Executive function and an eight-week sensory-motor training programme in independent-living individuals with Parkinson’s disease.

Puren, Michelle Sharon (2016-03)

Thesis (M Sport Sc)--Stellenbosch University, 2016

Thesis

ENGLISH ABSTRACT : Introduction: Executive dysfunction is a common non-motor symptom of Parkinson’s Disease (PD). However, in individuals with PD, executive function (EF) is also associated with motor functions, i.e. gait and balance (Xu et al., 2015) and impaired EF is a predictor of future recurrent falls (Mak et al., 2014). Previous research in PD has shown selected improvements in EF through varied exercise interventions, such as aerobic exercise, resistance training and combination exercise (David et al., 2015; Duchesne et al., 2015; Tanaka et al., 2009). Nevertheless, no research to date has investigated the influence of a balance or sensory-motor training (SMT) programme on EF in isolation. Therefore the current study investigated whether an eight-week sensory-motor training programme would alter EF in non-demented individuals with mild to moderate PD. Methods: A convenience sample of 42 individuals with idiopathic PD was divided into an experimental (EXP) and a placebo (PBO) group. This was a time-series design with an eight-week baseline phase (pre- to mid-intervention), followed by an eight-week treatment phase (mid- to post-intervention) in both groups. The baseline phase was the control period in which the participants continued their normal activities with no intervention. The EXP (n = 25; Age: 66 ± 8years; Hoehn & Yahr (HY) stage: 2.5, 2.0 – 3.0; Movement Disorder Society – Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) III rating: 31.9 ± 14.3) participated in an eight-week SMT, while the PBO (n = 17; Age: 71 ± 9years; HY: 2.0, 1.0 – 3.0; MDS-UPDRS III: 22.5 ± 10.0) wore a placebo feedback-wristband over the eight-week treatment phase. The primary outcome measures assessed were Updating (Trail Making Test, TMT), Set shifting (Wisconsin Card Sorting Test; WCST), Inhibition (Adapted Stroop Task), Perceived stability of balance (Activities-Specific Balance Confidence Scale; ABC) and Mobility (Timed Up and Go; TUG). Secondary outcome measures evaluated were Global cognition (Montreal Cognitive Assessment; MoCA), Disease severity (MDS-UPDRS and HY), Quality of life (Parkinson’s Disease Questionnaire; PDQ-39) and Depression (Hamilton Rating Scale for Depression; HAM-D). Participants were assessed at pre-, mid- and post-intervention over 16 weeks. Results: Treatment effects were observed for MDS-UPDRS III (p<0.01) and MDS-UPDRS total score (p=0.02), TMT A (p<0.0001), Global WCST Score (p<0.0001), Choice reaction time (CRT) 1: accuracy (p=0.04), CRT 2: time (p=0.007), Interference: accuracy (p<0.0001) and TUG (p<0.001). The EXP and PBO differed significantly at post-intervention in PDQ-39 variable Bodily discomfort (p=0.04), TMT A (p=0.03), CRT 2: time (p=0.01), Incongruent 1: time (p=0.04) and TUG (p<0.001).; and the changes over time in EXP, for the treatment phase for UPDRS II (p=0.04), PDQ-39 variable Stigma (p=0.01), CRT 2: time (p=0.048), ABC (p=0.01) and TUG (p<0.001). Conclusion: The eight-week SMT was beneficial for selected aspects of EF, namely Inhibition, perceived stability of balance, mobility and disease severity. The EF of Updating and Set shifting as well as global cognition, depressive moods, and quality of life, remained unchanged. Thus, a SMT programme has the potential to improve Inhibition and mobility in individuals with mild to moderate PD, which could result in better balance and a reduction in falls.

