Researchers from the University of Maryland School of Medicine and the Baltimore Veterans Affairs (VA) Medical Center have launched a study of exercise and computerized memory training to see if those activities may help people with Parkinson's disease prevent memory changes. The type of memory that will be examined is known as "executive function," which allows people to take in information and use it in a new way. Many Parkinson's patients develop problems with executive function, which can prevent them from working and may eventually require a caregiver to take over more of the complex cognitive tasks of daily living.
"Studies of normal aging show that memory and executive function can be improved with exercise, such as walking several days a week," explains Karen Anderson, MD (pictured), principal investigator and an assistant professor of neurology and psychiatry at the School of Medicine. Anderson is also a neuro-psychiatrist at the Maryland Parkinson's Disease and Movement Disorders Center at the University of Maryland Medical Center and a clinician in mental health at the Baltimore VA Medical Center.
"We want to see if exercise can slow or reverse some of these memory changes in Parkinson's patients," Anderson adds. "We will also investigate whether a computer game designed to improve executive function may make a difference as well. The other question is, what happens when you put the two interventions together - if there is memory improvement, will it be even better than with one of the interventions? Or is it more efficient to do just one or the other? We really do not know."
The researchers, who received funding through a VA Merit Award, plan to enroll about 90 patients. These patients will be divided randomly into three groups: exercisers walking on a treadmill, memory game players, and those doing both exercise and memory games.
Participants in each group will receive a memory assessment at the beginning of the study. They will come in three times a week for three months for their training and then will be tested again in three months to see if there may be longer-term benefits to the training.
With both the treadmill walking and the memory game, the exercise or video game will become more challenging as the participant improves. The memory training works like a video game, with players advancing to a higher level of difficulty. For the exercisers, trainers may increase the speed or slope of the treadmill to make it more aerobically challenging.
"This new study builds on our experience from a previous study of exercise for gait and mobility in Parkinson's disease. Since both motor function and cognitive function are important for mobility and performance of daily activities, this new study will investigate the individual and combined effects of treadmill training and cognitive training," explains Lisa Shulman, MD, co-investigator and professor of neurology at the School of Medicine.
"Parkinson's patients are eager to know if there is anything they can do to give them greater control over their condition. Mobility and memory are the two key components to preserve independence. If these treatment strategies are found to be effective, we will learn important new approaches to delaying disability," says Shulman, who is co-director of the Maryland Parkinson's Disease and Movement Disorders Center.
The treadmill training will take place at the Baltimore VA Medical Center in the Maryland Exercise and Robotics Center of Excellence, a gym facility with specialized equipment for people with physical limitations or balance issues. For safety, participants will wear a safety harness while walking on the treadmill. Experienced exercise physiologists will supervise each training session.
The computerized memory training game will take place at both the VA and School of Medicine.
"This study shows the commitment of our University of Maryland faculty to exploring new approaches, such as exercise and memory training, to help patients with illnesses such as Parkinson's disease around the world," says E. Albert Reece, MD, PhD, MBA, the vice president for medical affairs at the University of Maryland and dean of the School of Medicine.
The Maryland researchers expanded the exercise studies to Parkinson's patients after first finding success with treadmill training for stroke patients. That research - also conducted at the University of Maryland School of Medicine and the VA Maryland Health Care System - found that regular exercise on a treadmill can improve stroke patients' walking ability even years after they've had a stroke.
Co-investigator Richard Macko, MD, professor of neurology at the School of Medicine, says, "With stroke patients, we have seen that the consistent, repetitive motion of walking may help the brain to develop new connections to compensate for the damaged ones.
This new Parkinson's study takes the concept of exercise training for neurology patients in a new direction. We will be interested to see if this consistent training will produce benefits to memory."
Macko is director of the Maryland Exercise and Robotics Center of Excellence at the VA Maryland Health Care System. Parkinson's disease affects about one million people in the United States and Canada. Most people begin to develop symptoms in their late 50s or early 60s, although it can occur in younger people.
Parkinson's disease affects the brain's ability to produce dopamine, the neurotransmitter involved in the communication between the brain cells for motor control. Physical symptoms include tremor, muscle rigidity, and slowness of movement. There are also non-motor symptoms such as changes in memory ability, sleep disturbances, and depressed mood.
Parkinson's patients interested in enrolling in the exercise and memory study should call 443-827-0677.