Cognitive Exercise Research Articles

Investigating the effects of a daily multidisciplinary intensive outpatient rehabilitation program on innovative biomarkers in people with Parkinson's disease: Study protocol for a phase III randomized controlled clinical trial.

To date, there has been no medication that has prevented the progression of Parkinson's disease (PD). Many benefits of intensive and multidisciplinary rehabilitation program for PD are supported by clinical, epidemiological, and experimental data. The main question is whether high-intensity motor and cognitive exercises have an effect on the disease's biological mechanisms. This study protocol is a Randomized Controlled Trial (RCT) designed to determine the efficacy of an experimental, intensive, and multidisciplinary treatment in comparison to a home-based self-treatment in improving biomolecular and functional parameters in PD. A total of 72 participants will be randomly allocated to two different groups, experimental (n = 36) and control group (n = 36). The rehabilitation program will last 6 consecutive weeks and will involve the execution of a total of 30 sessions, one for each day of the week from Monday to Friday. Participants allocated to the control group will carry out a home-based self-treatment program that includes muscle-stretching and active mobilization exercises for 40'/day for 6 consecutive weeks. The primary outcome measure is the effects of both treatments on a new set of molecular biomarkers such as oligomeric alpha-synuclein and neurotrophic factors measured in peripheral neural derived extracellular vesicles (NDEVs). Secondary outcomes will include changes of motor and non-motor symptoms, balance and gait performance and cognitive functioning. This RCT has been registered as "Intensive Multidisciplinary Rehabilitation and Biomarkers in Parkinson's Disease" on 30 May, 2022 to ClinicalTrials.gov with the Study ID number: NCT05452655. This rehabilitation program is believed to be crucial in modifying biomolecular and functional parameters in people with PD. We expect that this study will provide additional evidence to understand the impact of an aerobic and intensive rehabilitation program on brain plasticity in patients with PD.

A Brief Analysis of the Application of Mindfulness-Based Cognitive Therapy in Reducing the Sense of Loneliness Among International Students

With the deepening of globalization, the number of international students has grown significantly. In unfamiliar environments, these students face challenges such as academic pressure and cross-cultural adaptation, which often lead to feelings of loneliness. In severe cases, loneliness can negatively impact their mental health and daily lives. As a psychological intervention, mindfulness-based cognitive therapy (MBCT) integrates mindfulness training with cognitive exercises, making its application in mental health highly significant. This paper first explains the definition and origin of MBCT and discusses its value in regulating emotions, changing thought patterns, and maintaining mental health. Based on the current causes of loneliness among international students, this paper explores targeted applications of MBCT to offer practical intervention methods that promote the holistic and healthy growth of international students.

Computerized cognitive games versus cognitive exergame: the comparison of motor and cognitive functions enhancement in the elderly

BackgroundConsidering the importance of cognitive and motor functions of the elderly people, the present study was conducted to evaluate the effectiveness of a cognitive exergame, called Neurolight compared to computerized cognitive games, in enhancing core executive functions and motor performance.MethodsA total of 36 individuals in the age range of 60 to 69 years were studied in the form of three groups: The control group continued their daily activities, while the Neurolight group underwent a cognitive-motor training and the Maghzineh performed a computer-based cognitive training program for 24 sessions. Before and after interventions, working memory, inhibitory control, and balance were measured respectively by the N-back, Stroop, and TUG tests.ResultsThe results showed that cognitive-motor exercises using Neurolight, for 24 sessions, were able to significantly improve working memory, inhibitory control, and balance in individuals in this age group.ConclusionThis finding supports the other studies suggesting combined cognitive and physical exercises for better effect. Based on its findings, the use of this exercise system can be suggested to coaches and therapists working with the elderly.

Masked Taper With Behavioral Intervention for Discontinuation of Benzodiazepine Receptor Agonists

