Neurocognitive Training Research Articles

Enhancing Cognitive Training Through Aerobic Exercise After a First Schizophrenia Episode: Theoretical Conception and Pilot Study.

Cognitive training (CT) and aerobic exercise have separately shown promise for improving cognitive deficits in schizophrenia. Aerobic exercise releases brain-derived neurotrophic factor, which promotes synaptic plasticity and neurogenesis. Thus, aerobic exercise provides a neurotrophic platform for neuroplasticity-based CT. The combination of aerobic exercise and CT may yield more robust effects than CT alone, particularly in the initial course of schizophrenia. In a pilot study, 7 patients with a recent onset of schizophrenia were assigned to Cognitive Training & Exercise (CT&E) and 9 to CT alone for a 10-week period. Posit Science programs were used for CT. Neurocognitive training focused on tuning neural circuits related to perceptual processing and verbal learning and memory. Social cognitive training used the same learning principles with social and affective stimuli. Both groups participated in these training sessions 2d/wk, 2h/d. The CT&E group also participated in an aerobic conditioning program for 30 minutes at our clinic 2d/wk and at home 2d/wk. The effect size for improvement in the MATRICS Consensus Cognitive Battery Overall Composite score for CT&E patients relative to CT patients was large. Functional outcome, particularly independent living skills, also tended to improve more in the CT&E than in the CT group. Muscular endurance, cardiovascular fitness, and diastolic blood pressure also showed relative improvement in the CT&E compared to the CT group. These encouraging pilot study findings support the promise of combining CT and aerobic exercise to improve the early course of schizophrenia.

Neurocognitive Deficits and Neurocognitive Rehabilitation in Adult Brain Tumors.

Neurocognitive deficits are common with brain tumors. If assessed at presentation using detailed neurocognitive tests, problems are detected in 80% of cases. Neurocognition may be affected by the tumor, its treatment, associated medication, mood, fatigue, and insomnia. Interpretation of neurocognitive problems should be considered in the context of these factors. Early post-operative neurocognitive rehabilitation for brain tumor patients will produce rehabilitation outcomes (e.g., quality of life, improved physical function, subjective neurocognition) equivalent to stroke, multiple sclerosis, and head injury, but the effect size and duration of benefit needs further research. In stable patients treated with radiotherapy +/- chemotherapy, the most frequent causes of distress include neurocognitive problems, psychological factors of anxiety, depression, fatigue, and sleep. Exercise, neurocognitive training, neurocognitive behavioral therapy, and medications to treat fatigue, behavior, memory, mood, and removal of drugs that may be associated with neurocognitive side effects (e.g., anti-epileptic drugs) all show promise in helping patients to manage the effects of their neurocognitive impairments better. As these are complex symptoms, multidisciplinary expertise is necessary to evaluate the influence of each variable to plan appropriate support and intervention. Neurocognitive rehabilitation should therefore occur in parallel with disease-centered, medical management from the outset. It should not occur in series, as a restricted phase in a patient's pathway. It should be considered in the pre- and post-operative period where there are good prospects of recovery, as one would for any brain-injured patient, so that the person may reach their optimal physical, sensory, intellectual, psychological, and social functional level. Yet the identification and selection of patients for early neurological rehabilitation and routine evaluation of cognition is uncommon in neurosurgical wards.

Neurocognitive training in the complex therapy of patients with schizophrenia

Neurocognitive deficits in schizophrenia patients is a major health and social problem of modern psychiatry nowadays. Many patients with schizophrenia are of working age and there is a high enough percentage of their disability. Objective To study the influence of neurocognitive training on higher cortical functions in schizophrenia patients and to evaluate their effectiveness in the treatment of schizophrenia. Material and methods We formed groups of patients diagnosed with paranoid schizophrenia undergoing treatment in the departments of rehabilitation and day hospital. Patients of the main group (102 patients) additionally participated in the training of cognitive deficits. Patients included in the comparison group (48 patients) received only pharmacotherapy. Study design Initial evaluation of patients was carried out at the first call, prior to the neurocognitive training. Follow-up study was conducted one month after completion of training programs and the final examination, after a year. In the comparison, group surveys were conducted with the similar frequency. Results After training, the cognitive processes in schizophrenia patients were obtained by increasing the tempo of the performance, improving concentration, improving the adequacy of long-term thinking and memory have identified trend towards an increase in operational short-term memory. According to the survey indicated, with an increase in all indicators (the difference with the control group ranged from 3 to 26%), the maximum improvement falls on visual memory, and minimal attention to the function. Conclusion The neurocognitive training showed itself as an effective method of correcting neurocognitive deficits.

