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.

Public Health Relevance

Over 80,000 Veterans with Parkinson's disease (PD) obtain their medical care within the Veterans Administration (VA) Health Care System and this number is expected to increase due to the greater longevity of the population. Cognitive impairment is one of the most debilitating aspects of PD; however, there are few treatment options available for these individuals. The aim of this project is to study the efficacy of a novel, manualized cognitive rehabilitation program fo individuals with PD and cognitive impairment. Given that a large proportion of Veterans with PD will develop cognitive deficits, it is imperative to develop an empirically-validated intervention that can slow or even reverse cognitive decline and improve quality of life in these individuals. The proposed program of research is wholly consistent with the VA's clinical care goals and will greatly benefit the VA and its role as a leader in providing high quality care and empirically-validated treatments to Veterans.

National Institute of Health (NIH)
Veterans Affairs (VA)
Non-HHS Research Projects (I01)
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Blank (RRD6)
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VA San Diego Healthcare System
San Diego
United States
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Holiday, Kelsey A; Pirogovsky-Turk, Eva; Malcarne, Vanessa L et al. (2017) Psychometric Properties and Characteristics of the North-East Visual Hallucinations Interview in Parkinson's Disease. Mov Disord Clin Pract 4:717-723
Moore, Raeanne C; Marquine, MarĂ­a J; Straus, Elizabeth et al. (2017) Predictors and Barriers to Mental Health Treatment Utilization Among Older Veterans Living With HIV. Prim Care Companion CNS Disord 19: