Computer-based Cognitive Training Program Research Articles

Predicting Adherence to Computer-Based Cognitive Training Programs Among Older Adults: Study of Domain Adaptation and Deep Learning.

Cognitive impairment and dementia pose a significant challenge to the aging population, impacting the well-being, quality of life, and autonomy of affected individuals. As the population ages, this will place enormous strain on health care and economic systems. While computerized cognitive training programs have demonstrated some promise in addressing cognitive decline, adherence to these interventions can be challenging. The objective of this study is to improve the accuracy of predicting adherence lapses to ultimately develop tailored adherence support systems to promote engagement with cognitive training among older adults. Data from 2 previously conducted cognitive training intervention studies were used to forecast adherence levels among older participants. Deep convolutional neural networks were used to leverage their feature learning capabilities and predict adherence patterns based on past behavior. Domain adaptation (DA) was used to address the challenge of limited training data for each participant, by using data from other participants with similar playing patterns. Time series data were converted into image format using Gramian angular fields, to facilitate clustering of participants during DA. To the best of our knowledge, this is the first effort to use DA techniques to predict older adults' daily adherence to cognitive training programs. Our results demonstrated the promise and potential of deep neural networks and DA for predicting adherence lapses. In all 3 studies, using 2 independent datasets, DA consistently produced the best accuracy values. Our findings highlight that deep learning and DA techniques can aid in the development of adherence support systems for computerized cognitive training, as well as for other interventions aimed at improving health, cognition, and well-being. These techniques can improve engagement and maximize the benefits of such interventions, ultimately enhancing the quality of life of individuals at risk for cognitive impairments. This research informs the development of more effective interventions, benefiting individuals and society by improving conditions associated with aging.

The Effects of Remote Cognitive Training Combined With a Mobile App Intervention on Psychosis: Double-Blind Randomized Controlled Trial.

Impairments in cognition and motivation are core features of psychosis and strong predictors of social and occupational functioning. Accumulating evidence indicates that cognitive deficits in psychosis can be improved by computer-based cognitive training programs; however, barriers include access and adherence to cognitive training exercises. Limited evidence-based methods have been established to enhance motivated behavior. In this study, we tested the effects of web-based targeted cognitive and social cognitive training (TCT) delivered in conjunction with an innovative digital smartphone app called Personalized Real-Time Intervention for Motivational Enhancement (PRIME). The PRIME app provides users with a motivational coach to set personalized goals and secure social networking for peer support. This study investigated whether deficits in cognition and motivation in people with a psychosis spectrum disorder (N=100) can be successfully addressed with 30 hours of TCT+PRIME as compared with 30 hours of a computer games control condition (CG) plus PRIME (CG+PRIME). Here, we describe our study procedures, the feasibility and acceptability of the intervention, and the results on all primary outcomes. In this double-blind randomized controlled trial, English-speaking participants completed all cognitive training, PRIME activities, and assessments remotely. Participants completed a diagnostic interview and remote cognitive, clinical, and self-report measures at baseline, posttraining, and at a 6-month follow-up. This study included participants from 27 states across the United States and 8 countries worldwide. The study population was 58% (58/100) female, with a mean age of 33.77 (SD 10.70) years. On average, participants completed more than half of the cognitive training regimen (mean 18.58, SD 12.47 hours of training), and logged into the PRIME app 4.71 (SD 1.58) times per week. The attrition rate of 22% (22/100) was lower than that reported in our previous studies on remote cognitive training. The total sample showed significant gains in global cognition (P=.03) and attention (P<.001). The TCT+PRIME participants showed significantly greater gains in emotion recognition (P<.001) and global cognition at the trend level (P=.09), although this was not statistically significant, relative to the CG+PRIME participants. The total sample also showed significant improvements on multiple indices of motivation (P=.02-0.05), in depression (P=.04), in positive symptoms (P=.04), and in negative symptoms at a trend level (P=.09), although this was not statistically significant. Satisfaction with the PRIME app was rated at 7.74 (SD 2.05) on a scale of 1 to 10, with higher values indicating more satisfaction. These results demonstrate the feasibility and acceptability of remote cognitive training combined with the PRIME app and that this intervention can improve cognition, motivation, and symptoms in individuals with psychosis. TCT+PRIME appeared more effective in improving emotion recognition and global cognition than CG+PRIME. Future analyses will test the relationship between hours of cognitive training completed; PRIME use; and changes in cognition, motivation, symptoms, and functioning. ClinicalTrials.gov NCT02782442; https://clinicaltrials.gov/study/NCT02782442.

