Exploring cognitive reserve's influence: unveiling the dynamics of digital telerehabilitation in Parkinson's Disease Resilience

Abstract

Abstract Telerehabilitation represents a novel digital approach to deliver rehabilitation for Parkinson's Disease (PD), particularly beneficial in the early stages of the condition to foster resilience, the capacity of the brain to maintain function with aging and disease. Within the resilience framework, the present work aims to investigate the role of cognitive reserve (CR) on response after telerehabilitation by deepening how experiential factors mediate the link between neural reserve and rehabilitation-enhanced functional capabilities changes. Forty-two PD participants (23 males, mean age: 68.88 ± 8.02) were administered a 4-month multidimensional neuromotor telerehabilitation intervention. To test the role of the CR on the link between brain change and treatment response the following measures were assessed: 1) CR proxy through the Cognitive Reserve Index questionnaire (CRIq), 2) disease-related brain changes by the total gray volume (TGV) index extracted by a 3T MRI examination (T1-3D sequence), 3) treatment response by computing 6-Minute Walk Distance (6MWD) Δ changes (baseline-after treatment). Participants were categorized as responders (N = 23) or non-responders (N = 19) based on 6MWD Minimal Clinical Important Difference. Correlations between neuromotor functions, CR proxy, and TGV were tested both at baseline and after treatment separately for responders and non-responders. Then, a multiple regression model (Wald backward option) was run to test significant predictors of 6MWT changes in each group. Results showed a direct association between 6MWD and CRIq both at baseline (r = 0.582, p < 0.001) and after the treatment (r = 0.681, p < 0.001) only in the responders. Moreover, in this group, the CRIq score (β = 0.24, p = 0.024), and especially the CRIq Leisure-Time sub-index (β = 0.19, p = 0.067), significantly predicted a 6MWD increment, together with the 6MWD baseline score (β = 0.70, p < 0.001). These findings suggest the role of the CR as a predictor and booster of telerehabilitation effect on PD neuromotor functioning.