Placebo effects are commonly observed in benzodiazepine receptor agonist hypnotic clinical trials. Clinical guidelines recommend discontinuing benzodiazepine receptor agonist hypnotics (particularly in older adults) and administering cognitive behavioral therapy for insomnia (CBTI) as first-line therapy for insomnia. It is unknown whether a novel intervention that masks the daily dose of benzodiazepine receptor agonist during tapering and augments CBTI with novel cognitive and behavioral exercises targeting placebo effect mechanisms improves benzodiazepine receptor agonist discontinuation. To compare a masked benzodiazepine receptor agonist taper plus augmented CBTI vs an unmasked taper plus standard CBTI. This randomized clinical trial conducted at an academic medical center and a Department of Veterans Affairs medical center included adults aged 55 years or older who had used lorazepam, alprazolam, clonazepam, temazepam, and/or zolpidem for current or prior insomnia, at doses of less than 8-mg diazepam-equivalent 2 or more nights per week for at least 3 months. Data were collected between December 2018 and November 2023. Data analyses were conducted between November 2023 and July 2024. Masked taper plus cognitive behavioral therapy-augmented program (MTcap); standard CBTI plus supervised (unmasked) gradual taper (SGT). The primary efficacy outcome was percentage achieving benzodiazepine receptor agonist discontinuation 6 months after treatment ended (6-month; intention-to-treat) measured with 7-day self-reported medication logs and for a subset, urine tests. Secondary outcomes were Insomnia Severity Index scores at 1 week posttreatment and 6 months posttreatment, percentage of participants that have discontinued benzodiazepine receptor agonist use at 1 week posttreatment, and benzodiazepine receptor agonist dose and the Dysfunctional Beliefs About Sleep-Medication subscale at 1 week and 6 months posttreatment. Of 338 participants who underwent in-depth screening, 188 participants (mean [SD] age, 69.8 [8.3] years, 123 male [65.4%] and 65 female [35.6%]) were randomly assigned to MTcap (n = 92) or SGT (n = 96). Compared with SGT, MTcap resulted in greater benzodiazepine receptor agonist discontinuation at 6 months (MTcap = 64 [73.4%], SGT = 52 [58.6%]; odds ratio [OR], 1.95; 95% CI 1.03-3.70; P = .04) and 1 week posttreatment (MTcap = 76 [88.4%], SGT = 62 [67.4%]; OR, 3.68; 95% CI, 1.67-8.12; P = .001) and reduced frequency of benzodiazepine receptor agonist use (nights/week) at 1 week posttreatment (-1.31; 95% CI, -2.05 to -0.57; P < .001). Insomnia Severity Index improved with no significant between-group difference at follow-up (baseline to 1 week posttreatment, 1.38; P = .16; baseline to 6 months, 0.16; P = .88). This randomized clinical trial found that a program combining masked tapering with novel cognitive and behavioral exercises targeting placebo mechanisms improved the percentage of long-term benzodiazepine receptor agonist discontinuation compared with standard CBTI plus an unmasked taper. ClinicalTrials.gov Identifier: NCT03687086.

Outcome Measures And Analysis Of Memory Movers- An Exercise Programme For The Brain, Body And Mind

Abstract Background Memory Movers is a six-week early intervention specialist programme designed for implementation in community settings to meet key healthcare needs for individuals experiencing memory difficulties/dementia and their family carers. This programme provides individuals with the knowledge, skills and education to care for their overall health and well-being. It supports mental health and well-being by utilising cognitive stimulation exercises in conjunction with physical health exercises and providing information and basic exercises in mental health. Methods The Specialist Mental Health Service for Older People collaborated with an Acute Hospital, local Council, and Sports and Wellbeing Partnership in designing a suitable, accessible programme to promote Mental Health and well-being in the community. The programme incorporates the following aspects of health: Memory, Movement, and Mental Health. Results Pre- and post-assessments were undertaken with results highlighting the following: The Life Satisfaction Scale improved by 6%; the Mood Rating Scale improved by 19% and the overall rating of experiencing feelings of anxiety was reduced by 14% within the final week. There was also a 101% increase in the average engagement in physical activity. A range of positive comments received from attendees were recorded on feedback questionnaires. Conclusion Findings highlighted that remaining active supports both physical and mental health. According to the HSE (2020), physical exercise can cause chemical changes in the brain, which can help improve mood. Cognitive stimulation is beneficial to brain health and cognition (Schulz 2015). These contribute to the overall well-being of individuals, promoting cognitive functioning and movement, as well as overall mental health and well-being. This programme also provides opportunities for social connection and integration with services.

Understanding Digital Dementia and Cognitive Impact in the Current Era of the Internet: A Review.

