Cognitive Rehabilitation In Patients Research Articles

Cognitive rehabilitation training in patients with brain tumor-related epilepsy and cognitive deficits: a pilot study.

The aim of this pilot observational study was to evaluate effect of cognitive rehabilitation training (RehabTr) on cognitive performances in patients with brain tumor-related epilepsy (BTRE) and cognitive disturbances. Medical inclusion criteria: patients (M/F) ≥ 18 years ≤ 75 with symptomatic seizures due to primary brain tumors or brain metastases in stable treatment with antiepileptic drugs; previous surgical resection or biopsy; >70 Karnofsky Performance Status; stable oncological disease. Eligible patients recruited from 100 consecutive patients with BTRE at first visit to our Center from 2011 to 2012. All recruited patients were administered battery of neuropsychological tests exploring various cognitive domains. Patients considered to have a neuropsychological deficit were those with at least one test score for a given domain indicative of impairment. Thirty patients out of 100 showed cognitive deficits, and were offered participation in RehabTr, of which 16 accepted (5 low grade glioma, 4 high grade glioma, 2 glioblastoma, 2 meningioma and 3 metastases) and 14 declined for various reasons. The RehabTr consisted of one weekly individual session of 1 h, for a total of 10 weeks, carried out by a trained psychologist. The functions trained were: memory, attention, visuo-spatial functions, language and reasoning by means of Training NeuroPsicologico (TNP(®)) software. To evaluate the effect of the RehabTr, the same battery of tests was administered directly after cognitive rehabilitation (T1), and at six-month follow-up (T2). Statistical analysis with Student T test for paired data showed that short-term verbal memory, episodic memory, fluency and long term visuo-spatial memory improved immediately after the T1 and remained stable at T2. At final follow-up all patients showed an improvement in at least one domain that had been lower than normal at baseline. Our results demonstrated a positive effect of rehabilitative training at different times, and, for these reasons, should encourage future research in this area with large, randomized clinical trials that evaluate the impact of a cognitive rehabilitation in patients with BTRE and cognitive deficits.

Rehabilitación cognitiva en daño cerebral adquirido: variables que median en la respuesta al tratamiento

ObjectiveTo identify the variables related to response to a cognitive rehabilitation program in a population of patients with acquired brain injury. Material and methodsThis retrospective study included 528 patients with acquired brain injury who received cognitive rehabilitation at our center between February 2008 and January 2013. We used logistic regression analysis to examine the impact of predictive variables on treatment response (dependent variable). Differences between pre- and post-treatment neuropsychological assessment were used to calculate treatment response in the domains of attention, memory, and executive function. ResultsFor the attention index, the variables positively associated with better treatment response were age at the time of injury (OR=0.97, 95% CI: 0.96-0.98) and place of treatment (OR=0.45, 95% CI: 0.27-0.73). For the memory index, the variables positively associated with better treatment response were age (OR=0.98, 95% CI: 0.96 to 0.99), etiology (OR=0.63, 95% CI: 0.39 to 1) and place of treatment (OR=0.48, 95% CI: 0.29 to 0.79); these variables were also significant for the executive index. ConclusionsThese findings suggest that part of the inter-individual differences in response to cognitive rehabilitation in patients with acquired brain injury could be explained by age, etiology and place of treatment.

A Network-Based Cognitive Rehabilitation in patients with Multiple Sclerosis and Mild Cognitive Impairment (P5.188)

A Network-Based Cognitive Rehabilitation in patients with Multiple Sclerosis and Mild Cognitive Impairment (P5.188)

Sharing the ICF-CY checklist of autistic children and adolescents in the network of local services.

Technological innovation, medical progress, demographic change, increased chronicity and new health risks are some factors that need and require a change towards new models of health care. The contribution is intended to describe a project defined as socially innovative, which relates to Rehabilitation, an initiative to support families and patients with memory problems and Alzheimer's Neuro center of the Mediterranean Pozzilli, Isernia. The specialists of the health facility Molise triggered several editions of the Cognitive Rehabilitation in patients with memory disorders and Group Psychotherapy for for those who live this experience in the first person and for those who are next as a caregiver or simply as members of the family. The analysis of this best practice has been investigated from the methodological point of view through a survey of qualitative in-depth interviews with patients and family members involved in this project, in order to highlight how this initiative has brought an innovation and a positive change, oriented towards new models of health care.

