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PARKINSON DISEASE (Disorder)MC4PD R01NCT07190404

Multicontext Approach for Cognitive Function in Parkinson Disease

A study testing A metacognitive strategy for cognitive rehabilitation called the Multicontext Approach., Cognitive (Process) Training and MC Approach Booster Session in people with PARKINSON DISEASE (Disorder), run by Washington University School of Medicine at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Mild cognitive decline is common in early Parkinson disease (PD) and is associated with disability, reduced quality of life (QOL), and increased risk for dementia. Medical treatments for PD do not prevent or treat cognitive decline and may even exacerbate the problem. Read more about this study

Who is it for?
Ages 50 years and older
Conditions the study is for
PARKINSON DISEASE (Disorder)
What is being tested?
A metacognitive strategy for cognitive rehabilitation called the Multicontext Approach., Cognitive (Process) Training and MC Approach Booster Session
Could I receive a placebo?
No, everyone receives an active treatment
How many people
114 participants
Where
1 siteUnited States
Study dates
20 May 2026to 31 Aug 2030
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 50 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Males and females over age 50 who meet criteria for typical idiopathic PD.
  • Hoehn \& Yahr stage I-III.
  • Have subjective cognitive decline (SCD) as defined by a positive answer to either question:
  • Do you feel like your thinking skills or memory are becoming worse or are worse than others your age?
  • Do you have problems or concerns with your thinking skills or memory?, and can list ≥1 daily cognitive challenge they want to address.
  • Medications should be stable for 4 weeks prior with no changes planned during the treatment portion of the study (Pre to Post); unplanned changes and changes over the follow-up period will be tracked and accounted for as appropriate.

Who cannot join

  • Dementia according to MDS criteria or MoCA score <21.
  • Other neurological disorders (e.g., stroke, seizures).
  • Current or history of major psychiatric disorder or psychotic symptoms (e.g., schizophrenia, bipolar disorder, delusions, hallucinations), drug abuse. Psychiatric conditions/symptoms that are common in PD (e.g., anxiety, depression) are permitted if deemed insufficient to interfere with participation.
  • Other circumstance that would interfere with participation (e.g., non-English speaking, blindness, lives >50mi away).

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Tasha D Doty, MA contact

785-865-8943

tdoty@wustl.edu

Erin Foster, PhD contact

314-286-1638

erfoster@wustl.edu

United States1 site, 1 recruiting
  • Washington University School of Medicine

    St Louis, Missouri, 63110

    Michelle Jenkerson, RN, BS, RRT, CCRC, 314-362-5626, Jenkerson_m@wustl.edu

    Recruiting

Other trials in United States

About this study

Official title: Efficacy and Mechanisms of a Metacognitive Strategy Intervention for Parkinson Disease-Related Cognitive Decline.

Mild cognitive decline is common in early Parkinson disease (PD) and is associated with disability, reduced quality of life (QOL), and increased risk for dementia. Medical treatments for PD do not prevent or treat cognitive decline and may even exacerbate the problem.

Unfortunately, existing cognitive interventions for PD, which focus on restoring deficient cognitive skills through cognitive training (repetitive practice of tasks that challenge specific cognitive skills), provide limited benefit for daily function and QOL. To overcome this limitation, the investigators use strategy training. the investigators help people develop targeted strategies to use in everyday life to circumvent cognitive deficits and accomplish daily activities. Contemporary cognitive rehabilitation evidence supports strategy training for other neurological conditions and mild cognitive impairment (MCI), but it has not been well-studied in PD. By teaching strategies for everyday cognition, the investigators hypothesize that our interventions will improve functional outcomes for people with PD.

Study participants will complete a baseline cognitive testing session, 10 cognitive treatment sessions with a trained occupational therapist, then have follow-up visits with the study team at 1-week, 3-months, 6-months, and 12-months after completing the study intervention.

Read the detailed description

Mild cognitive decline is common in early Parkinson disease (PD) and is associated with disability, reduced quality of life (QOL), and increased risk for dementia. Medical treatments for PD do not prevent or treat cognitive decline and may even exacerbate the problem. Therefore, behavioral interventions that attenuate its negative functional consequences and thus potentially delay dementia onset are a top research priority. Unfortunately, existing cognitive interventions for PD, which focus on restoring deficient cognitive skills through cognitive training (repetitive practice of tasks that challenge specific cognitive skills), provide limited benefit for daily function and QOL. To overcome this limitation, the investigators use strategy training. the investigators help people develop targeted strategies to use in everyday life to circumvent cognitive deficits and accomplish daily activities. Contemporary cognitive rehabilitation evidence supports strategy training for other neurological conditions and mild cognitive impairment (MCI), but it has not been well-studied in PD. By teaching strategies for everyday cognition, the investigators hypothesize that our interventions will improve functional outcomes for people with PD.

