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Parkinson's disease (PD) is a common neurological disorder characterized by motor dysfunction and early cognitive dysfunction in some patients
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Major cognitive impairments affect executive function, visuospatial perception, abstract thinking, memory, and verbal fluency, which can severely reduce quality of life
Quality of Life
The pathophysiology of cognitive impairment in PD remains unclear
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Changes in the levels of neurotransmitters such as acetylcholine and dopamine may be one mechanism
VR is a technological tool that involves the use of a three-dimensional computer-generated environment to detect the user's actions and location while providing a sense of presence in the environment
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Interaction with virtual objects enables users to experience multisensory feedback (such as visual, auditory, and kinesthetic) similar to feedback received in real life
Emerging evidence suggests that the combination of transcranial magnetic stimulation and exercise training has a potential therapeutic role for exercise rehabilitation, and the study reports that the priming effect of transcranial magnetic stimulation in increasing cortical excitability can enhance the effect of subsequent exercise training, thereby increasing the Exercise recovery in stroke and multiple sclerosis patients
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Considering that both VR and rTMS can improve cognitive function by addressing the neuronal and behavioral aspects of cognitive effects, an integrated approach may lead to more sensitive rehabilitation of cognitive symptoms in PD patients
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Positive effects of combined NIBS and VR therapy on motor and cognitive function
Taking this, Tsai-Chin Chenga et al.
of Yangming University in Taiwan, China, hypothesized that the integration of VR training and rTMS could enhance the cognitive improvement of rTMS in patients with PD and MCI
Hypothesized that the integration of VR training with rTMS could enhance the cognitive improvement of rTMS in PD and MCI patients
They randomized 40 PD and MCI patients into three groups, rTMS-VR group (n = 13), rTMS group (n = 11), and sham rTMS group (n = 16)
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rTMS is 10 consecutive intermittent theta-pulse stimulation (iTBS) on the left dorsolateral prefrontal cortex
In the rTMS-VR group, VR training was performed immediately after each rTMS treatment
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Cognitive function was measured using the Reproducible Assessment of Neuropsychological Status (RBANS) and the Montreal Cognitive Assessment (MoCA) at baseline, immediately after intervention, and at 3-month follow-up
They found that compared with the rTMS group, the rTMS-VR group showed significantly more improvements in post-intervention RBANS total and delayed memory scores and MoCA visuospatial/executive function scores (P = 0.
000∼0.
The significance of this study lies in the discovery that the comprehensive rTMS-VR regimen achieved significant effects on global cognitive function, enhancing working memory and visuospatial executive function more effectively than the rTMS regimen alone
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The combination of VR and rTMS can be an effective solution to improve cognitive function in PD patients
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Original source:
Cheng TC, Huang SF, Wu SY, Lin FG, Lin WS, Tsai PY.
Integration of Virtual Reality into Transcranial Magnetic Stimulation Improves Cognitive Function in Patients with Parkinson's Disease with Cognitive 6 Impairment: A Proof-of-Concept Study.
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