Cognitive stimulation in Parkinson's disease with mild cognitive impairment

Abstract

Background: Cognitive impairment is among the most frequent and disabling non-motor symptoms of Parkinson's disease (PD), often emerging early and substantially impacting autonomy and quality of life. While cognitive stimulation (CS) is supported in other neurodegenerative conditions, its role in PD is less explored. This study aimed to compare the efficacy of a therapist-guided, home-based CS program, delivered via a virtual reality rehabilitation system, with a conventional in-person CS intervention.

Methods: Of 123 individuals screened, 45 patients with PD and mild cognitive impairment (PD-MCI) were randomized to either the tele-rehabilitation group (TRG; n = 25) or the control group (CG; n = 20). Both groups received the same standardized 4-week CS program (20 multi-domain sessions, 5 days/week), targeting memory, attention, executive functions, language, and visuospatial skills. The TRG trained at home via the VRRS platform under remote supervision, while the CG attended outpatient sessions. Neuropsychological and clinical outcomes were assessed at baseline (T1), post-intervention (T2), and 6-month follow-up (T3). Analyses included repeated-measures ANOVA, multivariate linear regression, and categorical comparisons based on predefined clinical cut-offs.

Results: All participants completed the intervention with adherence exceeding 90% in both groups. At T2, the TRG showed greater improvements than the CG in global cognition, working memory, and delayed recall. These effects remained significant after adjusting for age, sex, baseline performance, and cognitive reserve index, and were robust to false discovery rate correction. Regression models confirmed these improvements. Categorical analyses also showed a marked reduction in pathological scores in the TRG in the same domains.

Conclusion: A short-term, therapist-guided CS program delivered via tele-rehabilitation effectively improved cognitive functioning in PD-MCI, with partial benefits maintained at 6 months, especially in memory and executive domains. The intervention was particularly beneficial for memory and executive functions, highlighting telemedicine as a promising and accessible option for cognitive care in PD.

Keywords: Cognitive stimulation; Digital health; Mild cognitive impairment; Non-pharmacological treatment; Parkinson’s disease; Tele-rehabilitation.

Fig. 1

Flowchart of study design and timeline. The study includes an initial eligibility screening, followed by written informed consent and baseline randomization (T1) into two groups: the Tele-Rehabilitation Group (TRG) and the Control Group (CG). The TRG received remote cognitive stimulation at home, while the CG participated in conventional outpatient therapy. Both groups underwent neuropsychological assessments at three time points: baseline (T1), after 4 weeks of treatment (T2), and 6 months post-intervention (T3). The arrows depict the progression and timeline of the interventions and follow-up assessments