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

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Abstract

Background

Given the relative importance of cognitive impairment, there was considerable interest in identifying the cognitive profile of PD patients, in order to ensure specific and appropriate therapeutic interventions.

Purpose

To determine the effects of physical exercise programs on cognitive function in PD patients, compared with the control group.

Data sources

Medline, Cochrane, Scopus, PEDro and Web of Science (last searched in September 2016).

Study selection

Randomized clinical trials examining the effects of physical exercise programs and cognitive function in PD patients. Nine studies fulfilled the selection criteria and were included in this review.

Data extraction

Characteristics of the publication, characteristics of the participants, test used for cognitive screening, cognitive domain assessed, tools used to assess cognitive function, characteristics of the experimental intervention, characteristics of the control group, mean results and standard deviation of function cognitive. The PEDro score was used to evaluate methodological quality.

Data synthesis

Most eligible studies showed good methodological quality based on the PEDro scale. Studies have shown that adapted tango for PD patients, cognitive training combined with motor training, and treadmill training promote the preservation or improvement of cognitive function in PD patients.

Limitations

The diversity of cognitive tests used to assess cognitive function and the high heterogeneity identified between the physical exercise programs.

Conclusions

Physical exercise programs promote positive and significant effects on global cognitive function, processing speed, sustained attention and mental flexibility in PD patients, at a mild to moderate stage for patients with a 6-year clinical diagnosis of PD. However, treadmill training performed 3 times a week for about 60 minutes and for a period of 24 weeks produced larger improvements in cognition.

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Most cited references 57

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Population-based norms for the Mini-Mental State Examination by age and educational level.

R Crum, J C Anthony, S S Bassett … (1993)

To report the distribution of Mini-Mental State Examination (MMSE) scores by age and educational level. National Institute of Mental Health Epidemiologic Catchment Area Program surveys conducted between 1980 and 1984. Community populations in New Haven, Conn; Baltimore, Md; St Louis, Mo; Durham, NC; and Los Angeles, Calif. A total of 18,056 adult participants selected by probability sampling within census tracts and households. Summary scores for the MMSE are given in the form of mean, median, and percentile distributions specific for age and educational level. The MMSE scores were related to both age and educational level. There was an inverse relationship between MMSE scores and age, ranging from a median of 29 for those 18 to 24 years of age, to 25 for individuals 80 years of age and older. The median MMSE score was 29 for individuals with at least 9 years of schooling, 26 for those with 5 to 8 years of schooling, and 22 for those with 0 to 4 years of schooling. Cognitive performance as measured by the MMSE varies within the population by age and education. The cause of this variation has yet to be determined. Mini-Mental State Examination scores should be used to identify current cognitive difficulties and not to make formal diagnoses. The results presented should prove to be useful to clinicians who wish to compare an individual patient's MMSE scores with a population reference group and to researchers making plans for new studies in which cognitive status is a variable of interest.

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Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease.

S Hoops, S Nazem, A Siderowf … (2009)

Due to the high prevalence of mild cognitive impairment (MCI) and dementia in Parkinson disease (PD), routine cognitive screening is important for the optimal management of patients with PD. The Montreal Cognitive Assessment (MoCA) is more sensitive than the commonly used Mini-Mental State Examination (MMSE) in detecting MCI and dementia in patients without PD, but its validity in PD has not been established. A representative sample of 132 patients with PD at 2 movement disorders centers was administered the MoCA, MMSE, and a neuropsychological battery with operationalized criteria for deficits. MCI and PD dementia (PDD) criteria were applied by an investigator blinded to the MoCA and MMSE results. The discriminant validity of the MoCA and MMSE as screening and diagnostic instruments was ascertained. Approximately one third of the sample met diagnostic criteria for a cognitive disorder (12.9% PDD and 17.4% MCI). Mean (SD) MoCA and MMSE scores were 25.0 (3.8) and 28.1 (2.0). The overall discriminant validity for detection of any cognitive disorder was similar for the MoCA and the MMSE (receiver operating characteristic area under the curve [95% confidence interval]): MoCA (0.79 [0.72, 0.87]) and MMSE (0.76 [0.67, 0.85]), but as a screening instrument the MoCA (optimal cutoff point = 26/27, 64% correctly diagnosed, lack of ceiling effect) was superior to the MMSE (optimal cutoff point = 29/30, 54% correctly diagnosed, presence of ceiling effect). The Montreal Cognitive Assessment, but not the Mini-Mental State Examination, has adequate psychometric properties as a screening instrument for the detection of mild cognitive impairment or dementia in Parkinson disease. However, a positive screen using either instrument requires additional assessment due to suboptimal specificity at the recommended screening cutoff point.

