Physiotherapy with dual task improves cognition in Parkinson’s disease with postural instability and gait disorders

Abstract Background Previous studies suggested that action observation training (AOT) and motor imagery (MI) improve motor learning in Parkinson’s disease (PD) patients. The aim of this study was to assess cognitive changes following a 6‐week training associated with dual‐task gait/balance exercises in PD patients with postural instability and gait disorders (PD‐PIGD). Method 25 PD‐PIGD patients were randomized into 2 groups: i) AOT‐MI+DUAL‐TASK group performed a 6‐week (W6) training consisting of AOT‐MI combined with practicing observed‐imagined gait and balance exercises; ii) DUAL‐TASK‐group performed the same exercises combined with landscape‐videos observation. At baseline, W6 and W14 patients underwent neurological, computerized cognitive and motor evaluations. A group of 23 healthy controls (HC) underwent a neuropsychological assessment at the study entry only. Cognitive changes in patients were monitored with the CANTAB (Cambridge Neuropsychological Test Automated Battery). Cognitive changes at each time point in the overall PD‐PIGD sample and between groups (AOT‐MI + DUAL‐TASK and DUAL‐TASK) were assessed. Result At baseline, no cognitive differences were found between the two PD‐PIGD groups. However, both PD groups performed worse than HC in several cognitive domains. Over time, both PD groups improved in terms of gait velocity and balance. Regarding cognitive changes, at W6 and at W14, all PD patients improved in terms of accuracy and reaction times in tests assessing attention switching and visuospatial localization abilities. No differences were observed between groups over time. Conclusion A physiotherapy approach associated with dual‐task gait/balance exercises can improve cognitive performances in PD‐PIGD patients that persist at long term. This improvement is evident in specific cognitive domains, which are usually affected in PD‐PIGD and can interfere with their motor performances.