Dementia encompasses symptoms resulting from brain damage that impairs cognitive functions, surpassing natural aging effects. This condition affects emotional regulation, behavior, and motivation while preserving consciousness. Dr. Manfred Spitzer coined the term 'digital dementia,' highlighting the cognitive decline associated with excessive reliance on digital devices such as smartphones and Google, potentially exacerbating attention deficit hyperactivity disorder (ADHD) and memory loss. This condition mirrors terms like 'digital amnesia' and 'the Google Effect,' highlighting the brain's tendency to offload peripheral information, leading to panic and forgetfulness. Spitzer's book, Digital Dementia, focuses on gaming effects on children and has thus popularized the term. Teenagers are known to use electronic devices regularly, correlating with rising cognitive impairments. The advent of the internet's fifth generation (5G) has transformed technology use, impacting mental health treatments and clinical practices globally. Digital media's influence on the developing brain encompasses motor skills, language, and cognition. Excessive digital media use in young adults correlates with lower cognitive empathy, affecting interpersonal understanding and facial recognition. Studies link heavy reliance on web-based media to decreased white matter integrity, crucial for language skills. Adolescents may be more vulnerable to anxiety and unrealistic expectations due to digital media overuse. Digital media overuse impacts brain development, especially cognitive and inhibitory control, attention, memory, and reasoning, essential for adapting to dynamic environments. Early exposure to fast-paced media can impair motor skills, spatial awareness, problem-solving, and language learning. Neuroimaging studies reveal that environmental factors like screen usage affect brain networks controlling social-emotional behavior and executive functions. Overreliance on smartphones diminishes gray matter in key brain regions, affecting cognitive and emotional regulation. The internet generation, characterized by advancements such as Web 3.0, introduces artificial intelligence and semantic web technologies, reshaping digital content processing. The neurobiological basis of digital dementia involves changes in the brain structure and function, with excessive screen exposure linked to cognitive impairments. Neuroplasticity, or the brain's adaptability, plays a role in cognitive decline from digital media overuse. Early childhood and adolescent brain development stages exhibit significant plasticity, influencing cognitive trajectories. Addressing digital dementia requires strategies to reduce screen time, promote cognitive exercises, and enhance awareness. Parents should regulate children's screen usage, encourage digital detox periods, and substitute screen time with other activities. Cognitive training programs such as Cogmed (Neural Assembly Int AB, Stockholm, SWE) and CogniFit (San Francisco, CA, USA) can improve memory and attention in older adults. Promoting balanced technology use and educating on the risks of excessive digital media consumption is crucial for maintaining cognitive health in the digital age.

Integrative Neuro-social cognitive Strategy Programme for Instilling REcovery (INSPIRE): a community-based cognitive remediation trial-study procotol

BackgroundAdults with schizophrenia experience a range of neurocognitive problems that affect their daily functioning. Evidence for the efficacy of cognitive remediation in schizophrenia has been established, but its implementation in under-resourced community-based settings is less well-studied. In recent years, interventions have also focused on the strategy-learning approach in favor of drill-and-practice. Moreover, there is an increasing recognition to address social cognition and negative symptoms alongside neurocognition.This study attempts to carry out cognitive remediation in a community mental health setting. The Neuropsychological and Educational Approach to Remediation (NEAR) is used as the cognitive remediation intervention. Neurocognitive and social cognitive games will be introduced during the computer-assisted cognitive exercises sessions. In addition, the instructional technique will foster the use of metacognition and cognitive strategies. Moreover, metamotivation training will be the focus of some bridging sessions to enhance motivation to engage in goal-directed learning behaviors.The aims of the study are to 1) investigate the effects of cognitive remediation on neurocognition, social cognition and functional outcomes of participants with schizophrenia/schizoaffective disorders in community mental health settings; and 2) explore the mediators for change (eg: metamotivation, metacognition and negative symptoms) in cognitive performance and functional outcomes.MethodsThis randomized controlled trial will be conducted in three Singapore Anglican Community Services (SACS) centers, where standard psychiatric rehabilitation is delivered. Participants who are randomized to the experimental arm will receive cognitive remediation and psychiatric rehabilitation, while those randomized to the control arm will receive standard psychiatric rehabilitation only. Cognitive remediation is carried out three times a week for 12 weeks. It consists of computer-assisted cognitive exercises, as well as bridging groups to aid transfer of learning to daily living. Baseline, post-intervention and eight-week follow-up measurements will be collected. Group by time differences in cognitive performance, negative symptoms, metamotivation, metacognition, functioning and recovery will be analyzed across the three time points. Mediators for improvement in cognitive performance and functioning will also be explored.DiscussionFindings of this research will add to the body of knowledge about the key therapeutic ingredients within a strategy-based cognitive remediation program and improve its implementation within under-resourced community settings.Trial registrationThis study has been registered with ClinicalTrials.gov (ID: NCT06286202). Date of registration: 29 February 2024. Date of last update: 21 May 2024.

Integrating lived experience to develop a tailored sleep intervention for people living with dementia and carepartners.

