Cognitive Rehabilitation for Individuals with Parkinson’s Disease: Developing and Piloting an External Aids Treatment Program

Abstract

Introduction: Cognitive deficits, including executive dysfunction and memory impairment, are common in Parkinson’s disease (PD), and can increase difficulty of daily activities. While impairment-based cognitive treatments have been shown to improve scores on formal neuropsychological batteries, little to no research has focused on functional improvement or quality of life in individuals with PD. Methods: Three individuals with idiopathic PD underwent an eight-week external aids treatment program to help achieve personalized goals measured by Goal Attainment Scaling (GAS), t-score analysis and descriptive measures, including questionnaires and interviews. A case series research design with baseline, post-intervention and 1-month maintenance outcome measures was used to evaluate the research questions. Principles of systematic instruction were implemented to train the use of external aids. Results: All three participants improved in the majority of their GAS Lab and Home goals from baseline to immediately post-training and at a 1-month maintenance assessment. Two participants demonstrated relatively stable goal attainment from post-treatment to the maintenance period; however, one participant demonstrated less stability. All participants also improved in the majority of their descriptive measures at post-treatment and at the one-month maintenance period. Discussion: This case series is the first study to examine an external aids treatment program for individuals with cognitive deficits secondary to idiopathic Parkinson’s disease. The positive findings from this study suggests that external cueing may facilitate goal achievement in PD. Outcomes were likely influenced by three primary factors: (1) a theoretically motivated focus on external cuing, (2) well-documented, systematic approach to instruction, and (3) the personalization of goals.