Effects Of Cognitive Intervention Research Articles

Effects of donepezil on cortical metabolic response to activation during 18FDG-PET in Alzheimer’s disease: a double-blind cross-over trial

Cholinergic enhancement is among the best established treatments of Alzheimer's disease (AD). The cognitive effects of treatment are thought to be mediated by improvement of neuronal transmission. Positron emission tomography using 18F-fluorodeoxyglucose (FDG-PET) by measuring cortical metabolic response to activation assesses integrity of neuronal transmission in vivo. To determine the effects of treatment with donepezil, a centrally selective acetylcholinesterase inhibitor, on cortical metabolism in AD using 18FDG-PET. We enrolled 23 patients, 18 of which completed the study, with mild to moderate probable AD (mini-mental status exam scores of 15-28, inclusive) in a double-blind cross over trial of 8 weeks donepezil compared to 8 weeks placebo with repeated double 18FDG-PET examinations during passive audio-visual stimulation. Effects of treatment on cortical metabolic response to stimulation were determined with a linear model on a voxel level using Statistical Parametric Mapping (SPM 99, Wellcome Department of Imaging Neuroscience, London). Effects of treatment on cognitive measures were not different between donepezil and placebo. During passive audio-visual stimulation, patients showed activation in posterior visual and auditory areas and decreased activation in frontal cortex and basal ganglia. Resting state metabolism was increased with donepezil in left prefrontal cortex and decreased in right hippocampus. Cortical response to activation was increased in right hippocampus with donepezil compared to placebo. Donepezil treatment shows a spatially limited functional effect on right hippocampus and left prefrontal cortical metabolism, independently of clinical response to treatment.

Retraining attention in MS

Cognitive decline is frequently observed in multiple sclerosis (MS) and has a major impact on quality of life. Therefore it would be important to offer therapeutic strategies to the patients. In the past, several studies were conducted on pharmacological or cognitive treatment. However, there is currently no specific treatment for cognitive decline and the studies published so far report heterogeneous results. The present paper focuses on the cognitive treatment strategies by reviewing and discussing the few studies that have been carried out in this area. In addition, results of a recently completed fMRI study on the visualization of cognitive training effects will be reported. This review clearly points out that further research in this area is needed to clarify the effects of cognitive intervention. Larger sample sizes and standardized neuropsychological outcome measures as well as standardized training tools are required to allow for comparisons between different studies and to improve our understanding of cognitive decline and the processes of cognitive recovery in MS.

Effect of a Brief Cognitive Training Programme in Patients with Long-lasting Back Pain Evaluated as Unfit for Surgery

The aim of the study was to evaluate the effect of cognitive intervention (information and physical exercise), on patients with long-lasting back pain referred for surgical evaluation at an orthopaedic hospital, but evaluated as unfit for surgery. One hundred and fifty-two patients were randomized to a five days intervention or control. The intervention had no significant effects on pain. At three-month follow-up, the patients in the intervention group used significantly more active strategies to cope with the back pain compared to the control group. This effect seemed to increase over time, being more pronounced at one-year follow-up evaluation.

Results from a phase II trial of conformal radiation therapy for pediatric patients with localized low-grade astrocytoma and quantification of radiation-related CNS effects

