Cognitive Rehabilitation Interventions Research Articles

Emerging From the Haze™: Pilot Feasibility Study Comparing Two Virtual Formats of a Cognitive Rehabilitation Intervention.

To gather feasibility and preliminary data comparing two virtual delivery methods for providing Emerging From the Haze™ (Haze) to cancer survivors compared to waitlist control (WLC). Eligible participants (N = 93) reported cancer-related cognitive impairment following chemotherapy for stage I-III solid tumors, Hodgkin lymphoma, or non-Hodgkin lymphoma. A three-arm randomized design was used to compare virtual live group presentation of Haze sessions, virtual prerecorded Haze group sessions, and WLC. Data were collected at baseline, week 10, and week 14. Feasibility was demonstrated. Significant cognitive function improvement at week 10 versus WLC was reported for the live group, and clinical improvement was reported for the prerecorded group. The prerecorded group reported significant improvement at week 14 versus WLC in physical activity, sleep, and health-related quality of life. Additional pilot and feasibility evidence for cognitive rehabilitation interventions was demonstrated. Prerecorded Haze delivery shows potential for clinical effectiveness and scalability. Future multisite research is warranted.

Web-based cognitive rehabilitation intervention for cancer-related cognitive impairment following chemotherapy for aggressive lymphoma: protocol for a randomised pilot trial

IntroductionCancer-related cognitive impairment is common among people diagnosed with and treated for cancer. This can be a distressing and disabling side effect for impacted individuals. Interventions to mitigate cognitive dysfunction...

Conceptual framework for tinnitus: a cognitive model in practice

Tinnitus is a conscious attended awareness perception of sourceless sound. Widespread theoretical and evidence-based neurofunctional and psychological models have tried to explain tinnitus-related distress considering the influence of psychological and cognitive factors. However, tinnitus models seem to be less focused on causality, thereby easily misleading interpretations. Also, they may be incapable of individualization. This study proposes a Conceptual Cognitive Framework (CCF) providing insight into cognitive mechanisms involved in the predisposition, precipitation, and perpetuation of tinnitus and consequent cognitive-emotional disturbances. The current CCF for tinnitus relies on evaluative conditional learning and appraisal, generating negative valence (emotional value) and arousal (cognitive value) to annoyance, distress, and distorted perception. The suggested methodology is well-defined, reproducible, and accessible, which can help foster future high-quality clinical databases. Perceived tinnitus through the perpetual-learning process can always lead to annoyance, but only in the clinical stage directly cause annoyance. In the clinical stage, tinnitus perception can lead indirectly to distress only with experiencing annoyance either with (“Ind-1C\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\underset{{\\mathcal {C}}}{{{\\varvec{Ind-1}}}}}$$\\end{document}” = 1.87; 95% CI 1.18–2.72)[“1st indirect path in the Clinical stage model”: Tinnitus Loudness →\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\rightarrow$$\\end{document} Attention Bias →\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\rightarrow$$\\end{document} Cognitive-Emotional Value →\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\rightarrow$$\\end{document} Annoyance →\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\rightarrow$$\\end{document} Clinical Distress]or without (“Ind-2C\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\underset{{\\mathcal {C}}}{{{\\varvec{Ind-2}}}}}$$\\end{document}”= 2.03; 95% CI 1.02–3.32)[ “2nd indirect path in the Clinical stage model”: Tinnitus Loudness →\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\rightarrow$$\\end{document} Annoyance →\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\rightarrow$$\\end{document} Clinical Distress] the perpetual-learning process. Further real-life testing of the CCF is expected to express a meticulous, decision-supporting platform for cognitive rehabilitation and clinical interventions. Furthermore, the suggested methodology offers a reliable platform for CCF development in other cognitive impairments and supports the causal clinical data models. It may also enhance our knowledge of psychological disorders and complicated comorbidities by supporting the design of different rehabilitation interventions and comprehensive frameworks in line with the “preventive medicine” policy.

Cognitive Impairment following Mild Traumatic Brain Injury (mTBI): A Review.

