Cognitive Strategy Use During the Weekly Calendar Planning Activity in People With Parkinson's Disease

Cognitive impairment is common among people with Parkinson’s disease (PwPD) without dementia and is related to reduced performance, participation and quality of life. Understanding how PwPD use strategies to support their cognitive performance can help therapists design targeted and effective interventions. This study investigated strategy use and effectiveness during a functional cognitive task among PwPD. Data are from the pre-treatment assessment of a randomized controlled trial of a metacognitive strategy intervention (Multicontext Approach) in PwPD. Participants (N=54) were PwPD without dementia but with subjective cognitive decline. They completed the Level II Adult/Older Adult Weekly Calendar Planning Activity. Strategy use, accuracy, completion time, and efficiency were assessed. Spearman rho and Mann-Whitney U tests were used; p<0.05 was considered significant. Participants who used more strategies had better accuracy (rs=0.33, p =0.01) and took longer to complete the task (rs=0.53, p<0.001). Participants most frequently used strategies for attending to information (94% of participants), followed by strategies for self-monitoring (85%), organizing (63%), and keeping track (43%). Participants who used strategies for organizing and self-monitoring had higher accuracy (ps<0.05), and those who used strategies for organizing and keeping track had longer completion time (ps<0.04). Participants who used strategies did not have better efficiency than those who did not (ps>0.14). PwPD who used certain strategies were more accurate but took longer to complete the task, so they were not more efficient. This implies that they are aware of potential task challenges but do not efficiently select or use strategies to manage them. These findings can exert a powerful influence on the field of occupational therapy by informing interventions that optimize strategy use during cognitively challenging activities to support occupational performance and participation in PwPD.

References

Broeders, M., de Bie, R. M., Velseboer, D. C., Speelman, J. D., Muslimovic, D., & Schmand, B. (2013). Evolution of mild cognitive impairment in Parkinson disease. Neurology, 81(4), 346-352. https://doi.org/10.1212/WNL.0b013e31829c5c86

Foster, E., Carson, L., Jonas, J., Kang, E., Doty, T., & Toglia, J. (2022). The Weekly Calendar Planning Activity to Assess Functional Cognition in Parkinson Disease. OTJR: Occupation, Participation, and Health, 42(4), 315-323. https://doi.org/10.1177/15394492221104075

Kudlicka, A., Hindle, J. V., Spencer, L. E., & Clare, L. (2018). Everyday functioning of people with Parkinson’s disease and impairments in executive function: a qualitative investigation. Disability and Rehabilitation, 40(20), 2351-2363. https://doi.org/10.1080/09638288.2017.1334240

Toglia, J. (2015). The Weekly Calendar Planning Activity (WCPA): A performance test of executive function. American Occupational Therapy Association Press.