Parkinson's Disease
Conditions
Keywords
Parkinson's Disease, Word Retrieval, Apraxia Symptoms, Dysarthria
Brief summary
Due to Parkinson's Disease (PD) speech and language (SL) deficits may occur. Further, the literature reports that PD patients, who have not undergone deep brain stimulation (DBS), have deficits regarding voice quality (e.g. loudness and intelligibility of their voice), while PD patients who have undergone DBS suffer from deficits in word retrieval and speech apraxia symptoms. To-date, therapeutic approaches focusing specifically on SL deficits observed in PD-DBS patients are yet to be developed and evaluated. Therefore, this study investigates the short-and longterm effectiveness of specific and intensive, high-frequency speech-language therapy in terms of reducing SL-deficits compared to a nonspecific and non-verbal sham treatment (i.e. a rhythmic balance-movement training (rBMT)) as well as to a 'no-therapy' condition.
Detailed description
In the course of Parkinson's disease (PD) speech and language (SL) deficits may often emerge. In addition, severe verbal fluency (VF) decline has been repeatedly observed in the context of deep brain stimulation (DBS) in PD. Interestingly, while PD non-DBS patients have deficits with respect to loudness and intelligibility of their voice, PD patients who have undergone DBS (PD-DBS) suffer rather from difficulties in semantic and phonemic word retrieval, and from speech apraxia symptoms. However, to-date and to the best of our knowledge, therapeutic approaches focusing specifically on SL deficits observed in PD-DBS patients are yet to be developed and evaluated regarding their effectiveness. Thus, this study investigates the short-and longterm effectiveness of specific and intensive, high-frequency speech-language therapy in terms of reducing SL-deficits compared to a nonspecific and non-verbal sham treatment (i.e. a rhythmic balance-movement training (rBMT)) as well as to a 'no-therapy' condition.
Interventions
OTHERSpecific SL-therapy
Provided by a professional speech-language therapist (SLT) on a one-to-one basis. In approx. 45 Minutes sessions, 3 times per week for 4 weeks in total.
OTHERRhythmic Balance-Movement Training (rBMT)
Provided on a one-to-one basis. In approx. 30-45 Minutes sessions, 3 times per week for 4 weeks in total.
Sponsors
University Hospital, Basel, Switzerland
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
45 Years to 80 Years
Healthy volunteers
Yes
Inclusion criteria
for all groups: * The patient is able to cooperate * The patient has the mental competence to provide informed consent to participate in the study * The patient speaks and understands German Specific Inclusion Criteria for the DBS Group * Fulfilling the above stated inclusion criteria as stated in a, b and c above * The patient is responsive to Levodopa (L-DOPA) * Having received or being scheduled for DBS
Exclusion criteria
* Severe psychiatric disease difficult to treat (compulsive disorder, depression, mania, psychosis, anxiety as outlined in International Classification of Diseases (ICD-10) (WHO 2015, current version). * Patient with dementia (DMS-V, Mini-Mental-Status-Test (MMS) \<24, Montreal Cognitive Assessment (MoCa) \<21) * Secondary Parkinsonism * Age ≤18 years * Pregnancy (early onset) * Presence of a known disease other than PD that shortens the life expectancy * Mental incompetence to provide informed consent to participate in the study * Previous intracranial surgery * Epilepsy * Contraindications for DBS seen in MRI-scan (malignant tumour, severe microvascular disease) * Insufficient skills of German language for participating in neuropsychological evaluations * Sensory problems, severe enough to significantly interfere with neuropsychological assessment * Alcohol and/or drug addiction
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Velocity in Gait | At Baseline (BL), T1 after 4 weeks (4W-directly after intervention), T2 after 6 months (6M). | Gait Velocity: meters per second |