Background: Mild Traumatic Brain Injury (mTBI) has been increasingly recognized as a public health concern due to its prevalence and potential to induce long-term cognitive impairment. We aimed to consolidate this observation by focusing on findings of neuropsychological assessments, neuroimaging, risk factors, and potential strategies for intervention to prevent and treat mTBI-associated cognitive impairments. Methods: A thorough search of PubMed, PsycINFO, and Embase databases was performed for studies published until 2024. Studies focusing on cognitive impairment after mTBI, with neurocognitive assessment as a primary outcome, were included. Results: We found consistent evidence of cognitive deficits, such as memory and attention impairments, and affected executive functions following mTBI. Neuroimaging studies corroborate these findings, highlighting structural and functional changes in the brain. Several risk factors for developing cognitive impairment post-mTBI were identified, including age, gender, genetics, and pre-existing mental health conditions. The efficacy of interventions, including cognitive rehabilitation and pharmaceutical treatment, varied across studies. Conclusions: Mild TBI can lead to significant long-term cognitive impairments, impacting an individual's quality of life. Further research is necessary to validate and standardize cognitive assessment tools post-mTBI, to elucidate the underlying neural mechanisms, and to optimize therapeutic interventions.

Correlation between the degree of cognitive impairment and emotional state in patients with Alzheimer’s disease.

This study aimed to investigate the correlation between cogni-tive dysfunction and emotional state in patients with Alzheimer’s disease and then propose intervention strategies. One hundred twenty-five patients with Alzheimer’s disease from June 2019 to May 2022 were selected as the study subjects and divided into two groups based on the degree of cognitive impair-ment, both receiving routine drug treatment and cognitive rehabilitation in-tervention. The Montreal Cognitive Assessment (MoCA) and the Positive and Negative Affect Scale (PANAS) were used to evaluate the cognitive function and emotional status of two groups of patients before the intervention and four and eight weeks of intervention and to analyze the correlations between the two. The results showed statistically significant differences between the two groups MoCA and PANAS scores (P<0.05). Before the intervention, the patient’s MoCA score was positively correlated with the PANAS positive emo-tion score and negatively correlated with the PANAS negative emotion score (P<0.05). After four and eight weeks of intervention, the patient’s MoCA score was positively correlated with the PANAS positive emotion score (P<0.05) and negatively correlated with the PANAS negative emotion score (P<0.05).

Empowering Minds and Bodies: The Impact of Exercise on Multiple Sclerosis and Cognitive Health.

Multiple sclerosis (MS) is a global health concern affecting around 2.6 million people. It is characterised by neural inflammation, myelin breakdown and cognitive decline. Cognitive impairment, especially reduced cognitive processing speed (CPS), which affects up to 67% of MS patients and frequently manifests before mobility concerns, is one of the disease's most serious side effects. Effective adaptation and the application of cognitive rehabilitation treatments depend on the early diagnosis of cognitive impairment. Although pharmaceutical therapies have some drawbacks, endurance training has become a promising alternative. Intensity-controlled endurance exercise has the ability to delay the onset of MS symptoms and enhance cognitive function. Exercise has also been shown to have neuroprotective effects in a number of neurological disorders, including MS, Parkinson's disease and stroke. This includes both aerobic and resistance training. A mix of aerobic exercise and weight training has shown promise, especially for people with mild cognitive impairment, but according to recent studies any amount of physical activity is beneficial to cognitive performance. In conclusion, this in-depth analysis highlights the crucial part endurance exercise plays in treating MS-related cognitive impairment. It improves not only neurological health in general but also cognitive performance. Exercise can help control MS in a way that dramatically improves quality of life and well-being.

Cognition in vestibular disorders: state of the field, challenges, and priorities for the future.

Vestibular disorders are prevalent and debilitating conditions of the inner ear and brain which affect balance, coordination, and the integration of multisensory inputs. A growing body of research has linked vestibular disorders to cognitive problems, most notably attention, visuospatial perception, spatial memory, and executive function. However, the mechanistic bases of these cognitive sequelae remain poorly defined, and there is a gap between our theoretical understanding of vestibular cognitive dysfunction, and how best to identify and manage this within clinical practice. This article takes stock of these shortcomings and provides recommendations and priorities for healthcare professionals who assess and treat vestibular disorders, and for researchers developing cognitive models and rehabilitation interventions. We highlight the importance of multidisciplinary collaboration for developing and evaluating clinically relevant theoretical models of vestibular cognition, to advance research and treatment.

