COGNITIVE REHABILITATION APPROACHES IN PARKINSON'S DISEASE: A REVIEW

Öz

Parkinson's disease is a neurodegenerative condition that not only affects motor symptoms but also cognitive functions. Cognitive impairments, often overlooked especially in the early stages, negatively impact patients' daily life activities. Cognitive problems ranging from mild cognitive impairment to dementia are associated with lower quality of life in both patients and caregivers. Therefore, cognitive rehabilitation plays a critical role in addressing cognitive decline in Parkinson's disease. Among these rehabilitation approaches are exercise, cognitive training, cognitive stimulation therapy, reality orientation therapy, reminiscence therapy, dual-task training, mindfulness-based interventions, and music therapy. These methods contribute to improvement in cognitive domains such as memory, attention, and executive functions. Early implementation of cognitive rehabilitation is important not only in slowing the progression of the disease but also in preventing or alleviating caregiver burnout. The aim of this review is to examine the methods used within the scope of cognitive rehabilitation in Parkinson's disease in the light of the literature

Anahtar Kelimeler

• parkinson's disease
• cognition
• rehabilitation

Parkinson Hastalığında Bilişsel Rehabilitasyon Yaklaşımları: Derleme

Öz

Parkinson hastalığı, sadece motor semptomlarla sınırlı kalmayan, aynı zamanda bilişsel fonksiyonları da etkileyebilen nörodejeneratif bir hastalıktır. Özellikle erken dönemde sıklıkla göz ardı edilen bu bilişsel etkilenimler, hastaların günlük yaşam aktivitelerini olumsuz etkiler. Hafif bilişsel bozukluktan demansa kadar uzanan geniş bir yelpazede ortaya çıkan bilişsel sorunlar hem hastalarda hem de bakıcılarda daha düşük yaşam kalitesi ile ilişkilidir. Bu nedenle Parkinson hastalığında bilişsel rehabilitasyon, bilişsel bozulma ile mücadelede kritik bir rol oynamaktadır. Bu rehabilitasyon yaklaşımları arasında egzersiz, bilişsel eğitim, bilişsel stimülasyon terapisi, gerçeklik yönelimi terapisi, anımsama terapisi, çift görev eğitimi, farkındalık temelli müdahaleler ve müzik terapi bulunmaktadır. Bu yöntemler, hafıza, dikkat, yürütücü fonksiyonlar gibi bilişsel alanlarda iyileşmeye katkı sağlamaktadır. Bilişsel rehabilitasyonun erken dönemde uygulanması, hastalığın seyrini yavaşlatmanın yanı sıra bakım verenlerin tükenmişliğini önleme veya hafifletme açısından önemlidir. Bu derlemenin amacı Parkinson hastalığında bilişssel rehabilitasyon kapsamında kullanılan yöntemleri literatür ışığında incelemektir.

Anahtar Kelimeler

• Parkinson hastalığı
• biliş
• rehabilitasyon

Kaynakça

1. 1. Simon DK, Tanner CM, Brundin P. Parkinson Disease Epidemiology, Pathology, Genetics, and Pathophysiology. Vol. 36, Clinics in Geriatric Medicine. 2020.
2. 2. Rouaud T, Corbillé AG, Leclair-Visonneau L, et al. Pathophysiology of Parkinson’s disease: Mitochondria, alphasynuclein and much more…. Vol. 177, Revue Neurologique. 2021.
3. 3. Chaudhuri JR, Mridula KR, Bandaru VS. Prevalence of non-motor symptoms in parkinson’s disease: A study from south india. Turk Noroloji Dergisi. 2021;27(1):52–7.
4. 4. Corallo F, De Cola MC, Buono V Lo, Lorenzo G Di, Bramanti P, Marino S. Observational study of quality of life of Parkinson’s patients and their caregivers. 2016 [cited 2024 Feb 28]; Available from: https://onlinelibrary.wiley.com/doi/10.1111/psyg.12196
5. 5. Abdelbari S, Ayoub BM, Amer HA, Kamel R. Surgical management of parkinson’s disease: The role of lesioning procedures in developing countries in the modern era. Open Access Maced J Med Sci. 2021;9(B):1241–62.
6. 6. BNP K, Korrapati N, Kouser Ali S. Parkinson’s Disease (Pathogenesis and Its Management): An Overview. J Alzheimers Dis Parkinsonism. 2016;06(06).
7. 7. Osborne JA, Botkin R, Colon-Semenza C, et al. Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline From the American Physical Therapy Association. Vol. 102, Physical Therapy. Oxford University Press; 2022.
8. 8. Leroi I, McDonald K, Pantula H, Harbishettar V. Cognitive impairment in parkinson disease: Impact on quality of life, disability, and caregiver burden. J Geriatr Psychiatry Neurol. 2012 Dec;25(4):208–14.

