Affective impact of cognitive training in individuals with cognitive impairment

Cognitive remediation therapy for partially remitted unipolar depression: A single-blind randomized controlled trial

Introduction. Non-drug methods of therapy for cognitive impairment is one of the topical areas of neurology. Studies have shown that cognitive training may be beneficial for maintaining mental alertness in healthy older adults, while patients with dementia and mild cognitive impairment are more likely to benefit from cognitive-motor training or rehabilitation. It is possible that the severity and type of cognitive disorders, as well as patients’ adherence to training, the correct construction of tasks, may affect the effectiveness of non-drug therapy for cognitive disorders.Аim. The aim of this study was to evaluate the effectiveness of cognitive-motor training developed at Sechenov University in patients with moderate cognitive impairment (MCI).Materials and methods. 41 patients were included in the study, including 8 women and 33 men, the average age of patients was 60.3 ± 8.5 years, the average level of education was 14.2 ± 8.7 years, of which 15 patients met the criteria AD, 26 – VCI criteria. Patients underwent quantitative neuropsychological testing, assessment of emotional disorders, and also assessed such indicators as satisfaction with the quality of life, adherence to therapy. Subsequently, the patients were divided into groups of individual and group cognitive training. Classes with patients were held according to the standard scheme, 30–50 minutes a day, for 40 days. After 3 months, 10 patients were randomly selected from the individual training group and received an additional course of group cognitive-motor training.Results. Тhe study showed that after 1.5 months, patients showed a significant decrease in the severity of cognitive disorders (p < 0.05). The greatest positive dynamics was noted in relation to the level of attention (p < 0.05), memory (including primary modal-nonspecific mnestic impairment, p < 0.05), logical operations (p < 0.05). The patients included in the study also showed a significant decrease in the severity of depression (p < 0.05). The analysis showed that significant positive dynamics was recorded both in patients of the individual CT group and in patients who received group CT (p < 0.05). The positive effect on cognitive functions was maintained during the three months of follow-up. Comparative analysis of study patients after 6 months showed that patients who received additional sessions with a trainer reported an additional improvement in well-being. These differences were statistically significant, despite the small number of patients included in the repeat CT group (p < 0.05).Conclusions. The effectiveness of cognitive-motor training in patients with MCI was noted. The results obtained allow us to recommend this type of cognitive-motor training for use in clinical practice by neurologists, therapists and psychiatrists as an additional effective method for the treatment of cognitive impairment.

Cognitive impairments, including MCI and dementia, significantly heighten fall risk due to motor dysfunction and balance deficits. Although physical activity is essential for dementia prevention, older adults often struggle with balance issues, fear of falling, and reduced mobility. This study investigated the impact of balance training, alone or combined with cognitive exercises, on functional balance and cognitive performance in individuals with cognitive impairments. A comprehensive literature search was conducted across three electronic databases to identify peer-reviewed studies written in English that examined the effects of balance-oriented physical therapy, either alone or in combination with cognitive training, on individuals with cognitive or concurrent cognitive and balance impairments. The outcomes of interest included balance and cognitive function. The risk of bias was evaluated independently by two reviewers using the ROB-1 tool. The effectiveness of the intervention was analyzed using RevMan software. This systematic review found that stand-alone physical exercise significantly improved postural stability in 15 out of 24 studies and enhanced cognitive function in 5 out of 25 studies. Furthermore, the integration of cognitive training alongside physical exercise demonstrated additional benefits in improving balance and cognition in 7 out of 11 studies. These findings suggest that such interventions may be beneficial for older adults with cognitive impairments, warranting further research to establish definitive conclusions. This systematic review emphasizes the potential benefits of physical balance exercises, often combined with cognitive training, in improving balance, cognitive function, and certain aspects of quality of life among individuals with cognitive impairment.

ABSTRACTAimsThe nucleus basalis of Meynert (NBM) is a major source of cholinergic innervation in the central nervous system. We aimed to investigate the characteristics of structural and functional alterations in the NBM and its projections in patients with mild cognitive impairment (MCI) and the effects of computerized cognitive training (CCT).MethodsForty‐five patients with MCI and 45 cognitively unimpaired controls (CUCs) were recruited. NBM volume, mean diffusivity (MD) of NBM white matter (WM) projections, and functional connectivity (FC) of projections of the NBM were measured with T1‐weighted imaging, diffusion tensor imaging (DTI), and resting‐state functional magnetic resonance imaging (rs‐fMRI). Thirty‐six MCI patients were randomly assigned to receive CCT or control training. The effects of CCT on the neuropsychological measures and MRI properties were analyzed with a linear mixed model (LMM).ResultsWe detected that compared with the CUCs, the MCI patients had a reduced volume of the NBM and a greater MD of both cholinergic pathways. Increased MD values of both pathways were related to lower scores of global cognition, processing speed and attention in all participants. After CCT intervention, significant group × timepoint effects on score of the Backward Digit Span and the FC between NBM and right putamen were observed in the CCT group compared to the control group.ConclusionNBM atrophy and WM pathway disruption occurred in MCI patients and were correlated with cognitive impairment. Working memory and the FC between NBM and right putamen could be improved by cognitive training.