Changes in patients’ religiosity related to dementia

Dementia is characterized by the presence of progressive cognitive and behavioral symptoms which affect normal functioning. With the purpose of determining if there are any changes related to patients’ religiosity due to dementia, we developed a questionnaire aiming to evaluate changes pre and post diagnostic. In effect, we observed that patients with dementia might experience a reduction of the importance given to religion and its associated practices with the disease progression. However, God’s belief did not show any changes despite the diagnosis. Therefore, we point out the relevance of incorporating religiosity as another aspect to take into account in the cognitive rehabilitation treatments.

ADVANCING RESEARCH ACROSS THE ADRD CONTINUUM IN UNDERREPRESENTED POPULATIONS

Abstract This symposium highlights innovative work advancing ADRD research with African Americans, Latinos, and Arab Americans. Included papers address critical issues along the ADRD spectrum from life course risk factors, through mild cognitive impairment (MCI), to dementia caregiving. Investigating links between the early-life environment and later-life ADRD risk, Dr. Tsotsoros examines cognitive correlates of adverse childhood experiences (ACEs) in two disparate samples, demonstrating the need to characterize risk pathways among older Latina women, who are at increased risk of both ACEs and ADRD. Using nationally representative data, Dr. Esiaka focuses on adult risk factors for ADRD among Black men. She shows that neighborhood physical disorder and poor sleep quality represent key risk factors for worse cognitive health in this critically understudied population. Moving along the ADRD continuum, Dr. Darwish focuses on another severely underrepresented group: Arab American immigrants with MCI. Based on in-depth work with older adults in Lebanon, she details cultural adaptations made in the development of a combined cognitive-behavioral and cognitive rehabilitation intervention for this group. Next, Dr. Bouldin uses nationally representative data on African American, Latino, and non-Latino White older adults with dementia to quantify racial/ethnic differences in the prevalence and correlates of caregiver support service use. Findings highlight both risk and resilience among dementia caregivers from minoritized racial/ethnic groups. Finally, Cerise Elliott from the National Institute on Aging (NIA) will offer perspectives on how disaggregating population subgroups through between- and within-group research designs can advance NIA’s goal of understanding and eliminating racial/ethnic inequalities across the ADRD continuum. This is an Alzheimer’s Disease and Related Dementias Interest Group Sponsored Symposium.

PERCEIVED COGNITIVE FUNCTION: RELATIONSHIPS WITH DIABETES COMPLICATIONS AND SELF-EFFICACY IN LATINX OLDER ADULTS

Abstract Cognitive dysfunction is a concern for individuals with type 2 diabetes (T2DM) and can affect diabetes self-management. However, it is often overlooked clinically and remains relatively understudied in Latinx older adults as a complication of T2DM. This project sought to explore the relationships between perceived cognitive dysfunction and its effects on self-efficacy and complications of T2DM in older Latinx adults. This was part of an analysis of baseline data from a larger randomized controlled trial investigating an cognitive rehabilitation intervention for older adults with T2DM. A total of 87 participants (mean age 67.3 +/- 5.4) completed a survey consisting of the Diabetes Empowerment Scale - short form (self-efficacy); PROMIS Bank v.2 - Cognitive Function (perceived cognitive function); and a self-report of number and type of diabetes complications. Participants had lower perceived cognitive dysfunction than the general population (Mean total score: 36.6 +/- 7.9); low self-efficacy (mean total score: 2.3 +/- 0.7) and reported at least 2 complications related to T2DM. Greater perceived cognitive dysfunction was related to lower self-efficacy (p = 0.04). Diabetes duration was positively associated with self-efficacy (p = 0.03), but not perceived cognitive dysfunction (p = 0.22). Self-efficacy was positively associated with number of diabetes complications (p = 0.03). Irrespective of diabetes duration, patients with more severe perceived cognitive dysfunction reported lower self-efficacy (p = 0.03) than those with lower levels of cognitive dysfunction. Assessment of cognitive function may help inform patient education interventions for Latinx older adults to improve the self-efficacy and potentially reduce complications.

