Goal Management Training for Parkinson Disease Mild Cognitive Impairment
Condition: Parkinson Disease; Mild Cognitive Impairment
MeSH terms: Parkinson Disease; Cognitive Dysfunction
Study type: Interventional

Summary: 
      Mild cognitive impairment is experienced by approximately 30% of patients with Parkinson's
      disease (PD-MCI), often affecting executive functions. There is currently no pharmacological
      treatment available for PD-MCI and non-pharmacological treatments are still scarce. The aim
      of this study was to test preliminary efficacy/effectiveness of two home-based cognitive
      interventions adapted for patients with PD-MCI: Goal Management Training, adapted for PD-MCI
      (Adapted-GMT), and a psychoeducation program combined with mindfulness exercises. Twelve
      persons with PD-MCI with executive dysfunctions, as measured by extensive neuropsychological
      evaluation, were randomly assigned to one of two intervention groups. Both groups received
      five sessions each lasting 60-90 minutes for five weeks, in presence of the caregiver.
      Measures were collected at baseline, mid-point, at one-week, four-week and 12-week
      follow-ups. Primary outcomes were executive functions assessed by subjective (DEX
      questionnaire patient- and caregiver-rated) and objective (Zoo Map Test) measures. Secondary
      outcomes included quality of life (PDQ-39), global cognition (DRS-II), and neuropsychiatric
      symptoms (NPI-12). Safety data (fatigue, medication change and compliance) were also
      recorded. Repeated measures ANCOVAs were applied to outcomes. Both groups significantly
      ameliorated executive functions overtime as indicated by improvements in DEX-patient and
      DEX-caregiver scores. PDQ-39 scores decreased at the four-week follow-up in the
      Psychoeducation/Mindfulness group whereas they were maintained in the Adapted-GMT group. All
      other measures were maintained over time in both groups. Adapted-GMT and
      Psychoeducation/Mindfulness groups both improved executive functioning. This is one of the
      first studies to test home-based approaches, tailored to the participant's cognitive needs,
      and involving caregivers.
    


Intervention name(s): Goal Management Training; Psychoeducation
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Goal Management Training® (GMT) has been developed to improve executive functions. It was validated in patients presenting executive dysfunction following many conditions: acquired traumatic brain injury, neurodevelopmental spina bifida, attention deficit and hyperactivity disorder (ADHD), subjective cognitive complaints and multiple sclerosis. GMT includes self-instruction strategies, self-monitoring exercises, cognitive training techniques, psychoeducation on cognitive processes, mindfulness exercises and assignments between sessions. It has been shown to increase patient awareness of deficits and improve cognitive control in goal-directed behaviors. The original GMT is a nine-week program administered to dysexecutive patients in 90-to-120-minute group sessions. Thus, it might be suitable for PD-MCI patients presenting with executive dysfunction.; See the Arm section for full details. For a justification of how we designed this intervention: Many clinical guidelines include general recommendations about giving information to PD patients and family so they can take part into decision process. However, few standardized psychoeducation interventions are available, and they don't include information on PD cognitive decline. Some studies investigated Mindfulness Based Stress Reduction (MBSR) and other related mindfulness interventions in PD patients. In this approach, formal meditative exercises are included to develop non-judgmental attention to experiences in the present moment. In elderly patients with MCI unrelated to PD, mindfulness interventions show positive effects on cognitive functioning, including attention, executive functioning and memory (Gard et al., 2014). Therefore, non-pharmacological interventions for PD-MCI including both education on cognitive symptoms, as well as mindfulness exercises, are promising.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Comparison of two different cognitive intervention (two groups, randomized, single blinded)
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Mild Cognitive Impairment; Parkinson Disease; Cognitive Intervention; Goal Management Training; Executive Functions