Review Article

Cognitive Training in Parkinson’s Disease: A Review of Studies from 2000 to 2014

Table 2

Summary of studies of CT in PD.  

Article byParticipantsDescription of training interventionOutcome measuresResults on outcome measures 
(# significant differences/total # of measures)
Description of setting 
# weeks|# sessions|session length (minutes)|total intervention length (hours)
Combined intervention or only CTStandardized interventionAssessed QOL

Sinforiani et al., 2004 [68]20 PD-MCI 
 MMSE~25 
No dementia 
H&Y 1.5 
TNP software, focus on attention, abstract reasoning, visuospatial abilities, different level of complexity.MMSE 
Digit span 
Corsi’s test 
COWAT FAS 
Babcock’s story 
Raven’s matrices 
WCST 
Stroop test
Pre-post improvement: 3/8 
Babcok’s story;
COWAT FAS;
Raven’s matrices
Computerized, hospital program 
6|12|60|12
CT and motor rehabilitationYes, TNP software.No

Sammer et al., 2006 [74]12 PD CT 
14 PD standard treatment 
 MMSE~27 
No dementia 
H&Y 2-3 
CT- BADS (unused subtests); Raven’s matrices; picture arrangement tasks, picture completion tasks, block design, object assembly (from WISC); short stories & discussions; pictures prompting stories.
Standard treatment, occupational therapy, physiotherapy, and physical 
treatment.
BADS, rule shifting 
BADS, six elements 
CET, German version 
TMT, German version 
Face name learning test 
Attention 
Wellbeing scale 
Verbal intelligence scale 
Hamilton Rating Scale for Depression
Pre-post improvement: 2/5 
CT more than standard treatment, improved on BADS rule shifting
CT and standard treatment groups, improved on BADS six elements
Noncomputerized, hospital program 
 3-4|10|30|5
Only CT in hospital versus standard treatmentNot standardized intervention. Additionally, task difficulty was adjusted according to each participant’s performance level. Yes.
No change (mood questionnaire)

Nombela et al., 2011 [71]5 PD CT 
5 PD untrained 
10 healthy controls 
MMSE 25-26 
H&Y 2.5
PD untrained & healthy controls, waitlist 
CT, one easy level Sudoku puzzle (4 4 grid, 2 2 blocks) daily for six months. Weekly meetings.
UPDRS 
MMSE 
Stroop accuracy 
Stroop RT 
Sudoku RT 
Brain activation
Posttraining PD CT versus PD untrained: 
Sudoku, faster solving time
Stroop, more correct answers, fewer missing answers, lower RT.
PD CT group showed brain activation pattern more similar to controls.
Noncomputerized, at home with weekly meetings to discuss progress, Sudoku table 1/day, for 6 months 
Impossible to calculate total training time
Only CTNo, Sudoku plus weekly meetings, much longer duration than traditional CT.No

Mohlman et al., 2011 [69]16 PD 
MMSE 28 
No dementia
Attention Process Training II (APT-II), audio CDs, pen and paper worksheets, response clickers.
Training sustained attention, divided attention, alternating attention, and selective attention.
Acceptability 
Feasibility 
COWAT 
Stroop 
Digit span f & b 
TMT B
Pre-post improvement.
No statistics
Computerized + daily practice, in lab, assisted 
4|4|90|6
Only CT but not assessing effectivenessYes, APT-II.Not reported

