The impact of cognitive interventions on cognitive symptoms in idiopathic Parkinson’s disease: a systematic review

This systematic review addressed efficacy of cognitive stimulation (CS), cognitive training (CT), and cognitive rehabilitation (CR) to improve cognitive functions in Parkinson’s disease (PD) with (PD-MCI) and without mild cognitive impairment (PD-H). Five databases were searched. Twelve CT, four CS, and a combination of CT with CR were found. PD-H benefited from CT or CS compared to active or passive controls in 42.1% of cognitive tests, and in 33.3% of psychological and functional measures. PD-MCI alone, compared with controls, only improved in 6.9% of cognitive measures after CT. PD-H and PD-MCI, alone or together, somehow improved information processing speed, attention, working memory, executive functions, and visual episodic memory. PD-MCI improved better than PD-H in global cognition and planning abilities. The outcomes suggest some efficacy of cognitive interventions in PD. However, small samples, lack of information regarding standardization of interventions, and poor methodological quality limit results validity and prevent firm conclusions.     

Sense of agency disturbances in movement disorders: A comprehensive review

Sense of agency refers to the experience that one’s self-generated action causes an event in the external environment. Here, we review the behavioural and brain evidence of aberrant experiences of agency in movement disorders, clinical conditions characterized by either a paucity or an excess of movements unrelated to the patient’s intention. We show that specific abnormal agency experiences characterize several movement disorders. Those manifestations are typically associated with structural and functional brain abnormalities. However, the evidence is sometimes conflicting, especially when considering results obtained through different agency measures. The present review aims to create order in the existing literature on sense of agency investigations in movement disorders and to provide a coherent overview framed within current neurocognitive models of motor awareness.     

Textured Foot Orthotics on Dynamic Stability and Turning Performance in Parkinson’s Disease

Abstract

The purpose of this study was to facilitate sensory feedback, with textured foot orthotics, to evaluate dynamic stability and turning behavior in Parkinson’s disease individuals. Seven participants with a diagnosis of idiopathic Parkinson’s disease, aged 55–80?years old, participated in this study. Participants completed three testing sessions; baseline, 4?weeks post-baseline, and 5?weeks post-baseline. Three experimental conditions were tested: footwear only (F), footwear?+?non-textured orthotic (FO), and footwear?+?textured orthotic (FOT). Kinematic, kinetic, and video data were collected during the steps preceding a turn task. Variables of interest included dynamic stability (maximum mediolateral (ML), minimum ML, and ML range of the center of mass (COM)-base of support (BOS) relationship) and turning performance (gait velocity and step count). There was a statistically significant increase in maximum ML COM-BOS distance (week 4 [0.1298 m?±?0.054] compared to week 0 [0.1069 m?±?0.050] p = .0076), and a significant decrease in step count (week 0-F [5.52 steps ± 1.08] to week 0-FO [5.23 steps ± 0.87] p = .0296) and (week 4-FO [5.24 steps ± 1.31] to week 4–FOT [4.67 steps ± 0.76] p = .0004). Textured foot orthotics modified dynamic stability and turning performance in Parkinson’s disease individuals completing a 180° degree turn. These preliminary results support this potential treatment option for rehabilitation professionals treating Parkinson’s disease.     

Optimising daily diary questionnaires about fatigue,psychological flexibility and well-being: perspectives of people with rheumatic disease

Objectives: The aim of this study was to understand the perspectives of people with rheumatic disease have about completing a pilot daily diary questionnaire on fatigue and well-being, with the objective of incorporating these perspectives into future daily studies.

Methods: Twenty-two participants with experience of rheumatic disease-related fatigue attended a focus group and/or an individual interview. Before the focus group or interview, participants completed a one-off quantitative diary about their fatigue and well-being that day. In the focus groups and interviews, participants were asked about their experience completing the questionnaire. Data were analysed using inductive thematic analysis.

Results: Three themes were identified. ‘Concerns about Misinterpretation and Ambiguity’ addressed the elements of the diary questionnaire that were confusing or unclear to participants. ‘Desire to Provide Useful and Accurate Information’ outlined participants’ uncertainty about how to report complex daily experiences. ‘Gaining Personal Insight through Diaries’ revealed the personal benefits participants gained, particularly the development of insight into their fatigue.

