Effectiveness of neuropsychological rehabilitation on memory and mood management of people with stroke

The effectiveness of neuropsychological rehabilitation is supported by the evidence found in previous reviews, but there is a lack of research regarding the effectiveness of remotely conducted neuropsychological rehabilitation. This review aimed to identify and evaluate the results of studies investigating the effectiveness of teleneuropsychological rehabilitation. Relevant articles were extracted from electronic databases and filtered to include studies published in 2016 or later to focus on recent practices. Data were synthesized narratively. A total of 14 randomized controlled studies were included in the synthesis (9 for children/adolescents, 5 for adults). The most common type of intervention was computerized cognitive training with regular remote contact with the therapist (seven studies). Regarding children and adolescents, the evidence for the effectiveness was found only for these types of interventions with improvements in cognitive outcomes. The results regarding the family-centered interventions were mixed with improvements only found in psychosocial outcomes. No support was found for the effectiveness of interventions combining cognitive and motor training. Regarding adults, all included studies offered support for the effectiveness, at least to some extent. There were improvements particularly in trained cognitive functions. Long-term effects of the interventions with generalization to global functioning remained somewhat unclear. Remote interventions focused on computerized cognitive training are promising methods within teleneuropsychological rehabilitation. However, their impact on long-term meaningful, everyday functioning remained unclear. More research is needed to reliably assess the effectiveness of teleneuropsychological interventions, especially with more comprehensive approaches.

Cognitive deficits are common symptoms in multiple sclerosis (MS), and evident even in the early stages of the disease. Cognitive functions most frequently affected are information processing, memory and learning, and attention. Deficits may have a multidimensional impact on quality of life by weakening the ability to work, impairing social functioning and increasing the strain of the caregiver. To date, no effective pharmacological treatment for cognitive decline has been established, although there is some evidence suggesting that disease-modifying therapies may help to preserve cognitive function. Neuropsychological rehabilitation aims at alleviation of the negative effects of cognitive impairments and has been found to be effective in patients with stroke and traumatic brain injury. This paper discusses the evidence on neuropsychological rehabilitation in MS based on a recent systematic literature review and suggests a model for alleviating the effects of cognitive impairments in MS. The preliminary research evidence on the effects of neuropsychological rehabilitation in MS is positive: rehabilitation may have favorable effects on patients' cognitive performance and coping with cognitive impairments. In clinical practice, the diagnostics and treatment of cognitive impairments should be improved. Neuropsychological rehabilitation should be an important part of a rehabilitation regimen in MS.

Changes in executive functions associated with alcohol consumption are frequently found in alcohol use disorder. Neuropsychological rehabilitation can play an essential role as an effective treatment in the recovery from these deficits, leading to the maintenance of abstinence. However, there are still some uncertainties regarding its impact on the recovery of deficits in executive functions. Our purpose is to present a protocol for a systematic review aiming to assess which neuropsychological rehabilitation programs are effective in the recovery of executive deficits in patients with alcohol use disorder. We will search the following databases: PubMed, Cochrane Library (CENTRAL), Web of Science, and Scopus, as well as the list of references of the identified studies. Screening, data extraction, and synthesis, as well as evaluation of the risk of bias, will be carried out by two reviewers independently, using ROBINS-I and RoB 2. Disagreements will be resolved using a third additional reviewer. Primary outcomes will correspond to changes in executive functions, following a neuropsychological rehabilitation program in patients with alcohol use disorder. The evidence will be synthesized using a narrative description of neuropsychological rehabilitation programs and the indicators of their effectiveness will be identified. The neuropsychological rehabilitation programs for executive functions will be assessed considering their different components and their impact on the recovery of these functions. The review described in this protocol will allow the development of guidelines for the design of more effective rehabilitation programs for clinical populations with alcohol use disorder.

The consequences of acquired brain injury include impairments in cognition, emotion, and behaviour. Neuro-psychology provides techniques for treating these disorders, but it is still important to establish which of all the available tools are most effective for this purpose. This article reviews existing studies on the effectiveness of neuropsychological rehabilitation, focusing on those areas more often impaired due to acquired brain injury. The purpose of the article is to guide and orient neuro-psychological rehabilitation of these patients based on the strongest evidence available in the literature. This paper focuses on cognitive domains such as attention and neglect, memory and language. There is enough evidence to recommend the neuropsychological rehabilitation of the above processes in patients with acquired brain injury.