París et al.,
2011 [75]
16 PD CT 
12 PD control 
Excluded MMSE <23, some MCI in both groups 
H&Y 2.37, 2.25
PD CT: 
SmartBrain intervention as well as pen and paper homework.
Individualized from a platform of 28 tasks focusing on attention, WM, executive function, memory, visuospatial abilities, psychomotor speed. Also training in language, calculations, and culture.
PD control: 
speech therapy, focus on speech and communication difficulties.
MMSE 
ACE 
Attention and WM: 
(i) WAIS III Digit Span f & b 
(ii) CVLT II-List A1 
Information processing speed: 
(i) SDMT 
(ii) TMT A 
(iii) Stroop, word subtest 
Verbal memory: 
(i) CVLT-II-Short-Delay Free Recall 
(ii) CVLT-II-Long-Delay Free Recall 
(iii) Logical Memory subtest I 
(iv) Logical Memory subtest II 
Learning: 
(i) CVLT-II-List A Total 
Visual memory: 
(i) ROCFT-Immediate Recall 
(ii) ROCFT-Delayed Recall 
Visuoconstructive abilities: 
(i) ROCFT-Copy 
Visuospatial Abilities: 
(i) RBANS-Line Orientation 
Verbal fluency: 
(i) Phonemic-COWAT FAS 
(ii) Semantic-COWAT Animals 
Executive functions: 
(i) TMT-B 
(ii) TOL-Total Moves 
(iii) TOL-Total Correct 
(iv) TOL-Rules Violations 
(v) Stroop Test-Interference 
PDQ-39 
Mood, geriatric depression scale 
Cognitive difficulties in activities of daily living, Cognitive Deficits Scale
SmartBrain group improved on 10/23 measures compared to PD control group.
Attention and WM 1/4: digit span forward
Information processing speed 1/3: Stroop word
Visual memory 2/4: ROCFT, immediate and delayed
Verbal 1/2: Semantic-Animals but not Phonemic-FAS 
Executive functions 3/5: TMT-B, TOL Total Moves, and Total Correct
Computerized and noncomputerized plus homework tasks, in lab and at home 
4|12|45|9 
Plus homework for unspecified amount of time 
Only CT versus speech therapyNo, selection of tasks plus SmartBrain, individualized for each participant.Yes.
No change on PDQ39, on measure of mood, or of activities of daily living

Pompeu et al., 2012 [76]16 PD General balance 
16 PD WiiFit 
H&Y 1-2 
MOCA 22-impaired
WiiFit and cognition (cognition as part of the game’s requirements, not specifically trained). Games used: 
Single Leg Extension, Torso Twist, Table Tilt, Tilt City, Soccer Heading, Penguin Slide, Rhythm Parade, Obstacle Course, Basic Step, Basic Run.
General Balance: Similar motor requirements as the Wii games.
UPDRS-II (activities of independent living) 
MOCA 
Static and dynamic balance measures
WiiFit and general balance exercise groups both showed improvement in UPDRS II(independent activities of daily living scale) and MOCA scores. No difference between groups before, after, or at 60-day follow-up.Computerized-sessions led by an instructor 
7|14|60|14
Combined with global exercises. Computerized but not cognitive focused.Yes, WiiFit games.Yes.
Both groups improved on UPDRS II-activities of independent living

Reuter et al., 2012 [79]71 PD CT (group A) 
75 PD CT + transfer (group B) 
76 CT + transfer + motor (group C) 
MCI in all groups
CT- BADS (unused subtests); Raven’s matrices; picture arrangement tasks, picture completion tasks, block design, object assembly (from WISC); short stories & discussions; pictures prompting stories.
CT + transfer: same as above + daily tasks such as grocery shopping, tending to a vegetable patch, and so forth.
CT + transfer + motor: same as above + games and tasks to enhance inhibitory control, WM, coordination, and so forth.
ADAS- Cog SCOPA – Cog BADS- six element 
BADS – zoo map 
BADS – instruction 
PASAT 
Goal Attainment Scale 
PDQ – 39 
UPDRS
No detailed statistics, all groups improved. The more involved groups (groups B and C) improved more.
There was a significant group time interaction, suggesting group C improved more than other groups on ADAS-Cog and SCOPA-Cog
Computerized and noncomputerized, hospital and at home, at least 14 sessions, 4/week, 60 minutes, then at home, 3/week, 45 minutes each.
Minimum: 
4|16|60|16
Only CT versus CT + transfer training versus CT + transfer training + psychomotor trainingNo 
Individualized
Yes.
Improvement in order of magnitude 
C > B > A

Disbrow et al., 2012 [70]14 PD CT impaired 
16 PD CT unimpaired 
21 Controls
Two-phase button press task, a motor sequence learning task, participants had to press numbered keys corresponding to the number sequence shown on screen. Sequence length varied between 1 and 4 digits.Motor sequence learning task 
TIADL 
TMT 
D-KEFS 
TUG 
Posttraining, the impaired PD group showed significant improvement in time for sequence initiation, time for sequence completion, and number of errors in the internally represented condition of the task.Computerized, adaptive difficulty, completed at home 
2|10|40|~6.5
Only CTYes, but adaptive difficulty.Yes.
No changes in time to complete instrumental activities of daily living

Naismith et al., 2013 [72]35 PD CT + psychoeducation 
15 PD waitlist 
MMSE 27
Neuropsychological Educational Approach to Remediation (NEAR), individualized, computer based training program devised according to their test results, using a mix of commercially available CT interventions and software programs.Wechsler Memory Scale III: 
LOGMEM I - Immediate LOGMEM II – Delayed 
TMT A 
TMT B 
COWAT FAS 
BDI
CT > waitlist improvement on 2/7 measures: 
LOGMEM I – Immediate
LOGMEM II – Delayed
Computerized, in lab group sessions 
7|14|120|28
CT combined with psychoeducationNo 
Individualized
Yes 
No effects on depression BDI.

