Cognitive Rehabilitation Techniques Research Articles

Cognitive impairment and its treatment in patients with multiple sclerosis

Cognitive impairment (CI) is a relatively common manifestation of multiple sclerosis (MS), which can occur with any type of the disease course and activity. The largest CI prevalence and severity are observed in progressive MS. In relapsing-remitting MS the most prominent deterioration of cognitive functions is seen during relapses; however, in some patients it can continue also throughout remission. In a small number of patients CI can be the most significant symptom of the disease; in addition, it sometimes can be the only clinical feature of the relapse. Despite this, in clinical practice CI remains out of the focus of attention, and is not evaluated when assessing the disease severity and/or activity, while CI is not included into EDSS. Nonetheless, a number of specialized neuropsychological tests and batteries has been developed recently, which can be used for both screening and detailed assessment of CI in MS, as well as for assessment of its changes over time. CI has a negative impact on MS patients' quality of life, their social interactions, daily and occupational activities. The influence of disease-modifying agents on CI has been poorly investigated; however, there is evidence that they can reduce the degree of CI. The optimal choice of pathogenetic treatment in patients with CI remains understudied. There is no convincing evidence of the effectiveness of symptomatic pharmacological treatment of CI in MS, and cognitive rehabilitation is the only approach with confirmed effectiveness. Considering the limitations of this technique (its availability, quite a big number of sessions), there is a need to search for other methods to increase its efficacy, including non-invasive neuromodulation (in particular, transcranial direct current stimulation or transcranial magnetic stimulation). This article is focused on a brief review of the main diagnostic methods of CI in MS, its pathogenetic and symptomatic treatment, and cognitive rehabilitation techniques, as well as on the results of the studies on non-invasive neuromodulation.

The Savant Syndrome: a Gift or a Disability? A Deeper Look into Metabolic Correlates of Hidden Cognitive Capacity.

Savant syndrome is a rare and unusual condition that occurs in the presence of severe developmental disabilities, disorders, and injuries. The syndrome can be congenital from birth to childhood or acquired as a result of a brain injury or damage to the central nervous system. There are several findings that indicate that savant syndrome usually occurs with significant brain metabolism alterations resulting in critical brain network changes. These types of changes in the brain are usually explained by the "tyranny of the left hemisphere" theory, which indicates the inhibition of the left hemisphere to allow the right hemisphere to develop savant abilities. Another way to temporarily simulate these types of changes in the brain can be through different neuromodulation techniques such as transcranial magnetic stimulation and transcranial direct current stimulation. Such neuromodulation techniques might help us discover the "hidden talent" potential through modulating the brain network metabolism. We herein discussed the types of savant syndrome along with its relation to specific neurometabolic network alterations. Furthermore, we provide a perspective on how newly developed neuromodulation and cognitive rehabilitation techniques can help simulate savant syndrome in healthy individuals through modulating the brain network activity.

Сognitive rehabilitation methods in multiple sclerosis patients

The prevalence of cognitive impairment in patients with multiple sclerosis is 40 to 65%. Improvement of cognitive-oriented therapy and search for its new techniques is considered to be promising for slowing the progression or for recovery of cognitive functions. It is related to low efficacy of medical treatment, preserved neuroplasticity in most patients with multiple sclerosis, positive results of studies on selected cognitive rehabilitation techniques in other nervous system disorders. The spectrum of techniques for cognitive training varies from technically feasible methods using a sheet of paper and a pen to the most advanced ones, such as the use of immersive virtual reality. The effectiveness of cognitive rehabilitation in patients with multiple sclerosis with virtual reality technologies has not been studied in large-scale randomized placebo-controlled studies.