Sleep disturbances are highly prevalent and have adverse health consequences for both people living with dementia and their carepartners. Despite this, they are under-addressed caregiving settings. This study aimed to explore these sleep disturbances and co-design a multimodal sleep intervention for people living with dementia and their carepartners. We conducted two focus groups and five semi-structured interviews (n = 4 people living with dementia, n = 6 carepartners). Active involvement of community advisors was sought throughout the design, development, and facilitation phases. Reflexive thematic analysis was used to explore sleep-related experiences and receive feedback to shape intervention development. People living with dementia reported disruptions to sleep and circadian rhythms, including sleep disturbances and confusion between day and night. Multiple sleep challenges were encountered by carepartners including insomnia, hypervigilance, and daytime impairment. The proposed sleep intervention was received positively, with significant insights emphasising the need for a multimodal toolkit approach, adaptation of the intervention across different dementia stages, and a focus on tailoring the program to carepartners. Sleep interventions for caregivers and care-recipients should target both sleep and daytime functioning to ensure holistic support. Participants were receptive towards time-friendly, online, multimodal sleep interventions that combine cognitive behaviour therapies, light therapy, mindfulness, and exercise elements.

Acute Sleep Deprivation and Cerebral and Skeletal Muscle Oxygenation: A Review and Future Directions

Cerebral and skeletal muscle oxygenation are critical research areas for understanding blood flow and oxygen delivery during various physiological states, including cognitive tasks and exercise. Measuring oxygenated and deoxygenated hemoglobin through functional near-infrared spectrometry (fNIRS) enables non-invasive assessment of cerebral and skeletal muscle oxygenation. Research using fNIRS to explore oxygenation after sleep deprivation (SD) is limited and often contradictory. We reviewed how SD affects cerebral and muscle oxygenation as part of a broader review of how SD affects exercise through altered physiologic and perceptual responses. Herein, we consolidate existing knowledge, identify gaps, and suggest directions for future investigation. A comprehensive literature review was conducted via predefined search parameters using PubMed and Google Scholar, focusing on studies that employed fNIRS to measure cerebral and/or skeletal muscle oxygenation in humans after SD (total or partial) or in individuals with chronically fragmented sleep due to obstructive sleep apnea (OSA). Select studies report increased cerebral oxygenation post-SD, potentially due to compensatory mechanisms and increased brain activity. Contrarily, several studies indicate decreased cerebral oxygenation following SD, potentially due to impaired endothelial function, cortical neurovascular coupling, suppressed brain activity, or decreased oxygen consumption. Cerebral oxygenation may be associated with perceived exertion, suggesting meaningful links to exercise. Interestingly, exercise training may mitigate the effects of SD on oxygenation. The only study investigating skeletal muscle oxygenation with regards to sleep status found a lower tissue saturation index in OSA participants compared to controls, though hemoglobin parameters did not differ. The effect of SD on oxygenation remains equivocal, with no studies fully elucidating the mechanisms underlying these changes. This review is the foundation for an ongoing prospective study investigating the impact of acute SD on exercise capacity and fNIRS-derived cerebral and skeletal muscle oxygenation, with two participants enrolled to date and interim analyses planned at n=5 participants.

Attitudes of Nursing Home Managers Regarding Cognitively Stimulating Activities in People With Dementia: A Multicentre Cross-Sectional Study.

Group-based cognitive stimulation has shown short-term benefits for the cognitive outcomes of people with dementia living in nursing homes (NH). However, group participation can be a barrier for people with advanced dementia, bedridden people or isolated people. The CogStim24 project seeks to develop and implement a new psychosocial intervention based on cognitively stimulating (CS) activities integrated into daily nursing care. As part of the intervention development process, this study aimed to survey NH managers' attitudes and describe currently used approaches to CS activities in German NH. We performed a multicentre cross-sectional study between September and December 2021 in randomly recruited NH in the German federal state of North Rhine-Westphalia. NH representatives were asked to fill in a self-developed online questionnaire. We analysed data descriptively, presenting means and standard deviations. For case scenario questions, we used a summative content analysis. We contacted 354 NH and 106 agreed to participate. Representatives of 64 facilities completed the survey. Almost all stated to have implemented CS activities. Cognitive exercises (98%), physical and relaxation exercises (98%) and reminiscence therapy (95%) were most often used. The majority (96%) thought that CS activities could support people with dementia in maintaining their cognitive functions and that nurses should have a key role in the implementation of CS activities. More than half believed that regular CS activities were easy to implement alongside routine nursing care. Results indicate that CS activities are frequently applied in German NH. The positive attitude of NH managers regarding the implementation and effects of CS activities is an important implementation resource. Nursing staff should be more involved in providing CS activities for people with dementia. Training, information, and implementation material must be made available for nursing staff who wish to have an active role in providing CS activities.