Edwards et al., 2013 [73]44 PD Speed of Processing Training (SOPT) 
43 PD waitlist 
H&Y 1–3 
MMSE 28
SOPT,self-administered, computer based training program that includes 5 exercises aimed at training speed of information processing. The exercises adapt in difficulty according to performance.UFOV 
Cognitive Self-Report Questionnaire 
Depressive symptoms (CES-D) 
SOPT > waitlist improvement on 1/3 measures: 
UFOV
Computerized, self-administered, at home 
12|36|60| ≥20
Only CTStandardized program (InSight), individually adaptive difficulty levels.Yes 
No effects on depression CES-D

Petrelli et al., 2014 [80]22 PD NeuroVitalis (NV) 
22 PD mentally fit (MF) 
21 PD waitlist 
H&Y 1–3 
No dementia 
MMSE 28 
Structured: Psychoeducation, group games, individual and group tasks, focusing on attention, memory, and executive functions.
Unstructured: 
Group conversation, group games, individual and group tasks, focusing on attention, memory, executive functions, language, and creative thinking. Tasks for each session chosen at random.
DemTect 
MMSE 
Brief Test of Attention 
Memo 
Complex figure-ROCFT and Taylor 
COWAT FAS 
BDI
PDQ-39 
NV > waitlist improved on 2/12: 
Memo-Verbal short term attention score and DemTect, digit span reverse.
MF > waitlist improved on BDI.
NV > MF improved on DemTect, digit span reverse.
Computerized, pen and paper and activities, in lab group sessions 
6|12|90|18 
Only CTNV group standardized intervention.
MF unstandardized, unstructured.
Yes.
MF improved on BDI scores. No changes in PDQ-39

Zimmermann et al. 2014 [81]19 PD CogniPlus 
20 PD WiiFit 
MMSE 29 
H&Y 1-2
CogniPlus-focused attention; N-Back; planning and action; response inhibition.
WiiFit-tennis, swordplay, archery, air sports.
Tests of Attentional Performance-Alertness 
Tests of Attentional Performance-WM 
TMT 
Block design test 
CVLT 
No overall test of improvement for each group separately.
WiiFit group improved over CogniPlus group on 1/5 measures: Tests of Attentional Performance-Alertness.
Computerized, in lab supervised by assistant
4|12|40|8
Only CT versus pure Wii sportsYes, both interventions. No

Peña et al., 2014 [77]22 PD REHACOP 
22 PD occupational therapy 
MMSE 27
REHACOP, group sessions including focus on attention, memory (visual and verbal, recall and recognition), language and verbal processing, executive functions (planning and logical reasoning), social cognition and Theory of Mind.Processing speed: 
TMT A 
Salthouse letter comparison test 
Verbal memory: 
Hopkins verbal learning test, learning and long term recall 
Visual memory: 
Brief visual memory test, learning and long term recall 
Executive function: 
Stroop word color, interference scores 
Theory of Mind: 
Happé test 
REHACOP > occupational therapy improved on 4/9 measures.
Processing speed
Visual memory
Theory of Mind
Functional disability
Noncomputerized, psychologist led group sessions
13|39|60|39
Only CTYes, REHACOP modules.Yes.
Functional disability scores improved in REHACOP group more than occupational therapy group

Cerasa et al., 2014 [78]8 PD RehaCom 
7 PD coordinated tapping task
RehaCom, computer assisted training of attention and information processing.
Tapping task, also computerized, using in-house software.
ROCFT 
Selective Reminding Test 
Judgement Line Orientation 
COWAT 
SDMT 
PASAT 
Digit span f & b 
Stroop 
TMT A & B
RehaCom > control tapping group improved on 2/20 measures.
Digit span forward
SDMT
Computerized, group sessions with weekly meetings 
6|12|60|12 
Only CTYes, RehaCom training.Yes.
 No changes in PDQ-39 scores or measures of mood

value indicators:
: <0.05.
: <0.01.
: <0.001.