Rationale and methodology for examining the acute effects of aerobic exercise combined with varying degrees of virtual reality immersion on cognition in persons with TBI

Persons with Traumatic Brain Injury (TBI) commonly present with long-term cognitive deficits in executive function, processing speed, attention, and learning and memory. While specific cognitive rehabilitation techniques have shown significant success for deficits in individual domains, aerobic exercise training represents a promising approach for an efficient and general treatment modality that might improve many cognitive domains concurrently. Existing studies in TBI report equivocal results, however, and are hampered by methodological concerns, including small sample sizes, uncontrolled single-group designs, and the use of suboptimal exercise modalities for eliciting cognitive improvements in this population. One particularly promising modality involves the application of environmental enrichment via virtual reality (VR) during aerobic exercise in persons with TBI, but this has yet to be investigated. One approach for systematically developing an optimal aerobic exercise intervention for persons with TBI involves the examination of single bouts of aerobic exercise (i.e., acute aerobic exercise) on cognition. Acute exercise research is a necessary first step for informing the development of high-quality exercise training interventions that are more likely to induce meaningful beneficial effects. To date, such an acute exercise paradigm has yet to be conducted in persons with TBI. To that end, we propose an acute exercise study that will investigate the acute effects of aerobic exercise with incremental degrees of environmental enrichment (VR) relative to a control comparison condition on executive function (divided attention and working memory) and processing speed in 24 people with TBI.

Effectiveness of Cognitive Rehabilitation on Agitation, Apathy and Cognitive Function in Male Elders with Mild Cognitive Impairment

Introduction: The elders need proper medical and psychiatric care and attention, so choosing a suitable therapeutic approach for their psychological care, especially in those with cognitive impairment, will be effective in improving psychological symptoms and their health. The present study aimed to investigate the effectiveness of cognitive rehabilitation on agitation, apathy and cognitive function.
 
 Methods: This quasi-experimental study carried out among male elders with mild cognitive impairment (MCI) in Kahrizak Charity nursing home in Alborz province in 2020. A sample of 36 male elders with MCI was purposefully selected and randomly assigned to experimental (n = 18) and control (n = 18) groups. Data were collected through Cohen-Mansfield Agitation Inventory; Apathy Evaluation Scale and Montreal Cognitive Assessment-Basic. The intervention group received 8 sessions of 90 minutes, cognitive rehabilitation based on kelly and O'Sullivan's cognitive rehabilitation strategies and techniques.
 
 Results: After controlling the mean scores of the pretest, a significant difference was observed in agitation (96.6 vs 101.9) apathy (30.02 vs 34.10) and cognitive function (19.60 vs 16.80) between experimental and control groups. This means that cognitive rehabilitation reduced agitation and apathy with effect sizes of 0.42 and 0.54 respectively and increased cognitive function with an effect size of 0.65.
 
 Conclusion: Considering the effectiveness of cognitive rehabilitation in reducing agitation, apathy and increasing cognitive function of the participants, cognitive rehabilitation is suggested to improve individual functioning and interpersonal relationships in the elderly with MCI.

Practitioners’ knowledge, acceptability and use of external memory aids with individuals with cognitive deficits: An exploratory study

ABSTRACT External memory aids (EMA) are within the most effective cognitive rehabilitation techniques, having demonstrated a positive impact in terms of memory functioning in individuals with multiple cognitive deficits. Despite its proven efficacy, there is yet poor dissemination of these techniques in clinical settings. The current study aims to evaluate the level of knowledge, degree of use, and usage expectations of EMAs by health practitioners, responsible to implement these techniques. A quantitative, descriptive, and cross-sectional study was developed, and 120 practitioners working with cognitively impaired patients participated in the study. One questionnaire was developed to assess participants’ knowledge and use of EMAs. Results indicate that the level of global knowledge regarding EMAs is poor, despite superior to its actual use. The degree of perceived acceptance of these prosthetics by their users is positive and stronger than the likelihood of practitioners to use these tools with their patients. This study suggests that the actual implementation of EMAs as rehabilitation tools is still poor, despite the growing evidence-based research highlighting its effectiveness to compensate for cognitive deficits. Future studies should target the current factors that are influencing the underutilization of EMAs, to improve and optimize its dissemination and to benefit cognitively impaired patients.

Neurocognitive Rehabilitation in COVID-19 Patients: A Clinical Review.