Specifically, the investigators use the Multicontext (MC) Approach to support daily cognitive function in people with PD with mild cognitive decline. The MC Approach is a metacognitive strategy intervention that targets awareness, strategy use, and self-efficacy to improve functional cognitive performance in daily life. Through therapist- mediated experiences with cognitively challenging functional activities, participants develop personalized strategies (e.g., self-talk, planning, checklists) to prevent or correct cognitive performance errors. The goal is to enable people to manage everyday cognitive challenges so they can perform and participate in meaningful activities and roles. In a development and proof-of-concept study, the investigators adapted and refined the treatment protocol and training materials, established good participant acceptance, and provided preliminary data on its benefits for daily cognitive function. In a subsequent pilot quasi-randomized controlled trial (R21AG063974), the investigators established trial feasibility and treatment fidelity and generated promising treatment effect data. Notably, the MC Approach produced clinically meaningful improvements in daily cognitive function that were larger than that of the cognitive task training control and that were maintained 3 and possibly 12 months post treatment. the investigators now have the experience, methods, and data to justify and prepare us for a full-scale efficacy trial.

The investigators will conduct a randomized controlled trial (RCT) to determine the short- and long-term efficacy of the MC Approach for improving daily cognitive function in people with PD with mild cognitive decline. Secondarily, the investigators will examine whether booster treatment enhances treatment effects and explore the cognitive-behavioral mechanisms of the MC Approach. PD participants (N=114) will complete baseline assessment, randomization to treatment group (MC n=76, Control n=38), 10 treatment sessions (1x/week), and 1 week, 3 months, and 6 months post treatment assessment. MC participants will then be randomized to a booster (MC+B n=38) or no-booster (MC n=38) condition, and the MC+B group will receive booster treatment within the following month. Then all three groups (Control, MC, MC+B) will complete 12-month assessment. Mixed model repeated measures analysis of variance will be used to compare change across treatment groups and over time.

Our primary study aims and hypotheses are:

Aim 1: Determine the effect of the MC Approach on daily cognitive function. H1: The MC group will report greater improvements in daily cognitive function than the Control group 1 week (H1a; short-term) and 12 months (H1b; long-term) post treatment. Participants will rate their performance on personalized functional cognitive goals using a standardized cognitive rehabilitation tool (primary outcome: Bangor Goal Setting Interview, (BGSI) at each testing timepoint. Primary analyses will include the 1-week and 12-month data for Control and MC participants; additional analyses can look at trajectories across all timepoints.

Aim 2: Examine the effect of booster MC Approach treatment on daily cognitive function.

H2: The MC+B group will report better daily cognitive function 12 months post initial treatment than the MC group. At 6 months post, MC+B participants will receive two booster treatment sessions to review and reinforce their learning and strategy use. Primary analyses will include the 6- and 12-month BGSI data, controlling for baseline.

Aim 3: Explore the effect of the MC Approach on the theorized intermediate treatment targets.

H3: The MC group will have greater improvements in awareness, strategy use, and self-efficacy than the Control group after treatment. Participants will complete measures of awareness, strategy use, and self-efficacy at each testing timepoint. Primary analyses will include all available timepoints. To further explore mechanisms of action, correlational analyses will examine if change in the targets relates to change in functional outcomes.

Being tested
A metacognitive strategy for cognitive rehabilitation called the Multicontext Approach., Cognitive (Process) Training, MC Approach Booster Session
Keywords
Parkinson Disease, occupational therapy
Medical subject headings
Parkinson Disease

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • A metacognitive strategy for cognitive rehabilitation called the Multicontext Approach.Behavioural

    The Multicontext Approach is a strategy training approach to cognitive intervention provides ways to maintain daily function despite the presence of cognitive deficits. It involves teaching people to use metacognitive, compensatory, or adaptive techniques to optimize information processing or bypass cognitive limitations and achieve task-related goals. Strategy training is recommended for those with mild (vs. more severe) cognitive deficits because it requires learning, capitalizes on existing cognitive resources, and aims to prevent or delay functional decline.

  • Cognitive (Process) TrainingBehavioural

    This treatment is functional task training, a widely-used approach in neurorehabilitation153,154 that parallels the cognitive training used in PD to-date but with functional cognitive tasks (vs. computer or paper \& pencil tasks) to improve ecological validity. It has the same structure within and across treatment sessions and uses the same treatment activities as the MC intervention. However, the OT does not use mediated learning techniques or explicitly address strategies, metacognition, or transfer/generalization. Rather, participants practice functional cognitive tasks with knowledge of results feedback and cueing by the OT to improve task performance.

  • MC Approach Booster SessionBehavioural

    MC+B participants will come from the MC Approach group only. They will receive 2 additional treatment sessions with their original OT within the month following their 6mo FU assessment. The OT will review the participant's relevant Post and FU data beforehand for treatment planning purposes. The first session will involve a review of goals, prior learning, and strategies and discussion of successes/challenges related to functional cognitive performance and strategy application since initial treatment. Then the same protocol (treatment activities with metacognitive framework and mediation, strategy bridging discussions, homework action planning and review) will be followed for the rest of the booster treatment to reinforce or re-activate prior learning, address new concerns, and develop supports for maintenance.

