Do cognitive measures and brain circuitry predict outcomes of exercise in Parkinson Disease: a randomized clinical trial.
BACKGROUND
There is emerging research detailing the relationship between balance/gait/falls and cognition. Imaging studies also suggest a link between structural and functional changes in the frontal lobe (a region commonly associated with cognitive function) and mobility. People with Parkinson's disease have important changes in cognitive function that may impact rehabilitation efficacy. Our underlying hypothesis is that cognitive function and frontal lobe connections with the basal ganglia and brainstem posture/locomotor centers are responsible for postural deficits in people with Parkinson's disease and play a role in rehabilitation efficacy. The purpose of this study is to 1) determine if people with Parkinson's disease can improve mobility and/or cognition after partaking in a cognitively challenging mobility exercise program and 2) determine if cognition and brain circuitry deficits predict responsiveness to exercise rehabilitation.


METHODS
This study is a randomized cross-over controlled intervention to take place at a University Balance Disorders Laboratory. The study participants will be people with Parkinson's disease who meet inclusion criteria for the study. The intervention will be 6 weeks of group exercise (case) and 6 weeks of group education (control). The exercise is a cognitively challenging program based on the Agility Boot Camp for people with PD. The education program is a 6-week program to teach people how to better live with a chronic disease. The primary outcome measure is the MiniBESTest and the secondary outcomes are measures of mobility, cognition and neural imaging.


CONCLUSIONS
The results from this study will further our understanding of the relationship between cognition and mobility with a focus on brain circuitry as it relates to rehabilitation potential.


BACKGROUND
This trial is registered at clinical trials.gov (NCT02231073).
Veterans Affairs Portland Health Care System, Portland, Oregon, USA. kingla@ohsu.edu.
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King
Veterans Affairs Portland Health Care System, Portland, Oregon, USA. petedani@ohsu.edu.|OHSU Parkinson's Center and Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, Oregon, 97239-3098, USA. petedani@ohsu.edu.
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Peterson
Veterans Affairs Portland Health Care System, Portland, Oregon, USA. mancinim@ohsu.edu.
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Mancini
Veterans Affairs Portland Health Care System, Portland, Oregon, USA. carlsonp@ohsu.edu.
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Carlson-Kuhta
Veterans Affairs Portland Health Care System, Portland, Oregon, USA. fling@ohsu.edu.
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Fling
Veterans Affairs Portland Health Care System, Portland, Oregon, USA. smulders@ohsu.edu.
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Smulders
Veterans Affairs Portland Health Care System, Portland, Oregon, USA. nuttj@ohsu.edu.
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Nutt
Veterans Affairs Portland Health Care System, Portland, Oregon, USA. Dalem@ohsu.edu.
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Dale
Veterans Affairs Portland Health Care System, Portland, Oregon, USA. carterju@ohsu.edu.
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Carter
Knight Cancer Institute and School of Nursing, Oregon Health & Science University, Portland, Oregon, USA. wintersk@ohsu.edu.
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Winters-Stone
Veterans Affairs Portland Health Care System, Portland, Oregon, USA. horakf@ohsu.edu.|OHSU Parkinson's Center and Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, Oregon, 97239-3098, USA. horakf@ohsu.edu.
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Horak
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis / Q000534:rehabilitation; D010353:Patient Education as Topic; D004856:Postural Balance / Q000502:physiology*; D011379:Prognosis