Role of Cognitive Rehabilitation in Patients Suffering From Schizophrenia with a Comorbid Addiction to Amphetamine and Cannabis

Introduction An important element of the rehabilitation in schizophrenia is cognitive rehabilitation, aimed at the greatest possible reduction in deficits. Objective The aim of this study was to examine cognitive functioning in schizophrenic patients with a comorbid addiction to psychoactive substances participating in a cognitive rehabilitation program. Methods All recruited patients were men, aged between 20 and 45 years. They were examined in the initial period of the stay at the treatment center and after 4-7 weeks of hospitalization, after the stabilization of acute psychotic symptoms. During this time patients participated in the cognitive rehabilitation program. Cognitive function were assessed: Trail Making Test (TMT A & B), Stroop Test, and Verbal Fluency Test. Patients were divided into two groups according to abused substances: a) amphetamine users (n = 15), b) cannabis users (n = 11). As for the medication – 25 of 26 patients were treated with second generation antipsychotics. Results After the process of rehabilitation of cognitive functions of all gained patients gained a significant improvement. The type of abused psychoactive substance did not significantly affect cognitive functioning. However, amphetamine-dependent patients achieved better results in some of the cognitive tests. Cognitive rehabilitation does not affect the reduction of psychopathological symptoms. However, in patients addicted to amphetamines a decrease in the severity of these symptoms was found. Conclusions Cognitive rehabilitation exerts a positive effect on cognitive functioning of schizophrenic patients with concomitant dependence on psychoactive substances.

Gocce di memoria: la riabilitazione cognitiva come social innovation. Il caso Neuromed

Technological innovation, medical progress, demographic change, increased chronicity and new health risks are some factors that need and require a change towards new models of health care. The contribution is intended to describe a project defined as socially innovative, which relates to Rehabilitation, an initiative to support families and patients with memory problems and Alzheimer’s Neuro center of the Mediterranean Pozzilli, Isernia. The specialists of the health facility Molise triggered several editions of the Cognitive Rehabilitation in patients with memory disorders and Group Psychotherapy for for those who live this experience in the first person and for those who are next as a caregiver or simply as members of the family. The analysis of this best practice has been investigated from the methodological point of view through a survey of qualitative in-depth interviews with patients and family members involved in this project, in order to highlight how this initiative has brought an innovation and a positive change, oriented towards new models of health care.

Cognitive Rehabilitation in Patients with Multiple Sclerosis

Cognitive Rehabilitation in Patients with Multiple Sclerosis

NI-31 * USING TUMOR LOCALIZATION MAPS TO IDENTIFY BRAIN LOCATIONS INVOLVED IN COGNITIVE FUNCTIONING IN GLIOMA PATIENTS BEFORE THERAPY

BACKGROUND: Cognition is often affected in patients with brain tumors. Apart from language function, direct tumor effects on discrete cognitive functions have barely been studied. In this study, we quantify baseline cognitive functioning in seven cognitive domains and identify brain locations involved in these cognitive domains using tumor localization maps (TLMs), which is a new approach. METHODS: Adult patients with glioma treated at the VU University Medical Center between 2006-2011 with available preoperative neuropsychological assessment were included. Cognition was tested for verbal, visuospatial and working memory, attention, executive functioning, information processing speed, and visuoconstructive abilities. Cognitive performance was compared to matched healthy controls. Tumor volumes for TLMs were segmented on MRI fluid attenuated inversion recovery (FLAIR) hyperintense signal abnormality for low-grade gliomas, and MRI T1 contrast-enhanced abnormality for high-grade gliomas. For each cognitive domain, we applied TLMs to link cognitive performance with location throughout the brain at 1 mm resolution. Considerations for spatial dependence and multiple comparisons were taken into account. PRELIMINARY RESULTS: Seventy-four patients (50 with low-grade glioma, 22 with high-grade glioma and 2 with other histology) were included so far. Mean age of patients was 40 years. Compared to healthy controls, preoperative cognitive functioning was significantly impaired in five of seven domains. Most frequently affected were attention and working memory (30% and 21% of patients, respectively). We found no differences in cognitive domain scores between patients with low-grade and high-grade glioma. Tumor localization maps are currently being processed and statistically compared voxel-wise for each of the seven cognitive domains. Preliminary results of the TLMs demonstrate that performance in specific cognitive domains is associated with specific brain tumor locations. CONCLUSION: Empirical evidence on location of cognition can be used for optimizing brain tumor surgery and be integrated in counseling and cognitive rehabilitation for patients with newly-diagnosed glioma.