8533 Background: A phase II trial of conformal radiation therapy (CRT) was conducted to determine if the irradiated volume could be reduced without affecting the rate of disease control for pediatric patients with localized low-grade astrocytoma (LGA) and to estimate the incidence and time to onset of clinically significant CNS effects. Methods: Between 8/97 and 1/03, 49 children (median age of 8.7 ± 4.0 yrs) were treated with CRT to 54 Gy using a 10mm anatomically-defined clinical target volume (CTV). The median CTV was 89.3 cc (range, 13.3–340.9 cc). Patients were evaluated serially with psychometric testing, provocative tests of endocrine function and standardized audiometry. Results: The study included mainly patients with juvenile pilocytic astrocytoma (n=31) involving the diencephalon or optic pathway (n=38) and the majority had visual impairment. Fourteen patients had prior chemotherapy and surgery was limited to subtotal resection (n=21) or biopsy (n=20). The 4-year actuarial event-free survival estimate was 84.2% ± 9.3% with a median follow-up of 31.0 months. Six patients experienced local (n=3) or distant (n=3) failure with a median time to failure of 18 months (range 5–54 months). A slight decline in scores for estimated IQ (−0.21 pts/yr; p=0.003), reading (−0.23 pts/yr, p=0.008), spelling (−0.19 pts/yr, p=0.02) and visual auditory learning (−0.16 pts/yr, p=0.06) were noted up to 48 months after CRT for the entire group. The effects on reading (p=0.044) and visual auditory learning (p=0.016) were more prominent in patients with large diencephalic and optic pathway tumors. Pre-CRT endocrinopathy was observed in the majority of patients affecting growth (43%), thyroid (34%), and ACTH (9%) secretion. Hearing loss due to CRT-alone was uncommon during the time interval of this study. Conclusions: The volume of irradiation may be reduced to a 10mm CTV without affecting disease control in localized LGA. Patients with LGA have a high rate of pre-existing endocrinopathy and the cognitive effects of treatment may be limited using focal radiation delivery strategies. No significant financial relationships to disclose.

P1-372 Practice effects on motor control in healthy seniors and patients with MCI and mild AD

It’s widely acknowledged that, as a neurodegenerative aging disease representing an intermediate stage between cognitive intactness and Alzheimer’s disease (AD), Mild cognitive impairment (MCI) poses an excessive burden on patients’ well-being, family members, health-care providers as well as the whole society. This study focuses on three cognitive interventions proposed by Clare and Woods, which are, Cognitive stimulation (CS), Cognitive training (CT) and Cognitive rehabilitation (CR). Our Network meta-analysis (NMA) aims to compar them with one another to determine the optimal cognitive intervention for elderly adults with MCI in improving their cognitive function. We applied extensive strategies to preliminary literature retrieval to identify relevant randomized controlled trials (RCTs) which scrupulously compared any two of the three cognitive interventions with one another or any one of the three with a control group as the placebo or non-active group in treating elder patients with MCI in accordance with Petersen’s criteria. Our NMA of cognitive interventions for patients diagnosed with MCI appraised the relative effectiveness of cognitive interventions across trials simultaneously. Our study attempts to summarize available data to suggest that CS (Mean difference [MD] = 0.95, 95% confidence interval [CI]:0.27, 1.70) and CT (MD = 0.70, [CI]:0.11,1.30) were significantly beneficial to MCI patients for improving their cognition status while CR (MD = 0.59, [CI]:-0.30,1.50) scored lowest. Our study suggested CS was most likely to be the best intervention for improving the cognitive function of MCI patients.

Trauma Territory style

Cognitive impairments have been identified as significant under-recognised negative sequelae of postintensive care syndrome. No treatment guidelines exist for cognitive interventions addressing the devastating consequences of impairments and their potential impact on outcomes of intensive care unit (ICU) survivors.The aim of the study was to identify all available cognitive interventions and measurable outcomes for the cognitive rehabilitation of adult ICU survivors, as reported in published articles. Secondary aims included to critically synthesise existing evidence in improving adult ICU survivors' cognitive outcomes after ICU discharge and to extract implications for future research.A scoping review was conducted based on a rigorous literature search (CINAHL, Embase, MEDLINE, PubMed, SCOPUS, Cochrane Library, and Google Scholar) using predefined keywords. The protocol was based on current guidelines. Eligibility criteria included published (i) experimental and quasi-experimental studies reporting the effects of cognitive interventions on cognitive outcomes of adult critical illness survivors after hospital discharge and (ii) protocols identifying cognitive interventions with predefined cognitive outcome measures.Seven studies were included: three experimental studies, two quasi-experimental studies, and two published protocols. Significant heterogeneity in the type of interventions, outcome measures, and assessment tools was noted. Interventions included variations of goal management training and an integrated multidisciplinary model. The setting, delivery, and duration of interventions varied. Cognitive outcomes included variations of global cognitive function and executive function. Overall, the evidence on the effects of cognitive interventions, as compared with routine care, in improving global cognitive function is inconclusive. More evidence support exists with respect to improving executive function.Although various cognitive intervention approaches have shown some positive effects on outcomes of ICU survivors after hospital discharge, the high risk of bias and high heterogeneity across studies preclude conclusions about the most appropriate post-ICU care to rehabilitate cognitive deficits in critical care survivors. This review highlighted a number of methodological limitations that require further investigation.