The social cognition individualized activities lab: Implementation of a new remediation intervention for social cognition

IntroductionPeople with schizophrenia exhibit deficits in neurocognitive and social cognitive (SC) processes which limit their social reintegration. SC was found to mediate in part the impact of neurocognitive dysfunctions on real-life functioning.ObjectiveThe purpose of this study was to implement a new intervention for patients with schizophrenia, the Social Cognition Individualized Activities Lab (So.C.I.A.L.) which trains both social cognition and neurocognitive functions.AimsTo determine the efficacy of the So.C.I.A.L in improving SC by a comparison with a validated cognitive remediation (CR) intervention: the Social Skills And Neurocognitive Individualized Training (SSANIT).MethodsNine stabilized patients accepted to participate in this pilot study. Five were randomized to So.C.I.A.L. and 4 to SSANIT. The two programs were matched for the overall treatment duration (20 weeks), as well as frequency and duration of the sessions. Both interventions included individual sessions of neurocognitive individualized training; So.C.I.A.L included group sessions on Emotion Recognition and Theory of Mind, while SSANIT group sessions of Social Skills Individualized Training.ResultsNo group difference was found for changes in neurocognition, while a significant group effect was observed for changes in SC, due to improvement only in the So.C.I.A.L. group.ConclusionsThe study results showed a specific effect of the So.C.I.A.L. on SC, beyond the effect on neurocognition. Further studies are needed to assess the impact of So.C.I.A.L. on real-life functioning in a larger group of subjects.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Combining Transcranial Direct Current Stimulation and Neurocognitive Training: The Way of the Future?

Combining Transcranial Direct Current Stimulation and Neurocognitive Training: The Way of the Future?

Does neurocognitive training have the potential to improve dietary self-care in type 2 diabetes? Study protocol of a double-blind randomised controlled trial

Dietary self-care is a key element of self-management in type 2 diabetes. It is also the most difficult aspect of diabetes self-management. Adhering to long-term dietary goals and resisting immediate food desires requires top-down inhibitory control over subcortical impulsive and emotional responses to food. Practising simple neurocognitive tasks can improve inhibitory control and health behaviours that depend on inhibitory control, such as resisting alcohol consumption. It is yet to be investigated, however, whether neurocognitive training can improve dietary self-care in people with type 2 diabetes. The aim of this randomised controlled trial is to investigate whether web-based neurocognitive training can improve the ability of people with type 2 diabetes to resist tempting foods and better adhere to a healthy dietary regime.

A Preliminary Multiple Case Report of Neurocognitive Training for Children With AD/HD in China

This preliminary multiple case study examined the behavioral outcomes of neurocognitive training on children with attention-deficit/hyperactivity disorder (AD/HD) in China, as well as parent acceptance of the treatment. The training approach targeted working memory, impulse control, and attention/relaxation (via brain electrical activity). Outcome measures included overt behavior as rated by parents and teachers, AD/HD symptom frequency, and parent opinion/feedback. Training was completed by five individuals and delivered via a themed computer game with electroencephalogram (EEG) input via a wireless, single-channel, dry-sensor, portable measurement device. The objective (i.e., training outcomes and EEG) and subjective (i.e., parent ratings/feedback and teacher ratings) data suggested that use of the neurocognitive training resulted in reduced AD/HD behaviors and improvement in socially meaningful outcomes. The parents expressed satisfaction with the training procedure and outcomes. It is concluded that the innovative neurocognitive training approach is effective for improving behavior and reducing symptoms of AD/HD for children in China.

Could training executive function improve treatment outcomes for eating disorders?

