COGNITIVE REHABILITATION FOR PEOPLE WITH PARKINSON’S DISEASE DEMENTIA AND DEMENTIA WITH LEWY BODIES: THE CORD-PD PILOT TRIAL

Abstract

Within 20 years of Parkinson's disease onset, approximately 80% of people will have developed Parkinson's disease dementia, a condition similar to Dementia with Lewy bodies. This pilot randomised controlled trial is the first to assess the application of goal-orientated cognitive rehabilitation for the management of cognitive difficulties experienced by people in the early stages of one of these dementias. Twenty-nine participants were randomised to either a treatment-as-usual control condition (TAU, n=9), an active control condition, relaxation therapy (RT, n=10), or the experimental condition, cognitive rehabilitation (CR, n=10). All participants identified goals relating to cognitive and social activities, but only those in the CR condition worked with a therapist to devise and practise strategies to attain these goals. Primary outcomes were participant ratings of goal attainment and satisfaction with goal attainment. Secondary outcomes were quality of life, mood, cognition, health status and everyday functioning. Caregivers rated their own quality of life and stress levels, as well as participants’ goal performance. Participants were assessed two months (post-intervention) and six months (follow-up) following randomisation. At the post-intervention assessment, CR was superior to TAU and RT for self-rated goal attainment (TAU d=1.63; RT d=1.81); self-rated satisfaction with goal attainment (TAU d=2.04; RT d=1.84) and the social domain of quality of life (TAU d=1.1; RT d=1.13). CR was also superior to TAU for depression (d=-1.22) and RT for self-efficacy (d=1.07). Caregivers’ ratings of patients’ goal attainment in CR were superior to RT ratings (d=1.19). At follow-up, CR remained superior to TAU (d=1.36) and RT (d=1.8) for self-rated goal attainment. CR was superior to TAU for indices of delayed memory recall (d=1.26); health status (d=-1.74) and quality of life (d=1.43). Also at follow-up, caregiver ratings of participants’ goal attainment in CR were superior to TAU (d=1.89) and RT (d=1.77) ratings. Caregivers in CR reported higher levels of quality of life (d=1.71), greater health status (d=1.41) and lower levels of stress (d=-1.42) than carers in TAU. Cognitive rehabilitation is feasible and potentially effective in managing the impact on everyday life of the cognitive difficulties experienced by people with dementias associated with Parkinson's disease.