Feasibility of a nurse-initiated brief cognitive behavioral strategy intervention program for symptom clusters experienced by patients with advanced non-small cell lung cancer

BackgroundA nurse-initiated brief cognitive behavioral Strategy (CBS) intervention program has shown alleviation effects of single symptoms. However, the feasibility of the brief CBS for symptoms included in the Pain and Fatigue symptom clusters in patients with advanced nonsmall cell lung cancer (NSCLC) has not been evaluated. ObjectiveTo evaluate the feasibility of application of the nurse-initiated brief CBS intervention program focusing on pain and fatigue symptoms among the Pain and Fatigue/anorexia symptom clusters experienced by patients with advanced NSCLC. MethodsIn this one-group pretest-posttest design, participants were 15 outpatients with NSCLC undergoing medical treatment (UMIN 000026996). After expressing consent to the study participation, the participants completed a baseline questionnaire and were given a booklet explaining brief cognitive behavioral therapies (relaxation, problem-solving strategies for symptom relief), exercise therapy, and tools. We provided follow-up calls five times and evaluated the retention and changes in symptom severities till the 10th week after the intervention. ResultsOf 15 participants, 10 (66.7%) completed the program. For pain relief strategies, 87% chose deep breathing for relaxation, and 80% fatigue relief with exercises. The median symptom severities (at the baseline and Wk10) showed downward tendencies: pain (2.00, 1.00), sadness (1.00, 0.00), and anxiety (1.00, 0.50). Implications for practiceWe need a randomized controlled trial to further test the effectiveness of the intervention in alleviating symptom and improving QOL of this population. ConclusionsThe nurse-initiated brief CBS intervention program is clinically practical in this population. Nurses may provide useful support for patient symptom management by brief CBS.

The Relationship Between Exercise Frequency and Cognitive Flexibility in Anxiety Disorder Patients Undergoing Combined Exercise and Cognitive Behavioral Therapy

This study investigates the relationship between exercise frequency and cognitive flexibility in patients with anxiety disorders undergoing combined Cognitive Behavioral Therapy (CBT) and exercise interventions. A longitudinal follow-up design was employed, with 80 participants randomized into four groups: low-frequency exercise, moderate-frequency exercise, high-frequency exercise, and a control group receiving CBT without exercise. Cognitive flexibility was assessed using the Wisconsin Card Sorting Test (WCST), and anxiety levels were measured by the Hamilton Anxiety Rating Scale (HAM-A) at baseline, post-intervention, and during 3-month and 6-month follow-ups. Results demonstrated a significant dose-response relationship, with higher exercise frequencies leading to greater improvements in cognitive flexibility and reductions in anxiety symptoms. The high-frequency exercise group exhibited the most substantial and sustained cognitive and emotional benefits, suggesting the importance of frequent exercise in enhancing and maintaining therapeutic outcomes in anxiety disorder treatment. These findings have critical implications for optimizing treatment strategies that integrate physical exercise with CBT to improve cognitive and emotional health in anxiety disorder patients.

Current Trends of Exercise Programs for Improving Cognitive Function in Older Adults

PURPOSE: Limited studies have analyzed exercise protocols for cognitive improvement in older adults. Therefore, we closely examined the composition, content, and operation methods of these exercise programs to identify current trends.METHODS: We searched the Web of Science, PubMed, and Google Scholar databases for studies published between 2019 and 2024. The search terms used included “older adults”, “cognitive function”, “mild cognitive impairment”, “dementia”, “exercise”, “physical activity”, and other related terms, in both Korean and English.RESULTS: Aerobic exercises primarily comprised step-based exercises (walking and stepping) and dance routines, typically lasting 15-60 minutes per session, 1-3 times per week for 6-24 weeks, regardless of the individual’s cognitive level. Assistant instructors often participated, and in cases of severe cognitive impairment, patients’ caregivers also participated. Resistance exercises were most often performed using body weight and elastic bands, along with other tools and equipment, such as balls, water bottles, or specialized equipment. The exercises commonly involved 8-12 repetitions, 2-3 sets, with 1-minute rest between sets. Several programs included functional exercises to improve daily living performance. Other activities that were incorporated into the exercise programs included exergames and balance, mind-body, peripheral, and eye exercises.CONCLUSIONS: Recent cognitive exercise programs for older adults typically last three months and use a variety of tools or digital technologies within the scope of older adult exercise guidelines. Exercises for people with severe cognitive impairment tend to be more individualized, gradual, and flexible in their approach.