Influence of Studies Published by the Journal of the American Geriatrics Society: Top 20 Articles from 2000-2015.

Cognitive impairments in schizophrenia significantly impact daily functioning and quality of life, posing a major therapeutic challenge. While both cognitive training and transcranial direct current stimulation (tDCS) have shown promise in improving cognitive function, their combined effects remain underexplored. This double-blind, sham-controlled, randomized clinical trial investigated whether adaptive working memory training (aWMT) paired with anodal tDCS to the right dorsolateral prefrontal cortex (DLPFC) enhances cognitive outcomes in schizophrenia. Twenty-eight individuals with schizophrenia or schizoaffective disorder completed ten sessions of aWMT with concurrent 2 mA anodal or sham tDCS. Cognitive improvements were assessed using the Brief Assessment of Cognition in Schizophrenia (BACS) at baseline, three days after training, and at follow-ups one month, and three months later. Clinical measures evaluated psychopathology, depression, and quality of life. Anodal tDCS significantly improved working memory performance during training, with gains partially sustained at follow-ups. Short-term transfer effects with large effect sizes were observed in the BACS, although clinical symptoms and quality of life remained unaffected. While preliminary, these findings indicate that tDCS could support cognitive training outcomes in schizophrenia. Larger randomized controlled trials are needed to confirm transfer effects and determine the long-term benefits of this approach. If proven effective, integrating tDCS into cognitive remediation therapies could represent an innovative strategy to address cognitive deficits in schizophrenia.

Neurocognitive impairment is considered a core component of schizophrenia, and is increasingly under investigation as a potential treatment target. On average, cognitive impairment is severe to moderately severe compared to healthy controls, and almost all patients with schizophrenia demonstrate cognitive decrements compared to their expected level if they had not developed the illness. Compared to patients with affective disorders, cognitive impairment in schizophrenia appears earlier, is more severe, and is more independent of clinical symptoms. Although the DSM-IV-TR and ICD-10 descriptions of schizophrenia include several references to cognitive impairment, neither the diagnostic criteria nor the subtypology of schizophrenia include a requirement of cognitive impairment. This paper forwards for consideration a proposal that the diagnostic criteria include a specific criterion of "a level of cognitive functioning suggesting a consistent severe impairment and/or a significant decline from premorbid levels considering the patient's educational, familial, and socioeconomic background". The inclusion of this criterion may increase the "point of rarity" with affective psychoses and may increase clinicians' awareness of cognitive impairment, potentially leading to more accurate prognosis, better treatment outcomes, and a clearer diagnostic signal for genetic and biological studies. Future research will need to address the validity of these possibilities. The reliable determination of cognitive impairment as part of a standard diagnostic evaluation will present challenges to diagnosticians with limited resources or insufficient expertise. Cognitive assessment methods for clinicians, including brief assessments and interview-based assessments, are discussed. Given the current emphasis on the development of cognitive treatments, the evaluation of cognition in schizophrenia is an essential component of mental health education.

Objective:Cognitive impairment is observed in up to two-thirds of persons with Multiple Sclerosis (MS). Impairments in cognitive processing speed (PS) is the most prevalent cognitive disturbance, occurs early in the course of disease and is strongly associated with disease progression, various brain parameters and everyday life functional activities. As such, cognitive rehabilitation for PS impairments should be an integral part of MS treatment and management. The current study examines the efficacy of Speed of Processing Training (SOPT) to improve processing speed (PS) in individuals with Multiple Sclerosis (MS). SOPT was chosen because of its significant positive results in the aging populations.Participants and Methods:This double-blind, placebo-controlled randomized clinical trial included 84 participants with clinically definite MS and impaired PS, 43 in the treatment group and 41 in the placebo control group. Outcomes included changes in the Useful Field of View (UFOV) and neuropsychological evaluation (NPE) including measure of PS (e.g., Pattern Comparison and Letter Comparison). Participants completed a baseline NPE and a repeat NPE post-treatment. Treatment consisted of 10 sessions delivered twice per week for 5 weeks. After the 5 weeks, the treatment group was randomized to booster sessions or no contact. Long-term follow-up assessments were completed 6 months after completion of treatment. The primary outcome were tests of PS including UFOV and neuropsychological testing.Results:A significant effect of SOPT was observed on both the UFOV (large effect) and Pattern Comparison with a similar pattern of results noted on Letter Comparison, albeit at a trend level. The treatment effect was maintained 6-months later. The impact of booster sessions was not significant. Correlations between degree of improvement on the UFOV and the number of levels completed within each training task were significant for both Speed and Divided Attention indicating that completion of more levels of training correlated with greater benefit.Conclusions:SOPT is effective for treating PS deficits in MS with benefit documented on both the UFOV and a neuropsychological measure of PS. Less benefit was observed as the outcome measures became more distinct in cognitive demands from the treatment. Long-term maintenance was observed. The number of training levels completed within the 10-sessions exerted a significant impact on treatment benefit, with more levels completed resulting in greater benefit.