Current gold standard treatments for eating disorders (EDs) lack satisfactory efficacy, and traditional psychological treatments do not directly address executive functioning deficits underpinning ED pathology. The goal of this paper is to explore the potential for enhancing ED treatment outcomes by improving executive functioning deficits that have been demonstrated to underlie eating pathology. To achieve our objective, we (1) review existing evidence for executive functioning deficits that underpin EDs and consider the extent to which these deficits could be targeted in neurocognitive training programs, (2) present the evidence for the one ED neurocognitive training program well-studied to date (Cognitive Remediation Therapy), (3) discuss the utility of neurocognitive training programs that have been developed for other psychiatric disorders with similar deficits, and (4) provide suggestions for the future development and research of neurocognitive training programs for EDs. Despite the fact that the body of empirical work on neurocognitive training programs for eating disorders is very small, we conclude that their potential is high given the combined evidence for the role of deficits in executive functioning in EDs, the initial promise of Cognitive Remediation Training, and the success in treating related conditions with neurocognitive training. Based on the evidence to date, it appears that the development and empirical evaluation of neurocognitive training programs for EDs is warranted.

A Comparative Study Among Residential Mental Health Services That Apply Different Rehabilitation Programs

In our program of rehabilitation Neuro-Cognitive Trainings (NCT), and especially Social Skills Training (SST) are the most effective interventions designed to improve social competence and other cognitive abilities of patients with schizophrenia. The psichopatological target are: Theory of Mind, Executive Functions and Deficit of Central Coherence. Thirty-four adult inpatients (from 18 to 55 years of age) with DSM V based diagnoses of schizophrenia were assigned to three different groups: structured rehabilitation program for 24 months (IPT-a group); structured rehabilitation program for 24 months (IPT-b group); generic intervention for 24 months (IPT-c group). The last one was considered as a control group. Firstly we investigate the efficacy of the cognitive intervention based on SST and NCT approaches of our rehabilitation program applied in two different Residential Mental Health Services; We compared this result with two other Residential Mental Health Services that didn’t apply this program and used to do a generic rehabilitation intervention based on social recreational activities plus support of daily life abilities. The most effective intervention on cognitive deficits, social and relational competences will benefit from a structured program based on cognitive remediation and social skills training

An Original Working Model of Psychiatric Rehabilitation

The aim of psychiatric rehabilitation is to achieve the maximum degree of freedom, autonomy and independence of the psychotic patients. We use an original program of rehabilitation born in the north of the Italy written in the book: ‘Freedom, Autonomy and Independence”, Milan 2011. The program is based above all on Neuro-Cognitive Trainings (NCT), and especially Social Skills Training (SST). We consider this interventions the most effective designed to improve social competence and other cognitive abilities of patients with schizophrenia. Methodology is largely oriented on cognitive behavior theory, but we developed an original program calibrated on the needs of our population of patients. Patients with schizophrenia can clearly improve their social competence with NCT and SST to different degrees. We show even a higher level of generalization and persistence of improvements. The most satisfying results are concerning cognitive functions, social and relational competences. Cognitive deficits, social and relational competences can clearly benefit from a structured program based on cognitive remediation and social skills training.

Psychological and Physiological Changes in Cognitive Functioning in Thalamic Lesion throughout the Rehabilitation Process

Aim: The aim of the study was to assess psychological and physiological changes in cognitive functioning of a thalamic-damaged patient who underwent a stroke rehabilitation program which involved treatment as usual (TAU) combined with a computer-based Neurocognitive Training (NT). Additionally, the healthy control (HC) group (n=13) was recruited to assess neural circuitry including thalamic involvement in comparison to a patient in acute thalamic stroke who underwent the same scanning procedure before implementation of NT. Methods: The patient (initials B.D.) was examined at three weeks after the ischemic stroke localized in left tuberothalamic territory. HCs and B.D. were evaluated using various cognitive measures and clinical scales. The computer-based NT was delivered individually once weekly for 60 minutes in a 12-week program. B.D. twice underwent a fMRI scanning session using a block-designed Stroop task: 1) after three weeks from lesion onset, and 2) after therapy. Results: Compared with HCs, B.D. before therapy demonstrated marked deficits in learning and remembering both verbal and visual material, long-term information storing, problem solving, attentional switching and working memory. After therapy, B.D. showed clinically significant improvement in memory, attention, and executive functions. B.D. showed a post-therapy decreased activation pattern and, by contrasting the congruent versus the incongruent condition, after treatment increased activations remained only in the left parietal lobule and right middle frontal gyrus. In HCs increased activation was detected in right anterior cingulate, frontal regions and striatal region during Stroop interference, which remains in line with other studies. Conclusions: Marked improvement was described in the patient after therapy. Further research is needed to increase knowledge about the involvement of the thalamus in key cognitive processes in the context of efficacy and effectiveness of neurocognitive training.

