Universität zu Köln

Ophey, Anja ORCID: 0000-0001-5858-7762 (2021). Effects and mechanisms of working memory training in patients with Parkinson's disease. PhD thesis, Universität zu Köln.

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Abstract

Objective: Cognitive decline is a common, debilitating non-motor symptom of patients with Parkinson’s Disease (PD), the second most frequent neurodegenerative disorder of older age. Non-pharmacological interventions including cognitive training are increasingly recognized to possibly prevent or delay the onset and/or slow down the progression of cognitive decline in patients with PD. In this context, targeted working memory training (WMT) is especially promising, considering (i) the vulnerability of working memory and executive functions in patients with PD, (ii) reliable short- and long-term near-transfer training effects following WMT in the working memory domain and potential far-transfer effects to other cognitive domains in healthy older adults, and (iii) overlapping neural correlates of working memory, WMT induced neural changes, and the pathophysiology of PD. The present thesis project aims to investigate the effects of targeted WMT in patients with PD. Furthermore, the understanding of mechanisms underlying WMT responsiveness should be promoted. Answering the question “who benefits most?” in terms of individual (e.g., sociodemographic, neuropsychological, biological) characteristics would perspectively help to match an individual participant to a specific form of cognitive intervention and, thereby, to maximize treatment outcomes against the debilitating cognitive decline associated with PD. Methods: The present thesis project comprises three studies. Study I evaluates a randomized controlled trial investigating the effects of a 5-week home-based computerized WMT in n = 76 patients with PD without cognitive impairment at posttest and 3-months follow-up. Study II constitutes a systematic review of n = 16 studies on predictors of WMT responsiveness in healthy older adults. Study III analyzes data of the randomized controlled trial reported in Study I with a structural equation modelling approach to investigate predictors of WMT responsiveness in patients with PD. Results: In Study I, WMT was feasible in patients with PD without cognitive impairment and evidence for positive near-transfer training effects in the working memory domain was found. No cognitive and clinical far-transfer effects were observed. Variability of training effects was large across participants. Study II revealed several methodological shortcomings of prognostic research in the field. Nevertheless, a pattern emerged according to which lower baseline performance and better hardware (e.g., younger age, higher intelligence) predict positive WMT responsiveness in healthy older adults. Study III revealed a similar pattern for patients with PD without clinically relevant cognitive decline. Lower baseline performance, younger age, higher fluid intelligence, higher education, and higher self-efficacy expectancy predicted larger positive WMT responsiveness in this patient group. Conclusion: Summarizing, the findings of the present thesis substantially contribute to the research area of evidence-based cognitive interventions against the debilitating cognitive decline associated with PD. Furthermore, the findings promote the implementation of precision medicine approaches in the context of cognitive interventions in general. The potential of non-pharmacological interventions against the debilitating age- and PD-associated cognitive decline is enormous and prognostic research may unlock the possibilities for modern healthcare on the road to precision medicine. High-quality research adhering to high methodological standards on the original-study-level as well as the synthesizing meta-level will be able to close the research gaps within the next years.

Item Type:	Thesis (PhD thesis)
Translated title:	Title Language Effekte und Mechanismen von Arbeitsgedächtnistraining bei Patient*innen mit Morbus Parkinson German
Creators:	Creators Email ORCID ORCID Put Code Ophey, Anja anja.ophey@web.de orcid.org/0000-0001-5858-7762 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-525355
Date:	13 July 2021
Language:	English
Faculty:	Faculty of Human Sciences
Divisions:	Faculty of Human Sciences > Department Psychologie
Subjects:	Psychology Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language Parkinson's disease English cognition English cognitive training English working memory training English cognitive decline English prognostic research English personalized medicine English
Date of oral exam:	17 June 2021
Referee:	Name Academic Title Haider, Frithilde Prof. Dr. Kalbe, Elke Prof. Dr.
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/52535