title: The Parkinson's Active Living (PAL) Program.
abstract: BACKGROUND
  Apathy, one of the most common neuropsychiatric symptoms in Parkinson's disease (PD), has been associated with reduced daily functioning, cognition, treatment compliance, quality of life, and increased caregiver burden and distress, among other outcomes.
  
  
  OBJECTIVE
  The purpose of the present study was to develop and gather pilot data on the feasibility, acceptability, and efficacy of the Parkinson's Active Living (PAL) program, to our knowledge, the first behavioral treatment specifically designed to target apathy in patients with PD. The Parkinson's Active Living is a primarily telephone-based, 6-week activity scheduling and monitoring intervention that incorporates external cueing to target disease-related self-generational deficits to reduce levels of apathy in nondemented, highly apathetic patients with PD.
  
  
  METHODS
  Participants aged 44 to 86 years (mean = 66, SD [standard deviation] = 10.7) ranging in disease duration from <1 to 23 years with elevated apathy (Apathy Evaluation Scale >35) were enrolled in a 1-arm trial and tested at 3 time points (baseline, posttest, and 1-month follow-up).
  
  
  RESULTS
  Feasibility aspects (ie, acceptability, demand, implementation, practicality, adaptation, integration, and expansion) and efficacy of PAL program are reported. Matched pairs t tests showed a medium to large effect of treatment on patient apathy (52% showing ≥1 SD improvement), depression (33% showing ≥1 SD improvement), and quality of life at posttest, with improvements in apathy and depression maintained at follow-up.
  
  
  CONCLUSIONS
  The program may hold promise as an effective nonpharmacological intervention for apathy in PD. Implications and future directions are discussed. Randomized controlled trials are needed.
authors.affiliation: 1 Department of Psychology, College of Arts and Sciences, University of South Florida, Tampa, FL, USA.|2 Department of Clinical and Health Psychology, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA.|3 Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, University of Florida, Gainesville, FL, USA.
authors.forename: London C
authors.initials: LC
authors.lastname: Butterfield
authors.affiliation: 1 Department of Psychology, College of Arts and Sciences, University of South Florida, Tampa, FL, USA.|4 Department of Neurology, College of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: Cynthia R
authors.initials: CR
authors.lastname: Cimino
authors.affiliation: 1 Department of Psychology, College of Arts and Sciences, University of South Florida, Tampa, FL, USA.|5 Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Salazar
authors.affiliation: 4 Department of Neurology, College of Medicine, University of South Florida, Tampa, FL, USA.|6 Department of Molecular Pharmacology and Physiology, College of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchez-Ramos
authors.affiliation: 2 Department of Clinical and Health Psychology, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA.|3 Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, University of Florida, Gainesville, FL, USA.|7 Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Dawn
authors.initials: D
authors.lastname: Bowers
authors.affiliation: 3 Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, University of Florida, Gainesville, FL, USA.|7 Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057565:Apathy; D017028:Caregivers; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010043:Outcome and Process Assessment, Health Care; D010300:Parkinson Disease / Q000150:complications / Q000628:therapy*; D010342:Patient Acceptance of Health Care; D016730:Program Development; D011788:Quality of Life / Q000523:psychology*; D017216:Telemedicine
keywords: Parkinson; acceptability; apathy; depression; development; feasibility; intervention; motivation; telehealth; telemedicine