9. 9. Caballol N, Martí MJ, Tolosa E. Cognitive dysfunction and dementia in Parkinson disease. In: Movement Disorders. 2007.
10. 10. Aarsland D, Batzu L, Halliday GM, et al. Parkinson disease-associated cognitive impairment. Nat Rev Dis Primers. 2021 Dec 1;7(1).
11. 11. Benito-León J, Louis ED, Posada IJ, et al. Populationbased case-control study of cognitive function in early Parkinson’s disease (NEDICES). J Neurol Sci. 2011 Nov 15;310(1–2):176–82.
12. 12. Aarsland D. Cognitive impairment in Parkinson’s disease and dementia with Lewy bodies. Parkinsonism Relat Disord. 2016 Jan 1;22:S144–8.
13. 13. Elgh E, Domellöf M, Linder J, Edström 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.
14. 14. Hobson P, Meara J. Risk and incidence of dementia in a cohort of older subjects with Parkinson’s disease in the United Kingdom. Movement Disorders. 2004 Sep;19(9):1043–9.
15. 15. Sun C, Armstrong MJ. Treatment of parkinson’s disease with cognitive impairment: Current approaches and future directions. Vol. 11, Behavioral Sciences. MDPI AG; 2021.
16. 16. Ahlskog JE. Aerobic Exercise: Evidence for a Direct Brain Effect to Slow Parkinson Disease Progression. Vol. 93, Mayo Clinic Proceedings. Elsevier Ltd; 2018. p. 360–72.
17. 17. Almikhlafi MA. The role of exercise in Parkinson’s Disease. Vol. 28, Neurosciences. Saudi Arabian Armed Forces Hospital; 2023. p. 4–12.
18. 18. Feng YS, Yang SD, Tan ZX, et al. The benefits and mechanisms of exercise training for Parkinson’s disease. Vol. 245, Life Sciences. Elsevier Inc.; 2020.
19. 19. Lau YS, Patki G, Das-Panja K, Le WD, Ahmad SO. Neuroprotective effects and mechanisms of exercise in a chronic mouse model of Parkinson’s disease with moderate neurodegeneration. European Journal of Neuroscience. 2011 Apr;33(7):1264–74.
20. 20. Da Silva PGC, Domingues DD, De Carvalho LA, Allodi S, Correa CL. Neurotrophic factors in Parkinson’s disease are regulated by exercise: Evidence-based practice. Vol. 363, Journal of the Neurological Sciences. Elsevier B.V.; 2016. p. 5–15.
21. 21. Castells-Sánchez A, Roig-Coll F, Lamonja-Vicente N, et al. Effects and Mechanisms of Cognitive, Aerobic Exercise, and Combined Training on Cognition, Health, and Brain Outcomes in Physically Inactive Older Adults: The Projecte Moviment Protocol. Front Aging Neurosci. 2019 Aug 14;11.
22. 22. Hirsch MA, Iyer SS, Sanjak M. Exercise-induced neuroplasticity in human Parkinson’s disease: What is the evidence telling us? Parkinsonism Relat Disord. 2016 Jan 1;22:S78–81.
23. 23. Intzandt B, Beck EN, Silveira CRA. The effects of exercise on cognition and gait in Parkinson’s disease: A scoping review. Vol. 95, Neuroscience and Biobehavioral Reviews. Elsevier Ltd; 2018. p. 136–69.
24. 24. Fan B, Jabeen R, Bo B, et al. Review Article What and How Can Physical Activity Prevention Function on Parkinson’s Disease? 2020
25. 25. John Rieger de Almeida E, Jungkenn Ibrahim H, Rosa Chitolina Schetinger M, Melazzo de Andrade C, Machado Cardoso A. Modulation of Inflammatory Mediators and Microglial Activation Through Physical Exercise in Alzheimer’s and Parkinson’s Diseases. 2022;47:3221–40. Available from: https://doi.org/10.1007/s11064-022-03713-x
26. 26. Fisher BE, Li Q, Nacca A, et al. Treadmill exercise elevates striatal dopamine D2 receptor binding potential in patients with early Parkinson’s disease. Neuroreport. 2013 Jul 10;24(10):509–14.
27. 27. Sacheli MA, Neva JL, Lakhani B, et al. Exercise increases caudate dopamine release and ventral striatal activation in Parkinson’s disease. Movement Disorders. 2019 Dec 1;34(12):1891–900.
