Feasibility and Acceptance of a Nonpharmacological Cognitive Remediation Intervention for Patients With Parkinson Disease

Abstract

Many patients with idiopathic Parkinson disease (PD) experience deficits in executive skills (ES; eg, attentional control, self-monitoring), which are associated with a range of impairing symptoms such as visual hallucinations, decreased motor control, and increased apathy. Pharmacological methods for improving ES in PD have shown to be somewhat unreliable. The goal of this study was to evaluate the feasibility and patient acceptance of a nonpharmacological cognitive remediation program that aimed to improve sustained, selective, alternating, and divided attentional abilities in a sample of 16 nondemented PD patients. Based on ratings of 4 feasibility dimensions (fatigue, effort, progress, enjoyment), patients with PD demonstrated a high degree of acceptance and successfully engaged in the program. As predicted, ratings of progress differed significantly across tasks according to difficulty level and were positively related to posttraining improvement in ES. Fatigue ratings showed negative associations with other indices across task types, suggesting that monitoring fatigue during cognitive remediation is essential. Patients' ratings of enjoyment did not correspond to task difficulty, indicating that tasks could be simultaneously challenging and rewarding. Males reported exerting greater effort during the training than females. It was concluded that the intervention is appropriate for testing in a randomized controlled trial.

Cognitive Rehabilitation for Executive Dysfunction in Parkinson's Disease: Application and Current Directions

“…Mohlman et al [26] completed a small ( n = 14) open trial to test the feasibility of an attention process training intervention for patients with a minimental state exam (MMSE) score >23 and idiopathic PD. The intervention consisted of in-person training with practice exercises and worksheets on attention tasks.…”

Executive dysfunction in Parkinson's disease: A review

“…However, cognitive impairment, of which executive dysfunction is an important reflection, has a significant impact on the quality of life of the patients (Schrag, Jahanshahi, & Quinn, ) and carers (Aarsland, Larsen, Karlsen, Lim, & Tandberg, ), and should therefore be considered in the clinical management of the disorder. There is now some evidence that intensive training programmes can be effective for improving executive dysfunction in PD (Hindle, Petrelli, Clare, & Kalbe, ; Mohlman, Chazin, & Georgescu, ; Reuter, Mehnert, Sammer, Ochsner, & Engelhardt, ; Ridgel et al ., ). With the increasing focus on patients’ active participation in their health care and the adoption of a self‐management approach to chronic illness, such training for the improvement of executive dysfunction can be incorporated in future self‐help guides for PD (Jahanshahi & Marsden ).…”

Parkinson's patients’ executive profile and goals they set for improvement: Why is cognitive rehabilitation not common practice?

“…However, in clinical practice, admittance to neuropsychological rehabilitation programmes is not yet part of standard therapy for patients with PD, despite the fact that these programmes have been shown to be effective in other patient groups with executive impairments (e.g., in patients with acquired brain injury) (Cicerone et al, 2011;Wilson, 2008). This is even more surprising given the fact that over the past few years several studies have been conducted that aimed to show the effectiveness of cognitive rehabilitation programmes in patients with PD (Edwards et al, 2013;Hindle, Petrelli, Clare, & Kalbe, 2013;Mohlman et al, 2010;Mohlman, Chazin, & Georgescu, 2011;Naismith, Mowszowski, Diamond, & Lewis, 2013;Nombela et al, 2011;Paris et al, 2011;Reuter, Mehnert, Sammer, Oechsner, & Engelhardt, 2012;Sammer, Reuter, Hullmann, Kaps, & Vaitl, 2006;Sinforiani, Banchieri, Zucchella, Pacchetti, & Sandrini, 2004). Overall, the results of these studies lead to the conclusion that cognitive 2 VLAGSMA ET AL.…”