Post COVID‐19 cognitive rehabilitation effects on depressive symptoms

AbstractBackgroundMore than 600 million people have been infected by Covid‐19 since the beginning of the pandemic. Common cognitive and psychological symptoms in these patients are memory impairment, attention difficulties, anxiety and depression, and neuropsychological rehabilitation is a possible strategy to improve them. In addition, some studies have shown a decrease in depressive symptoms after starting a cognitive rehabilitation program, although this was not the main objective of rehabilitation.MethodFive patients underwent mood assessment, more specifically, depressive symptoms. For this, the Patient Health Questionnaire‐9 (PHQ‐9) was used. The application was made immediately before and after the cognitive rehabilitation intervention, lasting 20 weekly sessions of about one hour of activity.ResultThe evaluation was performed on five patients with a mean age of 52.5 years (Table 1). These presented measures that indicated the presence of depressive symptoms at the beginning of the study. After 20 sessions of cognitive rehabilitation it was not possible to observe an objective change in depressive symptoms. This can be explained by the reduced number of individuals in the sample, which may have impaired the statistical calculation. But it was observed a clinical improvement of depressive symptoms was observed in 60% of patients and 40% remained stable (Table 2). Clinical improvement was also noted in patients, who reported that they were feeling better and that they resumed activities that they have previously avoided or that they were finding it easier, in addition to perceiving their own evolution throughout the treatment, increasing their sense of self‐efficacy and feeling more hopeful.ConclusionFinally, it is noted that cognitive rehabilitation is a possible strategy to improve not only cognitive impairment, but also the clinical manifestations of depressive symptoms in post‐Covid‐19 patients.

The role of group motivation in post COVID‐19 cognitive rehabilitation treatment

AbstractBackgroundCognitive rehabilitation is an effective treatment for remission of cognitive symptoms resulting from various pathologies. In Long Covid, it is known that the occurrence of cognitive symptoms is a result of the action of the virus in the brain, but the effectiveness of this technique for such patients has not yet been described. Furthermore, there is evidence that rehabilitation has its effect enhanced when individuals are engaged in treatment. Thus, the present report aims to describe the experience of a group of patients with cognitive symptoms from Long Covid undergoing cognitive rehabilitation treatment and discuss the effect of their motivation.MethodWe performed a cognitive rehabilitation intervention for individuals with cognitive symptoms after COVID‐19 infection. Six patients were followed up in 20 sessions and motivation and engagement were observed based on attendance at sessions and from patients ́ speeches during the therapeutic process.ResultThe participants had an average of 80% attendance at cognitive rehabilitation sessions. They also reported on the important role that the group played in the treatment, such as understanding that they were not the only individuals who had difficulties, which motivated them to continue the treatment and not give up, despite the fact that it was long (20 sessions). It was also noticed that the encouragement between them, based on the supportive relationships that were formed in the groups, was important to keep them focused on recovery.ConclusionParticipants in a group can identify with each other and realize that their difficulties are also present in others, which can help to face the difficulties of the treatment process and favor additional motivation. Thus, it is recommended that rehabilitation treatment be carried out in groups of patients. Lastly, interpersonal relationships among group members represent support and increased social support networks.

Analysis of the effectiveness of cognitive rehabilitation for patients with chronic mental illness: A meta-analysis

BACKGROUND People suffering from chronic mental illness are sensitive to stressful stimuli, lack coping skills, and have low self-esteem due to problems such as social situations. They also experience depression, isolation, fear, and frustration. Due to cognitive dysfunction, people suffering from chronic mental illness have inadequate cognitive processes that lead to distorted thinking. AIM To confirm the effectiveness of cognitive rehabilitation therapy in improving cognitive function and alleviating behavioral and psychological symptoms in patients with chronic mental illness, and to identify the cognitive function that had the main effect. METHODS The quality of the studies was evaluated using the Assessment of Multiple Systematic Reviews criteria, and data published from 2011 to December 2022 were searched using PubMed, Cochrane, RISS, KISS, and DBpia. The keywords used in the search were “mental illness,” “cognitive rehabilitation,” “cognition,” and “mental.” A meta-analysis was conducted on the 12 selected papers. RESULTS The level of evidence for the 12 documents was that of a randomized experimental study. Intervention types in cognitive rehabilitation can be divided into cognitive behavior, cognitive training, cognitive rehabilitation, and computerized cognitive programs. Most of the studies were on schizophrenia, and the measurement areas were cognitive functions (e.g ., concentration, memory, and executive function) as well as depression, sociability, and quality of life. As a result of the meta-analysis of each variable, the effect size for cognitive rehabilitation treatment was in the following order: Sociability, memory, concentration, executive function, quality of life, and depression. Particularly, sociability and memory exhibited significant effects. CONCLUSION Cognitive rehabilitation aids cognitive function and sociability in patients with chronic mental illness and can be used as evidence for cognitive rehabilitation in mental health and occupational therapy.