28. 28. Petzinger GM, Fisher BE, McEwen S, Beeler JA, Walsh JP, Jakowec MW. Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson’s disease. Vol. 12, The Lancet Neurology. 2013. p. 716–26.
29. 29. Duchesne C, Gheysen F, Bore A, et al. Influence of aerobic exercise training on the neural correlates of motor learning in Parkinson’s disease individuals. Neuroimage Clin. 2016;12:559–69.
30. 30. Johansson ME, Cameron IGM, Van der Kolk NM, et al. Aerobic Exercise Alters Brain Function and Structure in Parkinson’s Disease: A Randomized Controlled Trial. Ann Neurol. 2022 Feb 1;91(2):203–16.
31. 31. Altmann LJP, Stegemöller E, Hazamy AA, et al. Aerobic Exercise Improves Mood, Cognition, and Language Function in Parkinson’s Disease: Results of a Controlled Study. Journal of the International Neuropsychological Society. 2016 Oct 1;22(9):878–89.
32. 32. Tuon T, Souza PS, Santos MF, et al. Physical training regulates mitochondrial parameters and neuroinflammatory mechanisms in an experimental model of Parkinson’s disease. Oxid Med Cell Longev. 2015;2015.
33. 33. David FJ, Robichaud JA, Leurgans SE, et al. Exercise improves cognition in Parkinson’s disease: The PRET-PD randomized, clinical trial. Movement Disorders. 2015 Oct 1;30(12):1657–63.
34. 34. Marotta N, Calafiore D, Curci C, et al. Integrating virtual reality and exergaming in cognitive rehabilitation of patients with Parkinson disease: a systematic review of randomized controlled trials. Vol. 58, European Journal of Physical and Rehabilitation Medicine. Edizioni Minerva Medica; 2022. p. 818–26.
35. 35. Jäggi S, Wachter A, Adcock M, et al. Feasibility and effects of cognitive–motor exergames on fall risk factors in typical and atypical Parkinson’s inpatients: a randomized controlled pilot study. Eur J Med Res. 2023 Dec 1;28(1).
36. 36. Zimmermann R, Gschwandtner U, Benz N, et al. Cognitive training in Parkinson disease: Cognition-specific vs nonspecific computer training. Neurology. 2014;82(14).
37. 37. Clare L, Woods RT. Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer’s disease: A review. Vol. 14, Neuropsychological Rehabilitation. 2004. p. 385–401.
38. 38. Nousia A, Martzoukou M, Tsouris Z, et al. The beneficial effects of computer-based cognitive training in parkinson’s disease: A systematic review. Vol. 35, Archives of Clinical Neuropsychology. Oxford University Press; 2021. p. 434–47.
39. 39. Dunlosky J, Rawson KA, Marsh EJ, Nathan MJ, Willingham DT. Improving Students' Learning With Effective Learning Techniques: Promising Directions From Cognitive and Educational Psychology. Psychol Sci Public Interest. 2013 Jan;14(1):4-58. doi: 10.1177/1529100612453266. PMID: 26173288.
40. 40. Lampit A, Hallock H, Valenzuela M. Computerized Cognitive Training in Cognitively Healthy Older Adults: A Systematic Review and Meta-Analysis of Effect Modifiers. PLoS Med. 2014;11(11).
41. 41. Huntley JD, Gould RL, Liu K, Smith M, Howard RJ. Do cognitive interventions improve general cognition in dementia? A meta-analysis and meta-regression. Available from: http://dx.doi.org/
42. 42. Nombela C, Bustillo PJ, Castell PF, Sanchez L, Medina V, Herrero MT. Cognitive rehabilitation in Parkinson’s disease: Evidence from neuroimaging. Front Neurol. 2011;DEC.
43. 43. Belleville S, Bherer L. Biomarkers of Cognitive Training Effects in Aging.
44. 44. Chapman SB, Aslan S, Spence JS, et al. Neural mechanisms of brain plasticity with complex cognitive training in healthy seniors. Cerebral Cortex. 2015 Feb 1;25(2):396–405.
45. 45. Cerasa A, Gioia MC, Salsone M, et al. Neurofunctional correlates of attention rehabilitation in Parkinson’s disease: An explorative study. Neurological Sciences. 2014;35(8).