BackgroundNonpharmacologic interventions, such as cognitive training or physical exercise, are effective in improving cognitive functions for older adults with mild cognitive impairment (MCI). Some researchers have proposed that combining physical exercise with cognitive training may augment the benefits of cognition. However, strong evidence is lacking regarding whether a combined therapy is superior to a single type of training for older adults with MCI. Moreover, which combination approach – combining physical exercise with cognitive training sequentially or simultaneously – is more advantageous for cognitive improvement is not yet clear. This proposed study is designed to clarify these questions.Methods/designThis study is a single-blinded, multicenter, randomized controlled trial. Eighty individuals with MCI will be recruited and randomly assigned to cognitive training (COG), physical exercise training (PE), sequential training (SEQ), and dual-task training (DUAL) groups. The intervention programs will be 90 min/day, 2–3 days/week, for a total of 36 training sessions. The participants in the SEQ group will first perform 45 min of physical exercise followed by 45 min of cognitive training, whereas those in the DUAL group will perform physical exercise and cognitive training simultaneously. Participants will be assessed at baseline, after the intervention, and at 6-month follow-up. The primary cognitive outcome tests will include the Montreal Cognitive Assessment and the color-naming Stroop test. Other outcomes will include assessments that evaluate the cognitive, physical, and daily functions of older adults with MCI.DiscussionThe results of this proposed study will provide important information regarding the feasibility and intervention effects of combining physical exercise and cognitive training for older individuals with MCI.Trial registrationClinicalTrials.gov Identifier: NCT02512627, registered on 20 July 2015.

Depressive Symptoms and Activity in a Sample of Nursing Home Residents

Public perceptions about risk and protective factors for cognitive health and impairment: a review of the literature.

BACKGROUND Cognitive impairments are common in patients with lower-grade gliomas (LrGG, grades 1-3), yet evidence-based interventions are limited. Tele-health cognitive rehabilitation offers a potential solution. We conducted a pilot study investigating the adherence, satisfaction, and preliminary efficacy of tele-cognitive rehabilitation in adults with LrGG. MATERIAL AND METHODS Eligible participants were adults with stable LrGG (≥ 6 months post-treatment) reporting subjective and objective cognitive impairments (>1 SD below average in ≥2 domains). Patients received three months of individual cognitive rehabilitation Goal Management Training (GMT) via telehealth which is a behavioral treatment designed to address cognitive impairments. Cognitive assessments and patient-reported outcomes (PROs) were collected at baseline (T1), post-intervention (T2), and 9 months post-baseline (T3). Adequate adherence required ≥80% of participants completing ≥80% of sessions. Adequate satisfaction was defined as a score ≥6/7 on a post-T2 survey. Preliminary efficacy was assessed using repeated measures t-tests, effect sizes, and reliable change indices (RCI) for within-group changes (T1-T2, T1-T3). RESULTS Thirty-two patients (median age 48 years; median 61 months post-diagnosis; 46% astrocytoma and 46% oligodendroglioma; 82% IDH mutant; 39% grade 2 and 61% grade 3; 64% prior radiotherapy) were prospectively enrolled between May 2019 and September 2023. GMT adherence was high at 88%. Significant improvements were observed in the WAIS-IV Working Memory Index from T1 (mean z=-0.12, SD 1.13) to T2 (mean z=0.06, SD 1.09; p=0.03, eta²=0.18), with 25% demonstrating reliable improvement. PROs also improved: Fatigue Symptom Inventory Interference Index decreased significantly from T1 (mean=3.37, SD 2.48) to T3 (mean=2.55, SD 2.42; p=0.04, eta²=0.18). Clinically evident fatigue (FSI >3) decreased from 50% at T1 to 25% at T3. The Brief Symptom Inventory (BSI)-Somatic subscale improved significantly both from T1 (mean=0.06, SD 0.84) to T2 (mean=-0.38, SD 0.60; p=0.001, eta²=0.33) and T1-T3 (mean=-0.34, SD 0.76; p=0.01, eta²=0.28). Overall satisfaction with GMT was excellent (mean=6.87/7, SD 0.35). CONCLUSION Tele-cognitive rehabilitation using individual GMT is feasible for adults with stable LrGG, demonstrating good adherence and high patient satisfaction. Preliminary results show promising improvements in working memory, fatigue interference, and somatic distress, with some effects sustained 6 months post-intervention. Further research is warranted to confirm efficacy and explore mechanisms of action.