Timed Instrumental Activities of Daily Living Tasks: Relationship to Cognitive Function and Everyday Performance Assessments in Older Adults

Background: We live in a world where information is presented in a time-limited fashion and successful adaptation is dependent on time-limited responses. Slowed visual-processing speed is common among older adults. Its impact on everyday task performance is not clearly understood. Objective: The goal was to determine whether visual-processing speed, as well as memory and inductive reasoning, are independently associated with the time required by older adults to complete instrumental activities of daily living typical of everyday life. Methods: Five timed instrumental activities of daily (TIADL) tasks were administered to 173 older adults (ages 65–90 years) along with assessments of visual-processing speed, memory, and inductive reasoning. The dependent variable was the time required to perform the task (e.g., finding a telephone number, making change, finding and reading the ingredients on a can of food, finding food items on a shelf, reading instructions on medicine container). Medical and functional comorbidities known to affect task performance were measured in order to adjust for their impact on the dependent variable. Other measures of everyday task competence (Everyday Problems Test, Observed Tasks of Daily Living, questionnaire on IADL difficulties) were also administered in order to determine to what extent existing measures of everyday performance are associated with TIADL performance. Test-retest reliability of the TIADL score was assessed in a separate sample. Results: Although memory and reasoning were crudely related to the time needed to perform the TIADL tasks, only processing speed was independently associated with TIADL scores. Those older adults with slow processing speed were more likely to require longer times to complete everyday tasks. Previously developed measures of everyday task competence (e.g., Everyday Problems Test, Observed Tasks of Daily Living) based on accuracy scoring did not strongly predict TIADL performance. Conclusion: These results suggest a unique role for an everyday competence test that focuses on the timely completion of everyday tasks, rather than on an assessment of accuracy alone. TIADL measures may prove useful in evaluating the everyday effectiveness of cognitive interventions targeted at increasing information-processing speed.

The effect of pre‐operative psychological interventions on post‐operative outcomes in Chinese women having an elective hysterectomy

To test the effect of cognitive interventions with information given pre-operatively on post-operative outcomes in Chinese women undergoing elective hysterectomies. An experimental design. The experimental group (n=48) received cognitive distraction and cognitive reappraisal with information, the control group (n=48) received information only. Post-operative anxiety (Chinese State-Trait Anxiety Inventory and mean arterial blood pressure), post-operative requests for analgesia (drug record), post-operative pain (visual analogue scale) and satisfaction (Chinese Patient Satisfaction Questionnaire). Cognitive distraction and reappraisal with information produced lower post-operative anxiety and pain scores and higher levels of satisfaction than information only. Post-operative analgesic requests did not differ between groups. Cognitive distraction and reappraisal with information, when used with women undergoing a hysterectomy may have significant clinical benefits.

Effects of cognitive treatment in psychiatric rehabilitation.

Ninety subjects with severe and disabling psychiatric conditions, predominantly schizophrenia, participated in a controlled-outcome trial of the cognitive component of Integrated Psychological Therapy (IPT), a group-therapy modality intended to reestablish basic neurocognitive functions. The cognitive therapy was delivered to subjects in the experimental condition during intensive 6-month treatment periods. Control subjects received supportive group therapy. Before, during, and after the intensive treatment period, all subjects received an enriched regimen of comprehensive psychiatric rehabilitation, including social and living skills training, optimal pharmacotherapy, occupational therapy, and milieu-based behavioral treatment. IPT subjects showed incrementally greater gains compared with controls on the primary outcome measure, the Assessment of Interpersonal Problem-Solving Skills, suggesting that procedures that target cognitive impairments of schizophrenia spectrum disorders can enhance patients' response to standard psychiatric rehabilitation, at least in the short term, in the domain of social competence. There was equivocal evidence for greater improvement in the experimental condition on the Brief Psychiatric Rating Scale disorganization factor and strong evidence for greater improvement on a laboratory measure of attentional processing. There was significant improvement in both conditions on measures of attention, memory, and executive functioning, providing support for the hypothesis that therapeutic procedures that target impaired cognition enhance response to conventional psychiatric rehabilitation modalities over a 6-month timeframe.