| Cadence in Gait | At Baseline (BL), T1 after 4 weeks (4W-directly after intervention), T2 after 6 months (6M). | 4-Weeks and 6-Months Follow-up. To measure rhythmicity in gait, participants walked 6 metres at their individual pace. They were timed and amount of steps were counted. |
| Speech Velocity | At Baseline (BL), T1 after 4 weeks (4W-directly after intervention), T2 after 6 months (6M). | Speech Velocity at 4 weeks and at 6 months To measure rhythmicity in speech, participants read a text aloud ('the north wind and the sun') and were recorded using an Olympus. According to these speech samples, the count of elicited syllables per second was calculated. |
| Speech Cadence | At Baseline (BL), T1 after 4 weeks (4W-directly after intervention), T2 after 6 months (6M). | Speech Cadence 4 Weeks and at 6 Months To measure rhythmicity in speech, participants' speech was recorded while reading a text aloud ('the north wind and the sun'). Elicited syllables per inspiration were analysed. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Neuropsychiatric Self-rating Questionnaires | At 4 Weeks and 6 Months | Self-rating questionnaires investigating depression using the Beck's Depression Inventory (BDI). This is a 21 question, multiple choice, self-report questionnaire. Minimum score is 0 and maximum scores is 63. The higher the score the more severe is the depression. Details: 0-9: indicates minimal depression 10-18: indicates mild depression 19-29: indicates moderate depression 30-63: indicates severe depression. |
| Neuropsychological Standardised Test Battery | At 4 Weeks and at 6 Months | Inhibition Control (Stroop), Visio-Construction (Mosaic), Flexibility (Trail Making Test), Episodic Memory (Basel Verbal Learning Test -long delayed free recall), Working Memory (backwards digit span task by Wechsler). Scores were standardized (z-scores) to a mean of 0 and standard deviation of 1. The Z-score indicates the number of standard deviations away from the mean. A Z-score of 0 is equal to the mean of a reference population. Negative numbers indicate values lower than the reference population and positive numbers indicate values higher than the reference population |
| Health Status (UPDRS) | At Baseline and 6 Months | The complete questionnaire 'Unified Parkinson's Disease Rating Scale' (UPDRS) was filled out at BL and 6M. Scores may range from 0-4 per question. Final scores may add up to 199 points maximum. The higher the score, the worse disease severity/ degree of disability is. |
Countries
Switzerland
Participant flow
Recruitment details
From May 2015 to February 2018, N=32 patients with idiopathic Parkinson's disease (PD) were recruited from the University Hospital Basel (Switzerland) and N=22 healthy controls (HC) were recruited from senior health centers or sports groups independent of the hospital.
Pre-assignment details
Eligibility assessments were conducted by neurologists, neuropsychologists and speech-language therapists. Eligibility criteria led to 12 exclusions in the PD group and to 4 exclusions in the HC group. Therefore, final N count for the study were: N=20 PD patients and N=18 HC.
Participants by arm
| Arm | Count |
|---|---|
| rSLT, Then no Therapy, Then rBMT Specific, intensive and high-frequency SL-therapy. Approx. 45 Min. per session, 3 times per week for 4 weeks
Specific SL-therapy: Provided by a professional speech-language therapist (SLT) on a one-to-one basis. In approx. 45 Minutes sessions, 3 times per week for 4 weeks in total.
Then participants could be allocated to the no-therapy group, and after 6-month completion again into the rBMT intervention. | 8 |
| rBMT, Then rSLT, Then no Therapy Rhythmic Balance-Movement Training (rBMT); approx. 30-45 Minutes per session, 3 times per week for 4 weeks
Rhythmic Balance-Movement Training (rBMT): Provided on a one-to-one basis. In approx. 30-45 Minutes sessions, 3 times per week for 4 weeks in total.
Then participants could be enrolled in the rSLT group, and after 6-month completion again into the 'no-therapy' group. | 6 |
| No Therapy, Then rSLT or rBMT, Then rBMT or rSLT the 6-months-waiting list. PD patients who had to wait for/ or chose to receive treatments at a later time.