46. 46. Edwards JD, Hauser RA, O’Connor ML, Valdés EG, Zesiewicz TA, Uc EY. Randomized trial of cognitive speed of processing training in Parkinson disease. Neurology. 2013;81(15).
47. 47. París AP, Saleta HG, de la Cruz Crespo Maraver M, et al. Blind randomized controlled study of the efficacy of cognitive training in Parkinson’s disease. Movement Disorders. 2011;26(7).
48. 48. Dıez-Cirarda MD, Ojeda N, Pe J, et al. Long-term effects of cognitive rehabilitation on brain, functional outcome and cognition in Parkinson’s disease. Eur J Neurol [Internet]. 2018;25:5–12. Available from: https://onlinelibrary.wiley.com/doi/10.1111/ene.13472
49. 49. Guglietti B, Hobbs D, Collins-Praino LE. Optimizing Cognitive Training for the Treatment of Cognitive Dysfunction in Parkinson’s Disease: Current Limitations and Future Directions. Vol. 13, Frontiers in Aging Neuroscience. Frontiers Media S.A.; 2021.
50. 50. Leung IH, Walton CC, Hallock H, Simon Lewis MbmsJ, Valenzuela M, Lampit A. Cognitive training in Parkinson disease A systematic review and meta-analysis. 2015.
51. 51. Leroi I, Vatter S, Carter LA, et al. Parkinson’s-adapted cognitive stimulation therapy: a pilot randomized controlled clinical trial. Ther Adv Neurol Disord. 2019 Jul 1;12.
52. 52. McCormick SA, Vatter S, Carter LA, et al. Parkinson’sadapted cognitive stimulation therapy: feasibility and acceptability in Lewy body spectrum disorders. J Neurol. 2019 Jul 1;266(7):1756–70.
53. 53. Folkerts AK, Dorn ME, Roheger M, et al. Cognitive Stimulation for Individuals with Parkinson’s Disease Dementia Living in Long-Term Care: Preliminary Data from a Randomized Crossover Pilot Study. Parkinsons Dis. 2018;2018.
54. 54. Quayhagen MP, Quayhagen M, Corbeil RR, et al. Coping with dementia: Evaluation of four nonpharmacologic interventions. Int Psychogeriatr. 2000;12(2).
55. 55. Storey K, Foster E, Kalishman S, Doty T. Cognitive Stimulation Therapy for People with Parkinson’s Disease Dementia. Arch Phys Med Rehabil. 2021 Oct 1;102(10):e37– 8.
56. 56. Camargo CHF, Ladeira MA, Serpa RA, Jobbins, et al. The Effectiveness of Reality Orientation Therapy in the Treatment of Parkinson Disease Dementia. Am J Alzheimers Dis Other Demen. 2019 Mar 1;34(2):124–30.
57. 57. Spector AE, Orrell M, Davies SP, Woods B. Reality orientation for dementia. Cochrane Database of Systematic Reviews [Internet]. 2000 Jul 24;2010(1). Available from: http://doi.wiley.com/10.1002/14651858.CD001119.pub2
58. 58. Chiu HY, Chen PY, Chen YT, Huang HC. Reality orientation therapy benefits cognition in older people with dementia: A meta-analysis. Int J Nurs Stud. 2018 Oct 1;86:20–8.
59. 59. Macleod F, Storey L, Rushe T, McLaughlin K. Towards an increased understanding of reminiscence therapy for people with dementia: A narrative analysis. Dementia. 2021;20(4).
60. 60. Reitano MR, Guidetti M, Maiorana NV, et al. The Effects of a New Integrated and Multidisciplinary Cognitive Rehabilitation Program Based on Mindfulness and Reminiscence Therapy in Patients with Parkinson’s Disease and Mild Cognitive Impairment: A Pilot Study. 2023; Available from: https://doi.org/10.3390/brainsci13020201
61. 61. Saragih ID, Tonapa SI, Yao CT, Saragih IS, Lee BO. Effects of reminiscence therapy in people with dementia: A systematic review and meta-analysis. J Psychiatr Ment Health Nurs. 2022;29(6).
62. 62. Nakamura K, Kasai M, Nakai M, Nakatsuka M, Meguro K. The Group Reminiscence Approach Can Increase SelfAwareness of Memory Deficits and Evoke a Life Review in People With Mild Cognitive Impairment: The Kurihara Project Data. J Am Med Dir Assoc. 2016 Jun 1;17(6):501–7.
