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Memory Program for Parkinson's Helps Mood, Too

Friday October 04, 2013

Nancy Walsh

MedPage Today - An individualized neurocognitive intervention was more helpful for memory and mood than general supportive care for patients with Parkinson's disease and mild cognitive impairment, a researcher said here.

For instance, on the letter-number sequencing test, patients randomized to the neurocognitive intervention performed significantly better, with results having an effect size of 0.57 (f=4.01, P=0.046), according to Sarah K. Lageman, PhD, of Virginia Commonwealth University in Richmond.

In addition, 6 months after the intervention, scores on the multidimensional anxiety questionnaire were significantly improved, showing an effect size of 0.61 (f=9.42, P=0.022), she reported in a poster session at the World Parkinson Congress here.

"This intervention is intended to help patients maintain memory function and coping ability, and to provide them with a structured approach to deal with their problems as they come up," Lageman told MedPage Today.

The neurodegenerative process of Parkinson's disease progressively compromises patients' ability to be active and independent, but neurocognitive interventions specifically targeted to these patients have been lacking.

To fill that gap, she and her colleagues developed a 2-month, once-weekly program incorporating practical techniques for memory enhancement and problem solving, and are conducting a randomized trial comparing the intervention with a conventional, nondirective supportive therapy.

Thus far, eight patients and four controls have completed the program, and an additional 17 have been enrolled.

All participants had mild cognitive impairment as determined by scores one to two standard deviations below the mean on at least two mental function domains. Their mean age was 64, two-thirds were men, and almost all were white. The mean educational attainment was 17 years.

The first three sessions focused on education about Parkinson's-related changes in cognition and the introduction of a memory book and calendar as practical tools to help compensate for memory difficulties.

Sessions four through six reviewed the use of the memory book and calendar, identifying problem areas and troubleshooting techniques, and introduced problem-solving steps.

The last two sessions expanded the use of the calendar, identifying barriers to habitual use and developing strategies to facilitate daily use.

The nondirective support group involved client-centered psychotherapy with active listening and discussion, but without any training in specific memory or problem-solving skills.

Among the significantly superior outcomes for the neurocognitive program were:

California verbal learning test T-score, effect size 0.61 (f = 9.23, P=0.023)
Auditory attention at 6 months, effect size 0.92 (f = 72, P<0.001)
Nonspecific effects of therapy, effect size 0.26 (f = 4.46, P=0.22)

Trends also were seen for Parkinson's-related quality of life on the domains of stigma and social functioning, on clinician-rated motor symptoms, and on the California verbal learning test long-delay free recall test.

"Even with the small numbers thus far, we have been able to see improvements on learning and working memory in these cognitively impaired individuals. If a neurocognitive program can help keep people functioning better at least for a couple of years, that's a benefit," Lageman commented.

The study was funded by the Michael J. Fox Foundation. Lageman reported no disclosures.

Walsh, N. (4 Oct 2013). MedPage Today. Memory Program for Parkinson's Helps Mood, Too. www.medpagetoday.com.

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