Possibilities of a computerized training program for recovery of the attention and memory function in vascular cognitive disorders

Aim of the study was to assess the possibilities of recovering the functions of attention and short-term memory in patients with vascular cognitive disorders using a computer program for cognitive training. Material and methods. The study included 17 cardiac surgery patients who underwent a course of cognitive training, starting from 3–4 days after surgery, daily for 5–7 days. The cognitive training program consisted of tasks stimulating the functions of selective attention, visuospatial and working memory. Results. Almost all patients (88 %) reported an acceptable level of subjective difficulty in the performing cognitive training. After completing the cognitive training program, the selective attention improved in 53 % of cases, working memory – in 67 %, the visuospatial memory test scores – in 47 % of patients. Conclusions. The computer-based cognitive training program showed acceptable subjective difficulty in cardiac surgery patients. Approximately 50 % of patients showed an improvement in trained cognitive functions at the final stage of training. The results of approbation of the cognitive training program give an opportunity to determine the degree of compliance of cognitive rehabilitation methods with the psychophysiological status of patients undergoing cardiac surgery, including in the late postoperative period.

Feasibility of a novel neurofeedback system: a parallel randomized single-blinded pilot study

Neurocognitive assessment tools have been proposed to optimize, maintain, and improve perceptual-cognitive performance. Here, we investigated the feasibility and efficacy of a novel neurofeedback system, neuroMoon (nM), on cognitive abilities compared with one of the most popular perceptual-cognitive training (PCT) tools both in sports and rehabilitation called NeuroTracker (NT). Thirty-one young athletes performed a comprehensive battery of cognitive tests from the Vienna Test System before and after a 12-session computer-based cognitive training program using nM (n = 11, age 22.6 ± 3.8 years), nM sham (CON, n = 10, age 20.3 ± 1.2 years) or NT (n = 10, age 20.5 ± 1.7 years) device. A series of repeated-measures ANOVA was performed to detect changes in cognitive abilities in response to the training. Participants had faster median reaction time in both the color-naming and word-reading conditions of the Stroop test (all p < 0.005), regardless of group. Regarding the task switching test, statistical analysis indicated faster working time and mean reaction time of the incongruent stimuli, repetition task, and shifting task (all p < 0.005), nevertheless, these changes were also regardless of group. In addition, we found fewer omitted (pre: 17.5 ± 8.3, post: 6.4 ± 1.5, d = 1.311) and more correct (pre: 261.6 ± 36.1, post: 278.6 ± 38.7, d = − 1.020) post-intervention answers in the determination test, regardless of group. Finally, participants in each group performed the digit span backward test with larger post (6.42 ± 1.54) vs. pre (5.55 ± 1.43) scores following the PCT (d = − 0.801). Overall, PCT with nM as compared with NT induced similar results in cognitive abilities suggesting its potential to be used to achieve and maintain better mental performance. However, considering that the sham stimulation also induced similar improvements in cognitive abilities, future studies should clearly determine the cognitive measures that could benefit from NF training.

Computer-Based Cognitive Training vs. Paper-and-Pencil Training for Language and Cognitive Deficits in Greek Patients with Mild Alzheimer's Disease: A Preliminary Study.

