CG, MF to CG. DISCUSSION: This study gives evidence that cognitive training may be effective to prevent cognitive decline and onset of MCI in PD patients.
Subject(s)
Cognition Disorders/prevention & control , Cognitive Behavioral Therapy/methods , Parkinson Disease/therapy , Aged , Cognition Disorders/etiology , Cognitive Dysfunction/etiology , Cognitive Dysfunction/prevention & control , Female , Humans , Male , Middle Aged , Parkinson Disease/complications , Treatment OutcomeABSTRACT
The DemTect, a frequently used cognitive screening tool for the German-speaking population, has been proven to be age-, but not education-dependent. To date, scoring routines for persons under and over 60 years of age have been available. In order to describe the age-effect more specifically, the DemTect was administered to persons under 40 (n = 105; median 33 years [18 - 39]) and over 80 years of age [n = 68; median 83 years [80 - 93}). After transformation of the raw scores, which are based on the mean and standard deviation of the respective reference group, an adequate attribution of scores could be achieved and no differences between the groups can be observed in the total score or the subtest scores. The median of the transformed total score was 16 [5 18] for the younger and 15 [5 18] for the older age group. The new scoring routines supplement the scoring procedures of the DemTect for these age groups.
Subject(s)
Cognition Disorders/diagnosis , Neuropsychological Tests/statistics & numerical data , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Cognition Disorders/psychology , Dementia/diagnosis , Dementia/psychology , Female , Germany , Humans , Language , Male , Middle Aged , Neuropsychological Tests/standards , Reference Standards , Reproducibility of Results , Young AdultABSTRACT
Stroke-induced neuropsychological sequelae are frequent and highly relevant for the patient's prognosis, so that their diagnostic assessment at an early point in time is highly advisable to allow for the initiation of appropriate treatment. Because stroke patients in the acute and sub-acute phase of a stroke often show a general slowing and restricted resilience, investigation may be limited and is often only manageable by means of instruments that can be used at bedside. Preferably such neuropsychological tests should also be normalised for the target group. An overview of the neuropsychological instruments available in German, which were developed for or applied to stroke patients in the early phases of stroke and rehabilitation, is provided here. One of the nine instruments presented is the newly developed Cologne Neuropsychological Screening for Stroke Patients (German: Kölner Neuropsychologisches Screening für Schlaganfall-Patienten), which is introduced here. The instruments differ in form of investigation, duration, material volume and standardisation. The choice of a particular instrument in a given clinical or scientific context explicitly depends on the diagnostic goal as well as the resilience of the patient.
Subject(s)
Neuropsychological Tests , Stroke/diagnosis , Stroke/psychology , Germany , Humans , Language , Mental Disorders/etiology , Mental Disorders/psychology , Nervous System Diseases/etiology , Nervous System Diseases/psychologyABSTRACT
The aging of the population leads to increasing incidence rates of dementia. Besides pharmacotherapy, non-pharmacological interventions are becoming more and more recognised. Although the data can be regarded as insufficient, many studies indicate that neuropsychological therapy can lead to an improvement of cognitive and non-cognitive symptoms in patients with dementia and mild cognitive impairment, or even decelerate the course of decline. Regulating guidelines of the local health insurance companies do not yet include this type of intervention. However, they are recommended in the recently published German guidelines for the diagnosis and treatment of dementia. Scientific efforts for the evaluation of specific training programmes can be expected; implementation of the results into clinical practice is desirable.