The consequences of acquired brain injury include impairments in cognition, emotion and behaviour. Neuro-psychology provides techniques for treating these disorders, but it is still important to establish which of all the available tools are most effective for this purpose. This article reviews existing studies on the effectiveness of neuropsychological rehabilitation, focusing on those areas more often affected after acquired brain injury. The purpose of the article is to guide and orient neuro-psychological rehabilitation of these patients based on the strongest evidence available in the literature. In this second part, we will focus on the rehabilitation of executive functions, the behaviour modification, and psychotherapy applied in this area, as well as the application of new technologies. There is enough evidence to recommend the neuropsychological rehabilitation of executive functions, and the application of the above mentioned tools in patients with acquired brain injury.

A special challenge in the neuropsychological rehabilitation of adult patients with acquired brain injury is therapy in disorders of the executive (or supervisory) system. It is mainly due to the large capacity of the meaning of this term, including functions from the highest, prefrontal level of hierarchical cerebral regulation, and the lack of professionally prepared therapeutic programs for this diverse group of patients. The article presents the first Polish computer program ExeSystem containing tasks to be used in the rehabilitation of patients with executive dysfunctions. The training tasks are primarily functional, involving the executive aspects of attention, working memory, the ability to plan complex actions, learning to remember effectively, and the social aspects of behavior. Apart from therapeutic applications, the program may facilitate scientific research on the effectiveness of neuropsychological rehabilitation and the development of its standards. The authors also present preliminary data on the usefulness of the ExeSystem in rehabilitation based on the opinions of neuropsychologists using the program and patients undergoing therapy.

Cognitive deficits have been reported in 45%-70% of patients with multiple sclerosis (MS). Like other symptoms of MS, cognitive deficits are highly variable. Slowed information processing and memory and learning dysfunction are regarded as the most frequent cognitive deficits in MS. Both white and gray matter damages have been suggested to contribute to cognitive impairments in MS. There is no direct relationship between cognitive deficits and physical disability, disease duration or course of the disease. In addition to cognitive impairments, neuropsychiatric symptoms are observed in MS, the most common being alterations in mood state. Neurobehavioral deficits have multidimensional effects on the activities of daily living and quality of life. Consequently, attention should be paid to early diagnosis and treatment. Based on studies on cognitive retraining and more multimodal neuropsychological rehabilitation, both approaches show promise in the treatment of cognitive impairments and their harmful effects. This review introduces the frequency and characteristics of cognitive impairments, as well as main findings on the effects of neuropsychological rehabilitation in MS.

Suspend or amend? Randomized controlled trial on neuropsychological rehabilitation for epilepsy: A COVID-19 impact.

BackgroundCognitive impairment is a common feature in multiple sclerosis (MS) and may have a substantial impact on quality of life. Evidence about the effectiveness of neuropsychological rehabilitation is still limited, but current data suggest that computer-assisted cognitive training improves cognitive performance.ObjectiveThe objective of this study was to evaluate the efficacy of combined computer-assisted training supported by home-based neuropsychological training to improve attention, processing speed, memory and executive functions during 3 consecutive months.MethodsIn this randomized controlled study blinded for the evaluators, 62 MS patients with clinically stable disease and mild-to-moderate levels of cognitive impairment were randomized to receive a computer-assisted neuropsychological training program (n=30) or no intervention (control group [CG]; n=32). The cognitive assessment included the Brief Repeatable Battery of Neuropsychological Test. Other secondary measures included subjective cognitive impairment, anxiety and depression, fatigue and quality of life measures.ResultsThe treatment group (TG) showed significant improvements in measures of verbal memory, working memory and phonetic fluency after intervention, and repeated measures analysis of covariance revealed a positive effect in most of the functions. The control group (CG) did not show changes. The TG showed a significant reduction in anxiety symptoms and significant improvement in quality of life. There were no improvements in fatigue levels and depressive symptoms.ConclusionCognitive intervention with a computer-assisted training supported by home training between face-to-face sessions is a useful tool to treat patients with MS and improve functions such as verbal memory, working memory and phonetic fluency.