The purpose of the present study was to explore whether Computer-Based Cognitive Training (C-BCT) versus Paper-Pencil Cognitive Training (P-PCT) is more beneficial in improving cognitive and language deficits in Greek patients living with Alzheimer's disease (pwAD). Twenty pwAD were assigned to two groups: (a) the C-BCT group, receiving a computer-based cognitive training program using the RehaCom software, and (b) the P-PCT group, which received cognitive training using paper and pencil. The cognitive training programs lasted 15 weeks and were administered twice a week for approximately one hour per session. The analyses of each group's baseline versus endpoint performance demonstrated that the P-PCT group improved on delayed memory, verbal fluency, attention, processing speed, executive function, general cognitive ability, and activities of daily living. In contrast, the C-BCT group improved on memory (delayed and working), naming, and processing speed. Comparisons between the two groups (C-BCT vs. P-PCT) revealed that both methods had significant effects on patients' cognition, with the P-PCT method transferring the primary cognitive benefits to real-life activities. Our findings indicate that both methods are beneficial in attenuating cognitive and language deficits in pwAD. The need for large-scale neurobehavioral interventions to further clarify this issue, however, remains a priority.

SFEra APP: Description and Usability of a Novel Tablet Application for Executive Functions Training.

Executive functions include functions such as planning, working memory, inhibition, mental flexibility, and action monitoring and initiation, and are essential to carry out an independent everyday life. Individuals suffering from brain injury, such as a stroke, very commonly experience executive deficits that reduce the capacity to regain functional independence. In recent years, there has been a growing interest in developing tablet computer-based cognitive training programs for stroke patients and healthy aging adults since such programs can be included in non-supervised environments. In this respect, we described and evaluated the usability of a novel tablet application (app) for executive function training, developed in the context of the MEMORI-net project, a cross-border Italy-Slovenia program for the rehabilitation of stroke patients. We conducted a pilot study with a non-clinical sample of 16 participants to obtain information about the usability of the sFEra APP. Our descriptive analyses suggest that most users were satisfied with the overall experience and the app was highly usable, and instructions were clear, even with little previous experience with tablet applications. Acceptability and effectiveness will need to be evaluated in a clinical randomized controlled study.

The Effectiveness of GRADIOR: A Neuropsychological Rehabilitation Program for People with Mild Cognitive Impairment and Mild Dementia. Results of a Randomized Controlled Trial After 4 and 12 Months of Treatment.

Background: Computer-based cognitive training programs have been developed with promising results on the maintenance/improvement of cognitive performance in people with dementia.Objective: The objective was to evaluate the effectiveness of the cognitive rehabilitation program “GRADIOR” in people with mild cognitive impairment and mild dementia.Method: This study was a single-blind multicenter randomized clinical trial. Participants were recruited from hospitals/day centers. The experimental group (EG) and control group (CG) received computer-based cognitive training (CCT) and routine daily care, respectively. Outcome measures at T0: baseline, T1: at 4 months, T2: at 12 months were compared within and between-groups.Results: Significant differences or important effect sizes were detected at the intragroup and intergroup level for most variables, observing a trend of improvement and/or maintenance at 4 months by Visual Reasoning of Cambridge Cognitive Examination (CAMCOG), Digit and Arithmetic of WAIS-III, Semantic Verbal Fluency, Mini-Mental State Exam (MMSE), Trail Making Test (TMT)-A-Mistakes and at 12 months by Visual Reasoning of CAMCOG, Digit Symbol of WAIS-III, TMT-B-mistakes, Visual Memory of Rivermead Behavioural Memory Test, Lexical Verbal Fluency-P, Yesavage’s Geriatric Depression Scale (GDS), TMT-A-time scales whose objective was to evaluate some executive functions and/or the memory. The CG presented a worsening trend for most of the measures towards 12 months. There was also a significant interaction between “time and group” for MMSE (F = 8.971; p = 0.03; η2 = 0.019) and the GDS (F = 3.414; p = 0.04; η2 = 0.041), as well as small effect sizes for TMT-A-time (F = 1.641; p = 0.21; η2 = 0.021) and TMT-A-mistakes (F = 0.908; p = 0.41; η2 = 0.019).Conclusion: CCT with GRADIOR has been proved to benefit cognitive functions (ISRCTN:15742788).

