A Metacognitive Strategy Intervention for People With Parkinson’s Disease: Pilot and Feasibility Trial

Importance: Cognitive impairment is a common and disabling feature of Parkinson’s disease (PD), and interventions to mitigate its negative functional consequences are in high demand. Metacognitive strategy interventions, such as the Multicontext (MC) Approach, may support daily function among people with PD (PwPD). Objective: To determine feasibility, participant acceptance, and preliminary estimates of the MC Approach’s treatment effect for PwPD. Design: Quasi-randomized controlled pilot trial. Participants underwent pretreatment assessment, allocation to treatment group (MC, n 5 29; control, n 5 28), 10 treatment sessions, 1-wk posttreatment assessment, and 3-mo questionnaire follow-up. Setting: Participants’ homes. Participants: PwPD without dementia but with subjective cognitive concerns. Intervention: Ten weekly sessions of the MC Approach, which aimed to develop awareness and strategies to control cognitive performance across activities via therapist mediation, functional activity performance, and homework. The control intervention used the same structure and treatment activities but did not address awareness or strategy use or use mediated learning. Outcomes and Measures: Indicators of trial feasibility (recruitment, retention, study duration), participant acceptance (satisfaction, homework completion), and treatment effect (self-rated functional cognitive goal performance). Results: We enrolled 3 participants/mo and had 87% retention. Both groups’ satisfaction and homework completion were high. Compared with control participants, MC participants reported greater improvement in functional cognitive goal performance from preintervention to postintervention that was maintained at follow-up. Conclusions and Relevance: The MC Approach is a feasible, acceptable, and potentially efficacious intervention to address the functional cognitive goals of PwPD without dementia. A larger, fully randomized trial is required to provide definitive efficacy data.