Date Presented 03/22/24
This pilot study supports the multicontext approach as feasible and effective for people with Parkinson disease without dementia. Participants accepted and engaged in the intervention, and they reported improved functional cognitive performance.
Primary Author and Speaker: Erin R. Foster
Additional Authors and Speakers: Jessica Daniel, Emily Kubica
Contributing Authors: Jill E. Jonas, Joan Toglia
PURPOSE: People with Parkinson disease (PD) experience functional cognitive decline that limits occupational performance and participation. The Multicontext (MC) Approach may enable people with PD to use strategies to cope with functional cognitive challenges. This study investigated the effect of the MC Approach, as well as factors that may influence its effect, in people with PD.
DESIGN: Double-blind randomized controlled trial. Non-demented people with PD with subjective cognitive decline completed pre-treatment assessment, were randomized to the MC or Control group, received 10 weekly treatment sessions, and completed 1 week post-treatment assessment (MC n=26, Control n=21).
METHOD: The primary outcome was self-rated attainment of functional cognitive goals measured by the Bangor Goal Setting Interview (BGSI) at pre, treatment session 4 (Tx4), Tx7 and post. Potential effect modifiers were indicators of treatment engagement measured by standardized assessments: credibility and expectancy (pre, Tx4, Tx7, post), homework adherence (Tx2-10) and satisfaction (post). Data were analyzed with multilevel modeling.
RESULTS: The MC group had greater BGSI improvement than the Control group (p<0.001). Credibility and expectancy were high and moderate, respectively, and did not differ between groups or over time. Higher credibility and expectancy related to greater improvement in BGSI (p<0.003). The MC group had better homework adherence than the Control group (83% vs. 71%; p=0.002). Satisfaction was very high in both groups and did not differ. Satisfaction and homework adherence did not correlate with BGSI.
CONCLUSION: The MC Approach improved self-rated functional cognition among people with PD. Treatment engagement was high, with higher credibility and expectancy relating to better treatment response. This study is important to practice because it supports the MC Approach as an acceptable, engaging, and likely effective intervention to address functional cognition in PD.
References
Foster, E.R., Spence, D., Toglia, J. (2018). Feasibility of a cognitive strategy training intervention for people with Parkinson disease. Disability and Rehabilitation, 40(10):1127–1134. https://doi.org/10.1080/09638288.2017.1288275.
Toglia, J., Foster, E.R. (2021). The Multicontext Approach to Cognitive Rehabilitation: A Metacognitive Strategy Intervention to Optimize Functional Cognition. Columbus, OH: Gatekeeper Press.