Cognitive symptoms in multiple sclerosis have long been not recognized. The prevalence is now estimated to range between 30-70 %. Few studies exist on the long-time evolution. It seems that only a smaller subgroup of patients develops substantial progressive decline. Major domains of affection are information processing and attention. The closest association to morphological parameters on MRI is with measures of brain atrophy. The relevance of cognitive disturbances for daily living and quality of life is high. Sensitive screening instruments nowadays exist but their correlation to daily activities has not been rigorously studied. Immune modulating agents seem to slow progressive decline but again the evidence is weak. Effects of cholinergic drugs or other drugs acting on cognitive processing have not been studied in larger series. There is some evidence on the effectiveness of neuropsychological rehabilitation but as reviewed in the paper data are not conclusive on the improvement of quality of life and daily functioning. Information on cognitive disturbances is considered helpful from the patient view depending on the framing of presentation.

Neuropsychological rehabilitation has beneficial effects on perceived cognitive deficits in multiple sclerosis during nine-month follow-up

Introduction Although, as argued in Chapter 1, neuropsychological rehabilitation is partly concerned with the remediation or alleviation of emotional, behavioural and motor consequences of brain injury, it is probably true to say that the major role of neuropsychological rehabilitation is the treatment of cognitive deficits resulting from damage to the brain. What exactly is meant by the term ‘cognitive rehabilitation’? It is certainly aimed at a number of different cognitive functions including memory, attention, problem solving, communication, perceptual and spatial deficits. It should encompass methods for restoring cognitive functions and methods to teach compensatory strategies. It should also be concerned with reducing problems faced in everyday life. As indicated in Chapter 1, we need to recognize that rehabilitation is an interactive process involving the disabled person, therapeutic staff and, where possible, relatives and members of the wider community. As a consequence of these views, we suggest that cognitive rehabilitation is a process whereby brain injured people work together with healthcare professionals to remediate or alleviate cognitive deficits arising from a neurological insult. We are particularly concerned here with people who have sustained a non-progressive insult to the brain such as traumatic brain injury (TBI), encephalitis, hypoxic brain damage or a stroke. This is not to deny the value of rehabilitation for people with progressive conditions such as Alzheimer's disease and we accept that some valuable work is being done in this area (Clare and Woods, 2001).

Cognitive deficits are a common manifestation in multiple sclerosis (MS) and have a wide effect on the patient's quality of life. Alleviation of the harmful effects caused by these deficits should be a major goal of MS research and practice. The aim of this review was to evaluate the effects of neuropsychological/cognitive rehabilitation in MS by conducting a systematic review. A systematic literature search was carried out on reports drawn from Cochrane MS Group Specialised Register (To October 2010), Evidence-based medicine (EBM) reviews (To September 2010), MEDLINE (January 1950 to September 2010), EMBASE (1974 to September 2010), PsycINFO (January 1806 to September 2010), WEB OF SCIENCE (WOS) (January 1986 to September 2010), CINAHL (1982 to September 2010), and identified from the references in these reports. Randomised Controlled Trials (RCTs) and quasi-randomised trials evaluating the effects of neuropsychological rehabilitation in MS compared to other interventions or no intervention at all and employing neuropsychological rehabilitation methods and outcome measures were included. Two review authors individually judged the relevance, risk of bias, and content of the included studies. Results were combined quantitatively with meta-analyses according to the intervention type: 1) Cognitive training and 2) Cognitive training combined with other neuropsychological rehabilitation methods. In addition, narrative presentation was used in reporting the results of those studies which were inappropriate to be included in the meta-analysis. Fourteen studies (770 MS patients) fulfilled the inclusion criteria. On the basis of these studies, low level evidence was found that neuropsychological rehabilitation reduces cognitive symptoms in MS. Cognitive training was found to improve memory span (standardised mean difference 0.54 (95% confidence interval 0.2 to 0.88, P = 0.002)), working memory (standardised mean difference 0.33 (95% confidence interval 0.09 to 0.57, P = 0.006)), and immediate visual memory (standardised mean difference 0.32 (95% confidence interval 0.04 to 0.6, P = 0.02)). There was no evidence of an effect of cognitive training combined with other neuropsychological rehabilitation methods on cognitive or emotional functions. The overall quality as well as the comparability of the included studies were relatively low due to methodological limitations and heterogeneity of outcome measures. Although most of the pooled results in the meta-analyses yielded no significant findings, twelve of the fourteen studies showed some evidence of positive effects when the studies were individually analysed. The review indicates low level evidence for the positive effects of neuropsychological rehabilitation in MS. Interventions included in the review were heterogeneous. Consequently, clinical inferences can basically be drawn from single studies. Therefore, new trials may change the strength and direction of the evidence. To further strengthen the evidence, well-designed high quality studies are needed. In this systematic review, recommendations are given for improving the quality of future studies on the effects of neuropsychological rehabilitation in MS.