63. 63. Akanuma K, Meguro K, Meguro M, et al. Improved social interaction and increased anterior cingulate metabolism after group reminiscence with reality orientation approach for vascular dementia. Psychiatry Res Neuroimaging. 2011 Jun 30;192(3):183–7.
64. 64. Jahanbin I, Mohammadnejad S, Sharif F. The effect of group reminiscence on the cognitive status of elderly people supported by ilam welfare organization in 2013; a randomized controlled clinical trial. Int J Community Based Nurs Midwifery. 2014;2(4).
65. 65. Strobach T. The dual-task practice advantage: Empirical evidence and cognitive mechanisms. Vol. 27, Psychonomic Bulletin and Review. 2020.
66. 66. Ardenghi LG, Signorini AV, Maahs GS, et al. Deglutition impairment during dual task in parkinson disease is associated with cognitive status. Int Arch Otorhinolaryngol. 2021;25(1).
67. 67. Raffegeau TE, Krehbiel LM, Kang N, et al. A metaanalysis: Parkinson’s disease and dual-task walking. Vol. 62, Parkinsonism and Related Disorders. 2019.
68. 68. Salazar RD, Ren X, Ellis TD, et al. Dual tasking in Parkinson’s disease: Cognitive consequences while walking. Neuropsychology. 2017 Sep 1;31(6):613–23.
69. 69. Johansson H, Ekman U, Rennie L, Peterson DS, Leavy B, Franzén E. Dual-Task Effects During a Motor-Cognitive Task in Parkinson’s Disease: Patterns of Prioritization and the Influence of Cognitive Status. Neurorehabil Neural Repair. 2021 Apr 1;35(4):356–66.
70. 70. Fernandes Â, Rocha N, Santos R, Tavares JMRS. Effects of dual-task training on balance and executive functions in Parkinson’s disease: A pilot study. Somatosens Mot Res. 2015 Apr 3;32(2):122–7
71. 71. Park JH. Effects of Cognitive-Physical Dual-Task Training on Executive Function and Activity in the Prefrontal Cortex of Older Adults with Mild Cognitive Impairment. Brain & Neurorehabilitation. 2021;14(3).
72. 72. Maier F, Greuel A, Hoock M, et al. Impaired selfawareness of cognitive deficits in Parkinson's disease relates to cingulate cortex dysfunction. Psychol Med. 2023;53(4):1244-1253.
73. 73. Lehrner J, Kogler S, Lamm C, et al. Awareness of memory deficits in subjective cognitive decline, mild cognitive impairment, Alzheimer’s disease and Parkinson’s disease. Int Psychogeriatr. 2015;27(3).
74. 74. Kudlicka A, Clare L, Hindle J V. Awareness of executive deficits in people with Parkinson’s disease. Journal of the International Neuropsychological Society. 2013;19(5).
75. 75. Kudlicka A, Hindle J V., Spencer LE, Clare L. Everyday functioning of people with Parkinson’s disease and impairments in executive function: a qualitative investigation. Disabil Rehabil. 2018;40(20).
76. 76. Farhang M, Rojas G, Martínez P, et al. The Impact of a Yoga-Based Mindfulness Intervention versus PsychoEducational Session for Older Adults with Mild Cognitive Impairment: The Protocol of a Randomized Controlled Trial. Int J Environ Res Public Health. 2022 Nov 1;19(22).
77. 77. Pickut BA, Van Hecke W, Kerckhofs E, et al. Mindfulness based intervention in Parkinson’s disease leads to structural brain changes on MRI: A randomized controlled longitudinal trial. Vol. 115, Clinical Neurology and Neurosurgery. 2013. p. 2419–25.
78. 78. Buchwitz TM, Ruppert-Junck MC, Greuel A, et al. Exploring impaired self-awareness of motor symptoms in Parkinson's disease: Resting-state fMRI correlates and the connection to mindfulness. PLoS One. 2023;18(2):e0279722.
79. 79. Subramanian I. Complementary and Alternative Medicine and Exercise in Nonmotor Symptoms of Parkinson’s Disease. In: International Review of Neurobiology. Academic Press Inc.; 2017. p. 1163–88.
