Urban Ekman

Cognitive impairments often make it difficult to act independently and can cause significant psycho-social suffering. People with early cognitive impairment frequently suffer from existential anxiety, health problems (such as stress symptoms, anxiety, and depression), and social avoidance. There is a great need for improved treatment and rehabilitation methods to alleviate these negative consequences. This project aims to evaluate a newly developed psychological treatment for individuals with cognitive impairments and to study which underlying mechanisms predict positive treatment effects. Adequate support to adapt to the changed living conditions can help the individual with cognitive impairment to preserve functionality and maintain good health. The benefit of the upcoming research is significant as it has the potential to improve the care of a large proportion of patients with cognitive impairment, who currently lack effective psychological treatment/rehabilitation. We expect that the project will provide improved support to those suffering from psychological symptoms in relation to their cognitive impairments. In addition, we expect the method to be useful for those who struggle with adherence to lifestyle changes (ie, increasing the patient's motivation to adhere to lifestyle changes that may benefit their cognitive impairment). Thus, the current project may provide a new path towards improved prevention/manageability of cognitive decline.

Life means combining motor-cognitive skills, e.g., walking, talking and navigating. Aging or neurological diseases, e.g., Parkinson’s disease (PD) compromises these skills needed for an independent life. It is uncertain which brain alterations lead to these difficulties and how to target these heterogenous motor-cognitive difficulties. Current treatments apply a "one-size-fits-all" approach, which needs to evolve towards personalized rehabilitation, reaching beyond a simple adaption to disease severity.Our multimodal project combines physiotherapy, neurology, psychology and neuroimaging to characterize motor-cognitive skills during complex walking, identify underlying brain alterations and subtype PD to inform a novel exercise approach for people with PD. This 5 years proposal has 4 stages: 1) Exploring brain alterations and links to the motor-cognitive skills in healthy and PD 2) PD subtyping using neuroimaging, motor, cognitive and clinical data 3) Characterization of exercise responsiveness in PD and 4) Development and testing of a personalized motor-cognitive exercise program. We combine novel techniques for data collection with in-depth analysis of existing data (EXPANd trial). The results will have an immediate application and clinical relevance for personalized rehabilitation in older and PD. There is no cure for PD yet, thus positive findings would revolutionize treatment, giving new hope to patients for a life with improved health, independence and higher quality.

The burden of cognitive impairment is severe, and often obstructs affected people to act independently, and their families frequently carry a large responsibility. A great challenge for our society is to support the maintenance of cognitive health to avoid cognitive disability and decrease health-economic costs. In an RCT, we will evaluate the efficacy of PIPCI in an RCT comparing the intervention with both an active control group condition (cognitive training), and a waiting list control group condition. The primary objective is to evaluate intervention-related changes in psychological flexibility (the ability to notice and accept interfering thoughts, emotions, and bodily sensations without acting on them, when this serves action in line with personal values). The secondary objectives are to further evaluate intervention-related changes with measures of psychological health, cognitive measures and biological markers. The usefulness of the forthcoming research is significant as it has the potential to improve the care of a substantial proportion of patients with cognitive impairment, which today lack effective psychological treatment/rehabilitation.