Enhancement of response learning in male rats with intrastriatal infusions of a BDNF - TrkB agonist, 7,8-dihydroxyflavone.

Enhancement of learning and memory by cognitive and physical exercise may be mediated by brain-derived neurotrophic factor (BDNF) acting at tropomyosin receptor kinase B (TrkB). Upregulation of BDNF and systemic administration of a TrkB agonist, 7,8-dihydroxyflavone (7,8-DHF), enhance learning of several hippocampus-sensitive tasks in rodents. Although BDNF and 7,8-DHF enhance functions of other brain areas too, these effects have mainly targeted non-cognitive functions. One goal of the present study was to determine whether 7,8-DHF would act beyond the hippocampus to enhance cognitive functions sensitive to manipulations of the striatum. Here, we examined the effects of intrastriatal infusions of 7,8-DHF on learning a striatum-sensitive response maze and on phosphorylation of TrkB receptors in 3-month-old male Sprague Dawley rats. Most prior studies of BDNF and 7,8-DHF effects on learning and memory have administered the drugs for days to months before assessing effects on cognition. A second goal of the present study was to determine whether a single drug treatment near the time of training would effectively enhance learning. Moreover, 7,8-DHF is often tested for its ability to reverse impairments in learning and memory rather than to enhance these functions in the absence of impairments. Thus, a third goal of this experiment was to evaluate the efficacy of 7,8-DHF in enhancing learning in unimpaired rats. In untrained rats, intrastriatal infusions of 7,8-DHF resulted in phosphorylation of TrkB receptors, suggesting that 7,8-DHF acted as a TrkB agonist and BDNF mimic. The findings that a single, intra-striatal infusion of 7,8-DHF 20 min before training enhanced response learning in rats suggest that, in addition to its trophic effects, BDNF modulates learning and memory through receptor mediated cell signaling events.

Usability and Tolerability of Virtual Reality-Based Cognitive Stimulation in Healthy Elderly Volunteers-A Feasibility Clinical Trial.

Background: The aim of the current pilot study was to evaluate the usability, acceptability, and tolerability of virtual reality (VR)-based cognitive stimulation exercises (CSEs) in healthy young versus old populations before health care integration. A secondary aim was to assess the accuracy of VR games as a proxy for cognitive stimulation, specifically for attention. VR-based CSEs promise to improve attention and brain function through varied learning systems. Methods: This is a Phase 1 feasibility clinical trial at a single center. It involves 30 healthy volunteers randomly selected using the American Society of Anesthesiologists (ASA) physical status classification system. Participants fall into ASA 1 (age >18-35 years, n = 15) or ASA 2 (age >60 years, n = 15) categories. All participants tested the ReCognitionVR-based CSEs. Feasibility criterion: Participants in each group were monitored for completion of 20 minutes of VR-based CSEs. Acceptability criterion: Proportion of participants with system usability scale (SUS) >35 or SUS score of 87.5. Safety (tolerability) monitoring: Sessions were monitored for neurological, cardiovascular, or pulmonary adverse events (AEs). Safety criterion: No more than 10% of sessions stopped due to neurological, cardiovascular, or pulmonary AEs. Results: The primary outcome (feasibility) of ReCognitionVR-based CSEs was 100%. For the secondary outcome (acceptability), there was no group difference in SUS scores (ASA 1 = 88.17 ± 12.83 vs. ASA 2 = 88.39 ± 10.22, P = 0.81). For the tertiary outcome (safety), mild transient uneasiness was reported by two (13.4%) ASA 1 participants (resolved in 2 minutes), and one (6.67%) ASA 1 participant experienced a temporary >20% increase in blood pressure from baseline. No ASA 2 participants had AEs. Conclusion: The feasibility, acceptability, and safety of ReCognitionVR-based CSEs in healthy elderly volunteers are acceptable, indicating that the evaluation of the ReCognitionVR-based CSEs in hospitalized patients is reasonable.

Extended Reality in Revolutionizing Neurological Disease: A New Era for Chronic Condition Treatment.

