Dissociable effects of attention vs working memory training on cognitive performance and everyday functioning following fronto-parietal strokes

Polly V Peers,Duncan E Astle,John Duncan,Fionnuala C Murphy,Adam Hampshire,Tilak Das,Tom Manly

doi:10.1080/09602011.2018.1554534

Abstract

ABSTRACTDifficulties with attention are common following stroke, particularly in patients with frontal and parietal damage, and are associated with poor outcome. Home-based online cognitive training may have the potential to provide an efficient and effective way to improve attentional functions in such patients. Little work has been carried out to assess the efficacy of this approach in stroke patients, and the lack of studies with active control conditions and rigorous evaluations of cognitive functioning pre and post-training means understanding is limited as to whether and how such interventions may be effective. Here, in a feasibility pilot study, we compare the effects of 20 days of cognitive training using either novel Selective Attention Training (SAT) or commercial Working Memory Training (WMT) programme, versus a waitlist control on a range of attentional and working memory tasks. We demonstrate separable effects of each training condition, with SAT leading to improvements in spatial and non-spatial aspects of attention and WMT leading to improvements on closely related working memory tasks. In addition, both training groups reported improvements in everyday functioning, which were associated with improvements in attention, suggesting that improving attention may be of particular importance in maximising functional improvements in this patient group.

Highlights

Stroke is the leading cause of long-term disability in the UK and other developed nations, with high costs for health and care provision (Saka, McGuire, & Wolfe, 2009)
Patients were selected without knowledge of their behavioural difficulties, but on the basis that they had large lesions compromising frontal and parietal regions
Partial and Whole Report TVA paradigm. This test, based on tasks extensively used in many studies (Duncan et al 1999, Peers et al 2005 and Habekost, 2015 for review), was used to assess the attention parameters of spatial bias, attentional selection (α) and visual short-term memory capacity (VSTM) operationalised in Bundesen’s (1990) Theory of Visual Attention (TVA)

Summary

Introduction

An advantage to comparing two forms of cognitive training was that it allowed us to examine both specific cognitive effects and general benefits To this end, we randomly allocated patients with likely difficulties in attention following stroke to a WMT, SAT or a waitlist, WL, condition. This would question whether any form of training could be effective, or whether this null finding could be due to “dose” or insensitivity of the outcome measures Both forms of training could produce equivalent general benefits compared with WL suggesting common mechanisms which could potentially be due to motivational or social influences as opposed to training specific cognitive abilities. Given the importance of attention for outcome in stroke, we have included a measure of everyday function to examine whether specific improvements in cognitive function influence everyday functioning

Participants

Procedure

Results

Discussion