After 6-month completion, participants could enrol in the rSLT or the rBMT intervention program, and then upon 6-month completion again in the opposite intervention program, being rBMT or rSLT, respectively. | 6 |
| Healthy Controls; no Therapy Healthy Controls received no therapy. | 17 |
| Total | 37 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Testing and Therapy Period 2 | Withdrawal by Subject | 2 | 0 | 0 | 0 |
| Testing and Therapy Period 3 | Accident prior to treatment | 2 | 2 | 0 | 0 |
| Testing and Therapy Period 3 | Lost to Follow-up | 0 | 0 | 0 | 1 |
| Testing and Therapy Period 3 | Required other therapy (dysphagia) | 1 | 2 | 2 | 0 |
| Testing and Therapy Period 3 | Withdrawal by Subject | 0 | 0 | 3 | 0 |
Baseline characteristics
| Characteristic | rBMT, Then rSLT, Then no Therapy | No Therapy, Then rSLT or rBMT, Then rBMT or rSLT | Healthy Controls; no Therapy | Total | rSLT, Then no Therapy, Then rBMT |
|---|---|---|---|---|---|
| Age, Continuous | 69.9 years STANDARD_DEVIATION 6.7 | 65.1 years STANDARD_DEVIATION 6.7 | 67.9 years STANDARD_DEVIATION 5.2 | 68.9 years STANDARD_DEVIATION 6.3 | 69.4 years STANDARD_DEVIATION 7.1 |
| Gait Cadence | 2.7 steps per second STANDARD_DEVIATION 0.8 | 2.7 steps per second STANDARD_DEVIATION 0.7 | 1.7 steps per second STANDARD_DEVIATION 0.2 | 2.5 steps per second STANDARD_DEVIATION 0.8 | 2.7 steps per second STANDARD_DEVIATION 0.8 |
| Gait velocity | 1.2 meters per second STANDARD_DEVIATION 0.4 | 1.2 meters per second STANDARD_DEVIATION 0.3 | .8 meters per second STANDARD_DEVIATION 0.08 | 1.2 meters per second STANDARD_DEVIATION 0.4 | 1.3 meters per second STANDARD_DEVIATION 0.4 |
| Race and Ethnicity Not Collected | — | — | — | 0 Participants | — |
| Region of Enrollment Switzerland | 6 participants | 6 participants | 17 participants | 37 participants | 8 participants |
| Sex: Female, Male Female | 3 Participants | 2 Participants | 10 Participants | 18 Participants | 3 Participants |
| Sex: Female, Male Male | 3 Participants | 4 Participants | 7 Participants | 19 Participants | 5 Participants |
| Speech Cadence | 9 Spoken syllables per inspiration STANDARD_DEVIATION 3.9 | 8.2 Spoken syllables per inspiration STANDARD_DEVIATION 0.6 | 21.6 Spoken syllables per inspiration STANDARD_DEVIATION 0.6 | 12.2 Spoken syllables per inspiration STANDARD_DEVIATION 7.4 | 8.4 Spoken syllables per inspiration STANDARD_DEVIATION 3.5 |
| Speech Velocity | 5.3 spoken syllables per second STANDARD_DEVIATION 0.6 | 4.9 spoken syllables per second STANDARD_DEVIATION 0.4 | 2.3 spoken syllables per second STANDARD_DEVIATION 1.6 | 4.4 spoken syllables per second STANDARD_DEVIATION 1.4 | 5.3 spoken syllables per second STANDARD_DEVIATION 0.6 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 20 | 1 / 20 | 0 / 20 | 0 / 18 |
| other Total, other adverse events | 0 / 20 | 0 / 20 | 0 / 20 | 0 / 18 |
| serious Total, serious adverse events | 0 / 20 | 0 / 20 | 0 / 20 | 0 / 18 |
Outcome results
Primary
Cadence in Gait
4-Weeks and 6-Months Follow-up. To measure rhythmicity in gait, participants walked 6 metres at their individual pace. They were timed and amount of steps were counted.