Extended reality (XR), which includes virtual reality (VR), augmented reality (AR), and mixed reality (MR), provides promising advancements in managing chronic neurological disorders such as Parkinson's disease (PD), multiple sclerosis (MS), Alzheimer's disease, and stroke. This review examines the impact of XR technologies on neurological care, highlighting their ability to create immersive, interactive environments that enhance rehabilitation through tailored motor and cognitive exercises. XR supports neuroplasticity by providing engaging, contextually relevant exercises and real-time feedback, offering innovative alternatives to traditional methods. The technical issues, clinical validation, and accessibility must be addressed despite the potential benefits. Future developments should focus on refining XR applications, integrating them with complementary technologies, and establishing robust policies to guide their effective and ethical use. XR is poised to revolutionize neurological rehabilitation, promising improved patient outcomes and transforming medical training.

Community-based complex interventions to sustain independence in older people, stratified by frailty: a systematic review and network meta-analysis.

Sustaining independence is important for older people, but there is insufficient guidance about which community health and care services to implement. To synthesise evidence of the effectiveness of community services to sustain independence for older people grouped according to their intervention components, and to examine if frailty moderates the effect. Systematic review and network meta-analysis. Studies: Randomised controlled trials or cluster-randomised controlled trials. Participants: Older people (mean age 65+) living at home. Interventions: community-based complex interventions for sustaining independence. Comparators: usual care, placebo or another complex intervention. Living at home, instrumental activities of daily living, personal activities of daily living, care-home placement and service/economic outcomes at 1 year. We searched MEDLINE (1946-), Embase (1947-), CINAHL (1972-), PsycINFO (1806-), CENTRAL and trial registries from inception to August 2021, without restrictions, and scanned reference lists. Interventions were coded, summarised and grouped. Study populations were classified by frailty. A random-effects network meta-analysis was used. We assessed trial-result risk of bias (Cochrane RoB 2), network meta-analysis inconsistency and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation for network meta-analysis). We included 129 studies (74,946 participants). Nineteen intervention components, including 'multifactorial-action' (multidomain assessment and management/individualised care planning), were identified in 63 combinations. The following results were of low certainty unless otherwise stated. For living at home, compared to no intervention/placebo, evidence favoured: multifactorial-action and review with medication-review (odds ratio 1.22, 95% confidence interval 0.93 to 1.59; moderate certainty) multifactorial-action with medication-review (odds ratio 2.55, 95% confidence interval 0.61 to 10.60) cognitive training, medication-review, nutrition and exercise (odds ratio 1.93, 95% confidence interval 0.79 to 4.77) and activities of daily living training, nutrition and exercise (odds ratio 1.79, 95% confidence interval 0.67 to 4.76). Four intervention combinations may reduce living at home. For instrumental activities of daily living, evidence favoured multifactorial-action and review with medication-review (standardised mean difference 0.11, 95% confidence interval 0.00 to 0.21; moderate certainty). Two interventions may reduce instrumental activities of daily living. For personal activities of daily living, evidence favoured exercise, multifactorial-action and review with medication-review and self-management (standardised mean difference 0.16, 95% confidence interval -0.51 to 0.82). For homecare recipients, evidence favoured the addition of multifactorial-action and review with medication-review (standardised mean difference 0.60, 95% confidence interval 0.32 to 0.88). Care-home placement and service/economic findings were inconclusive. High risk of bias in most results and imprecise estimates meant that most evidence was low or very low certainty. Few studies contributed to each comparison, impeding evaluation of inconsistency and frailty. Studies were diverse; findings may not apply to all contexts. Findings for the many intervention combinations evaluated were largely small and uncertain. However, the combinations most likely to sustain independence include multifactorial-action, medication-review and ongoing review of patients. Some combinations may reduce independence. Further research is required to explore mechanisms of action and interaction with context. Different methods for evidence synthesis may illuminate further. This study is registered as PROSPERO CRD42019162195. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128862) and is published in full in Health Technology Assessment; Vol. 28, No. 48. See the NIHR Funding and Awards website for further award information.

The Efficacy of the Cognitive Exercise Therapy Approach by Telerehabilitation in People Living with HIV: Preliminary Results.