P16.12 * BRAIN LOCATIONS INVOLVED IN BASELINE COGNITIVE FUNCTIONING OF PATIENTS WITH GLIOMA BEFORE THERAPY

INTRODUCTION: Cognition is often affected in patients with brain tumors. Apart from language function, direct tumor effects on discrete cognitive functions have barely been studied. In this study, we quantify baseline functioning in seven cognitive domains and identify brain locations involved in these cognitive domains using tumor localization maps (TLMs), which is a new approach. METHODS: Adult patients with glioma treated at the VU University Medical Center between 2006-2011 with available preoperative neuropsychological assessment were included. Cognition was tested for verbal memory, visuospatial memory, working memory, attention, executive functioning, information processing speed, and visuoconstructive abilities. Cognitive performance was compared to healthy controls, matched for age, sex, and educational level. Tumor volumes for TLMs were segmented on MRI fluid attenuated inversion recovery (FLAIR) hyperintense signal abnormality for low-grade gliomas, and MRI T1 contrast-enhanced abnormality for high-grade gliomas. For each cognitive domain, we applied TLMs to link cognitive performance with location throughout the brain at 1 mm resolution. Considerations for spatial dependence and multiple comparisons were taken into account. PRELIMINARY RESULTS: Seventy-four patients (7 with WHO grade I, 43 with grade II, 12 with grade III, and 10 with grade IV glioma, and 2 with other histology) were included so far. Mean age of patients was 40 years. Preoperative cognitive functioning was significantly impaired in five of seven domains compared to healthy controls. Most frequently affected were attentional function and working memory capacity (30% and 21% of patients, respectively). No differences in cognitive domain scores were observed between patients with low-grade and high-grade glioma. Tumor localization maps are currently being processed and statistically compared voxel-wise for each of the seven cognitive domains. Preliminary results of the TLMs demonstrate that performance in specific cognitive domains is associated with specific brain tumor locations. CONCLUSION: Empirical evidence on location of cognition can be used for optimizing brain tumor surgery and be integrated in counseling and cognitive rehabilitation for patients with newly-diagnosed glioma.

Cognitive rehabilitation for people living with schizophrenia - the newest interventions

The article reviews the latest interventions in cognitive rehabilitation for patients with schizophrenia. Studies referring to cognitive rehabilitation for people with schizophrenia from the last three years, found in the PubMed database, are presented. The authors categorised cognitive rehabilitation trainings in terms of targeted cognitive spheres - neurocognitive training, social cognition training, emotion perception training and combined training - and present current trends within this approaches. Cognitive function improvements after cognitive remediation are specific to the rehabilitation target and there are no clear differences between training types in the way they influence other cognitive domains or symptoms. There is a need to heighten transfer of gained / enhanced cognitive skills to functional ones. Therefore new methods of cognitive remediation are explored . The future direction in cognitive rehabilitation is to enhance benefits by combining various forms of cognitive remediation and by emphasizing patient specificity in planning and conducting cognitive interventions.

Biomarkers and perfusion – training-induced changes after stroke (BAPTISe): protocol of an observational study accompanying a randomized controlled trial

BackgroundPhysical activity is believed to exert a beneficial effect on functional and cognitive rehabilitation of patients with stroke. Although studies have addressed the impact of physical exercise in cerebrovascular prevention and rehabilitation, the underlying mechanisms leading to improvement are poorly understood. Training-induced increase of cerebral perfusion is a possible mediating mechanism. Our exploratory study aims to investigate training-induced changes in blood biomarker levels and magnetic resonance imaging in patients with subacute ischemic stroke.Methods/designThis biomarker-driven study uses an observational design to examine a subgroup of patients in the randomized, controlled PHYS-STROKE trial. In PHYS-STROKE, 215 patients with subacute stroke (hemorrhagic and ischemic) receive either 4 weeks of physical training (aerobic training, 5 times a week, for 50 minutes) or 4 weeks of relaxation sessions (5 times a week, for 50 minutes). A convenience sample of 100 of these patients with ischemic stroke will be included in BAPTISe and will receive magnetic resonance imaging (MRI) scans and an additional blood draw before and after the PHYS-STROKE intervention. Imaging scans will address parameters of cerebral perfusion, vessel size imaging, and microvessel density (the Q factor) to estimate the degree of neovascularization in the brain. Blood tests will determine several parameters of immunity, inflammation, endothelial function, and lipometabolism. Primary objective of this study is to evaluate differential changes in MRI and blood-derived biomarkers between groups. Other endpoints are next cerebrovascular events and functional status of the patient after the intervention and after 3 months assessed by functional scores, in particular walking speed and Barthel index (co-primary endpoints of PHYS-STROKE). Additionally, we will assess the association between functional outcomes and biomarkers including imaging results. For all endpoints we will compare changes between patients who received physical fitness training and patients who had relaxation sessions.DiscussionThis exploratory study will be the first to investigate the effects of physical fitness training in patients with ischemic stroke on MRI-based cerebral perfusion, pertinent blood biomarker levels, and functional outcome. The study may have an impact on current patient rehabilitation strategies and reveal important information about the roles of MRI and blood-derived biomarkers in ischemic stroke.Trial registrationNCT01954797.

