Parkinson Hastalığında Kombine Bir Motor-Bilişsel Müdahaleye Boyuna Tepki Desenleri: Keşif Tek Kol Çalışması

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Abstract Background Combined motor–cognitive exercise is a promising non-pharmacological intervention for both motor and non-motor symptoms in Parkinson’s disease (PD). However, many exercise trials do not meet their primary endpoints, possibly because of substantial inter-individual variability in treatment response. In this exploratory single-arm study, we aimed to evaluate the overall effects of a combined motor–cognitive intervention and the heterogeneity of intervention responsiveness. Methods Thirty-eight individuals with PD completed a specialist-led combined motor–cognitive training program and were assessed at baseline, 8 weeks, and 20 weeks. Linear mixed-effects models were used to assess overall changes over time. To identify latent response subgroups that were not detected by group-level analyses, a multivariate latent class linear mixed model was applied to Unified Parkinson’s Disease Rating Scale Part III and Montreal Cognitive Assessment scores. Elastic net logistic regression was used to identify predictors of subgroup membership. Results Significant improvements were observed in Unified Parkinson’s Disease Rating Scale Part II, depressive symptoms, lower-extremity functional performance, and balance, whereas Unified Parkinson’s Disease Rating Scale Part III and 6-minute walk distance worsened over time. Latent class analysis identified two distinct response subgroups that were primarily differentiated by divergent trajectories of Unified Parkinson’s Disease Rating Scale Part III scores. Key predictors of subgroup membership were anxiety, grip strength, and the cognitive domain of quality of life, with the model accounting for 54.9% of the variance. Conclusions These findings indicate substantial heterogeneity in response to combined motor–cognitive interventions in PD and support the identification of response-based subgroups. Accounting for this heterogeneity may improve intervention design, refine outcome evaluation, and support more personalized rehabilitation strategies. Trial registration: Clinical Research Information Service of the Republic of Korea (CRIS), KCT0009353, registered on April 19, 2024.

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