Ann Rehabil Med.  2022 Oct;46(5):263-273. 10.5535/arm.22014.

Effects of Intensive Exercise on Cognitive Dysfunction in Patients With Pure Cerebellar Degeneration: A Single-Arm Pilot Study

• Shimamoto T
• Uchino K
• Mori A
• Nojima K
• Iiyama J
• Misumi Y
• Ueda M
• Uchino M

• KMID: 2535744
• DOI: http://doi.org/10.5535/arm.22014

Abstract

Objective
To clarify the profile of cognitive dysfunction and the effects of intensive exercise in spinocerebellar degeneration (SCD).
Methods
We enrolled 60 healthy controls and 16 patients with purely cerebellar type SCD without gait disturbance or organic changes other than cerebellar changes. To assess cognitive function, we evaluated the participants using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and Montreal Cognitive Assessment-Japanese (MoCA-J) at admission and after intensive exercise.
Results
Compared to the controls, SCD patients showed significant cognitive decline. As a result of intensive exercise, significant improvements in motor and cognitive functions were observed: the MMSE score improved from 27.7±1.9 to 29.0±1.3 points (p<0.001); the FAB score improved from 14.8±2.2 to 15.8±2.0 points (p=0.002); and the MoCA-J score improved from 24.6±2.2 to 26.7±1.9 points (p<0.001). For sub-scores, significant improvements were noted in serial 7, lexical fluency, motor series, and delayed recall.
Conclusion
Our study indicates that intensive exercise can be effective not only for motor dysfunction but also for cognitive dysfunction (Clinical Trial Registration No. UMIN-CTR: UMIN000040079).

Keyword

Spinocerebellar degenerations; Rehabilitation; Cognition; Exercise

Figure

• 

  Fig. 1 Cognitive function scores for (A) MMSE, (B) FAB, and (C) MoCA-J comparing healthy controls and SCD. Note the significant reduction in MMSE, FAB, and MoCA-J scores of patients with SCD compared to healthy controls. SCD, spinocerebellar degeneration; MMSE, Mini-Mental State Examination; FAB, Frontal Assessment Battery; MoCA-J, Montreal Cognitive Assessment-Japanese. **p<0.01, ***p<0.001.

• 

  Fig. 2 Item-specific scores of cognitive function measures for (A) MMSE, (B) FAB, and (C) MoCA-J comparing healthy controls and patients with SCD. There was a significant decrease in (A) serial 7 (p<0.001) on the MMSE; (b) lexical fluency (p<0.001) and motor series (p=0.006) on the FAB; and (c) serial 7 (p=0.007), language repeat (p<0.001), language fluency (p<0.001), and abstraction (p<0.001) on the MoCA-J. SCD, spinocerebellar degeneration; MMSE, Mini-Mental State Examination; FAB, Frontal Assessment Battery; MoCA-J, Montreal Cognitive Assessment-Japanese. **p<0.01, ***p<0.001.

• 

  Fig. 3 Comparison of motor function and ADL before and after exercise. (A) SARA scores (significantly improved from 10.7±4.7 to 8.0±4.1 points after exercise). (B) BBS scores (significantly increased from 43.6±8.7 to 48.8±7.1 points after exercise). (C) FIM scores (significantly increased from 119.7±5.2 to 122.3±3.8 points after exercise). Each letter from A through P corresponds to a different patient. ADL, activities of daily living; BE, before exercise; AE, after exercise; SARA, Scale for the Assessment and Rating of Ataxia; BBS, Berg Balance Scale; FIM, Functional Independence Measure. *** p<0.001.

• 

  Fig. 4 Comparison of MMSE scores before and after exercise. ( A) Score comparison in each patient ( A through P). The scores significantly improved from 27.7±1.9 to 29.0±1.3 points after exercise. (B) Comparison of average scores for each item. Improvement in the “serial 7” score (attention and calculation) was the most prominent; it significantly improved from 3.9±1.1 to 4.8±0.4 points (p=0.007). BE, before exercise; AE, after exercise; MMSE, Mini-Mental State Examination. **p<0.01, ***p<0.001.

• 

  Fig. 5 Comparison of FAB scores before and after exercise. (A) Score comparison in each patient (A through P). The scores significantly improved from 14.8±2.2 to 15.8±2.0 points after exercise. (B) Comparison of average scores for each item. “Lexical fluency” and “motor series” scores significantly improved from 1.9±0.7 to 2.4±0.6 points (p=0.0353) and from 2.2±0.7 to 2.6±0.7 points (p=0.0353), respectively. BE, before exercise; AE, after exercise; FAB, Functional Independence Measure. *p<0.5, **p<0.01.

• 

  Fig. 6 Comparison of MoCA-J scores before and after exercise. (A) Score comparison in each patient (A through P). The scores significantly improved from 24.6±2.2 to 26.7±1.9 points after exercise. (B) Comparison of average scores for each item. The “memory items” score (delayed recall) significantly improved from 3.2±1.0 to 4.1±0.8 points. BE, before exercise; AE, after exercise; MoCA-J, Montreal Cognitive Assessment-Japanese. **p<0.01, ***p<0.001.

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