Modifications of Functional Connectivity of the Anterior Cingulum Correlate with Medium-Term Effects of Cognitive Rehabilitation in Patients with Multiple Sclerosis (P04.030)

Modifications of Functional Connectivity of the Anterior Cingulum Correlate with Medium-Term Effects of Cognitive Rehabilitation in Patients with Multiple Sclerosis (P04.030)

Data mining applied to the cognitive rehabilitation of patients with acquired brain injury

Acquired brain injury (ABI) is one of the leading causes of death and disability in the world and is associated with high health care costs as a result of the acute treatment and long term rehabilitation involved. Different algorithms and methods have been proposed to predict the effectiveness of rehabilitation programs. In general, research has focused on predicting the overall improvement of patients with ABI. The purpose of this study is the novel application of data mining (DM) techniques to predict the outcomes of cognitive rehabilitation in patients with ABI. We generate three predictive models that allow us to obtain new knowledge to evaluate and improve the effectiveness of the cognitive rehabilitation process. Decision tree (DT), multilayer perceptron (MLP) and general regression neural network (GRNN) have been used to construct the prediction models. 10-fold cross validation was carried out in order to test the algorithms, using the Institut Guttmann Neurorehabilitation Hospital (IG) patients database. Performance of the models was tested through specificity, sensitivity and accuracy analysis and confusion matrix analysis. The experimental results obtained by DT are clearly superior with a prediction average accuracy of 90.38%, while MLP and GRRN obtained a 78.7% and 75.96%, respectively. This study allows to increase the knowledge about the contributing factors of an ABI patient recovery and to estimate treatment efficacy in individual patients.

Multiple Sclerosis: Effects of Cognitive Rehabilitation on Structural and Functional MR Imaging Measures—An Explorative Study

To evaluate brain changes after cognitive rehabilitation in patients with clinically stable relapsing-remitting (RR) multiple sclerosis (MS) by using neuropsychologic assessment and structural and functional magnetic resonance (MR) imaging techniques. The study was conducted with approval of the involved institutional review boards. Written informed consent was obtained from each participant. Twenty patients with RR MS and cognitive deficits at baseline were randomly assigned to undergo treatment (n = 10), which entailed computer-assisted cognitive rehabilitation of attention and information processing and executive functions, or to serve as a control subjects (n = 10) without cognitive rehabilitation. All patients underwent a standardized neuropsychologic assessment and MR imaging at baseline and after 12 weeks. Changes in gray matter (GM) volumes on three-dimensional T1-weighted images and changes in normal-appearing white matter (NAWM) architecture on diffusion-weighted images were assessed. Changes in functional activity at functional MR imaging during the Stroop task and at rest were also investigated by using linear models. As compared with their performance at baseline, the patients in the treatment group improved at tests of attention and information processing and executive functions. Neither structural modifications to GM volume nor modifications to NAWM architecture were detected at follow-up in both groups. Functional MR imaging demonstrated modifications of the activity of the posterior cingulate cortex (PCC)/precuneus and dorsolateral prefrontal cortex (PFC) during the Stroop task, as well as modifications of the activity of the anterior cingulum, PCC and/or precuneus, left dorsolateral PFC, and right inferior parietal lobule at rest in the treatment group compared with the control group. In the treatment group, functional MR imaging changes were correlated with cognitive improvement (P < .0001 to .01). Rehabilitation of attention and information processing and executive functions in RR MS may be effected through enhanced recruitment of brain networks subserving the trained functions.