Improve the management of cancer-related cognitive impairment in clinical settings: a European Delphi study.

Cancer-related cognitive impairment (CRCI) is under-addressed by healthcare professionals owing to a lack of clinical management guidelines. This European Delphi study proposes recommendations to healthcare professionals for the management of CRCI in patients with non-central nervous system (non-CNS) cancers. Twenty-two recommendations were developed based on a literature review and authors' clinical experience, split into three categories: screening, cognitive assessment, intervention. The survey included European professionals, experts in CRCI. The Delphi method was used: experts rated the clinical relevancy of recommendations on a 9-point Likert scale in three rounds. A recommendation was accepted if all votes were between 7 and 9. Recommendations not accepted in round 1 and round 2 were deleted, or modified and rated in round 3. Eighteen professionals (psychologists, physicians, researchers) voted and accepted 15 recommendations. Experts recommended the systematic screening of CRCI, followed by a short objective cognitive assessment, if complaints screened. A comprehensive evaluation is recommended if CRCI persists 6 months post-treatment. Cognitive rehabilitation, physical activity, meditative-movement therapy, and multimodal intervention should be offered. Recommendations about frequency and duration of interventions, the professional to administer cognitive rehabilitation and the use of meditation and cognitive training without psychoeducation were not accepted. This survey provides 15 recommendations to assist healthcare professionals in detecting, assessing and offering interventions for CRCI. These recommendations should be included in supportive care to help healthcare professionals to detect CRCI and propose the best available intervention for patients with cognitive complaints. Developing CRCI management in clinical settings would improve patients' quality of life.

26 Improvement in Executive Function Following Goal-Oriented Attentional Self-Regulation Training in Veterans with mTBI

Objective:Goal-Oriented Attentional Self-Regulation (GOALS) is a cognitive rehabilitation training that targets difficulties with executive control functions. Prior research has found that GOALS training improves executive function, functional outcomes, and PTSD symptoms in Veterans with comorbid PTSD and TBI. The objective of this study is to assess the effects of GOALS training versus an active time-matched Behavioral Health Education (BHE) intervention in military Veterans with history of mTBI and executive function difficulties.Participants and Methods:Thirty-four veterans with a history of mild TBI (>6 months post-injury) and cognitive difficulties were randomized to GOALS or BHE group intervention. GOALS is a cognitive rehabilitation intervention that incorporates mindfulness-based attention regulation training, and goal management strategies applied to participant-defined goals. It consists of ten 2-hour sessions administered in small group format, and three individual 1-hour sessions. The BHE group is a matched control condition that mirrors GOALS in terms of duration and level of involvement. Participants completed a comprehensive evaluation consisting of neuropsychological and ecologically valid functional performance measures of complex attention and executive function, before and after GOALS or BHE intervention. Overall neuropsychological attention/executive functioning included measures of working memory (Letter Number Sequencing, Auditory Consonant Trigrams), mental flexibility (Design & Verbal Fluency Switching, Trails B, Stroop Inhibition/Switching), inhibition (Stroop Inhibition), and sustained attention (Digit Vigilance). The Goal Processing Scale (GPS) was used to measure ecologically valid complex functional performance.Results:Post GOALS training, but not post BHE, participants significantly improved on measures of attention /executive function including overall performance (p=.02), working memory (p=.04), sustained attention (p=.03)., and inhibition (p=.01). On measures of complex functional task performance, post GOALS participants significantly improved in the domain of planning (p=.02).Conclusions:GOALS training improved performance on neuropsychological and ecologically valid functional measures of complex attention and executive function in Veterans with mild TBI and cognitive difficulties. The current study highlights how mindfulness-based attention regulation and goalmanagement strategies applied to personal goals has positive effects across various outcomes. A percentage of individuals with mTBI continue to report persistent problems with cognition and daily functioning. Cognitive rehabilitation training such as GOALS may be beneficial for those with persistent difficulties following mTBI, even in chronic phase.

