Prospective memory impairment in Parkinson disease-related cognitive decline: Intervention and mechanisms

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Erin R. Foster R01 AG065214-01A1 Prospective memory impairment in Parkinson disease-related cognitive decline: Intervention and mechanisms PROJECT SUMMARY/ABSTRACT Parkinson disease dementia (PDD) – one of the Alzheimer’s Disease Related Dementias (ADRD) – is associated with increased disability, mortality and healthcare costs among people with PD. The long term goal of this research is to reduce disability and delay the onset of the ADRD PDD by enabling people at risk for PDD to cope with cognitive decline to maintain daily function. Existing medical (e.g. surgical, pharmacological) treatments for PD do not prevent or treat cognitive impairment, so behavioral interventions that mitigate its negative functional consequences and potentially delay or slow PDD are a top research priority. Unfortunately, the widely-used process training approach to cognitive intervention (repetitive practice of tasks designed to challenge and improve particular cognitive functions) has been unsuccessful in improving daily function and quality of life in this population. To overcome this limitation, the investigators take a strategy training approach, teaching targeted strategies that people can use in their everyday lives to circumvent cognitive deficits and accomplish daily tasks. Strategy training is a practice standard for cognitive rehabilitation in brain injury and stroke, but its application to PDD is novel. Moreover, the strategy training intervention developed for this study explicitly focuses on generalization of training to daily function, an aspect that is critically lacking from many typical strategy training approaches and from PD-related cognitive intervention research to date. This project addresses prospective memory, or the ability to remember to execute delayed intentions at the appropriate moment in the future. Good prospective memory is essential for independent living (e.g. paying bills, turning the stove off), employment, social relationships, and compliance with important health behaviors (e.g. taking medications). People at risk for PDD have prospective memory deficits that relate to worse daily function and quality of life. Therefore, prospective memory impairment is a relevant cognitive problem to address in this population. The primary objective of the current project is to determine the efficacy of mechanistically-targeted strategy training on prospective memory among people at risk for PDD (those with PD-related mild cognitive impairment; PD-MCI). It is a single-blind randomized controlled trial comparing the effects of strategy training to the traditional process training approach on objective laboratory prospective memory performance (Aim 1) and reported everyday prospective memory function (Aim 2). Additional objectives are to investigate neural mechanisms of prospective memory impairment in PD-MCI (Aim 3) and neural and behavioral predictors of prospective memory training response (Aim 4). This project leverages participants, data and infrastructure from an existing longitudinal cohort of PD, PD-MCI, PDD and control participants to evaluate short-term and long-term training effects, neurobiological mechanisms, and predictors of treatment response. This work will meet the pressing need for effective cognitive interventions that delay functional impairment associated with the ADRD PDD and will positively impact function and quality of life in this population.