The Cognitive Exercise Therapy Approach, referred to as BETY, is a biopsychosocial model that has demonstrated effectiveness in improving the quality of life among various patient populations with chronic diseases. This study aimed to determine the efficacy of BETY combined with telerehabilitation for people living with HIV (PLWH). Fifty PLWH who were virologically suppressed receiving follow-up and treatment at Şanlıurfa Training and Research Hospital were included in this study. Patients were divided into the telerehabilitation group (TG) and the control group (CG). In addition to routine treatments, the TG underwent group rehabilitation exercises via Zoom application for 60 minutes three times a week for 12 weeks (a total of 36 sessions) under the supervision of a physiotherapist, following the principles of BETY. The CG received no intervention and continued with routine medication treatments. Before and after the exercise therapy, the BETY Scale (BETY-BQ), Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Clinical Frailty Scale, and Frail Scale were administered to both the TG and the CG. The responses to the scales were compared between the two groups after the 12-week period. The preliminary results included data from 10 patients in the TG and 15 patients in the CG who completed the 12-week treatment. In the TG, significant differences were observed in the SF-36 pain subscale and the BETY total score, while in the CG, significant differences were found in the SF-36 emotional role functioning and vitality subscales (p<0.05). In the TG, negative values were observed in all BETY-BQ subscales, indicating improvement in all parameters. Additionally, the mean value of the SF-36 pain subscale increased from 79 before treatment to 91.5 after treatment. Our preliminary results indicate that the BETY method applied by telerehabilitation may be effective in reducing pain and improving biopsychosocial conditions in PLWH. Telerehabilitation with cognitive exercise therapy can provide an alternative treatment option by complementing routine therapies and offering the opportunity to participate anonymously in group therapies in PLWH.

The effects of conventional treatment in addition to Pilates on biopsychosocial status in chronic neck pain: A randomized clinical trial.

Although guidelines and systematic reviews recommend the use of exercise in the treatment of chronic pain and neck pain, there are no clear recommendations for conservative treatments frequently used in clinics. The effect of supporting clinical Pilates exercises with passive physiotherapy methods on biopsychosocial status is still unknown. The objective was to investigate the effects of conventional treatment (CT) in addition to clinical Pilates on pain levels, physical condition, functional status, and psychosocial status in individuals with chronic neck pain. Fifty women were randomly divided into 2groups, the clinical Pilates group (Pilates, n= 25), and the group receiving CT in addition to clinical Pilates (Pilates-CT, n= 25). Both groups received treatment 3days a week for 6weeks. The CT program involved the implementation of hot pack (HP) application, Transcutaneous Electrical Nerve Stimulation (TENS), and therapeutic ultrasound (US) to the cervical area. CT in addition to Pilates was more effective in reducing the Visual Analog Scale (at rest and during activity), Neck Disability Index, Fear-Avoidance Beliefs Questionnaire, NeckPix Scale, Hospital Anxiety and Depression Scale-depression, and Cognitive Exercise Therapy Approach-Biopsychosocial questionnaire scores (p< 0.05) and in increasing the degree of change in the extension range of motion (ROM) and cervical flexor endurance values and scores in the energy parameter of Short Form-36 (p< 0.05). CT provided in addition to Pilates was more effective in reducing pain levels, disability, fear of movement, depression levels, and negative biopsychosocial status and improving extension ROM and cervical flexor endurance, neck awareness, and the energy/vitality parameter of quality of life in individuals with chronic neck pain.

Exploring Symptom Overlaps: Post-COVID-19 Neurological Syndrome and Post-Concussion Syndrome in Athletes.

The COVID-19 pandemic has introduced new challenges in managing neurological conditions, particularly among athletes. This paper explores the intersection of post-COVID-19 neurological syndrome (PCNS/PASC) and post-concussion syndrome (PCS), focusing on their implications in sports medicine. Our analysis covers the symptomatology, pathophysiology, and management strategies for PCNS/PASC and PPCS, with special attention paid to the unique challenges faced by athletes recovering from these conditions, including the risk of symptom exacerbation and prolonged recovery. Key findings reveal that both PCNS/PASC and PPCS present with overlapping symptoms such as cognitive difficulties, exercise intolerance, and mental health issues, but differ in specific manifestations like anosmia and ageusia, unique to COVID-19. Pathophysiological analysis reveals similarities in blood-brain barrier disruption (BBB) but differences in the extent of immune activation. Management strategies emphasize a gradual increase in physical activity, close symptom monitoring, and psychological support, with a tailored approach for athletes. Specific interventions include progressive aerobic exercises, resistance training, and cognitive rehabilitation. Furthermore, our study highlights the importance of integrating neurology, psychiatry, physical therapy, and sports medicine to develop comprehensive care strategies. Our findings underscore the dual challenge of COVID-19 and concussion in athletes, necessitating a nuanced, interdisciplinary approach to effective management. Future research should focus on the long-term neurological effects of both conditions and optimizing treatment protocols to improve patient outcomes. This comprehensive understanding is crucial for advancing the management of athletes affected by these overlapping conditions and ensuring their safe return to sports.