Objective: In this randomized controlled trial [1], our objective was to assess the effect of online home-based cognitive training on objective cognitive functioning and subjective cognitive complaints.

Background: Cognitive dysfunction is highly prevalent in Parkinson’s disease (PD) and a large proportion of patients eventually develops PD-related dementia [2,3]. Currently, no effective treatment is available, but the results of earlier small trials suggest that cognitive training may be effective in relieving cognitive dysfunction in PD patients [4].

Method: In this double-blind RCT we enrolled 140 non-demented PD patients with significant subjective cognitive complaints. Participants were randomized into an adaptive multi-domain cognitive training group (CT) focusing on executive functions and a non-adaptive active control group (AC). Both groups individually performed 24 45-minute online home-based intervention sessions over a period of eight weeks. We performed neuropsychological and questionnaire assessments at baseline and after the intervention to assess training-induced cognitive improvement. The primary outcome of this study was accuracy on the Tower of London (ToL) task. Secondary outcomes included ToL reaction time, subjective cognitive complaints and other neuropsychological tasks. We performed multivariate mixed-model analyses on the intention-to-treat population to assess the difference between CT and AC.

Results: There was no significant difference between CT and AC on ToL accuracy: B = -.696, 95% CI: -3.36 to 1.97, p > .05. The CT group showed a significantly larger training-induced improvement on the reaction time on the more demanding ToL items, compared with AC (B = -1.35, 95% CI: -2.33 to 0.37, p = .007). Analyses of other neuropsychological tests showed similar improvements in speed of processing. There was no effect of CT compared with AC on subjective cognitive complaints.

Conclusion: This study is the first large-scale cognitive training trial in non-demented PD patients. Results showed a significant effect of CT on processing speed in an executive function task, but not on accuracy or on subjective complaints. These results imply that CT may have a beneficial effect on cognitive function, but –in the short term– may have a limited effect on daily functioning.

References: [1] van Balkom TD, Berendse HW, van der Werf YD, et al. COGTIPS: a double-blind randomized active controlled trial protocol to study the effect of home-based, online cognitive training on cognition and brain networks in Parkinson’s disease. BMC Neurol 2019; 19(1): 179. [2] Aarsland D, Creese B, Politis M, et al. Cognitive decline in Parkinson disease. Nat Rev Neurol 2017; 13(4): 217-31. [3] Litvan I, Aarsland D, Adler CH, et al. MDS Task Force on mild cognitive impairment in Parkinson’s disease: critical review of PD-MCI. Mov Disord 2011; 26(10): 1814-24. [4] Leung IH, Walton CC, Hallock H, Lewis SJ, Valenzuela M, Lampit A. Cognitive training in Parkinson disease: A systematic review and meta-analysis. Neurology 2015; 85(21): 1843-51.

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