: COVID-19 has affected many people all around the world for more than two years now have suffered many long-term consequences which is commonly referred to as long-haulers. Despite multiorgan complaints in long haulers, symptoms related to cognitive functions commonly referred as brain fog are seen in the high risk covid patients with age more than 50, women more than men, obesity, asthma and those who experienced more than five symptoms during the first week of covid illness. Long term isolation has certainly contributed to high level of anxiety and stress calling for an empathetic response to this group of covid patients as there is no specific test to detect long haulers and no specific cognitive rehabilitation techniques available as of today.

70925 A TL1 team approach to investigate attention and learning at the intracranial network level and assess the effect different cognitive rehabilitation strategies have on measures of attention and learning

ABSTRACT IMPACT: Access to intracranial recording in our epileptic sample provides a unique opportunity to characterize neurological activation patterns associated with attention and implicit learning; this foundational physiological understanding will serve to better guide cognitive rehabilitation techniques in TBI patients that aim to improve functioning across these cognitive domains. OBJECTIVES/GOALS: 1) Investigate the network level interactions of attention and learning during an attention network task (ANT) and an implicit learning contextual cueing (CC) task. 2) Assess the effect that attention rehabilitation strategies have on behavioral and neural responses pre/post-attentional intervention. METHODS/STUDY POPULATION: This study involves refractory epilepsy patients (rEP) with implanted intracranial electrodes and moderate-to-severe traumatic brain injury (m/sTBI) survivors. In rEP, we are identifying network level modulations of cortical regions via the ANT, which probes components of attention (alerting, orienting, and executive control) and a CC task that probes implicit learning. We hypothesize that modulation of attention and learning can be seen at the neuronal level. In TBI we will assess improvement following two behavioral attention rehabilitation paradigms; and use our results from epileptic patients to guide measurement of treatment-related neuroplastic change via scalp electroencephalography. RESULTS/ANTICIPATED RESULTS: Preliminary behavioral results from the rEP cohort are in line with previous studies and the intracranial data is suggestive of region- and task-specific modulations in memory and attention related systems. Following completion of recruitment, we expect to more concretely identify regions and networks that exhibit modulatory effects associated with attention and implicit learning. Additionally, we anticipate that deficits in attention will be mitigated following training and hypothesize that implicit learning rate will improve in TBI patients as a result of both attentional rehabilitation paradigms. DISCUSSION/SIGNIFICANCE OF FINDINGS: Characterizing intracranial activity in epilepsy patients will give electrophysiology data unattainable in TBI patients. This intracranial perspective will enable us to propose mechanisms of action that may result from our interventions and enable critique of current rehabilitation treatments.

Management of Cognitive Impairment After Stroke

In this review, we present the reader with the latest diagnostic and therapeutic approaches in the management of patients with post-stroke cognitive impairment (PSCI). We discuss the most commonly utilized and validated neuropsychological assessments and neuroimaging diagnostic assessment tools. We also provide a critical appraisal of the pharmacological treatment approaches of PSCI, in addition to highlighting the latest emerging non-pharmacological and technological advances in cognitive rehabilitation techniques. Advanced MRI techniques and newer PET tracers are being utilized heavily in research into cognitive impairment. Non-invasive brain stimulation (NIBS), computer-based cognitive training (CBCT), and virtual reality (VR)–based rehabilitation are playing an increasing role in recent trials of cognitive rehabilitation techniques of PSCI patients. In approaching patients with PSCI, neuropsychological assessment and neuroimaging should be undertaken to aid in the diagnosis and classification of underlying pathological processes. Aggressive vascular risk factor modification, in addition to the use of cholinesterase inhibitors, is the recommended pharmacological treatment approach in these patients. This should be accompanied by encouraging exercise and prescribing conventional cognitive rehabilitation, while attempting to incorporate newer technological treatment modalities such as NIBS, CBCT, and VR. We identified a significant need for future research into treatment modalities aimed at PSCI and vascular dementia (VaD).

