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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

A Journal on Physical Medicine and Rehabilitation after Pathological Events


Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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European Journal of Physical and Rehabilitation Medicine 2017 Nov 16

DOI: 10.23736/S1973-9087.17.04837-7

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Cognitive reserve as a variable impacting the effectiveness of rehabilitation on balance in Parkinson’s disease

Giulia PICCININI 1, 2, Isabella IMBIMBO 2, Diego RICCIARDI 3, Daniele CORACI 2, Claudia SANTILLI 2, Maria R. LO MONACO 3, Claudia LORETI 2, Maria C. VULPIANI 1, Maria C. SILVERI 3, Luca PADUA 2, 3

1 Physical Medicine and Rehabilitation Unit, Sant’Andrea Hospital, “Sapienza” University of Rome, Rome, Italy; 2 Don Carlo Gnocchi Foundation Onlus, Milan, Italy; 3 Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy


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BACKGROUND: Cognitive reserve (CR) can be considered an active expression of brain resilience in response to damage. Several studies have shown the influence of CR on cognitive impairment and its relationship with cognitive function in Parkinson’s disease (PD).
AIM: To show if CR influences the effectiveness of balance rehabilitation in PD patients who performed a conventional rehabilitative treatment.
DESIGN: Observational longitudinal study.
SETTING: Neurology outpatient Unit, University Hospital.
POPULATION: Fifty-three patients affected by idiopathic PD, stage 2-3 at the Hoehn and Yahr scale.
METHODS: Each patient underwent 32 group sessions of conventional rehabilitative treatment. At baseline, patient CR was assessed by the Cognitive Reserve Index questionnaire (CRIq). The primary outcome was the evaluation of static and dynamic balance modifications, induced by the treatment, through the Berg Balance Scale (BBS), assessed at T0 and T1. Mini Mental State Examination, Unified Parkinson’s Disease Rating Scale Part III (clinician-scored monitored motor evaluation) and Brief Intelligence Test were assessed only at T0 and used as descriptive variables.
RESULTS: Considering the clinically meaningful change, BBS improved in 26% of patients worsened in 2% and was unchanged in 72%. BBS score significantly improved in older patients, and in those with lower CRI total score. A significant inverse correlation was observed between changes in BBS and work and education related CR. Patients with lower baseline BBS score showed more improvement in balance.
CONCLUSIONS: We found an inverse correlation between CR level and balance improvement in PD patients who underwent conventional rehabilitation: higher improvement in BBS was observed in those with a lower CRI score. This may suggest that patients with higher CRI could benefit from more stimulating modes of non conventional rehabilitation (e.g. robotic, virtual reality).
CLINICAL REHABILITATION IMPACT: Rehabilitation should be individually tailored with CR considered as a significant variable.


KEY WORDS: Cognitive reserve - Parkinson disease - Rehabilitation - Motor outcome - Balance

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Publication History

Article first published online: November 16, 2017
Manuscript accepted: November 8, 2017
Manuscript revised: November 2, 2017
Manuscript received: May 26, 2017

Cite this article as

Piccinini G, Imbimbo I, Ricciardi D, Coraci D, Santilli C, Lo Monaco MR, et al. Cognitive reserve as a variable impacting the effectiveness of rehabilitation on balance in Parkinson’s disease. Eur J Phys Rehabil Med 2017 Nov 16. DOI: 10.23736/S1973-9087.17.04837-7

Corresponding author e-mail

luca.padua@unicatt.it