This is an update of the Cochrane review 'Neuropsychological rehabilitation for multiple sclerosis' (first published in The Cochrane Library 2011, Issue 11).Cognitive deficits are a common manifestation of multiple sclerosis (MS) and have a significant effect on the patient's quality of life. Alleviation of the harmful effects caused by these deficits should be a major goal of MS research and practice. To assess the effects of neuropsychological/cognitive rehabilitation on health-related factors, such as cognitive performance and emotional well-being in patients with MS. The Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group Trials Search Co-ordinator searched their Specialised Register which, among other sources, contains trials from CENTRAL (The Cochrane Library 2013, Issue 2), MEDLINE, EMBASE, CINAHL, LILACS, PEDro and clinical trials registries (28 May 2013). We contacted authors of the studies for additional information. Randomised controlled trials (RCTs) and quasi-randomised trials evaluating the effects of neuropsychological rehabilitation in MS compared to other interventions or no intervention. Two review authors individually judged the eligibility of the included studies, assessed risk of bias and extracted data. We combined results quantitatively in meta-analyses according to the intervention type: 1) cognitive training and 2) cognitive training combined with other neuropsychological rehabilitation methods. Twenty studies (986 participants; 966 MS participants and 20 healthy controls) fulfilled the inclusion criteria. The mean age of the participants was 44.6 years, mean length of education was 12.3 years and 70% of the participants were women. Most of the participants had a relapsing-remitting course of disease. The mean Expanded Disability Status Scale score was 3.2 and the mean duration of disease was 14.0 years.On the basis of these studies, we found low-level evidence that neuropsychological rehabilitation reduces cognitive symptoms in MS. Cognitive training was found to improve memory span (standardised mean difference (SMD) 0.54, 95% confidence interval (CI) 0.20 to 0.88, P = 0.002) and working memory (SMD 0.33, 95% CI 0.09 to 0.57, P = 0.006). Cognitive training combined with other neuropsychological rehabilitation methods was found to improve attention (SMD 0.15, 95% CI 0.01 to 0.28, P = 0.03), immediate verbal memory (SMD 0.31, 95% CI 0.08 to 0.54, P = 0.008) and delayed memory (SMD 0.22, 95% CI 0.02 to 0.42, P = 0.03). There was no evidence of an effect of neuropsychological rehabilitation on emotional functions.The overall quality, as well as the comparability of the included studies, was relatively low due to methodological limitations and heterogeneity of interventions and outcome measures. Although most of the pooled results in the meta-analyses yielded no significant findings, 18 of the 20 studies showed some evidence of positive effects when the studies were individually analysed. This review found low-level evidence for positive effects of neuropsychological rehabilitation in MS. The interventions and outcome measures included in the review were heterogeneous, which limited the comparability of the studies. New trials may therefore change the strength and direction of the evidence.

Background: There is preliminary evidence on the positive effects of neuropsychological rehabilitation on cognition in multiple sclerosis (MS), but the generalisability of the findings is limited by methodological problems. Objective: The aim of the present study was to determine the effects of strategy-oriented neuropsychological rehabilitation on MS. Methods: A total of 102 relapsing–remitting MS patients with subjective and objective attentional deficits were randomised into an intervention and a control group. Neuropsychological assessments were performed at baseline, at three months immediately after the intervention, and at six months. Patients in the intervention group received neuropsychological rehabilitation once a week in 60-minute sessions for 13 consecutive weeks. The control group received no intervention. Results: Neuropsychological rehabilitation including computer-based attention and working memory retraining, psychoeducation, strategy learning and psychological support did not improve cognitive performance but had a positive effect on perceived cognitive deficits. The intervention group perceived significantly fewer deficits than the control group both immediately after the intervention and at six months. The personal rehabilitation goals were also well achieved. Conclusions: Strategy-oriented neuropsychological rehabilitation did not improve cognitive performance but reduced perceived cognitive deficits in MS.