Cognitive Training in Parkinson's Disease, the iPARK Study
NCT ID: NCT03680170
Last Updated: 2021-06-22
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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UNKNOWN
NA
80 participants
INTERVENTIONAL
2017-02-01
2023-02-01
Brief Summary
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The iPARK trial is expected to provide novel and clinical useful information whether updating training is an effective training paradigm in PD. Further it will hopefully contribute to a better understanding of cognitive function in PD.
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Detailed Description
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Although prescription of dementia medication in PD most likely has increased during the last decade there are limited evidence of treatment effects . This particular patient group is already burdened by polypharmacy and therefore investigating non-pharmacological interventions is of crucial importance. A recent systematic review of cognitive intervention studies in PD suggests that there is evidence of clinically meaningful improvements in overall cognition and moderate to large effect sizes on measures of working memory, processing speed and executive functions. Another review on the topic suggested that the results are promising, at least in the immediate or short term for some cognitive domains, but due to inconsistencies between studies and lack of methodological salience there are still a lot of questions unanswered. Baseline factors such as cognitive functioning, Hoehn and Yahr stage, premorbid intelligence all can have contributing effects on individual differences in training gain. Therefore it is important to thoroughly investigate baseline characteristics.
In the future, studies need to include more participants, be hypothesis driven and include more detail of the cognitive profile, training intervention and outcome measures.
One approach to cognitive training that has received a lot of attention and critique is process-based cognitive training, such as training focusing on working memory (WM) and executive functions (EF). The purpose of the process based approach is to strengthen general cognitive processes important to global cognitive functioning. WM and EF play central roles in several different functions such as episodic memory, reading comprehension and problem solving to mention a few. Research has also shown that WM and EF is negatively affected both in normal and pathological aging, such as PD.
Training of executive functioning and working memory have gained some promising results in healthy adults, showing improvements in working memory and executive functioning but there is also an indication of broader generalizations of training gain. Previously the effect of process-based updating training in healthy young and older individuals has been studied. Results showed that a period of updating training increased Blood Oxygen Level Dependent (BOLD) activity in striatum related to increased cognitive performance in both groups. Also a corresponding effect of training on dopaminergic neurotransmission was detected.
In the light of the dopamine dysfunction in PD, with negative effects on both motoric and cognitive function it is of interest to study if a non-invasive, non-pharmacological intervention can lead to better updating function with increased dopamine levels in patients with PD. The iPARK study is a double blinded randomized controlled trial that will examine the effect of a web-based cognitive training program with focus on updating training.
The primary question asked will be if updating training will improve the ability to update contents in working memory and also if there will be improvements in other cognitive functions such as psychomotor speed, working memory, executive functions and episodic memory. Further the aim is to investigate if there will be improvements in self-perceived everyday cognitive function and psychological health as well as if the effects seen will be sustained over a period of four months. Baseline factors will be investigated to see if they have a modulating effect on training. Further the iPARK trial will determine if a web-based training performed at home without active supervision is a feasible approach in this particular patient group. Compliance, adherence and expectations will be measured systematically.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
TRIPLE
Study Groups
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Working memory updating training
Training with web-based program on the internet for 30 sessions (4-5 times a week). The result of the training is registered.
Intervention Device: web-based cognitive training
Working memory updating training
Each training session includes four working memory updating tasks that is performed at the participants home on their computer via internet. Each training session takes about 20 minutes to perform.
Placebo training
Low dose, short term memory training. Intervention: Training with computer based program on the internet for 30 sessions (4-5 times a week).
Intervention Device: Web-based cognitive training
Placebo training
Each training session includes four short term memory tasks that is performed at the participants home on their computer via internet. Each training session takes about 20 minutes to perform.
Interventions
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Working memory updating training
Each training session includes four working memory updating tasks that is performed at the participants home on their computer via internet. Each training session takes about 20 minutes to perform.
Placebo training
Each training session includes four short term memory tasks that is performed at the participants home on their computer via internet. Each training session takes about 20 minutes to perform.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
2. Hoehn and Yahr stage I-III
3. Pathological dat scan
4. A score of 24 or over on the MMSE AND be without Dementia
5. Stable medication over the past three months
6. Owns and is able to use a home based computer or tablet with internet connection.
Exclusion Criteria
2. Ongoing cognitive training
3. Diagnosis of PDD
4. Drug or alcohol abuse
45 Years
75 Years
ALL
No
Sponsors
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Karlstad University
OTHER
Umeå University
OTHER
Responsible Party
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Anna Stigsdotter Neely
Professor
Principal Investigators
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Anna S Neely, Prof
Role: PRINCIPAL_INVESTIGATOR
Karlstad University
Locations
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Umeå University department of psychology
Umeå, Västerbotten County, Sweden
Countries
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Central Contacts
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Facility Contacts
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References
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Aarsland D, Kurz MW. The epidemiology of dementia associated with Parkinson disease. J Neurol Sci. 2010 Feb 15;289(1-2):18-22. doi: 10.1016/j.jns.2009.08.034. Epub 2009 Sep 4.
Elgh E, Domellof M, Linder J, Edstrom M, Stenlund H, Forsgren L. Cognitive function in early Parkinson's disease: a population-based study. Eur J Neurol. 2009 Dec;16(12):1278-84. doi: 10.1111/j.1468-1331.2009.02707.x. Epub 2009 Jun 15.