80. 80. Brancatisano O, Baird A, Thompson WF. Why is music therapeutic for neurological disorders? The Therapeutic Music Capacities Model. Vol. 112, Neuroscience and Biobehavioral Reviews. Elsevier Ltd; 2020. p. 600–15.
81. 81. Bunt L, Stige B. Music therapy: An art beyond words, 2nd edition. Music Therapy: An Art Beyond Words, 2nd Edition. 2014.
82. 82. Sihvonen AJ, Särkämö T, Leo V, Tervaniemi M, Altenmüller E, Soinila S. Music-based interventions in neurological rehabilitation. Vol. 16, The Lancet Neurology. Lancet Publishing Group; 2017. p. 648–60.
83. 83. McPherson T, Berger D, Alagapan S, Fröhlich F. Active and Passive Rhythmic Music Therapy Interventions Differentially Modulate Sympathetic Autonomic Nervous System Activity. J Music Ther. 2019 Aug 13;56(3):240–64.
84. 84. Fan L, Hu EY, Hey GE, Hu W. Music Therapy for Gait and Speech Deficits in Parkinson’s Disease: A Mini-Review. Vol. 13, Brain Sciences. Multidisciplinary Digital Publishing Institute (MDPI); 2023.
85. 85. Sotomayor MJM, Arufe-Giraldez V, Ruiz-Rico G, Navarro-Paton R. Music Therapy and Parkinson’s Disease: A Systenatic Review From 2015-2020. Int J Environ Res Public Health. 2021 Oct 10;18(11618):2–16.
86. 86. Pereira APS, Marinho V, Gupta D, Magalhães F, Ayres C, Teixeira S. Music Therapy and Dance as Gait Rehabilitation in Patients With Parkinson Disease: A Review of Evidence. Vol. 32, Journal of Geriatric Psychiatry and Neurology. 2019.
87. 87. Lesiuk T, Bugos JA, Murakami B. A rationale for music training to enhance executive functions in parkinson’s disease: An overview of the problem. Healthcare (Switzerland). 2018 Jun 1;6(2).
88. 88. Spina E, Barone P, Mosca LL, et al. Music Therapy for Motor and Nonmotor Symptoms of Parkinson’s Disease: A Prospective, Randomized, Controlled, Single-Blinded Study. Vol. 64, Journal of the American Geriatrics Society. Blackwell Publishing Inc.; 2016. p. e36–9.
89. 89. Ziemann U, Paulus W, Nitsche MA, et al. Consensus: Motor cortex plasticity protocols. Brain Stimulation, 2008, 1(3), 164–182.
90. 90. Begemann MJ, Brand BA, Ćurčić-Blake B, Aleman A, Sommer IE. Efficacy of non-invasive brain stimulation on cognitive functioning in brain disorders: a meta-analysis. Psychol Med. 2020;50(15):2465-2486.
91. 91. Rektorová I, Anderková Ľ. Noninvasive Brain Stimulation and Implications for Nonmotor Symptoms in Parkinson's Disease. Int Rev Neurobiol. 2017;134:1091-1110. doi: 10.1016/bs.irn.2017.05.009. Epub 2017 Jun 9. PMID: 28805565.
92. 92. Trung J, Hanganu A, Jobert S, et al. Transcranial magnetic stimulation improves cognition over time in Parkinson's disease. Parkinsonism Relat Disord. 2019 Sep;66:3-8. doi: 10.1016/j.parkreldis.2019.07.006. Epub 2019 Jul 8. PMID: 31300260.
93. 93. Doruk D, Gray Z, Bravo GL, Pascual-Leone A, Fregni F. Effects of tDCS on executive function in Parkinson's disease. Neurosci Lett. 2014 Oct 17;582:27-31. doi: 10.1016/j.neulet.2014.08.043. Epub 2014 Aug 30. PMID: 25179996
94. 94. Del Felice A, Castiglia L, Formaggio E, et al. Personalized transcranial alternating current stimulation (tACS) and physical therapy to treat motor and cognitive symptoms in Parkinson's disease: A randomized cross-over trial. Neuroimage Clin. 2019;22:101768
95. 95. Dinkelbach L, Brambilla M, Manenti R, Brem AK. Noninvasive brain stimulation in Parkinson's disease: Exploiting crossroads of cognition and mood. Neurosci Biobehav Rev. 2017 Apr;75:407-418. doi: 10.1016/j.neubiorev.2017.01.021. Epub 2017 Jan 21.
96. 96. Rektorova I, Biundo R. Non-invasive brain stimulation to treat cognitive symptoms of Parkinson's disease. Parkinsonism Relat Disord. 2019 Sep;66:1-2. doi: 10.1016/j.parkreldis.2019.09.012. Epub 2019 Sep 14. PMID: 31542281.