Brain Training Decreases Severity of Parkinson’s Freezing of Gait, Study Reports

Brain training reduces the severity and duration of freezing of gait and improves cognition and daytime sleepiness in Parkinson’s patients, a study shows.

The study, “Cognitive training for freezing of gait in Parkinson’s disease: a randomized controlled trial,” appeared in the journal npj Parkinson’s Disease.

Freezing of gait is a symptom of Parkinson’s disease and occurs when patients temporarily feel as if their feet are glued to the floor and hesitate before stepping forward. This often leads to falls and lower quality of life. Studies have shown a connection between freezing of gait and impaired attention and cognitive control.

Researchers in Australia conducted a double-blind trial with Parkinson’s patients who self-reported freezing of gait and had no signs of dementia. Patients were randomly assigned to either cognitive training intervention (20 patients) or an “active control” (18 patients).

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Cognitive training consisted of exercises where participants were asked to get up from a chair and walk to a spot marked with a box 5 meters away. Conditions in which patients completed different tasks involving the box were evaluated. Two trials of each condition were completed, one with a left turn and one to the right.

The conditions included: one in which participants walked to the box, turned 180 degrees, and returned to their chair; one where they completed a 540-degree turn in the box before returning to the chair; one in which they shuffled around the box, keeping their inside foot to the outside of the box; and a dual task, where they did the same exercise as the first 180-degree condition, but also completed a cognitive task as they walked, either naming aloud the months backwards or multiples of nine or seven.

Study interventions were conducted twice weekly for seven weeks. Each session took two hours.

The initial 30-45 minutes were common to both groups and included education about a number of topics related to Parkinson’s. Patients undergoing cognitive training then conducted computer tasks targeting processes such as attention, working memory, and brain processing speed. Patients in the active control group completed nonspecific computer tasks.

Investigators primarily evaluated the percentage of time spent frozen during cognitive training, which was analyzed while subjects were both on and off dopaminergic medications. Researchers also assessed several other measures, including mood, well-being, anxiety and depression, sleep quality, and quality of life.

For patients on dopaminergic medication, results showed that those on cognitive training had a significant decrease in the severity of their freezing of gait compared with patients in the active control group. Cognitive training also led to improvements in processing speed and reduced daytime sleepiness.

In contrast, no differences were found when comparing patients not taking regular dopaminergic treatment.

“These results add to the growing body of evidence showing that [cognitive training] is a useful therapeutic technique worthy of continued exploration in [Parkinson’s],” the researchers wrote in the study.

“We believe there is reason to be hopeful for the use of these trials in the future,” Simon Lewis, MD, the study’s senior author and a professor of cognitive neuroscience at the University of Sydney’s Brain and Mind Centre, said in a press release.

He also emphasized the positive feedback from participants and family members, and added that “the results of this pilot study highlight positive trends, and the importance of nonpharmacological trials involving cognitive training has become increasingly clear.”

The researchers also noted the importance of their finding that improvements only occur in patients on dopaminergic medication, “the normal day-day state for patients with Parkinson’s,” said Courtney Walton, PhD, the study’s lead author, who is now at the University of Queensland.

“While more research is needed to better understand and establish these findings, it’s likely that participants in the off- dopaminergic state were too impaired to benefit from any of the potential changes initiated through cognitive training,” Walton said.