Determinants of Adherence to a "GRADIOR" Computer-Based Cognitive Training Program in People with Mild Cognitive Impairment (MCI) and Mild Dementia.

Background: Computer-based programs have been implemented from a psychosocial approach for the care of people with dementia (PwD). However, several factors may determine adherence of older PwD to this type of treatment. The aim of this paper was to identify the sociodemographic, cognitive, psychological, and physical-health determinants that helped predict adherence or not to a “GRADIOR” computerized cognitive training (CCT) program in people with mild cognitive impairment (MCI) and mild dementia. Method: This study was part of a randomized clinical trial (RCT) (ISRCTN: 15742788). However, this study will only focus on the experimental group (n = 43) included in the RCT. This group was divided into adherent people (compliance: ≥60% of the sessions and persistence in treatment up to 4 months) and non-adherent. The participants were 60–90 age and diagnosed with MCI and mild dementia. We selected from the evaluation protocol for the RCT, tests that evaluated cognitive aspects (memory and executive functioning), psychological and physical health. The CCT with GRADIOR consisted of attending 2–3 weekly sessions for 4 months with a duration of 30 min Data analysis: Phi and Biserial-point correlations, a multiple logical regression analysis was obtained to find the adherence model and U Mann–Whitney was used. Results: The adherence model was made up of the Digit Symbol and Arithmetic of Wechsler Adult Intelligence Scale (WAIS-III) and Lexical Verbal Fluency (LVF) -R tests. This model had 90% sensitivity, 50% specificity and 75% precision. The goodness-of-fit p-value of the model was 0.02. Conclusions: good executive functioning in attention, working memory (WM), phonological verbal fluency and cognitive flexibility predicted a greater probability that a person would be adherent.

The effects of computer-based cognitive training program on reaction times of patients with early stage Alzheimer's disease and traumatic brain injury

Objective: Computer-Based Cognitive Training Programs (CBCT) are considered to be effective both in reducing cognitive deficits in the process of Alzheimer's disease (AD) and the treatment of cognitive dysfunction in patients with traumatic brain injury (TBI). This research aimed to investigate the effects of this program on reaction times of AD and TBI patients and to evaluate its applicability for patients with various levels of cognitive dysfunction. Material and Methods: The data of patients with early-stage Possible AD or TBI who had at least 20 sessions of the CBCT program because of cognitive dysfunctions were evaluated retrospectively. The age, gender, educational status, marital status, systemic diseases, family history for dementia, and disease duration of the patients were recorded. NoroSOFT® Cognitive Training Program was applied to all participants three days a week for eight weeks. The patients' total scores, total accuracy percentages, and total levels as well as the reaction times of all patients in the first and last session of their performance, were determined at the end of the program. Results: In this study, the data of 31 patients [17 Traumatic Brain Injury (54.8%), 14 Early-Stage Alzheimer's disease (45.2%)] who completed the CBCT Program were analyzed. The mean age of Alzheimer's patients was 73.28±4.89 years, and the mean age of TBI patients was 30.94 ± 12.24 years. The reaction times at the end of the program were significantly better in both groups than before (in TBI;14.55±7.32 sec, 7.23±3.07 sec p&lt;0.01 / in AD; 13.43±6.90 sec, 9.48±3.55 sec p&lt;0.01). Total memory scores were found to be significantly better in patients with TBI than in patients with AD (1404.64±435.87 points, 932.47±503.06 points p=0.01, respectively) at the end of the program. There was no drop-out of the patients and no side effects were reported during the program. Conclusion: CBCT programs are easily applicable and sustainable interventions in the patients with TBI and early-stage AD. Cognitive exercises may improve patients' reaction times and should be considered in routine treatment protocols.