Time frame: At Baseline (BL), T1 after 4 weeks (4W-directly after intervention), T2 after 6 months (6M).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Specific SL-therapy for PD-DBS and Non-DBS | Cadence in Gait | Gait Cadence-4W | 2.5 steps per second | Standard Deviation 0.3 |
| Specific SL-therapy for PD-DBS and Non-DBS | Cadence in Gait | Gait Cadence-6M | 2.8 steps per second | Standard Deviation 0.8 |
| rBMT for PD-DBS and Non-DBS | Cadence in Gait | Gait Cadence-6M | 2.7 steps per second | Standard Deviation 0.8 |
| rBMT for PD-DBS and Non-DBS | Cadence in Gait | Gait Cadence-4W | 2.5 steps per second | Standard Deviation 0.6 |
| PD-DBS/ Non-DBS; no Therapy | Cadence in Gait | Gait Cadence-4W | 2.7 steps per second | Standard Deviation 0.7 |
| PD-DBS/ Non-DBS; no Therapy | Cadence in Gait | Gait Cadence-6M | 2.7 steps per second | Standard Deviation 0.7 |
| Healthy Controls; no Therapy | Cadence in Gait | Gait Cadence-4W | 1.7 steps per second | Standard Deviation 0.2 |
| Healthy Controls; no Therapy | Cadence in Gait | Gait Cadence-6M | 1.7 steps per second | Standard Deviation 0.2 |
Primary
Speech Cadence
Speech Cadence 4 Weeks and at 6 Months To measure rhythmicity in speech, participants' speech was recorded while reading a text aloud ('the north wind and the sun'). Elicited syllables per inspiration were analysed.
Time frame: At Baseline (BL), T1 after 4 weeks (4W-directly after intervention), T2 after 6 months (6M).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Specific SL-therapy for PD-DBS and Non-DBS | Speech Cadence | Speech Cadence 4W | 15.6 spoken syllables per inspiration | Standard Deviation 3.6 |
| Specific SL-therapy for PD-DBS and Non-DBS | Speech Cadence | Speech Cadence 6M | 13.3 spoken syllables per inspiration | Standard Deviation 4.6 |
| rBMT for PD-DBS and Non-DBS | Speech Cadence | Speech Cadence 6M | 13.6 spoken syllables per inspiration | Standard Deviation 4.7 |
| rBMT for PD-DBS and Non-DBS | Speech Cadence | Speech Cadence 4W | 13.1 spoken syllables per inspiration | Standard Deviation 4.7 |
| PD-DBS/ Non-DBS; no Therapy | Speech Cadence | Speech Cadence 4W | 10.9 spoken syllables per inspiration | Standard Deviation 3.9 |
| PD-DBS/ Non-DBS; no Therapy | Speech Cadence | Speech Cadence 6M | 10.5 spoken syllables per inspiration | Standard Deviation 3.5 |
| Healthy Controls; no Therapy | Speech Cadence | Speech Cadence 4W | 21.6 spoken syllables per inspiration | Standard Deviation 6 |
| Healthy Controls; no Therapy | Speech Cadence | Speech Cadence 6M | 21.6 spoken syllables per inspiration | Standard Deviation 6 |
Primary
Speech Velocity
Speech Velocity at 4 weeks and at 6 months To measure rhythmicity in speech, participants read a text aloud ('the north wind and the sun') and were recorded using an Olympus. According to these speech samples, the count of elicited syllables per second was calculated.
