Cognitive Rehabilitation for Individuals with Parkinson's Disease and MCI

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 DESCRIPTION: Cognitive deficits in Parkinson's disease (PD) are often progressive and frequently represent the most debilitating symptom that result in decreased functional outcome and quality of life (QoL). It is estimated that 20-50% of individuals with PD meet criteria for Mild Cognitive Impairment (PD-MCI), which is characterized as the transitional phase between normal cognition and dementia. Unfortunately, there are few pharmacologic treatment options to help with cognitive impairments associated with PD-MCI. Cognitive rehabilitation based on the development of compensatory strategies represents a non-pharmacological approach to improve cognition in PD-MCI. However, to our knowledge there are no studies examining this approach in PD, which is a critical gap in our knowledge. Moreover, neuropsychiatric symptoms (e.g. sleep difficulty, mood), common in PD, are often neglected in traditional interventions. Thus, the overall aim of this investigation is to determine the efficacy of a novel, manualized compensatory cognitive rehabilitation program to improve cognitive deficits as well as improve neuropsychiatric symptoms and quality of life/health status (QoL/HS) in individuals with PD-MCI. This program, Cognitive Symptom Management and Rehabilitation Therapy for Parkinson's Disease (CogSMART-PD), is a 10-week intervention that provides cognitive skills training and teaches compensatory strategies to help individuals with PD-MCI cope with and adapt to cognitive deficits. Also, the program provides psychosocial and stress-reducing techniques to attenuate common neuropsychiatric symptoms that often negatively impact cognitive functioning and QoL. Our preliminary data demonstrated that CogSMART-PD holds great promise for the treatment of cognitive and neuropsychiatric symptoms in PD-MCI. To our knowledge, this is the first proposed randomized, parallel, controlled study to investigate the efficacy of a compensatory cognitive rehabilitation program adapted specifically for PD. We hypothesize that cognitive functioning, neuropsychiatric symptoms, and quality of life/health status will improve in PD-MCI participants following 10 weeks of the CogSMART-PD, and these improvements will be maintained at 6- and 12-months post-treatment. One hundred ten participants with PD-MCI based on the criteria set forth by the Movement Disorder Society will be recruited for this study. Over-recruitment by 20% will be instituted to account for subject attrition or unusable data. Participants will be randomized into either a 10-week CogSMART-PD intervention group (n = 55) or 10-week supportive care group (n = 55). All participants will be assessed with a battery of tests that measure objective and subjective cognitive function, neuropsychiatric symptoms, disease severity, motor symptoms, and quality of life/health status by an examiner blinded to group assignment. Assessments will be administered at baseline, 10 weeks (post-treatment), and 6- and 12- months (follow-ups). Data will be primarily analyzed using analyses of covariance and linear random effects modeling. Results of this study will provide essential information about a non-pharmacological intervention for individuals with PD-MCI that could improve their cognition, neuropsychiatric symptoms, and quality of life/ health status. Moreover, these results may demonstrate the first evidence of preventing or stabilizing functional cognitive decline in PD and could provide a manualized and systematic program that can be feasibly implemented and disseminated throughout the VA Healthcare System.