Predictors of Neuropsychological Improvement Following Cognitive Rehabilitation in Patients with Gliomas—Erratum

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Smart rehabilitation for the 21st century: The Tampa Smart Home for veterans with traumatic brain injury

INTRODUCTION In this editorial, we report on the development of a smart-home-based cognitive prosthetic that will deliver 24/7 rehabilitation at the James A. Haley Veterans' Hospital Polytrauma Transitional Rehabilitation Program (PTRP) facility in Tampa, Florida. The Tampa Smart Home was designed to address two weaknesses identified by PTRP clinicians in the rehabilitation process for patients with traumatic brain injury (TBI): (1) patient safety and (2) inadequate timing and repetition of prompts used to overcome TBI-related cognitive and memory deficits. Smart homes monitor residents' behaviors and provide assistance for various physical and neurological disabilities [1]. The Tampa Smart Home creates a pervasive supportive environment to assist cognitive rehabilitation in patients with TBI [2-3] by continuously identifying the movements and locations of all patient residents and clinical staff. The location information permits the intelligent software to deliver customized prompts and information to the patient via numerous interactive multimedia displays located on walls throughout the PTRP. The residential setting lends itself well to the enriched interactive rehabilitative environment, in which patients with TBI are immersed in their rehabilitation, and leverages the digital generation of veterans' active technology engagement to facilitate their own recovery [4]. A powerful feature of the Tampa Smart Home is the precision of the customized therapeutic information that can be provided to the recovering veteran. Individual-level data for every interaction with clinical and medical staff and with the interactive displays are recorded continuously and analyzed using state-of-the-art data mining, which, when fully implemented, will allow staff to visualize subtle but therapeutically significant behavioral changes to better inform treatment plans and potentially prevent untoward medication effects on veterans' memory, as well as gait and balance. This approach is expected to yield important insights into the cognitive recovery process by assisting therapists in targeting problem behaviors for remediation and then linking the behaviors to automata that ensure consistently provided therapy. Consistently delivered automated interventions will shorten recovery time while complementing or reducing therapist monitoring of patient locations and activities within the facility. BACKGROUND AND RELATED WORK Department of Veterans Affairs Polytrauma Centers The signature injuries of soldiers returning from Afghanistan and Iraq are polytrauma and TBI [5-6]. In the majority of Department of Veterans Affairs (VA) clinical cases, polytrauma and TBI are caused by blast injuries from improvised explosive devices, although TBI also results from noncombat events such as motor vehicle accidents. Polytrauma is defined as injuries to two or more body systems from one event. An extreme example would be injuries that simultaneously result in limb amputation, TBI, burns, deafness, and blindness, with long-term physical and cognitive impairments and functional disabilities. TBI, while part of the constellation of injuries encompassing polytrauma, is the most serious and common injury [5]. The variable emotional, cognitive, and behavioral consequences of TBI determine the specific course of rehabilitation [3]. Mild injuries, managed properly, have excellent recovery prospects; moderate to severe injuries require specialized care and intensive early rehabilitation and often require lifelong assistance to manage routine daily activities. The VA has four polytrauma centers that serve as regional centers for medical and rehabilitation care and hubs for research and education located in Minneapolis, Minnesota; Palo Alto, California; Richmond, Virginia; and Tampa, Florida. The comprehensive medical and rehabilitation services provided include acute medical care, outpatient programs, and PTRPs. …

Frontal stroke: Problem solving, decision making, impulsiveness, and depressive symptoms in men and women.

The present study compared men and women who suffered a frontal lobe stroke with regard to problem solving, decision making, impulsive behavior and depressive symptoms and also correlated these variables between groups. The sample was composed of 10 males and nine females. The study period was 6 months after the stroke. The following instruments were used: Wisconsin Card Sort Test (WCST), Iowa Gambling Task (IGT), Barrat Impulsiveness Scale (BIS11), and Beck Depression Inventory (BDI). For the exclusion criteria of the sample, the Mini International Psychiatric Interview (M.I.N.I Plus) and Mini Mental Stage Examination (MMSE) were used. To measure functional severity post-stroke, the Rankin Scale was used. The average age was 60.90 ± 8.93 years for males and 60.44 ± 11.57 years for females. In females, total impulsiveness (p = .013) and lack of planning caused by impulsiveness (p = .028) were significantly higher compared with males, assessed by the BIS11. These data indicate that females in the present sample who suffered a chronic frontal lesion were more impulsive and presented more planning difficulties in situations without demanding cognitive processing. These results that show gender differences should be considered when planning psychotherapy and cognitive rehabilitation for patients who present these characteristics.