Conclusions: People with rheumatic disease are willing to complete a daily diary questionnaire, but emphasise it is important for diary questionnaires to have clear instructions, questionnaire items and response scales. Addressing these concerns will ensure the reliability and validity of quantitative diary data.     

Brief Cognitive Behavioral Therapy for Insomnia in Parkinson's Disease: A Case Series Study1

Parkinson's disease (PD) patients frequently suffer from insomnia and insomnia can result in reduction of quality of life in PD. Although pharmacotherapy is most applicable for insomnia, it may cause side-effects in PD. The purpose of the study was to investigate the efficacy of brief cognitive behavioral therapy for insomnia (CBTI) in PD. A total of 11 PD patients aged 43–84 years with chronic insomnia received two sessions of CBTI. Patients reported a significant decrease in total score for the Insomnia Severity Index (ISI). The total score for the Parkinson's Disease Sleep Scale (PDSS) improved. Although objective sleep measured by actigraph did not improve, subjective sleep measured by sleep diary improved. Functional impairment measured by the Sheehan Disability Scale (SDS) significantly decreased. These results revealed that brief CBTI was effective in improving insomnia in PD, with improvements extending to functional impairments that had been affected by insomnia. Additionally, this non-pharmacotherapy treatment could be easily applied to PD patients who may have difficulty coming to the clinic frequently due to physical symptoms.     

Executive performance on the preschool executive task assessment in children with sickle cell anemia and matched controls

Executive deficits are commonly reported in children with sickle cell anemia. Earlier identification of executive deficits would give more scope for intervention, but this cognitive domain has not been routinely investigated due to a lack of age-appropriate tasks normed for preschool children. In particular, information relating to patient performance on an executive task that reflects an everyday activity in the classroom could provide important insight and practical recommendations for the classroom teacher at this key developmental juncture as they enter the academic domain. The performance of 22 children with sickle cell anemia was compared to 24 matched control children on the Preschool Executive Task Assessment. Findings reveal that children with sickle cell anemia are performing poorer than their matched peers on this multi-step assessment. In particular, children with sickle cell anemia required more structured support to shift focus after a completed step, as reflected by poorer scores in the quantitative Sequencing and Completion domains. They also required more support to stay on task, as seen by poorer ratings in the qualitative Distractibility domain.

Abbreviations:PETA: Preschool Executive Task Assessment; SCA: Sickle Cell Anemia; EF: Executive Functioning.     

生物-心理-社会医学模式与控烟及吸烟相关性疾病的防控

大量流行病学研究证实，吸烟是导致肺癌的首要危险因素。因此，控烟才是解决问题的根本途径。本文简述了吸烟的主要危害及目前我国吸烟的现状，在此基础上提出需要在生物-心理-社会医学模式的理论框架下全面考虑控烟及吸烟相关疾病的预防和管理。     

Living in the mo(ve)ment: An ethnographic exploration of hospice patients’ experiences of participating in Tai Chi

PurposeTai Chi is increasingly being used as a complimentary therapy in hospice care to help patients self-manage multiple and complex health needs. However, currently there is limited understanding of Tai Chi from patients’ perspective, including what participation in this mindfulness based movement (MBM) exercise means to their experiences of living with an advanced, incurable disease. The purpose of this study was to explore outpatients’ lived experiences of hospice-based Tai Chi in relation to mindfulness.Methods19 participants (15 females; 4 males, aged between 50 and 91 years old) with a range of advanced, incurable diseases (cancer, COPD, pulmonary fibrosis, pulmonary arterial hypertension) who attended day therapy at a local hospice took part in Tai Chi sessions. Using a focused ethnographic approach, multi-methods including 17 semi-structured interviews (averaging 40 min), participant observations (equating to 200 h spent in the day therapy unit), and informal conversations were used to collect data over a 6 month period. Data was analysed using a thematic framework approach.ResultsFour main themes were constructed that demonstrated participants’ lived experiences of mindfulness during participation in hospice-based Tai Chi sessions. Main themes included: (1) mind-body respite; (2) being present with others; (3) tranquil and therapeutic atmosphere and; (4) physical limitations.ConclusionTai Chi may be an important therapeutic strategy for helping patients with advanced, incurable disease experience mindfulness. The findings of this study support the use of MBM exercises such as Tai Chi as a non-pharmacological adjunct to conventional treatments within palliative care settings.