Evaluation of a computer-based cognitive training program for early-stage Alzheimer’s disease

Evaluation of a computer-based cognitive training program for early-stage Alzheimer’s disease

NCOG-38. PREDICTORS OF COGNITIVE PERFORMANCE IN PATIENTS WITH PRIMARY BRAIN TUMORS: AN ANALYSIS OF BRAIN FITNESS CENTER (BFC) AT WALTER REED NATIONAL MILITARY MEDICAL CENTER

Abstract INTRODUCTION Although developed initially for patients with traumatic brain injury (TBI), cognitive rehabilitation training (CRT) has expanded its use to include patients suffering from a variety of neurocognitive disorders including neurologic malignancies. The Brain Fitness Center (BFC) at Walter Reed National Military Medical Center (WRNMMC) is a cognitive rehabilitation clinic that offers computer-based cognitive training programs as an adjunctive rehabilitation resource for a diverse patient population with cognitive complaints. METHODS Using a retrospective analysis of data from the BFC at WRNMMC, our study analyzed forty patients with primary brain tumors who had completed both symptom self-report questionnaires and cognitive assessments at the BFC. Self-report questionnaires included the neurobehavioral symptom inventory (NSI) and headache symptom inventory (HIT-6) while cognitive assessments were done using the Automated Neuropsychological Assessment Metrics (ANAM). Our study examined the relationship between subjective cognitive complaints, headache severity, neuropsychiatric symptoms and objective cognitive performance before and after initial CRT. The influence of high vs low grade tumors was also evaluated. RESULTS Our analysis demonstrated that increased number of affective symptoms, particularly self-reported irritability, were the strongest predictors of baseline, objective cognitive performance (r= -.377, p=0.008). Patient self-reported forgetfulness, but not overall subjective cognitive complaints, was also negatively correlated with objective cognitive performance (r= - 0.353, p= 0.020). A mean difference in objective cognitive performance between high grade and low grade tumors was also found (p=0.003). CONCLUSIONS Our results point to potential patient-level factors which could predict benefit from CRT including self-reported irritability, self-reported forgetfulness, and tumor grade. Further prospective studies will help to examine the true benefit of sustained CRT, and the subset of patients with CNS neoplasms most likely to benefit from this training.

Executive Function After Prenatal Alcohol Exposure in Children in a South African Population: Cross-sectional Study.

BackgroundAlcohol is a teratogen; its consumption during pregnancy can lead to negative birth outcomes, collectively referred to as fetal alcohol spectrum disorders. Neurodevelopmental delays in higher-order cognitive functions that affect development of executive functions are a common feature. Studies on executive function in children have focused on children diagnosed with fetal alcohol spectrum disorder, and there is a lack of information on the impact on children not diagnosed with fetal alcohol spectrum disorder but who had been exposed to alcohol.ObjectiveThe aim of this study was to compare the development of executive function in children between 4 and 6 years of age with and without prenatal exposure to alcohol.MethodsChildren both exposed and not exposed to alcohol were recruited as part of a feasibility RCT evaluating a computer-based cognitive training program for improving executive function development. The study was conducted in a low–socioeconomic status community in South Africa with a high prevalence of fetal alcohol spectrum disorder. Neurodevelopment was assessed in participating children; NEPSY-II standardized scores for executive function domains were compared using a multivariate analysis of variance with group membership as the predictor variable.ResultsNo significant differences in executive functions assessments (P=.39) were found between children in the alcohol-exposed group (n=76) and those in the nonexposed group (n=40). Both groups showed moderate to severe delays in domains. In all but one subtest, the average score for both groups was below the 25th percentile of expected norms.ConclusionsWe expected that alcohol exposure would have a measurable impact on executive function development. The lack of differences highlights the prevalence of developmental delays in low–socioeconomic status communities in South Africa and suggests that children are exposed to various threats to cognitive development.International Registered Report Identifier (IRRID)RR2-10.2196/14489

Methodological Designs Applied in the Development of Computer-Based Training Programs for the Cognitive Rehabilitation in People with Mild Cognitive Impairment (MCI) and Mild Dementia. Systematic Review.