3 Optimizing Cognitive Rehabilitation of the Injured Warfighter

Objective:Many individuals who experienced a mild traumatic brain injury (mTBI) have persistent cognitive complaints. Traditional cognitive rehabilitation (TCR) interventions were primarily developed for severe neurological injury which has limited effectiveness in rehabilitation of active duty military personnel who have the goal of returning to full military operational status. To remain on active duty, warfighters must have sufficient mental competency to safely and effectively function in complex environments such as combat. There is need for a cognitive rehabilitation approach that addresses demands of military personnel to expedite return to duty. The Strategic Memory Advanced Reasoning Training (SMART) program is novel alternative to TCR. SMART is an evidence-based advanced reasoning protocol that enhances cognitive domains essential to military readiness (e.g., mental agility, strategic learning, problem solving, and focus) and requires less than half of the treatment time. The objective of this study was to assess the efficacy of SMART compared to TCR in terms of overall recovery as well as change in specific cognitive domains.Participants and Methods:Participants were recruited from a military treatment facility. All patients had at least one diagnosed mTBI as well as persistent cognitive complaints. Participants completed the Rey-15 to ensure performance validity. Final sample was SMART n = 28 and SCORE n = 19. Primary dependent measure was the Global Deficit Scale (GDS). GDS was calculated from: Hopkins Verbal Learning Test-Revised (HVLT-R); Delis Kaplan Executive Functioning System Color Word (CW) and Trail Making (TM), Paced Auditory Serial Addition Test (PASAT), and the Symbol Digit Modality Test (SDMT). Demographically corrected t-scores were converted to deficit scores as follows: >40 = 0, 35-39 = 1, 30-34 = 2, 25-29 = 3, 20-24 = 4, <20 = 5. Deficit scores were averaged to calculate GDS. For each measure, Hohen’s g was analyzed for effect size comparisons pre-post treatment.Results:Average number of treatment hours was significantly lower in the SMART condition (SMART: M = 18.47 hours, SD = 2.17; TCR: M = 42.42 hours, SD = 3.79, p <.001). A repeated measures ANOVA showed a significant change on GDS post-treatment (F = 30.25, p < .001) with a large effect size (n2 = .402); however, the interventions did not differ on GDS change. Impact on cognitive domains was relatively equivalent for processing speed (SMART h = 0.67 vs TCR h = -.54) and executive function (SMART h = -0.92 vs TCR h = -.85); however, SMART had a larger impact on memory (SMART h = -0.81 vs TCR h = -.39). SMART resulted in large improvements in retention and recognition memory which were minimally impacted by TCR.Conclusions:Both TCR and SMART had comparable effectiveness in improving cognitive impairment, though SMART was completed in less than half of the treatment time. Both interventions had large effect sizes on processing speed and executive functioning; however, SMART was more effective in improving long-term memory. Memory is an integral part of military readiness. Further investigation is required to determine the relative effectiveness of these two approaches to improving cognitive readiness of the warfighter.

74 A Phase I Trial of Accelerated, HighDose Repetitive Transcranial Magnetic Stimulation to Improve Cognition in Amnestic MCI

Objective:Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation therapy most widely used in depression, has shown evidence of secondary benefits for cognition in both neurologic and neuropsychiatric conditions. The recent development of more efficient stimulation protocols, such as accelerated high-dose intermittent theta burst (iTBS)-rTMS, has substantially reduced treatment burden by shortening the treatment course by >50%. This study aimed to establish the safety, feasibility, acceptability, and preliminary efficacy of iTBS-rTMS as a tool for bolstering cognition in individuals with amnestic mild cognitive impairment (aMCI).Participants and Methods:Twenty-four patients with aMCI were enrolled in an open-label phase I trial of iTBS-rTMS; 2 withdrew prior to initiating treatment due to personal circumstances. All participants had received a diagnosis of MCI due to possible AD from a healthcare provider (i.e., neurologist or neuropsychologist) and met actuarial neuropsychological criteria for aMCI. This sample of older adults (range: 61.5-85.2 years, M = 74.1, SD = 5.71) was predominantly White/non-Hispanic (n = 23; Black/non-Hispanic: n = 1), roughly half female (n = 13), with a college education (range: 12-20 years, M = 15.9, SD = 2.5). Participants received 24 sessions of iTBS-rTMS to the left dorsolateral prefrontal cortex over 3 days (8 sessions each, lasting roughly 2 hours per day). Participants rated their perceptions and experience of common side effects during and after each treatment session as well as retrospectively at post-treatment and 4-week follow-up. They completed structural and functional brain MRI, neuropsychiatric evaluations, and neuropsychological assessments before and after treatment and were administered a subset of these measures at 4-week follow-up. MoCA scores were used to monitor for adverse neurocognitive effects, and the fluid cognition composite score from the NIH Toolbox Cognition Battery was used to test preliminary efficacy.Results:We achieved a high retention rate (95%), with 21 of the 22 participants completing all study procedures. There were no clinically significant adverse neuroradiological, neuropsychiatric, or neurocognitive effects of treatment. Participant reports indicated high tolerability and acceptability, with a modal rating of 0 (on a scale from 0=not at all to 10=extremely) for six common side effects (i.e., headache, pain, scalp irritation, facial twitching, fatigue, fear/anxiety), assessed both during and after each treatment session. They reported very low desire to quit despite some participants rating the treatment as moderately tiring. We observed significant, large effect-size (d = 0.98) improvements in fluid cognition from pre- to post-treatment.Conclusions:Our findings support the safety, feasibility, and acceptability of iTBS-rTMS treatment in patients with aMCI. Further, although not explicitly dosed for efficacy, we provide preliminary evidence of improved fluid cognition as a function of treatment, highlighting the potential of this treatment for improving trans-domain cognitive impairment. These promising results can directly inform future trials aimed at optimizing treatment parameters, broadening the indication to other MCI subtypes, and testing the augmentation of established cognitive rehabilitation interventions when combined with rTMS.