Pre-attention and Working Memory in ADHD: A 25-Year Follow-Up Study

Objective: The aim of the study was to compare the development of working memory and preliminary stages of attentional processing in individuals with ADHD over a 23- to 25-year period. Method: Individuals with ADHD (n = 19) and healthy controls (n = 26) were followed up after 13 years (T2) and 23 to 25 years (T3) after initial assessment (T1). They were reassessed with diagnostic measures and the Backward masking task (pre-attention) and the Digit span distractibility test with and without distraction conditions (working memory). Results: The ADHD group performed below the healthy controls on all time points on the Digit span distractibility test. On the distractibility condition, we found a selective decline in performance from T2 to T3 for the ADHD group. Conclusion: The results highlight that ADHD individuals continue to display working memory deficits, also in adulthood, thus creating an imperative for cognitive rehabilitation techniques to help address attention difficulties.

Feasibility and potential effects of interdisciplinary home-based reablement program (I-HARP) for people with cognitive and functional decline: a pilot trial

Objectives: To test feasibility and potential effects of the interdisciplinary Home-bAsed Reablement Program (I-HARP) that integrates evidence-based strategies and cognitive rehabilitation techniques into a dementia-specific, bio-behavioural-environmental intervention.Methods: A parallel-group randomised controlled pilot trial was conducted in Sydney, Australia, targeting community-dwelling people with amnestic mild cognitive impairment or mild/moderate stages of dementia and their carer (n = 18 dyads). I-HARP comprised: up to 12 home visits by registered nurse, occupational therapist, and psychologist, tailored to the individual client’s needs; <A$1000 for home modification/assistive devices; and individual carer support, all provided over four months. Additional allied health services were recommended when necessary. Clients’ daily activities, mobility, mood, caregiver burden, and quality of life were assessed at baseline, four months and 12 months. Semi-structured interviews were conducted with I-HARP participants post intervention.Results: Of 51 dyads who expressed interest in participation, 25 were eligible, with 76% consent rate (19/25 eligible dyads consented), and high adherence to the program (all nine intervention group participants completed and complied). Challenges included: need for better carer and allied health support, with more targeted recruitment points to speed up the process. The I-HARP group showed favourable effects across most outcomes at short-term (4 months) and longer-term (12 months) assessments. However, wide Confidence Intervals (CIs) point to the degree of uncertainty around interpretation of these results.Conclusion: The delivery of I-HARP, a dementia-specific reablement program and the trial design concerning randomisation, screening and consent procedures, were deemed feasible, acceptable and appropriate for the target population group. Building on the success and lessons from the pilot, a larger trial is currently underway.

An overview of repetitive transcranial magnetic stimulation (rTMS) in Alzheimer’s disease

Background. Alzheimer’s disease (AD) is the most frequent neurocognitive disorder. It affects 50% to 75% of the cases of dementia, and is characterized by a progressive cognitive decline that hinders behavior and functionality. Its etiology is still uncertain, and the efficiency of treatments is limited. Repetitive transcranial magnetic stimulation (rTMS) has been used as an alternative therapeutic strategy, but the clinical impact on Alzheimer’s disease has hardly been studied. Objective. To describe the effects of rTMS on cognition, the behavioral and psychological symptoms of dementia (BPSD), and functionality, considering the various modes of application. Method. The PubMed, ScienceDirect, and PsycInfo databases were consulted using key words relating to the topic of study. Articles published between 2006 and 2016 were selected. Results. The studies that have assessed the clinical effect of rTMS have used various parameters to stimulate and compare the different cortical areas, principally the dorsolateral prefrontal cortex. A variety of benefits have been proposed for patients with Alzheimer’s disease in cognitive domains such as language and episodic memory, as well as behavior and functionality in everyday activities. Discussion and conclusion. rTMS has been suggested as a possible treatment for AD, and the results indicate the need for further studies with different methodological designs and more participants, in addition to cognitive rehabilitation techniques. The objective is to identify the most efficient parameters for stimulation and to explore new cortical targets.

Effectiveness of Animal Assisted Therapy after brain injury: A bridge to improved outcomes in CRT.