In recent years, different computer-based cognitive training (CT) programs for people with dementia (PwD) have been developed following a psychosocial approach. Aim: This systematic review aims to identify the methodological designs applied in the development of computer-based training (CCT) programs for the rehabilitation of cognitive functioning in people with mild cognitive impairment (MCI) or mild dementia. Methods: A systematic review was conducted using the databases PubMed and PsycINFO. The search period was between 2000–2019. The study selection and data extraction processes were carried out by two independent reviewers. The protocol was registered in International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42020159027. Results: Thirteen studies met the inclusion criteria. The most frequently used methodological design in the development of CCT programs for people with MCI or mild dementia was the user-centered design (UCD). This design involves an interactive system characterized by the inclusion of end users from the initial stages of its development, throughout the establishment of functional requirements, and in the evaluation of the program’s usability and user-experience (UX). Conclusion: UCD was the most used methodological design for the development of CCT programs although there was quite some variation in how this design was applied. Recommendations for future studies about the development of CCT programs for people with MCI and mild dementia are given. Central focus should be the inclusion and active participation of end users from the initial stages of development.

Development of tablet personal computer-based cognitive training programs for children with developmental disabilities whose cognitive age is less than 4 years.

This study was to develop tablet personal computer-based cognitive training programs for children with developmental disabilities whose cognitive age is less than 4 years. Twelve cognitive training programs (named Injini) were designed comprising cognitive domains that included attention, visual and auditory perception, memory, executive function, language, and reasoning. In addition, programs related to learning experiences, such as self-regulation, role play, learning of number, and letter/shape concepts, comparison, classification, and pattern matching, were included. Six of 12 programs comprised approximately 10 levels for each program, with different difficulty levels. Other programs consisted of universal tasks that did not have a difficulty level. To ensure that the difficulty level was appropriate, we pre-tested the pilot version of Injini among 80 children with typical development aged 18 to 41 months. After modifying the pilot version, we developed the final version and tested it among 80 children with cognitive impairment whose cognitive age was 18 to 41 months. All children were assessed using the Bayley Scales of Infant and Toddler Development to determine their development and cognitive age. The difficulty level analyses in children with typical development revealed several inappropriate results wherein the success rate did not decrease with increase in level in some programs. After adjusting the difficulty level, the analyses in children with cognitive impairment demonstrated that the success rate gradually decreased with increasing level in all programs. Cognitive training programs for children with developmental disabilities were successfully developed.

Computer-based cognitive training for older adults: Determinants of adherence.

The possibilities of computer-based cognitive training (CCT) in postponing the onset of dementia are currently unclear, but promising. Our aim is to investigate older adults´ adherence to a long-term CCT program, and which participant characteristics are associated with adherence to the CCT. This study was part of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). Participants were 60-77-year-old individuals with increased dementia risk, recruited from previous population-based studies. The participants included in this study (n = 631) had been randomized to receive a multi-domain lifestyle intervention, including CCT. The measure of adherence was the number of completed CCT sessions (max = 144) as continuous measure. Due to a substantial proportion of participants with 0 sessions, the zero inflated negative binomial regression analyses were used to enable assessment of both predictors of starting the training and predictors of completing a higher number of training sessions. Several cognitive, demographic, lifestyle, and health-related variables were examined as potential predictors of adherence to CCT. Altogether, 63% of the participants participated in the CCT at least once, 20% completed at least half of the training, and 12% completed all sessions. Previous experience with computers, being married or cohabiting, better memory performance, and positive expectations toward the study predicted greater odds for starting CCT. Previous computer use was the only factor associated with a greater number of training sessions completed. Our study shows that there is a large variation in adherence to a long-lasting CCT among older adults with an increased risk of dementia. The results indicate that encouraging computer use, and taking into account the level of cognitive functioning, may help boost adherence to CCT.