Individual Differences in Response to Prediction Bias Training

Depressed and dysphoric individuals predict negative outcomes more often than healthy individuals, and more frequently than positive outcomes. However, it is unclear if there is a causal relationship between negative emotional processing biases and depressive symptoms. We examined whether prediction-targeted neurocognitive training changed symptoms, behavior, and physiological reactivity to positive or negative feedback in euthymic and dysphoric undergraduates. Participants were randomized to a positive training intervention or neutral training. Among participants who received the positive training, pupillary reactivity to negative feedback predicted decreased symptoms and decreased after each session. Neither effect was present in the neutral training group. Both groups were more likely than controls to predict positive outcomes after training. Data suggested that change in a physiological mechanism indexing emotional reactivity and change in depressive symptoms during a targeted intervention may be related, and that it is possible, using psychophysiology, to predict which individuals will respond to neurocognitive intervention.

Transcranial electric stimulation and neurocognitive training in clinically depressed patients: a pilot study of the effects on rumination.

Rumination is a cognitive-affective thinking style that plays a key role in the onset and maintenance of depression. Recently, it was shown that clinically depressed patients who received a neurocognitive training - involving two weeks of repetitive cognitive control exercises that necessitate prefrontal engagement - are more able to control over ruminative negative thoughts than patients who only received treatment as usual. Transcranial Direct Current Stimulation (tDCS) is a biological technique that can directly modulate prefrontal excitability via the manipulation of neural membrane potentials. In this randomized double-blind trial, we investigated whether bifrontal tDCS (anode over the left/cathode over the right dorsolateral prefrontal cortex (DLPFC)) would enhance the influence of a neurocognitive training on depressive brooding, the maladaptive form of rumination. Major depressed patients were trained using a procedure based on the Paced Auditory Serial Addition Task (PASAT), a task that relies heavily on working memory and is found to engage the DLPFC. One group (n=19) completed the PASAT training together with active tDCS and another group (n=14) completed the same training together with sham (placebo) tDCS. In both groups, depressive brooding was reduced following the PASAT training. Moreover, we observed that improvement in working memory over the course of the training was associated with a greater reduction in depressive brooding post- versus pre-intervention. However, tDCS did not moderate this association between changes in working memory and changes in depressive brooding. Possible explanations for this absent moderation of tDCS, as well as avenues for future research to influence ruminative thinking in depression, are discussed.

Improving outcomes for youth with ADHD: a conceptual framework for combined neurocognitive and skill-based treatment approaches.

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent and chronic mental health condition that often results in substantial impairments throughout life. Although evidence-based pharmacological and psychosocial treatments exist for ADHD, effects of these treatments are acute, do not typically generalize into non-treated settings, rarely sustain over time, and insufficiently affect key areas of functional impairment (i.e., family, social, and academic functioning) and executive functioning. The limitations of current evidence-based treatments may be due to the inability of these treatments to address underlying neurocognitive deficits that are related to the symptoms of ADHD and associated areas of functional impairment. Although efforts have been made to directly target the underlying neurocognitive deficits of ADHD, extant neurocognitive interventions have shown limited efficacy, possibly due to misspecification of training targets and inadequate potency. We argue herein that despite these limitations, next-generation neurocognitive training programs that more precisely and potently target neurocognitive deficits may lead to optimal outcomes when used in combination with specific skill-based psychosocial treatments for ADHD. We discuss the rationale for such a combined treatment approach, prominent examples of this combined treatment approach for other mental health disorders, and potential combined treatment approaches for pediatric ADHD. Finally, we conclude with directions for future research necessary to develop a combined neurocognitive + skill-based treatment for youth with ADHD.