Animal Assisted Therapy (AAT) has been widely used as a complementary therapy in mental health treatment especially to remediate social skill deficits. The goal of AAT is to improve social, emotional, and cognitive functioning. The purpose of this article is to draw upon the literature on AAT and explore specific applications to cognitive rehabilitation therapy (CRT) and social skills training. This study provides a systematic review of most of the available literature on ATT and assesses that potential uses of ATT for brain injury rehabilitation. Although the efficacy of AAT is not currently well documented by rigorous research, (Kazin, 2010) anecdotal evidence suggests that brain injury survivors may benefit from the combination of AAT and cognitive rehabilitation techniques. Acquired Brain Injury (ABI) survivors with cognitive impairments can benefit from AAT as part of a comprehensive and holistic rehabilitation treatment plan.

A systematic review of pediatric cognitive rehabilitation in the elementary and middle school systems.

Cognitive Rehabilitation Therapy (CRT) is efficacious in remediating cognitive deficits, and has been demonstrated to be effective in a school setting. The purpose of this paper is to review the literature on pediatric CRT as it relates to successful re-integration of TBI survivors into the school system and community. This systematic review of the literature suggests that social re-integration strategies which incorporate problem-solving, reasoning, self-awareness, and positive social skills within a developmental framework are the most effective techniques for Pediatric CRT. Children and adolescents with cognitive impairments benefit from a holistic approach to rehabilitation which incorporates developmental, social, and emotional considerations, as well as, cognitive rehabilitation techniques. This systematic review identifies several avenues for effective therapeutic interventions for school aged TBI survivors. Many are supported by laboratory based efficacy studies. Future research should investigate optimal ages for particular treatments, as well as, the effectiveness of treatments across different social settings.

Cognitive Impairment and Rehabilitation Strategies After Traumatic Brain Injury.

Traumatic brain injury (TBI) is among the significant causes of morbidity and mortality in the present world. Around 1.6 million persons sustain TBI, whereas 200,000 die annually in India, thus highlighting the rising need for appropriate cognitive rehabilitation strategies. This literature review assesses the current knowledge of various cognitive rehabilitation training strategies. The entire spectrum of TBI severity; mild to severe, is associated with cognitive deficits of varying degree. Cognitive insufficiency is more prevalent and longer lasting in TBI persons than in the general population. A multidisciplinary approach with neuropsychiatric evaluation is warranted. Attention process training and tasks for attention deficits, compensatory strategies and errorless learning training for memory deficits, pragmatic language skills and social behavior guidance for cognitive-communication disorder, meta-cognitive strategy, and problem-solving training for executive disorder are the mainstay of therapy for cognitive deficits in persons with TBI. Cognitive impairments following TBI are common and vary widely. Different cognitive rehabilitation techniques and combinations in addition to pharmacotherapy are helpful in addressing various cognitive deficits.

Systematic Implementation of Cognitive Rehabilitation Techniques in an Outpatient Brain Injury Treatment Setting

To implement a process to assure consistent use of evidence-based cognitive rehabilitation procedures by therapists in an outpatient brain rehabilitation setting.

A review of postoperative cognitive dysfunction: Diagnostic and rehabilitation

Postoperative cognitive dysfunction is a very common event after cardiac surgery, especially in elder patients and with lower education levels. The prevention of POCD should be done using a few simple features before surgery and during surgery, such as corticosteroids before surgery to reduce inflammation of the brain, which affect cognition. When possible, the anesthetic technique must be performed using the bispectral index (BIS) for controlling the length and depth of surgical anesthesia. The use of anesthetics that cause less damage in cognition in relation to other drugs that are already established as POCD trigger can also be the best way. The use of imaging tests that facilitate the research of cognitive disorders such as the use of structural and functional MRI or EEG for the accuracy of the survey brain region affected and that affected functions are good resources for cognitive rehabilitation. The cognitive rehabilitation techniques are very diversified as the use of digital games and activities that stimulate neuropsychological functions. The use of direct electrical current stimulation (tDCS) or of other electrical stimulation techniques can help the patient on rehabilitation of cognitive functions during the postoperative period. Key-Words : Traumatic brain injury, cognitive rehabilitation therapy, adults, cognitive scales, well-being, functional status. Trial registration : This trial will be registered at www.clinicaltrials.gov

