Efficacy of Cognitive Rehabilitation Using Virtual Reality and Computer-based Cognitive Stimulation on Cognitive Impairment Associated to Movement Disorders

Summary

Mild cognitive impairment associated with movement disorders occurs in up to one third of patients in early stages of the disease, and confers an increased risk of developing dementia. Non-pharmacological interventions to improve cognition have so far been based on computer-based cognitive stimulation and rehabilitation programs. These interventions base their mechanism of action on neuroplasticity and how improvements in cognitive function will generalize to functional improvement.

Despite having shown certain indicators of efficacy in previous exploratory studies and clinical trials, cognitive rehabilitation continues to show insufficient evidence and requires further study.

To date, there are no previous studies using immersive virtual reality (IVR) to improve cognition. Both IVR and cognitive stimulation are based on the premise that they allow the simulation of ecological environments for rehabilitation than conventional rehabilitation, as well as being more efficient by allowing control of extraneous variables and providing safe spaces for patients. The only PD rehabilitation studies that have been conducted using IVR aimed to improve gait and balance disturbances compared to conventional physiotherapy treatment or non-immersive virtual reality (NIVR).

We hypothesize that a cognitive rehabilitation program using IVR or computer-mediated cognitive stimulation could have a greater beneficial effect on the cognitive status of patients with cognitive impairment associated with movement disorders compared to other modalities such as music therapy, delaying the worsening of cognitive functions.

Conditions

• Parkinson Disease
• Huntington Disease

Interventions

DEVICE

Immersive Virtual Reality (Parkinson's disease)

This tool involves placing sensors in the space where it will be used, wearing virtual reality glasses, and using controllers to create realistic fictional spaces and interact with them. The program used for the study consists of an interface and a set of tasks designed specifically for the type of cognitive process deficits related to frontal function (executive functions) that are predominantly presented by patients with cognitive impairment associated with Parkinson's disease. This is due to the effect of the disease's pathophysiology on a series of brain circuits and structures that range from the basal ganglia to the frontal lobe. The affected functions correspond to the individual's ability to plan, sequence, organize, make decisions, be flexible, abstract, conceptualize, inhibit, among others.

DEVICE

Computer-based cognitive rehabilitation (Parkinson's disease)

This consists of a 24-week computerized cognitive stimulation program using the NeuronUp software. The intervention includes a limited number of tasks developed ad hoc by NeuronUp and the researchers specifically aimed at stimulating the cognitive domains typically affected in movement disorders. These are cognitive processes mostly ascribed to frontal function, as well as other less prevalent but equally disabling processes mainly associated with basal ganglia and fronto-striatal circuitry, such as executive functions, attention and working memory, language, processing speed, and social cognition. Thus, the programs are the same for PD and HD, although the parameters of the number of errors, level of difficulty, and number of correct answers required to advance to the next level have been adjusted to be more demanding in PD and less in HD, with the aim of customizing this type of intervention to the clinical characteristics of each disease.

DEVICE

Computer-based cognitive rehabilitation (Huntington's disease)

This consists of a 24-week computerized cognitive stimulation program using the NeuronUp software. The intervention includes a limited number of tasks developed ad hoc by NeuronUp and the researchers specifically aimed at stimulating the cognitive domains typically affected in movement disorders. These are cognitive processes mostly ascribed to frontal function, as well as other less prevalent but equally disabling processes mainly associated with basal ganglia and fronto-striatal circuitry, such as executive functions, attention and working memory, language, processing speed, and social cognition. Thus, the programs are the same for PD and HD, although the parameters of the number of errors, level of difficulty, and number of correct answers required to advance to the next level have been adjusted to be more demanding in PD and less in HD, with the aim of customizing this type of intervention to the clinical characteristics of each disease.

BEHAVIORAL

Music-therapy (Huntington's disease)

The process used in each session will be standardized, while the content will be flexible, administering the guidelines according to the mood of the patients and their needs at that time. The therapist's clinical experience will guide them, providing sufficient space for flexible adaptation within the treatment guideline. While the sessions will be standardized, without limiting the music therapist in their interactions, the intervention itself will be applied during the experimental period, using all of the cognitive music therapy exercises detailed below in all groups: auditive perception training, musical sensorial orientation, control of musical attention, training of musical executive function, training in musical mnemotecnia and associative training of mood and musical memory

Sponsors & Collaborators

• Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2021-10-13

Primary Completion

2022-09-21

Completion

2023-12-01

Countries

• Spain

Study Locations