Improving cognition in people with multiple sclerosis: study protocol for a multiarm, randomised, blinded trial of multidomain cognitive rehabilitation using a video-serious game (E-SEP cognition)

IntroductionMultiple sclerosis (MS) is a prevalent neurological disease characterised by disseminated areas of demyelination and atrophy within the central nervous system, inducing cognitive disorders in 45%–65% of persons with MS...

Symposium 11: Military TBI: Neural and Clinical Correlates of Cognitive Function

Summary Abstract:This symposium will highlight recent advances in understanding, assessment, and treatment of the effect traumatic brain injury has on cognitive functioning in military Service Members and Veterans. Since 2000, U.S. Service Members have sustained over 450,000 brain injuries, the majority of which are mild. Although TBI mechanisms and characteristics among Service Members can differ from civilians in significant ways, research being conducted at Department of Defense and Veterans Affairs sites to address this problem can also yield benefits to civilians with TBI. Four presentations will focus on various aspects of TBI evaluation and treatment based on findings from their own research. Dr. Mark Ettenhofer will present findings relating to promising new eye tracking measures and their relationship to standardized cognitive test results among Service Members with mild traumatic brain injury. Next, Dr. Victoria Merritt will examine the role of symptom attribution on treatment-seeking Veterans with a remote history of traumatic brain injury. In particular, Dr. Merritt will be examining both self-reported symptoms as well as performance on objective neurocognitive tests. Dr. Jason Bailie will describe an ongoing study comparing a novel approach to cognitive rehabilitation, Strategic Memory Advanced Reasoning Training (SMART), to traditional cognitive rehabilitation interventions in Active Duty Service Members. The results of this study have significant implications for treatment of all individuals with chronic symptoms following mTBI, regardless of military status. Finally, Dr. Jared Rowland will present findings on the influence of mild traumatic brain injury and blast exposure on the relationship between brain function, cognitive outcomes, and symptom severity in a sample of Iraq and Afghanistan combat veterans. This study will demonstrate how the relationship between aspects of the functional connectome and cognitive function are changed by TBI and blast. Overall, these studies highlight novel approaches to the understanding, assessment, and treatment of TBI being implemented in the Department of Defense and Veterans Affairs that have high applicability to the civilian population.

Computer-assisted cognitive rehabilitation in neurological patients: state-of-art and future perspectives.

Advances in computing technology enabled researchers and clinicians to exploit technological devices for cognitive training and rehabilitation interventions. This expert review aims to describe the available software and device used for cognitive training or rehabilitation interventions of patients with neurological disorders. A scoping review was carried out to analyze commercial devices/software for computerized cognitive training (CCT) in terms of feasibility and efficacy in both clinical and home settings. Several cognitive domains responding to the different patients' needs are covered. This review showed that cognitive training for patients with neurological diseases is largely covered by several devices that are widely used and validated in the hospital setting but with few translations to remote/home applications. It has been demonstrated that technology and software-based devices are potential and valuable tools to administer remotely cognitive rehabilitation with accessible costs. According to our results, CCT entails the possibility to continue cognitive training also in different settings, such as home, which is a significant breakthrough for the improvement of community care. Other possible areas of use should be the increase in the amount of cognitive therapy in the free time during the hospital stay.