Feasibility of a Cognitive Strategy Training Intervention for Parkinson’s Disease

PURPOSE: To determine the feasibility of a novel cognitive strategy training intervention for Parkinson’s disease (PD).

RATIONALE: Cognitive impairment is common in PD without dementia and contributes to disability and reduced quality of life. Unfortunately, existing cognitive rehabilitation programs for PD, which focus on cognitive process training and do not consider transfer to real-world performance, have limited effectiveness.

We have developed an intervention to support people with PD in learning metacognitive and compensatory strategies and applying them in their everyday lives to improve their cognitive and occupational performance. Establishing aspects of its feasibility, such as participant engagement, acceptance, and adherence, is a necessary first step in determining whether it may eventually be effective in clinical practice.

DESIGN: Consecutive case series. The intervention was based on the Multicontext Treatment Approach and consisted of at least six individual treatment sessions at the participant’s home or community. It was tailored to each participant’s goals and cognitive performance problems but used a standardized approach across and within sessions for all participants. Various baseline and outcome measures were completed in pre- and posttreatment testing sessions, and feasibility measures were completed pre-, post-, and throughout treatment.

PARTICIPANTS: Seven volunteers with Stage II PD and without dementia who identified at least one cognitive concern and expressed an interest in learning ways to address it.

MEASURES: Feasibility measures included the Credibility and Expectancy Questionnaire (CEQ; range = 0–10; administered pre-, mid-, and posttreatment), Client Satisfaction Questionnaire (CSQ; range = 8–32; posttreatment), enjoyment and effort ratings (0 = none, 5 = extreme; each treatment session), percentage of homework completion, and logistical information (e.g., scheduling). Preliminary efficacy was explored with the Canadian Occupational Performance Measure (COPM; range = 1–10; pre- and posttreatment). Higher scores on the rating scales are better.

ANALYSIS: Descriptive statistics were used. Group-level descriptive data are presented below as mean ± standard deviation. Individual-level data can be presented on the poster.

RESULTS: CEQ scores were positive and increased over the course of the intervention, with Expectancy scores (pre: 6.6 ± 1.1; mid: 7.8 ± 1.0; post: 8.4 ± 0.8) tending to be higher than Credibility scores (pre: 5.1 ± 1.4; mid: 5.6 ± 1.3; post: 6.1 ± 1.5). CSQ scores ranged from 30 to 32 (30.5 ± 0.58). Almost all (93%) effort and enjoyment ratings were ≥3 (Much), and homework completion rates ranged from 58% to 100% (83.4 ± 19.6). Duration of the intervention ranged from 6 to 11 wk (9 ± 2), with treatment sessions averaging 1.7 hr (± 0.5). COPM Performance and Satisfaction ratings improved from 5 ± 2 and 4 ± 2 at pretreatment to 7 ± 2 and 7 ± 2 at posttreatment.

DISCUSSION: These findings support the feasibility and potential efficacy of the intervention. Participants were very satisfied with the intervention, it made sense to them (CEQ Credibility), and they felt like they could improve from it (CEQ Expectancy). The effort, enjoyment, and homework completion data indicate good engagement and adherence. Finally, preliminary analysis of the COPM suggests the potential for clinically significant improvements in self-identified problem areas.

IMPACT: Interventions for managing PD-related cognitive impairment are in high demand from clients, families, practitioners, and scientists in the PD community. The long-term impact of this work will be an effective occupational therapy intervention for addressing the functional consequences of cognitive impairment in PD, which ultimately will lead to better performance, participation, and quality of life for this population.