Goal Setting for Cognitive Rehabilitation in Mild to Moderate Parkinson’s Disease Dementia and Dementia with Lewy Bodies

Abstract

Alongside the physical symptoms associated with Parkinson's disease dementia and dementia with Lewy bodies, health services must also address the cognitive impairments that accompany these conditions. There is growing interest in the use of nonpharmacological approaches to managing the consequences of cognitive disorder. Cognitive rehabilitation is a goal-orientated behavioural intervention which aims to enhance functional independence through the use of strategies specific to the individual's needs and abilities. Fundamental to this therapy is a person's capacity to set goals for rehabilitation. To date, no studies have assessed goal setting in early-stage Parkinson's disease dementia or dementia with Lewy bodies. Semistructured interviews were carried out with 29 participants from an ongoing trial of cognitive rehabilitation for people with these conditions. Here, we examined the goal statements provided by these participants using qualitative content analysis, exploring the types and nature of the goals set. Participants' goals reflected their motivations to learn new skills or improve performance in areas such as technology-use, self-management and orientation, medication management, and social and leisure activities. These results suggest that goal setting is achievable for these participants, provide insight into the everyday cognitive difficulties that they experience, and highlight possible domains as targets for intervention. The trial is registered with ISRCTN16584442 (DOI 10.1186/ISRCTN16584442 13/04/2015).

Goal‐orientated cognitive rehabilitation for dementias associated with Parkinson's disease―A pilot randomised controlled trial

“…The CORD‐PD pilot RCT is the first study to apply goal‐oriented CR for dementias associated with PD, using an individualised intervention to address goals that are meaningful to the person and that take account of the person's cognitive and functional abilities. People with mild to moderate PDD and DLB are able to participate in goal setting for CR using the BGSI, and the current results indicate that CR is a feasible and potentially effective intervention for individuals with PDD and DLB.…”

“…As this was a pilot study intended to provide information that will inform the sample size calculation for a full scale randomised trial, no formal power calculation was undertaken. The original published trial design aimed to recruit 15 in each arm . One of the key objectives of this pilot study was to identify the most robust and sensitive outcome measures for development of a larger RCT, and therefore due to the exploratory nature of this study, Bonferroni corrected P values and confidence intervals were deemed too stringent for the purposes of the current analyses.…”

“…Participants completed baseline demographic, clinical, and cognitive assessments, and a goal-setting interview for CR was conducted, as described previously. 18,24 Following the baseline visits, participants were randomised to 1 of the 3 treatment arms: CR, relaxation therapy (RT) or treatment-as-usual (TAU). Post-intervention and follow-up assessments were conducted with the researcher 2 and 6 months from randomisation, respectively.…”

“…The efficacy of CR for people with Alzheimer's disease (AD) has previously been indicated in a pilot study and a large multi‐centre randomised controlled trial (RCT) of CR is currently underway to assess its effectiveness for people with AD and other dementias excluding PDD and DLB . Recently, we showed that people with PDD and DLB were able to engage in goal setting for CR, with goals being selected most often in self‐management and orientation, medication adherence, learning new skills, and maintaining social and leisure activities …”

“…17 Recently, we showed that people with PDD and DLB were able to engage in goal setting for CR, with goals being selected most often in self-management and orientation, medication adherence, learning new skills, and maintaining social and leisure activities. 18 The aims of the current study were to examine the appropriateness and feasibility of CR for people with PDD and DLB, and explore indications of the treatment's efficacy relative to an active control condition or treatment as usual. Additional aims included assessing the usefulness of outcome measures and obtaining effect sizes to inform the development of future RCTs of CR in PDD and DLB.…”