Long-term treatment of chronic schizophrenia

Long-term treatment of patients with chronic schizophrenias requires integration of many therapeutic approaches, co-operation of several professions, and regard for the views of patients and relatives. This review deals with practical aspects of pharmacotherapy, psychotherapy, cognitive resp. psychological treatments, social resp. milieu therapy, rehabilitation, interventions based on the concept of Expressed Emotions (EE), psychoeducation and work with relatives. Continuous neuroleptic treatment is indispensable in most cases to achieve social integration. Indications for adding on antidepressants, lithium, carbamazepine, benzodiazepines and other drugs are discussed, as well as treatment of negative symptoms, depression and management of treatment-resistant symptoms. Psychotherapy needs to regard the possibilities of the patient. In the context of a stable long-term relationship, the patient is supported in experiencing himself as a subject capable of action. Effectiveness of cognitive treatments to date is limited. The best results are achieved by social skills training. Social therapy, which aims at the improvement of functional aspects of the patient, is of paramount importance. Improved possibilities for work rehabilitation are contrasted by difficulties in financing long-term social rehabilitation. Interventions based on the EE concept are highly effective, but are rarely used. Programs that merely convey information without targeting behaviour modification are ineffective. The functions of facilities of treatment in the community are explained, the integrative role of case-management is stressed.

Eating disorders: Efficacy of pharmacological and psychological interventions

Eating disorders represent a spectrum of overlapping conditions that combine disturbances in eating with various forms of traditional psychopathology. Medications are often helpful in the management of the psychopathology associated with anorexia nervosa but no compound has been shown to assist weight gain reliably or alter other core features of the condition. Contingency management and other behavior therapy procedures are effective in promoting weight gain in anorexia nervosa. The limited effectiveness of cognitive interventions for anorexia nervosa may be due to the complex of physical symptoms associated with low body weight. Antidepressants reduce binging and purging in bulimia nervosa and binge eating disorder, although this action appears to be independent of any antidepressant effect. Cognitive/behavioral interventions also reduce binging and purging, and comparisons of this therapy with medication indicate that psychotherapy alone is more effective than medication alone. Moreover, changes produced by cognitive/behavioral interventions endure longer than medication where higher relapse rates are common. Most studies also reveal no advantage of medication over cognitive/behavioral therapy alone in the reduction of bulimic symptoms.

Multivariate Structural Modeling of Plasticity in Fluid Intelligence of Aged Adults.

This article is concerned with modeling the structure of cognitive intervention effects in adult intellectual development. Within the Cattell-Horn (Cattell, 1971 ; Horn, 1970, 1982) theory of fluid and crystallized intelligence, the ability of older adults to improve their performance on fluid intelligence tests, with or without tutor-guided instruction in test-relevant cognitive skills, is examined using multidimensional longitudinal structural equation models. The models reflect in some of their parameters substantively interesting aspects of temporal change at the ability level, and are applied to data from a two-group cognitive intervention study of plasticity in fluid intelligence of older adults (Baltes, Dittmann-Kohli, & Kliegl, 1986). Training effects are found in the experimental group that are more salient than the practice/experience effects in the control group; both types of effects are maintained over a six month testing period. Exploration of the nature of the practice effects in the control group reveals patterns of test performance improvement that are equivalent to those in the experimental group, as reflected in the interrelationships among initial ability levels and maximal improvements at the ability dimensions relative to initial status. The results suggest (a) considerable plasticity in adult intellectual functioning, and (b) that healthy aged adults may be capable - based on experience with repeatedly presented measures - to markedly improve their performance on fluid intelligence tests by capitalizing on interdependencies between fluid subabilities.