Time frame: At Baseline (BL), T1 after 4 weeks (4W-directly after intervention), T2 after 6 months (6M).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Specific SL-therapy for PD-DBS and Non-DBS | Speech Velocity | Speech velocity 4W | 3.6 spoken syllables per second | Standard Deviation 0.7 |
| Specific SL-therapy for PD-DBS and Non-DBS | Speech Velocity | Speech velocity 6M | 3.8 spoken syllables per second | Standard Deviation 0.8 |
| rBMT for PD-DBS and Non-DBS | Speech Velocity | Speech velocity 6M | 4.8 spoken syllables per second | Standard Deviation 0.9 |
| rBMT for PD-DBS and Non-DBS | Speech Velocity | Speech velocity 4W | 4.2 spoken syllables per second | Standard Deviation 0.9 |
| PD-DBS/ Non-DBS; no Therapy | Speech Velocity | Speech velocity 4W | 4.9 spoken syllables per second | Standard Deviation 0.7 |
| PD-DBS/ Non-DBS; no Therapy | Speech Velocity | Speech velocity 6M | 4.9 spoken syllables per second | Standard Deviation 0.6 |
| Healthy Controls; no Therapy | Speech Velocity | Speech velocity 4W | 2.3 spoken syllables per second | Standard Deviation 0.6 |
| Healthy Controls; no Therapy | Speech Velocity | Speech velocity 6M | 2.3 spoken syllables per second | Standard Deviation 0.6 |
Primary
Velocity in Gait
Gait Velocity: meters per second
Time frame: At Baseline (BL), T1 after 4 weeks (4W-directly after intervention), T2 after 6 months (6M).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Specific SL-therapy for PD-DBS and Non-DBS | Velocity in Gait | Gait Velocity-4W (4Weeks) | 1.2 meter per second | Standard Deviation 0.2 |
| Specific SL-therapy for PD-DBS and Non-DBS | Velocity in Gait | Gait Velocity-6M (6 Months) | 1.3 meter per second | Standard Deviation 0.8 |
| rBMT for PD-DBS and Non-DBS | Velocity in Gait | Gait Velocity-6M (6 Months) | 1.2 meter per second | Standard Deviation 0.4 |
| rBMT for PD-DBS and Non-DBS | Velocity in Gait | Gait Velocity-4W (4Weeks) | 1.2 meter per second | Standard Deviation 0.3 |
| PD-DBS/ Non-DBS; no Therapy | Velocity in Gait | Gait Velocity-4W (4Weeks) | 1.2 meter per second | Standard Deviation 0.3 |
| PD-DBS/ Non-DBS; no Therapy | Velocity in Gait | Gait Velocity-6M (6 Months) | 1.2 meter per second | Standard Deviation 0.3 |
| Healthy Controls; no Therapy | Velocity in Gait | Gait Velocity-4W (4Weeks) | .8 meter per second | Standard Deviation 0.08 |
| Healthy Controls; no Therapy | Velocity in Gait | Gait Velocity-6M (6 Months) | .8 meter per second | Standard Deviation 0.08 |
Comparison: First Reliable Change (RC), Reliable Change Index (RCI) were calculated on every individual score. Further, ANOVAs and t-tests were administered in order to verify differences between groups or interventions. Significance levels were set at p \< .05.
p-value: 0.05ANOVA
Secondary
Health Status (UPDRS)
The complete questionnaire 'Unified Parkinson's Disease Rating Scale' (UPDRS) was filled out at BL and 6M. Scores may range from 0-4 per question. Final scores may add up to 199 points maximum. The higher the score, the worse disease severity/ degree of disability is.
Time frame: At Baseline and 6 Months
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Specific SL-therapy for PD-DBS and Non-DBS | Health Status (UPDRS) | UPDRS-BL | 38.6 score on a scale | Standard Deviation 19.1 |
| Specific SL-therapy for PD-DBS and Non-DBS | Health Status (UPDRS) | UPDRS-6M | 35.6 score on a scale | Standard Deviation 16.7 |
| rBMT for PD-DBS and Non-DBS | Health Status (UPDRS) | UPDRS-6M | 41.7 score on a scale | Standard Deviation 19.1 |
| rBMT for PD-DBS and Non-DBS | Health Status (UPDRS) | UPDRS-BL | 37.3 score on a scale | Standard Deviation 20.6 |
| PD-DBS/ Non-DBS; no Therapy | Health Status (UPDRS) | UPDRS-BL | 42.8 score on a scale | Standard Deviation 20.2 |
| PD-DBS/ Non-DBS; no Therapy | Health Status (UPDRS) | UPDRS-6M | 37 score on a scale | Standard Deviation 20.1 |
| Healthy Controls; no Therapy | Health Status (UPDRS) | UPDRS-BL | 0 score on a scale | Standard Deviation 0 |
| Healthy Controls; no Therapy | Health Status (UPDRS) | UPDRS-6M | 0 score on a scale | Standard Deviation 0 |
p-value: 0.05ANOVA
Secondary
Neuropsychiatric Self-rating Questionnaires
Self-rating questionnaires investigating depression using the Beck's Depression Inventory (BDI). This is a 21 question, multiple choice, self-report questionnaire. Minimum score is 0 and maximum scores is 63. The higher the score the more severe is the depression. Details: 0-9: indicates minimal depression 10-18: indicates mild depression 19-29: indicates moderate depression 30-63: indicates severe depression.