Predictors of Neuropsychological Improvement Following Cognitive Rehabilitation in Patients with Gliomas

This study investigated the specific patient factors that predict responsiveness to a cognitive rehabilitation program. The program has previously been demonstrated to be successful at the group level in patients with gliomas, but it is unclear which patient characteristics optimized the effect of the intervention at the individual level. Four categories of possible predictors of improvement were selected for evaluation: sociodemographic and clinical variables, self-reported cognitive symptoms, and objective neuropsychological test performance. Hierarchical logistic regression analyses were conducted, beginning with the most accessible (sociodemographic) variables and ending with the most difficult (baseline neuropsychological) to identify in clinical practice. Nearly 60% of the participants of the intervention were classified as reliably improved. Reliable improvement was predicted by age (p = .003) and education (p = .011). Additional results suggested that younger patients were more likely to benefit specifically from the cognitive rehabilitation program (p = .001), and that higher education was also associated with improvement in the control group (p = .024). The findings are discussed in light of brain reserve theory. A practical implication is that cognitive rehabilitation programs should take the patients' age into account and, if possible, adapt programs to increase the likelihood of improvement among older participants.

Effects of growth hormone (GH) replacement and cognitive rehabilitation in patients with cognitive disorders after traumatic brain injury

Objective: To assess the effects of growth hormone (GH) treatment combined with cognitive rehabilitation in patients with adult growth hormone deficiency (GHD) and cognitive disorders occurring after traumatic brain injury (TBI).Participants: Nineteen adult patients with TBI: GHD was found in 11 of them.Intervention: Patients were treated with GH (GHD; sc; 1 mg/day) or vehicle (controls; sc; 1 mg/day); daily cognitive rehabilitation therapy was performed in both groups for 3 months.Main outcome measures: The GHRH–arginine test established GHD. The neuropsychological test WAIS was performed before commencing the treatment and 3 months after commencing it.Results: Controls achieved significant improvements in digits and in manipulative intelligence quotient (IQ) (p < 0.05 vs. baseline). GHD achieved significant improvements in more cognitive parameters: understanding, digits, numbers and incomplete figures (p < 0.05 vs. baseline) and similarities, vocabulary, verbal IQ, manipulative IQ and total IQ (p < 0.01). GHD reached significantly greater improvements than controls in similarities (p < 0.01) and in vocabulary, verbal IQ and total IQ (p < 0.05).Conclusion: GH administration significantly improved cognitive rehabilitation in GHD patients. Since at the end of treatment period plasma IGF-I levels were similar in both groups it is likely that exogenous GH administration is responsible for the significant differences found.

Activation and Effective Connectivity Changes Following Explicit-Memory Training for Face–Name Pairs in Patients With Mild Cognitive Impairment

Background. Mild cognitive impairment (MCI) is often a precursor to Alzheimer disease. Little research has examined the efficacy of cognitive rehabilitation in patients with MCI, and the relevant neural mechanisms have not been explored. The authors previously showed the behavioral efficacy of cognitive rehabilitation using mnemonic strategies for face–name associations in patients with MCI. Here, the authors used functional magnetic resonance imaging (fMRI) to test whether there were training-specific changes in activation and connectivity within memory-related areas. Methods. A total of 6 patients with amnestic, multidomain MCI underwent pretraining and posttraining fMRI scans, during which they encoded 90 novel face–name pairs and completed a 4-choice recognition memory test immediately after scanning. Patients were taught mnemonic strategies for half the face–name pairs during 3 intervening training sessions. Results. Training-specific effects comprised significantly increased activation within a widespread cerebral cortical network involving medial frontal, parietal, and occipital regions; the left frontal operculum and angular gyrus; and regions in the left lateral temporal cortex. Increased activation common to trained and untrained stimuli was found in a separate network involving inferior frontal, lateral parietal, and occipital cortical regions. Effective connectivity analysis using multivariate, correlation-purged Granger causality analysis revealed generally increased connectivity after training, particularly involving the middle temporal gyrus and foci in the occipital cortex and the precuneus. Conclusion. The authors’ findings suggest that the effectiveness of explicit-memory training in patients with MCI is associated with training-specific increases in activation and connectivity in a distributed neural system that includes areas involved in explicit memory.