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Cognitive profile of patients with newly diagnosed Parkinson disease.

Dino Muslimovic, Bart Post, Johannes Speelman … (2005)

To determine the frequency and pattern of cognitive dysfunction in patients with newly diagnosed Parkinson disease (PD) and to identify its demographic and clinical correlates. A cohort of 115 consecutive patients with newly diagnosed PD and 70 healthy controls underwent a comprehensive neuropsychological assessment including tests of psychomotor speed, attention, language, memory, executive and visuospatial functions, as well as measures of affective status. Patients also received quantitative ratings of motor symptom severity and functional status. Neuropsychological performance of PD patients was compared with that of healthy controls and with available normative data. Independent demographic and clinical predictors of cognitive impairment were identified with multiple logistic regression analysis. Relative to controls, PD patients performed significantly worse on most cognitive measures. However, further analysis revealed that group differences in cognitive performance could mainly be explained by measures of immediate memory and executive function. Comparison with normative data showed that impairments were most frequent on measures of executive function, memory and psychomotor speed. In all, 24% of PD patients (4% of controls) displayed defective performance on at least three neuropsychological tests and were classified as cognitively impaired. Late onset of disease was an independent predictor of cognitive dysfunction in PD. Cognitive impairments are common even in newly diagnosed Parkinson disease patients, with deficits being most prominent in the domains of memory and executive functions. Older age at disease onset is likely to be an important determinant of cognitive dysfunction in Parkinson disease.

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Author and article information

Contributors

Franciele Cascaes da Silva:

ORCID: http://orcid.org/0000-0002-4444-9403

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Rodrigo da Rosa Iop: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – review & editing

Laiana Cândido de Oliveira: Role: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – review & editing

Alice Mathea Boll: Role: Data curationRole: Formal analysisRole: MethodologyRole: Writing – review & editing

José Gustavo Souza de Alvarenga: Role: MethodologyRole: SupervisionRole: Writing – review & editing

Paulo José Barbosa Gutierres Filho: Role: InvestigationRole: MethodologyRole: Writing – review & editing

Lídia Mara Aguiar Bezerra de Melo: Role: InvestigationRole: MethodologyRole: Writing – review & editing

André Junqueira Xavier: Role: InvestigationRole: MethodologyRole: Writing – review & editing

Rudney da Silva: Role: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – review & editing

Stephen D Ginsberg: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 27 February 2018

Publication date Collection: 2018

Volume: 13

Issue: 2

Electronic Location Identifier: e0193113

Affiliations

[1 ] University of State of Santa Catarina, Center for Health Sciences and Sports, Adapted Physical Activity Laboratory, Florianópolis, Santa Catarina, Brazil

[2 ] University of Brasilia, Faculty of Physical Education, Brasilia, Brazil

[3 ] University of Southern Santa Catarina, Medicine Course, Florianópolis, Santa Catarina, Brazil

Nathan S Kline Institute, UNITED STATES

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: francascaes@ 123456yahoo.com.br

Author information

Franciele Cascaes da Silva http://orcid.org/0000-0002-4444-9403

Article

Publisher ID: PONE-D-17-28468

DOI: 10.1371/journal.pone.0193113

PMC ID: 5828448

PubMed ID: 29486000

SO-VID: 9ba59c63-f0e4-4430-b9b5-972be0340728

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 1 August 2017

Date accepted : 5 February 2018

Page count

Figures: 1, Tables: 5, Pages: 19

Funding

The authors declare that the work has not received funding.

Custom metadata

Data Availability All relevant data are within the paper and its Supporting Information files.

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

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Abstract

Background

Purpose

Data sources

Study selection

Data extraction

Data synthesis

Limitations

Conclusions

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PLOS Climate

Most cited references 57

Population-based norms for the Mini-Mental State Examination by age and educational level.

Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease.

Cognitive profile of patients with newly diagnosed Parkinson disease.

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