A Metacognitive Strategy Intervention for People With Parkinson's Disease: Pilot and Feasibility Trial.

Overview

abstract

IMPORTANCE: Cognitive impairment is a common and disabling feature of Parkinson's disease (PD), and interventions to mitigate its negative functional consequences are in high demand. Metacognitive strategy interventions, such as the Multicontext (MC) Approach, may support daily function among people with PD (PwPD). OBJECTIVE: To determine feasibility, participant acceptance, and preliminary estimates of the MC Approach's treatment effect for PwPD. DESIGN: Quasi-randomized controlled pilot trial. Participants underwent pretreatment assessment, allocation to treatment group (MC, n = 29; control, n = 28), 10 treatment sessions, 1-wk posttreatment assessment, and 3-mo questionnaire follow-up. SETTING: Participants' homes. PARTICIPANTS: PwPD without dementia but with subjective cognitive concerns. INTERVENTION: Ten weekly sessions of the MC Approach, which aimed to develop awareness and strategies to control cognitive performance across activities via therapist mediation, functional activity performance, and homework. The control intervention used the same structure and treatment activities but did not address awareness or strategy use or use mediated learning. OUTCOMES AND MEASURES: Indicators of trial feasibility (recruitment, retention, study duration), participant acceptance (satisfaction, homework completion), and treatment effect (self-rated functional cognitive goal performance). RESULTS: We enrolled 3 participants/mo and had 87% retention. Both groups' satisfaction and homework completion were high. Compared with control participants, MC participants reported greater improvement in functional cognitive goal performance from preintervention to postintervention that was maintained at follow-up. CONCLUSIONS AND RELEVANCE: The MC Approach is a feasible, acceptable, and potentially efficacious intervention to address the functional cognitive goals of PwPD without dementia. A larger, fully randomized trial is required to provide definitive efficacy data. Plain-Language Summary: Cognitive impairment is one of the most common and disabling features of Parkinson's disease. As such, cognitive interventions that support daily function for this population are in high demand. The purpose of this study was to establish the feasibility of one such potential intervention, the Multicontext (MC) Approach, among people with Parkinson's disease (PwPD) without dementia. We also wanted to generate preliminary estimates of its effect on everyday cognitive function to inform future definitive trials. In a pilot quasi-randomized controlled trial, we found that the MC Approach is feasible, safe, and acceptable for people with PwPD. We also found that it may improve self-rated performance of daily cognitive goals. We can now proceed with a full-scale randomized controlled trial to determine its efficacy. Ultimately, this work will meet the pressing need for evidence-based cognitive interventions that improve or maintain occupational performance and participation among PwPD.