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Kehagia AA, Barker RA, Robbins TW. Neuropsychological and clinical heterogeneity of cognitive impairment and dementia in patients with Parkinson's disease. Lancet Neurol. 2010 Dec;9(12):1200-1213. doi: 10.1016/S1474-4422(10)70212-X. Epub 2010 Sep 27.
Landau SM, Lal R, O'Neil JP, Baker S, Jagust WJ. Striatal dopamine and working memory. Cereb Cortex. 2009 Feb;19(2):445-54. doi: 10.1093/cercor/bhn095. Epub 2008 Jun 11.
Ekman U, Eriksson J, Forsgren L, Mo SJ, Riklund K, Nyberg L. Functional brain activity and presynaptic dopamine uptake in patients with Parkinson's disease and mild cognitive impairment: a cross-sectional study. Lancet Neurol. 2012 Aug;11(8):679-87. doi: 10.1016/S1474-4422(12)70138-2. Epub 2012 Jun 27.
Ito K, Nagano-Saito A, Kato T, Arahata Y, Nakamura A, Kawasumi Y, Hatano K, Abe Y, Yamada T, Kachi T, Brooks DJ. Striatal and extrastriatal dysfunction in Parkinson's disease with dementia: a 6-[18F]fluoro-L-dopa PET study. Brain. 2002 Jun;125(Pt 6):1358-65. doi: 10.1093/brain/awf134.
Seppi K, Weintraub D, Coelho M, Perez-Lloret S, Fox SH, Katzenschlager R, Hametner EM, Poewe W, Rascol O, Goetz CG, Sampaio C. The Movement Disorder Society Evidence-Based Medicine Review Update: Treatments for the non-motor symptoms of Parkinson's disease. Mov Disord. 2011 Oct;26 Suppl 3(0 3):S42-80. doi: 10.1002/mds.23884.
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Glizer D, MacDonald PA. Cognitive Training in Parkinson's Disease: A Review of Studies from 2000 to 2014. Parkinsons Dis. 2016;2016:9291713. doi: 10.1155/2016/9291713. Epub 2016 Sep 5.
Klingberg T. Training and plasticity of working memory. Trends Cogn Sci. 2010 Jul;14(7):317-24. doi: 10.1016/j.tics.2010.05.002. Epub 2010 Jun 16.
Morrison AB, Chein JM. Does working memory training work? The promise and challenges of enhancing cognition by training working memory. Psychon Bull Rev. 2011 Feb;18(1):46-60. doi: 10.3758/s13423-010-0034-0.
Shipstead Z, Redick TS, Engle RW. Is working memory training effective? Psychol Bull. 2012 Jul;138(4):628-654. doi: 10.1037/a0027473. Epub 2012 Mar 12.
Unsworth N, Engle RW. Simple and complex memory spans and their relation to fluid abilities: Evidence from list-length effects. Journal of Memory and Language 54(1): 68-80, 2006.
Unsworth N, Engle RW. The nature of individual differences in working memory capacity: active maintenance in primary memory and controlled search from secondary memory. Psychol Rev. 2007 Jan;114(1):104-32. doi: 10.1037/0033-295X.114.1.104.
Gabrieli JDE, Singh J, Stebbins GT, & Goetz CG. Reduced working memory span in Parkinson's disease: Evidence for the role of frontostriatal system in working and strategic memory. Neuropsychology, 10(3): 322-332,1996.
McCabe DP, Roediger HL, McDaniel MA, Balota DA, Hambrick DZ. The relationship between working memory capacity and executive functioning: evidence for a common executive attention construct. Neuropsychology. 2010 Mar;24(2):222-243. doi: 10.1037/a0017619.
Chein JM, Morrison AB. Expanding the mind's workspace: training and transfer effects with a complex working memory span task. Psychon Bull Rev. 2010 Apr;17(2):193-9. doi: 10.3758/PBR.17.2.193.
Dahlin E, Neely AS, Larsson A, Backman L, Nyberg L. Transfer of learning after updating training mediated by the striatum. Science. 2008 Jun 13;320(5882):1510-2. doi: 10.1126/science.1155466.
Backman L, Nyberg L, Soveri A, Johansson J, Andersson M, Dahlin E, Neely AS, Virta J, Laine M, Rinne JO. Effects of working-memory training on striatal dopamine release. Science. 2011 Aug 5;333(6043):718. doi: 10.1126/science.1204978.
Dahlin E, Nyberg L, Backman L, Neely AS. Plasticity of executive functioning in young and older adults: immediate training gains, transfer, and long-term maintenance. Psychol Aging. 2008 Dec;23(4):720-30. doi: 10.1037/a0014296.
Backman L, Waris O, Johansson J, Andersson M, Rinne JO, Alakurtti K, Soveri A, Laine M, Nyberg L. Increased dopamine release after working-memory updating training: Neurochemical correlates of transfer. Sci Rep. 2017 Aug 2;7(1):7160. doi: 10.1038/s41598-017-07577-y.
Domellof ME, Walton L, Boraxbekk CJ, Backstrom D, Josefsson M, Forsgren L, Stigsdotter Neely A. Evaluating a frontostriatal working-memory updating-training paradigm in Parkinson's disease: the iPARK trial, a double-blinded randomized controlled trial. BMC Neurol. 2020 Sep 7;20(1):337. doi: 10.1186/s12883-020-01893-z.
Other Identifiers
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dnr 2017-02371
Identifier Type: OTHER_GRANT
Identifier Source: secondary_id
dnr 2014-1654
Identifier Type: -
Identifier Source: org_study_id
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