Strategy Use Among People With Parkinson’s Disease During the Weekly Calendar Planning Activity

IMPORTANCE: Cognitive impairment is a common manifestation of Parkinson's disease (PD) that can limit participation. A clearer understanding of how people with PD (PwPD) use strategies to support their functional cognition can guide interventions designed to promote occupational performance. OBJECTIVE: To investigate strategy use by PwPD during a functional cognitive task and how it relates to task performance. DESIGN: Cross-sectional within and between groups. SETTING: Participants' homes. PARTICIPANTS: PwPD without dementia (N = 51) were allocated into two groups according to Montreal Cognitive Assessment score: ≥26 for those with PD and normal cognition (PD-NC; n = 27) and ≤25 for those with PD and mild cognitive impairment (PD-MCI; n = 24). OUTCOMES AND MEASURES: Performance outcomes (accuracy, total time, and efficiency) and strategy use on the Level 2 Adult/Older Adult version of the Weekly Calendar Planning Activity (WCPA). RESULTS: In the whole PD group, increased strategy use correlated with higher accuracy and longer total time, and four specific strategies correlated with higher accuracy (p < .04). The PD-NC group had higher accuracy and used more strategies than the PD-MCI group (p < .02), including three strategies associated with higher accuracy (cross off entered appointments, enter fixed appointments first, cross off free day; p < .03). In the PD-NC group, increased strategy use correlated with higher accuracy and longer total time (p < .02). Strategy use and WCPA performance outcomes did not correlate in the PD-MCI group (p > .10). CONCLUSIONS AND RELEVANCE: This study adds to the understanding of how PwPD select and use strategies to support their functional cognition and suggests that PwPD could potentially benefit from interventions to optimize strategy use in occupational performance. Plain-Language Summary: People with Parkinson's disease experience changes in thinking and memory that affect their ability to participate in daily activities, and they use fewer strategies to support their cognition than their peers without Parkinson's disease. We investigated the strategies people with Parkinson's disease use to support their thinking and memory during a simulated functional activity, the Weekly Calendar Planning Activity. We sought to understand whether the strategies they used were related to better performance on the activity, and we explored differences in strategy use between people with Parkinson's disease with normal cognition and those with Parkinson's disease with possible mild cognitive impairment. We found that people with Parkinson's disease who used more strategies performed more accurately. Participants with Parkinson's disease with normal cognition used strategies that supported their accuracy but took longer to complete the task. Participants with Parkinson's disease with possible mild cognitive impairment used fewer strategies and ones that did not support their performance. Our findings indicate that people with Parkinson's disease may benefit from interventions focused on selecting and using strategies to improve their daily functioning.