title: Does Cognitive Impairment Affect Rehabilitation Outcome in Parkinson's Disease?
abstract: BACKGROUND
  The cognitive status is generally considered as a major determinant of rehabilitation outcome in Parkinson's disease (PD). No studies about the effect of cognitive impairment on motor rehabilitation outcomes in PD have been performed before.
  
  
  OBJECTIVE
  This study is aimed to evaluate the impact of cognitive decline on rehabilitation outcomes in patients with PD.
  
  
  METHODS
  We retrospectively identified 485 patients with PD hospitalized for a 4-week Multidisciplinary Intensive Rehabilitation Treatment (MIRT) between January 2014 and September 2015. According to Mini Mental State Examination (MMSE), patients were divided into: group 1-normal cognition (score 27-30), group 2-mild cognitive impairment (score 21-26), group 3-moderate or severe cognitive impairment (score ≤ 20). According to Frontal Assessment Battery (FAB), subjects were divided into patients with normal (score ≥13.8) and pathological (score <13.8) executive functions. The outcome measures were: Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Disability Scale (PDDS), Six Minutes Walking Test (6MWT), Timed Up and Go Test (TUG) and Berg Balance Scale (BBS).
  
  
  RESULTS
  All scales had worse values with the increase of cognitive impairment and passing from normal to pathological executive functions. After rehabilitation, all the outcome measures improved in all groups (p < 0.0001). Between groups, the percentage of improvement was significantly different for total UPDRS (p = 0.0009, best improvement in normal MMSE group; p = 0.019, best improvement in normal FAB group), and BBS (p < 0.0001, all pairwise comparisons significant, best improvement in patients with worse MMSE score; p < 0.0001, best improvement in patients with pathological FAB). TUG (p = 0.006) and BBS (p < 0.0001) improved in patients with pathological FAB score, more than in those with normal FAB score.
  
  
  CONCLUSIONS
  Patients gain benefit in the rehabilitative outcomes, regardless of cognition. Our data suggest that rehabilitation could be effective also in Parkinsonian subjects with cognitive impairment, as well as with dysexecutive syndrome.
authors: Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital Gravedona ed Uniti, Italy.
authors: Davide
authors: D
authors: Ferrazzoli
authors: Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital Gravedona ed Uniti, Italy.
authors: Paola
authors: P
authors: Ortelli
authors: Department of Biomedical Engineering, Scientific Institute of Montescano, S. Maugeri Foundation IRCCS Montescano, Italy.
authors: Roberto
authors: R
authors: Maestri
authors: Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital Gravedona ed Uniti, Italy.
authors: Rossana
authors: R
authors: Bera
authors: Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Centre, Sieratzki Chair in Neurology, Sackler School of Medicine, Sagol School for Neuroscience, Tel-Aviv University Tel-Aviv, Israel.
authors: Nir
authors: N
authors: Giladi
authors: Department of Physiology, Pharmacology and Neuroscience, CUNY Medical School New York, NY, USA.
authors: Maria Felice
authors: MF
authors: Ghilardi
authors: Parkinson Institute, Istituti Clinici di Perfezionamento Milano, Italy.
authors: Gianni
authors: G
authors: Pezzoli
authors: Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital Gravedona ed Uniti, Italy.
authors: Giuseppe
authors: G
authors: Frazzitta
keywords: Parkinson’s disease; cognitive impairment; dysexecutive syndrome; learning; neurorehabilitation