AFRIKAANSE OPSOMMING : Inleiding: Uitvoerende disfunksie is `n algemene nie-motoriese simptoom van Parkinson se Siekte (PD). In individue met PD, word uitvoerende funksie (EF) egter ook geassosieer met motoriese funksies soos loopgang en balans (Xu et al., 2015) en ingekorte EF is `n voorteken van toekomstige herhalende val insidente (Mak et al., 2014). Vorige navorsing oor PD het getoon dat sekere verbeteringe in EF gevolg het deur middel van verskeie oefeningintervensies, soos aërobiese-, weerstands- en kombinasie oefeninge (David et al., 2015; Duchesne et al., 2015; Tanaka et al., 2009). Nogtans het geen navorsing tot dusver die invloed van `n balans of sensoriese-motoriese oefenprogram (SMT) op EF in isolasie ondersoek nie. Daarom het die onderhawige studie ondersoek ingestel om te bepaal of `n agt-weke sensoriese-motoriese oefeningsprogram EF sal verbeter in nie-demensie individue met ligte tot matige PD. Metodes: Geriefshalwe is `n steekproef van 42 individue met idiopatiese PD opgedeel in `n eksperimentele (EXP) groep of `n placebo (PBO) groep. Hierdie was `n tyd-reeks ontwerp met `n agt-weke basislyn fase (pre- tot mid-intervensie) gevolg deur `n agt-weke behandelingsfase (mid- tot post-intervensie) in beide groepe. Die basislyn fase was die kontrole periode waartydens die deelnemers voortgegaan het met hul normale aktiwiteite sonder enige intervensie. Die EXP groep (n = 25; Ouderdom: 66 ± 8jaar; Hoehn & Yahr (HY) stadium: 2.5, 2.0 – 3.0; “Movement Disorder Society – Unified Parkinson’s Disease Rating Scale” (MDS-UPDRS) III rating: 31.9 ± 14.3) het deelgeneem aan `n agt-weke SMT, terwyl die PBO groep (n = 17; Oud: 71 ± 9jaar; HY: 2.0, 1.0 – 3.0; MDS-UPDRS III: 22.5 ± 10.0) `n placebo terugvoer-armband oor die agt-weke behandelingsfase gedra het. Die primêre eindresultate wat getoets is was Opdatering (Trail Making Test, TMT), Stel verskuiwing (Wisconsin Card Sorting Test; WCST), Inhibisie (Aangepaste Stroop Task), Waargenome stabiliteit van balans (Activities-Specific Balance Confidence Scale; ABC) en mobiliteit (Timed Up and Go; TUG). Die sekondêre eindresultate wat geëvalueer is was Globale kognisie (Montreal Cognitive Assessment; MoCA), Siekte erns (MDS-UPDRS en HY), Lewenskwaliteit (Parkinson’s Disease Questionnaire; PDQ-39) en Depressie (Hamilton Rating Scale for Depression; HAM-D). Deelnemers is getoets by pre-, mid- en post-intervensie oor 16 weke. Resultate: Behandelingseffekte is waargeneem vir MDS-UPDRS III (p<0.01) en MDS-UPDRS totaal (p=0.02), TMT A (p<0.0001), Globale WCST Telling (p<0.0001), Keuse reaksietyd (CRT) 1: akkuraatheid (p=0.04), CRT 2: tyd (p=0.007), Interferensie: akkuraatheid (p<0.0001) en TUG (p<0.001). Die EXP en PBO het statisties betekenisvol verskil tydens post-intervensie in PDQ-39 veranderlike Liggaamlike ongemak (p=0.04), TMT A (p=0.03), CRT 2: tyd (p=0.01), Inkongruent 1: tyd (p=0.04) en TUG (p<0.001).; en die veranderinge met verloop van tyd in EXP, vir die behandelingsfase UPDRS II (p = 0.04), PDQ-39 veranderlike Stigma (p = 0,01), CRT 2: tyd (p = 0,048), ABC (p = 0,01) en TUG (p <0,001). Gevolgtrekking: Die agt-weke SMT was voordelig vir sekere aspekte van EF, naamlik Inhibisie, persepsie van balans stabiliteit, mobiliteit en die erns van die siekte. Die EF van Opdatering en Stel verskuiwing asook globale kognisie, depressiewe gemoedstoestande en lewenskwaliteit het onveranderd gebly. Dus, `n SMT program het die potensiaal om Inhibisie en mobiliteit te verbeter in individue met lig tot matige PD, wat kan lei tot beter balans en afname in val insidente.

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