Executive functioning problems of juvenile sex offenders with low levels of measured intelligence

Background Many hypotheses have been proposed to address the relationship between sex offenders and neuropsychological functions.Method The purpose of this study was to evaluate differences in executive functions between juvenile sex offenders and non-sex offenders with/without low IQ by using the Behavioural Assessment of the Dysexecutive Syndrome (BADS) and the Wechsler IQ Test.Results The sex offenders with low IQ had significantly lower scores than the non-sex offenders with low IQ in switching attention, processing speed, working memory, and prospective memory. No differences between the sex offenders and the non-sex offenders without low IQ were found in all tests.Conclusion These findings show that the neuropsychological characteristics of juvenile sex offenders are related to their IQ level, and suggest that juvenile sexual offending is related to the possibility of having developmental deficits. The combination of cognitive behavioural therapy and neurocognitive training for treatment is therefore important.

EPA-1469 – Neurocognitive training and functional outcome: is there any evidence of a direct relationship

Impairments of neurocognitive functioning were largely documented in patients with schizophrenia. These deficits have strong relationships with functional outcome and represent unmet needs of available treatments for schizophrenia. Studies on the efficacy of cognitive remediation (CR) targeting these dysfunctions produced encouraging results. In fact, several reviews and meta-analyses (1,2) and our own data (3) indicate that CR approaches determine improvements of cognitive functioning in patients with schizophrenia. An impact on functional outcome was reported more consistently when the CR program was combined with a psychosocial intervention, such as vocational rehabilitation or social skills training (1–4). The mechanisms underlying synergistic effects of combining CR with other interventions are not clear. At the moment, studies with an optimal design to address mechanisms of interactions between the two rehabilitation approaches are lacking. Our data on differential effects of the two programs on functional outcome suggested that programs integrating cognitive and social skills training might target a larger number of functional impairments, but should be planned carefully and individually to fully exploit the synergistic potential, while avoiding the interference of detrimental effects of one program component with the favorable impact of the other component.

Cognitive rehabilitation for people living with schizophrenia - the newest interventions

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

Neurocognitive training for traumatic brain injury: A pilot feasibility study

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Training cognitive flexibility in patients with anorexia nervosa: A pilot randomized controlled trial of cognitive remediation therapy

Inefficient cognitive flexibility is considered a neurocognitive trait marker involved in the development and maintenance of anorexia nervosa (AN). Cognitive Remediation Therapy (CRT) is a specific treatment targeting this cognitive style. The aim of this study was to investigate the feasibility and efficacy (by estimating the effect size) of specifically tailored CRT for AN, compared to non-specific cognitive training. A prospective, randomized controlled, superiority pilot trial was conducted. Forty women with AN receiving treatment as usual (TAU) were randomized to receive either CRT or non-specific neurocognitive therapy (NNT) as an add-on. Both conditions comprised 30 sessions of computer-assisted (21 sessions) and face-to-face (9 sessions) training over a 3-week period. CRT focused specifically on cognitive flexibility. NNT was comprised of tasks designed to improve attention and memory. The primary outcome was performance on a neuropsychological post-treatment assessment of cognitive set-shifting. Data available from 25 treatment completers were analyzed. Participants in the CRT condition outperformed participants in the NNT condition in cognitive set-shifting at the end of the treatment (p = 0.027; between-groups effect size d = 0.62). Participants in both conditions showed high treatment acceptance. This study confirms the feasibility of CRT for AN, and provides a first estimate of the effect size that can be achieved using CRT for AN. Furthermore, the present findings corroborate that neurocognitive training for AN should be tailored to the specific cognitive inefficiencies of this patient group.

The neurophysiology of neuro-feedback and neurocognitive training in ADHD

The neurophysiology of neuro-feedback and neurocognitive training in ADHD