EPA-1657 – The impact of a neuropsychological rehabilitation group program (NRGP) on cognitive and emotional functioning in institutionalized elderly

Introduction Cognitive rehabilitation techniques, reminiscence therapy, and reality orientation therapy, have shown an impact on cognition, life satisfaction, mood, and on the progression of cognitive decline in elderly. Objectives To test the effectiveness of a NRGP on the cognitive and emotional functioning of institutionalized elderly. Methods . Design single blind randomized controlled study with paired groups. Participants Coimbra institutionalized elderly, aged between 64-92 (N = 88) with cognitive impairment no dementia, mostly women (75.0%). Intervention randomization of participants to the rehabilitation group/RG (n = 41) and to the comparison/waiting-list group/CG (n = 23). NRGP involved groups of five elders, and took 90 min. per day, once a week, for 10 weeks. Measurements Mini-Mental State Examination/MMSE, Frontal Evaluation Battery/FAB, Geriatric Depression Scale/GDS. Analysis We used general linear model with repeated measures analysis of variance. Results RG improved significantly on cognitive, and executive function (p Conclusions A NRGP including cognitive rehabilitation, reminiscence therapy, and reality orientation proved to be effective on cognitive and executive functioning, and on depressive symptoms of institutionalized elders with cognitive impairment no dementia.

Nonpharmacological enhancement of cognitive function in Parkinson's disease: A systematic review

Cognitive decline and dementia are frequent in patients with Parkinson's disease (PD). The evidence for nonpharmacological therapies in Alzheimer's disease and other dementias has been studied systematically, but the evidence is unclear for their efficacy in cognition and dementia in PD. An international collaboration produced a comprehensive, systematic review of the effectiveness and of nonpharmacological and noninvasive therapies in cognitively intact, cognitively impaired, and PD dementia groups. The interventions included cognitive rehabilitation, physical rehabilitation, exercise, and brain stimulation techniques but excluded invasive treatments, such as surgery and deep brain stimulation. The potential biases and evidence levels for controlled trials (CTs) were analyzed based on Cochrane and National Institute for Health and Clinical Excellence criteria. After exclusions, 18 studies were reviewed, including 5 studies of cognitive training, 4 of exercise and physical therapies, 4 of combined cognitive and physical interventions, and 5 of brain stimulation techniques. The methodology, study populations, interventions, outcomes, control groups, analyses, results, limitations, biases, and evidence levels of all reviewed studies were described. There were 9 CTs, including 6 randomized CTs (RCTs). Although 5 trials showed positive results, only 1 study of cognitive training achieved evidence grading of 1+ with a low risk of bias. There were no studies on PD dementia. Current research on nonpharmacological therapies for cognitive dysfunction and dementia in PD is very limited in quantity and quality. There is an urgent need for rigorous RCTs of nonpharmacological treatments for cognitive impairment and dementia in PD.

Mnemonic strategy training partially restores hippocampal activity in patients with mild cognitive impairment

Learning and memory deficits typify patients with mild cognitive impairment (MCI) and are generally attributed to medial temporal lobe dysfunction. Although the hippocampus is perhaps the most commonly studied neuroanatomical structure in these patients, there have been few attempts to identify rehabilitative interventions that facilitate its functioning. Here, we present results from a randomized, controlled, single-blind study in which patients with MCI and healthy elderly controls (HEC) were randomized to either three sessions of mnemonic strategy training (MS) or a matched-exposure control group (XP). All participants underwent pre- and posttraining fMRI scanning as they encoded and retrieved object-location associations. For the current report, fMRI analyses were restricted to the hippocampus, as defined anatomically. Before training, MCI patients showed reduced hippocampal activity during both encoding and retrieval, relative to HEC. Following training, the MCI MS group demonstrated increased activity during both encoding and retrieval. There were significant differences between the MCI MS and MCI XP groups during retrieval, especially within the right hippocampus. Thus, MS facilitated hippocampal functioning in a partially restorative manner. We conclude that cognitive rehabilitation techniques may help mitigate hippocampal dysfunction in MCI patients.