Time frame: At 4 Weeks and 6 Months
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Specific SL-therapy for PD-DBS and Non-DBS | Neuropsychiatric Self-rating Questionnaires | BDI-4W | 8 score | Standard Deviation 1.8 |
| Specific SL-therapy for PD-DBS and Non-DBS | Neuropsychiatric Self-rating Questionnaires | BDI-6M | 7.4 score | Standard Deviation 1.7 |
| rBMT for PD-DBS and Non-DBS | Neuropsychiatric Self-rating Questionnaires | BDI-6M | 8.8 score | Standard Deviation 1.6 |
| rBMT for PD-DBS and Non-DBS | Neuropsychiatric Self-rating Questionnaires | BDI-4W | 7.6 score | Standard Deviation 2.1 |
| PD-DBS/ Non-DBS; no Therapy | Neuropsychiatric Self-rating Questionnaires | BDI-4W | 7.1 score | Standard Deviation 1.9 |
| PD-DBS/ Non-DBS; no Therapy | Neuropsychiatric Self-rating Questionnaires | BDI-6M | 8.3 score | Standard Deviation 1.8 |
| Healthy Controls; no Therapy | Neuropsychiatric Self-rating Questionnaires | BDI-4W | 5.5 score | Standard Deviation 2.2 |
| Healthy Controls; no Therapy | Neuropsychiatric Self-rating Questionnaires | BDI-6M | 5.4 score | Standard Deviation 2.2 |
Secondary
Neuropsychological Standardised Test Battery
Inhibition Control (Stroop), Visio-Construction (Mosaic), Flexibility (Trail Making Test), Episodic Memory (Basel Verbal Learning Test -long delayed free recall), Working Memory (backwards digit span task by Wechsler). Scores were standardized (z-scores) to a mean of 0 and standard deviation of 1. The Z-score indicates the number of standard deviations away from the mean. A Z-score of 0 is equal to the mean of a reference population. Negative numbers indicate values lower than the reference population and positive numbers indicate values higher than the reference population
Time frame: At 4 Weeks and at 6 Months
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Specific SL-therapy for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Episodic Memory-4W | -.9 z-scores | Standard Deviation 1.7 |
| Specific SL-therapy for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Episodic Memory-6M | -.7 z-scores | Standard Deviation 1.5 |
| Specific SL-therapy for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Working Memory-4W | .6 z-scores | Standard Deviation 0.8 |
| Specific SL-therapy for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Working Memory-6M | -.3 z-scores | Standard Deviation 1.1 |
| Specific SL-therapy for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Visuo-Construction-4W | .4 z-scores | Standard Deviation 1.03 |
| Specific SL-therapy for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Visa-Construction-6M | .03 z-scores | Standard Deviation 1 |
| Specific SL-therapy for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Inhibition (Stroop)-4W | .6 z-scores | Standard Deviation 0.8 |
| Specific SL-therapy for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Inhibition (Stroop)-6M | -.04 z-scores | Standard Deviation 0.9 |
| Specific SL-therapy for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Flexibility (TMT)-4W | -.4 z-scores | Standard Deviation 0.8 |
| Specific SL-therapy for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Flexibility (TMT)-6M | -.6 z-scores | Standard Deviation 1.02 |
| rBMT for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Working Memory-4W | .2 z-scores | Standard Deviation 0.9 |
| rBMT for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Flexibility (TMT)-4W | -.6 z-scores | Standard Deviation 1.3 |
| rBMT for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Working Memory-6M | .13 z-scores | Standard Deviation 0.9 |
| rBMT for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Visuo-Construction-4W | .14 z-scores | Standard Deviation 1.1 |