BackgroundRecent meta-analyses point towards cognitive impairments in obsessive-compulsive disorder (OCD), particularly in such executive function subdomains as planning and organization. Scant attention has focused on cognitive remediation strategies that may reduce cognitive dysfunction, with a possible corresponding decrease in symptoms of OCD.ObjectiveThe aim of this study was to assess the implementation of a standardized cognitive remediation program, Goal Management Training (GMT), in a pilot sample of individuals with OCD.MethodNineteen individuals with a primary DSM-5 diagnosis of OCD were randomized to receive either the 9-week GMT program (active group; n = 10) or to complete a 9-week waiting period (waitlist control; n = 9). Groups were assessed at baseline, post-treatment, and 3-month follow-up. The assessment comprised neuropsychological tasks assessing a variety of cognitive domains, and subjective measures of functioning and of symptom severity.ResultsThe active condition showed significant improvements from baseline to post-treatment on measures of inattention, impulsivity, problem-solving, and organization compared to controls. Moreover, whereas the active group reported a significant improvement in subjective cognition over the course of treatment, no such improvement emerged in the waitlist group over this same period. Neither group showed improvement on indices of depressive, anxiety, or OCD-related symptom severity.DiscussionThe results of this small pilot investigation indicate that, although promising, this protocol requires several modifications to be best suited for this population. Replication of these findings is awaited, with current results potentially limited by sample characteristics including motivation to seek and complete treatment, and high attrition at 3-month follow-up (n = 6 completers).Trial RegistrationNCT02502604. (December 7, 2018)

Physical Activity After Traumatic Brain Injury

BackgroundIndividuals with schizophrenia have heterogeneous impairments of the auditory processing system that likely mediate differences in the cognitive gains induced by auditory training (AT). Mismatch negativity (MMN) is an event-related potential component reflecting auditory echoic memory, and its amplitude reduction in schizophrenia has been linked to cognitive deficits. Therefore, MMN may predict response to AT and identify individuals with schizophrenia who have the most to gain from AT. Furthermore, to the extent that AT strengthens auditory deviance processing, MMN may also serve as a readout of the underlying changes in the auditory system induced by AT.MethodsFifty-six individuals early in the course of a schizophrenia-spectrum illness (ESZ) were randomly assigned to 40 h of AT or Computer Games (CG). Cognitive assessments and EEG recordings during a multi-deviant MMN paradigm were obtained before and after AT and CG. Changes in these measures were compared between the treatment groups. Baseline and trait-like MMN data were evaluated as predictors of treatment response. MMN data collected with the same paradigm from a sample of Healthy Controls (HC; n = 105) were compared to baseline MMN data from the ESZ group.ResultsCompared to HC, ESZ individuals showed significant MMN reductions at baseline (p = .003). Reduced Double-Deviant MMN was associated with greater general cognitive impairment in ESZ individuals (p = .020). Neither ESZ intervention group showed significant change in MMN. We found high correlations in all MMN deviant types (rs = .59–.68, all ps < .001) between baseline and post-intervention amplitudes irrespective of treatment group, suggesting trait-like stability of the MMN signal. Greater deficits in trait-like Double-Deviant MMN predicted greater cognitive improvements in the AT group (p = .02), but not in the CG group.ConclusionsIn this sample of ESZ individuals, AT had no effect on auditory deviance processing as assessed by MMN. In ESZ individuals, baseline MMN was significantly reduced relative to HCs, and associated with global cognitive impairment. MMN did not show changes after AT and exhibited trait-like stability. Greater deficits in the trait aspects of Double-Deviant MMN predicted greater gains in global cognition in response to AT, suggesting that MMN may identify individuals who stand to gain the most from AT.Trial registrationNCT00694889. Registered 1 August 2007.