Efficacy of a computer-based cognitive training program to enhance planning skills in 5 to 7-year-old normally-developing children

We designed and evaluated the efficacy of a computer-based cognitive training program (Executive Function Enhancement Program [EFEP]) to stimulate executive functions through enhancing planning in normally-developing children. A total of 111 Colombian children participated in the study. Fifty-nine (53%) of the children were assigned to the experimental condition (application of the EFEP program) with two levels of planning performance, and fifty-two (47%) to the waiting list control condition with the same two levels of planning. The training program was applied three times a week over six weeks, with post-intervention assessment two weeks after the end of training. A follow-up assessment was carried out three months later. Results showed that the intervention program was particularly effective in the children with lower pre-intervention performance in planning, demonstrating that the program is an efficient therapeutic instrument for enhancing the executive function of planning in children between 5 and 7 years old.

L’entraînement de la mémoire de travail est-il bénéfique pour les enfants présentant un trouble déficit de l’attention/hyperactivité ?

IntroductionChildhood attention-deficit/hyperactivity disorder is known to be associated with impairment across multiple domains, including social, familial, emotional and academic functioning. Available therapies, and in particular medical treatment, fail to produce lasting improvement in academic and learning outcomes. In this context, recent years have seen a growing interest of experts and practitioners for computer-based cognitive training programs. Indeed, it has been proposed that repeated training of specific executive functions may result in lasting benefits for children with ADHD, especially in the school setting. Cogmed RoboMemo, a program targeting working memory, is the cognitive training that has been the most extensively studied. Literature findingsMeta-analyses have established that the vast majority of children with ADHD present with decreased performance levels compared to typically developing children when performing working memory tasks. Working memory deficits, in turn, have been linked with classroom inattention and decreased academic performance. Based on these findings, models describing working memory deficits as a core feature of ADHD, accounting both for inattentive and hyperactive symptoms, have been proposed. In this theoretical context, interventions specifically targeting working memory deficits in ADHD appear as particularly promising. However, despite this solid theoretical background, meta-analyses of randomized controlled trials relying on the Cogmed RoboMemo program have consistently failed to evidence significant therapeutic effects on key targets, including ADHD symptoms or academic performance. These results suggest that early reports of clinical efficacy with non-blinded assessors were confounded by placebo and expectancy effects. DiscussionDifferent hypotheses have been proposed to explain this lack of significant therapeutic effect. First, it has been observed that Cogmed RoboMemo primarily targets the storage/rehearsal capacity of the child, whereas children with ADHD appear mostly impaired when performing tasks with a strong central executive load (i. e. requiring manipulation and dynamic updating of information). The Cogmed cognitive training program may therefore simply focus on the wrong element of working memory in the context of ADHD. Second, authors have questioned whether RoboMemo practice truly results in increased working memory capacity, proposing that children may simply learn task-specific strategies that they are unable to use in a broader context. In line with this idea, it has also been suggested that training in a non-ecological situation could be insufficient, if children with ADHD do not also learn strategies to apply the capacity acquired in the class context. Finally, one recent randomized control trial suggests that potential methodological limitations (lack of follow-up and/or limited training intensity) may have prevented previous studies from documenting the beneficial effects of the Cogmed program. ConclusionsMeta-analyses available to date indicate that claims regarding the academic, behavioral, and learning benefits associated with Cogmed RoboMemo are unsupported in ADHD. New studies with a follow-up assessment are needed to ensure that beneficial long-term effects of the program have not been overlooked. The development and evaluation of new cognitive training programs targeting the central executive component of working memory is warranted. More research is also necessary to help understand how working memory capacity of children with ADHD could be in improved in an ecological context.

Efficacy of a computer-based cognitive training program in older people with subjective memory complaints: a randomized study

ABSTRACTObjective: the aim of this study was to investigate the effect of computer-assisted cognitive training in healthy older adults with subjective memory complaints.Methods: Forty older adults, mean age (standard deviation) = 66.4 (5.6) with subjective memory complaints, were included in this study. Participants were randomly assigned to an integrated psychostimulation program (IPP) (N = 17), a computerized cognitive training (CCT) (N = 12) or a control group (N = 11). The training was applied for 8 weeks (90 min/d, 4 d/week for IPP, and 60 min/d, 4 d/week for CCT). Effectiveness was evaluated with a neuropsychological assessment battery, used before and after the implementation of the cognitive training.Results: According to the data analysis, with analysis of covariance (ANCOVA), we found a statistically significant change in the majority of the cognitive variables measured before and after the experimental conditions compared with the control group. Although, according to a paired t-test, the IPP was more effective in the improvement of cognitive functioning in the participants. Additionally, a decrease in anxiety symptoms was observed after the cognitive intervention in IPP and CCT conditions.Conclusion: Our findings suggested that cognitive training of moderate intensity, supported by a web platform, could lead to significant improvements in cognitive and psychological well-being in older people with subjective memory complaints.