| rBMT for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Visa-Construction-6M | .07 z-scores | Standard Deviation 0.9 |
| rBMT for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Inhibition (Stroop)-4W | .8 z-scores | Standard Deviation 1.4 |
| rBMT for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Flexibility (TMT)-6M | -1.2 z-scores | Standard Deviation 1.1 |
| rBMT for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Inhibition (Stroop)-6M | .3 z-scores | Standard Deviation 0.6 |
| rBMT for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Episodic Memory-4W | -.3 z-scores | Standard Deviation 1.2 |
| rBMT for PD-DBS and Non-DBS | Neuropsychological Standardised Test Battery | Episodic Memory-6M | -.6 z-scores | Standard Deviation 0.8 |
| PD-DBS/ Non-DBS; no Therapy | Neuropsychological Standardised Test Battery | Inhibition (Stroop)-6M | .7 z-scores | Standard Deviation 0.7 |
| PD-DBS/ Non-DBS; no Therapy | Neuropsychological Standardised Test Battery | Inhibition (Stroop)-4W | .7 z-scores | Standard Deviation 0.9 |
| PD-DBS/ Non-DBS; no Therapy | Neuropsychological Standardised Test Battery | Flexibility (TMT)-6M | -.3 z-scores | Standard Deviation 0.8 |
| PD-DBS/ Non-DBS; no Therapy | Neuropsychological Standardised Test Battery | Episodic Memory-4W | -.7 z-scores | Standard Deviation 0.3 |
| PD-DBS/ Non-DBS; no Therapy | Neuropsychological Standardised Test Battery | Working Memory-6M | -.2 z-scores | Standard Deviation 0.8 |
| PD-DBS/ Non-DBS; no Therapy | Neuropsychological Standardised Test Battery | Visa-Construction-6M | .2 z-scores | Standard Deviation 0.6 |
| PD-DBS/ Non-DBS; no Therapy | Neuropsychological Standardised Test Battery | Flexibility (TMT)-4W | -.8 z-scores | Standard Deviation 0.3 |
| PD-DBS/ Non-DBS; no Therapy | Neuropsychological Standardised Test Battery | Episodic Memory-6M | -.3 z-scores | Standard Deviation 1.1 |
| PD-DBS/ Non-DBS; no Therapy | Neuropsychological Standardised Test Battery | Visuo-Construction-4W | .4 z-scores | Standard Deviation 0.9 |
| PD-DBS/ Non-DBS; no Therapy | Neuropsychological Standardised Test Battery | Working Memory-4W | -.2 z-scores | Standard Deviation 0.8 |
| Healthy Controls; no Therapy | Neuropsychological Standardised Test Battery | Visuo-Construction-4W | .4 z-scores | Standard Deviation 0.8 |
| Healthy Controls; no Therapy | Neuropsychological Standardised Test Battery | Inhibition (Stroop)-6M | .4 z-scores | Standard Deviation 0.7 |
| Healthy Controls; no Therapy | Neuropsychological Standardised Test Battery | Visa-Construction-6M | .8 z-scores | Standard Deviation 1.05 |
| Healthy Controls; no Therapy | Neuropsychological Standardised Test Battery | Flexibility (TMT)-6M | .8 z-scores | Standard Deviation 1.3 |
| Healthy Controls; no Therapy | Neuropsychological Standardised Test Battery | Inhibition (Stroop)-4W | .2 z-scores | Standard Deviation 1.3 |
| Healthy Controls; no Therapy | Neuropsychological Standardised Test Battery | Episodic Memory-6M | -.2 z-scores | Standard Deviation 1.1 |
| Healthy Controls; no Therapy | Neuropsychological Standardised Test Battery | Working Memory-4W | .1 z-scores | Standard Deviation 1.7 |
| Healthy Controls; no Therapy | Neuropsychological Standardised Test Battery | Working Memory-6M | -.5 z-scores | Standard Deviation 1.4 |
| Healthy Controls; no Therapy | Neuropsychological Standardised Test Battery | Episodic Memory-4W | -.4 z-scores | Standard Deviation 1.7 |
| Healthy Controls; no Therapy | Neuropsychological Standardised Test Battery | Flexibility (TMT)-4W | .2 z-scores | Standard Deviation 1.05 |
p-value: 0.05ANOVA