Graduation Year

2013

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Psychology

Major Professor

Cynthia R. Cimino

Co-Major Professor

Brent Small

Keywords

Apathy, Behavioral Activation, Intervention, Motivation, Treatment

Abstract

Apathy, a symptom reflecting motivational and self-initiation impairment, is one of the most common neuropsychiatric symptoms in Parkinson's disease (PD), with an average estimated prevalence of 40-45%. Elevated apathy has been associated with a host of negative associates and consequences, including cognitive impairment, poor daily functioning, poor treatment compliance and illness outcome, reduced quality of life, and increased caregiver burden and distress. While some studies have evaluated pharmacologic approaches to the treatment of apathy, few studies have evaluated non-pharmacologic approaches and we have identified no studies that have evaluated the efficacy of non-pharmacologic treatments of apathy in Parkinson's patients despite the need for such research. The purpose of the present study was to develop and gather pilot data on the acceptability, feasibility, and estimated efficacy of a primarily telephone-based, 6-week activity scheduling and monitoring intervention that incorporates an external cueing component to target disease-related self-generational deficits, on reducing levels of apathy in non-demented, highly apathetic PD patients. The project included three phases: (1) development of protocol materials, (2) determine ease of training paraprofessional interventionists, and (3) to assess feasibility, acceptability, and estimated effect of treatment in a one-arm uncontrolled trial. Patient apathy, depression, and quality of life significantly improved post-treatment and improvements in apathy and depression were maintained at one-month follow-up. While enrollment proved challenging, feasibility, acceptability, and efficacy data were strong and promising. Larger, randomized controlled trials are needed to investigate the efficacy of the presented intervention.

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