COMPUTER-BASED COGNITIVE TRAINING IN MILD COGNITIVE IMPAIRMENT PATIENTS: PRELIMINARY RESULT

Cognitive therapy is the one of the non-pharmacological therapy of the dementia, is consisted of the cognitive stimulation, cognitive training and cognitive rehabilitation. Computer based cognitive training (CBT) is one of the efficient methods of cognitive training which improve cognitive functions among cognitively impaired elderly individuals. The objective of this study is to report the preliminary result of customer-designed training programs using tablet computer on training the mild cognitive impaired patients. Patients with diagnoses of amnestic mild cognitive impairment (AMCI) were included. We assessed patient information, and Mini-Mental Status Examination (MMSE). The Brain Health (Willis Memorial Hospital, Busan, South Korea) is used as the customer-designed training programs based on the tablet computer, which is training multi-domain and/or single cognition. Eligible AMCI patients were randomly assigned to either the Personal training (PT) or the Group training (GT). Participants attended a 12-week program, where they were required to spend at least 1 hour each course and 2 times per week to training the Brain Health. The efficacy was measured by the change of MMSE scale, and the satisfaction level was detected using a three-item Likert-type scale: satisfactory; ordinary; unsatisfactory. Five and six patients completed total 25 and 14 times of the scheduled program. The mean MMSE scores were increased after training in both PT and GT groups. The satisfaction scale was different in each group. All patients of the PT group reported ordinary or satisfactory, otherwise there were opinions of unsatisfactory about the CBT program in the GT group. The GT group's dissatisfaction reason was the feeling of pressure about disclosure of one's mistake or error during the program. The improvements of the MMSE score in both groups mean this customer-designed training programs based on the tablet computer might working to enhancement of memory in AMCI patients. However, the satisfaction was better in the PT group than in the GT group. The reason of the dissatisfaction, the feeling of pressure about disclosure of one's error, should be considered when the CBT programming in South Korea or Asian population.

Attention-memory training yields behavioral and academic improvements in children diagnosed with attention-deficit hyperactivity disorder comorbid with a learning disorder.

BackgroundRecent studies have suggested that children with attention-deficit hyperactivity disorder (ADHD) may benefit from computerized cognitive training. Therapy implementation is especially complicated when ADHD is associated with learning disorders (LDs). This study tested the efficacy of a computer-based cognitive training program, namely, computerized cognitive training (CCT), in children with ADHD comorbid with an LD (ADHD-LD), with or without psychostimulant medication.Materials and methodsAfter diagnostic evaluations, 27 children with ADHD-LD (8 unmedicated and 19 medicated) participated in CCT, which is intended to improve attention, memory, reasoning, visual processing, and executive functioning. The participants completed 24 1-hour sessions over 3 months. Neuropsychometric and standardized academic test results before and after training were compared to assess treatment efficacy. Shapiro–Wilk normality tests were applied, and subsequent Wilcoxon tests were used to identify significant differences in pre-versus post-training performance.ResultsAfter CAT, children diagnosed with ADHD-LD showed 1) improvements in trained skills, measured directly within the software and indirectly by external psychometric tests; 2) improvements in attention, memory, and some executive functioning; 3) improvements in academic performance, particularly in mathematics; and 4) reductions in maladaptive behavioral features.ConclusionThe present findings suggest that cognitive training programs should be explored further as potential adjunctive therapies to improve outcomes in children with ADHD-LD.