Study groups in NCT07190404
Study groupRoleWhat they receive
MC ApproachExperimentalThe experimental Multicontext Approach Intervention
Receives: Behavioral: A metacognitive strategy for cognitive rehabilitation called the Multicontext Approach.
Process TrainingActive comparatorThe Control Group cognitive process training
Receives: Behavioral: Cognitive (Process) Training
MC + BoosterExperimentalFrom the MC Approach group only, MC+Boster participants will receive 2 additional treatment sessions with their original OT within the month following their 6mo FU assessment.
Receives: Behavioral: MC Approach Booster Session

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Bangor Goal Setting Interview

    A standardized cognitive rehabilitation tool to identify functional cognitive problems and develop treatment goals. Participants rate their goal attainment on a scale from 0 (not successful) to 10 (very successful); readiness to work on the specific goal on a scale of 0 (not ready to change) to 10 (Extremely ready to change); and the importance of the goal to them on a scale from 0 (not important) to 10 (extremely important).

    Measured: Goals will be assessed during the intervention at 2- and 4-weeks after Baseline testing; at POST intervention 11-weeks after Baseline; then one year from the final intervention session (63-weeks after Baseline).

Secondary outcomes (3)
  1. The Cognitive Self-Efficacy Questionnaire

    A self-reported questionnaire of a person's confidence in their ability to handle cognitively or mentally challenging situations. Participants rate their self-recognition of cognitive lapses (higher score indicates better recognition of cognitive lapses); their confidence to complete cognitively challenging situations (higher score indicates higher confidence); and their self-efficacy for everyday cognitive tasks (higher scores indicate higher self-efficacy).

    Measured: Participants will complete this questionnaire at the Baseline session, then after the participant finishes the intervention sessions at 11-, 23-, 35- and 63-weeks after Baseline.

  2. The Weekly Calendar Planning Activity

    A performance-based assessment of executive function. The activity involves following and organizing a list of appointments or errands into a weekly schedule while keeping track of rules, and avoiding scheduling conflicts. Participants are scored on how many appointments are entered accurately, how many are missing or have errors (total of 17 possible). The total time it takes to complete the task is also measured. Observations are also made about any cognitive strategies used during the task.

    Measured: The weekly calendar planning activity is administered at treatment session 1 of the intervention (1 week after Baseline), then after the participant completes the intervention at 11- and 63-weeks after Baseline.

  3. The Self-Regulation Skills Interview

    A clinical tool designed to measure a range of metacognitive skills essential for rehabilitation planning. Participants are asked in an interview what their main area of cognitive difficulty is, their awareness of this difficulty and in what situations they experience it, and if they know of any strategies or are using any strategies that they could use to cope with their main cognitive difficulty. They are also rated on their motivation to learn new strategies on a scale of 0 (Not at all) to 10 (Very motivated).

    Measured: Participants are interviewed with the SRSI at treatment session 1 of the intervention (1 week after Baseline) then 1-week post intervention (11 weeks after Baseline).

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Sep 2025
  2. Study start20 May 2026
  3. Primary completion31 Aug 2029 (estimated)
  4. Study completion31 Aug 2030 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Investigator, Outcomes assessor
Enrolment
114 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07190404
Sponsor's protocol ID
202508056
Acronym
MC4PD R01
Status last verified
Jul 2026
First submitted
9 Sep 2025
Last updated
14 Jul 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: This project will generate data obtained from participant surveys, interviews and cognitive testing, and care partner surveys. Data will be collected from 114 adults with Parkinson disease (PD) and their care partners at baseline and then 1 week, 3 months, 6 months and 12 months after treatment, generating 1 longitudinal quantitative dataset. Individual data (with identifiers removed and not linkable) will be made available for sharing. All data produced from this project will be preserved and shared to maximize the potential of knowledge gained from this dataset and the time/effort contributed by the participants. Data will be stored in common and open formats, (e.g., csv, txt, pdf, html) and deposited into Digital Commons Data@Becker, which is maintained at Bernard Becker Medical Library at WUSM.

Questions about this trial

What is this clinical trial studying?

A study testing A metacognitive strategy for cognitive rehabilitation called the Multicontext Approach., Cognitive (Process) Training and MC Approach Booster Session in people with PARKINSON DISEASE (Disorder), run by Washington University School of Medicine at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 14 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Tasha D Doty, MA (785-865-8943, tdoty@wustl.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Bangor Goal Setting Interview (time frame: Goals will be assessed during the intervention at 2- and 4-weeks after Baseline testing; at POST intervention 11-weeks after Baseline; then one year from the final intervention session (63-weeks after Baseline).). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Jul 2026.

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