Effects of test anxiety, ego stress, and attentional skills training on arithmetic reasoning: An experimental evaluation of a brief counseling strategy

Abstract Two hundred forty high school students (120 male and 120 female) in India performed a moderately difficult multiple choice Arithmetic Reasoning task after undergoing short-term (40 minutes) cognitive treatment in the form of Attentional Skills Training. A 2 × 2 × 2 (Test Anxiety x Attentional Skills Training x Stress) design with separate analysis for boys and girls indicated these results: with intervention the high anxiety subjects under ego stress conditions, compared to their high-anxious control, low-anxious ego stress, or low-anxious control counterparts, reported the maximum significant improvement in performance on the Arithmetic Reasoning test. The low-anxiety subjects performed consistently well with or without treatment or stress conditions. The findings shed new light on the attentional theory of test anxiety, and it was reasoned that long-term effects of cognitive treatment be studied by using varied performance tasks (difficulty level controlled) on different gender and age groups across cultures.

A Longitudinal Study of Two Early Intervention Strategies: Project CARE

65 families with children at risk for cognitive difficulties were randomly assigned at the time of the child's birth to 1 of 3 groups, 2 intervention and 1 control. For the most intensive intervention group, family education was combined with a center-based educational day-care program; the less intensive intervention group received the home-based family education program only. To assess the cognitive performance of children, The Bayley Scales of Infant Development were administered at 6, 12, and 18 months; the Stanford-Binet Intelligence Test at 24, 36, and 48 months; and the McCarthy Scales of Children's Abilities at 30, 42, and 54 months. On each test after the 6-month assessment, scores of children in the educational day-care plus family support group were greater than those in the other 2 groups. No cognitive intervention effects were obtained for the family education group. Group effects were not obtained for measures of either the quality of the home environment or parent attention.

An individualized cognitive intervention: Does it increase the efficacy of behavioral interventions for obesity?

This study examined the effectiveness of the addition of a cognitive intervention based on individualized assessment to a behavioral intervention. Sixty-three subjects who were at least 15% overweight were randomly assigned to a behavioral intervention or a behavioral intervention and a cognitive intervention focused on changing specific maladaptive self-statements related to weight loss. It was predicted that the behavioral and cognitive intervention would result in greater weight loss and reduction in body fat than the behavioral alone intervention at posttest and at 3-month follow-up; results did not support this hypothesis. Support was found for the construct validity of the behavioral intervention with significant differences between time points on behavioral measures observed. On the cognitive measures, both treatment conditions showed changes over time on cognitive measures, but differences between the treatments were not significant. Based on the results of this study, it is suggested that future research examining the effectiveness of cognitive interventions in the area of weight loss include measures other than those that are weight-related, longer follow-ups to assess long-term maintenance, and sufficient amounts of cognitive therapy so that clients have fully integrated the newly learned cognitive dialogues into their everyday lives.

Cognitive Therapy with Aged Persons: Implications of Research Design for Its Implementation and Evaluation

On the basis of intervention research with elderly persons, numerous research design issues are discussed that influence the implementation and evaluation of cognitive therapy with aged individuals. These issues reflect a concern for the impact of placebo effects, sampling, and attrition on treatment efficacy, as well as attention to the measurement of rational thinking in the aged. Moreover, environmental support for rational solutions to everyday problems among older persons may vary. It is argued that given the limited research to date, an awareness of such issues must temper conclusions about the effectiveness of cognitive interventions with older persons.

Assessment and cognitive-behavioral interventions

The use of methods for assessing cognitions is crucial for the development of cognitive-behavioral therapies. Seven approaches to assessing cognitions are described and discussed: in vivo thought sampling, and the assessment of imagery, cognitive style, beliefs, attributions, self-efficacy expectations, and self-statements. Emphasis is placed upon a description of the assessment methods, a consideration of their role in the validation of cognitive explanations of emotional disorders, and a call for the verification of the effects of cognitive treatments upon cognitions. Discussion also considers the overlap among the various approaches to cognitive assessment and the question of the accessibility of cognitive information.

Effects of cognitive intervention on latent ability measured from analogy items.

Effects of cognitive intervention on latent ability measured from analogy items.