Neurocognitive Training Research Articles

Immediate and Sustained Effects of Neurofeedback and Working Memory Training on Cognitive Functions in Children and Adolescents with ADHD: A Multi-Arm Pragmatic Randomized Controlled Trial

Objective: To evaluate the effects of neurocognitive training methods on targeted cognitive functions in children and adolescent with ADHD. Method: A pragmatic four-arm randomized controlled trial compared two types of neurofeedback (Slow Cortical Potential and Live Z-score) and Working-memory training (WMT) with treatment as usual. N = 202 participants with ADHD aged 9 to 17 years were included. A battery of cognitive function tests was completed pretreatment, posttreatment, and after 6-months. Results: The effects of WMT on spatial and verbal working-memory were superior to neurofeedback and treatment as usual at posttreatment, but only partially sustained at follow-up. No other consistent effects were observed. We found no clear indications that effects were moderated by ADHD presentation, ongoing medication, age, or sex. Conclusion: The sustained effects of neurocognitive training on cognitive functioning in children and adolescents with ADHD may be limited. Future research should focus on more personalized forms of neurocognitive training.

The effect of non-invasive brain stimulation on neuroplasticity in the early recovery period after ischemic stroke

Studying the different variants of NIBS influence on synaptic neuroplasticity in the early recovery period after ischemic stroke. The rehabilitation of 62 patients with PSCI syndrome after ischemic stroke outcomes were studied. The patients were assigned to 5 groups. Patients from the control group underwent standardized nootropic therapy and course sessions with a neuropsychologist. The rest of the patients were divided into 4 groups, in which, in addition to the basic program of cognitive rehabilitation, different options for the course use of NIBS were used: photochromotherapy (PCT) with narrow-band optical radiation (NOR) with a wavelength of 530 nm (green light); rhythmic transcranial magnetic stimulation (rTMS) with a low-intensity high-frequency running pulsed magnetic field; infrared radiation with a wavelength of 1-56 microns, modulated by terahertz frequencies (IRMT); bioacoustic correction (BAC). We analyzed the dynamics of changes in scores of MMSE scales, FAB, Roshchina. In order to assess the effect of NIBS on neuroplasticity, the concentrations of BDNF and antibodies to the NR2 fragment of the NMDA receptor were evaluated before and after the completion of the rehabilitation course. Concentration values of antibodies to the NR2 subunit of the NMDA receptor in all groups remained consistently above the norm (more than 2 ng/ml) throughout the entire course of rehabilitation. Differences between groups in the dynamics of BDNF concentration in the peripheral blood were revealed. There was a significant (p<0.05) decrease in its concentration by almost 2 times by the end of rehabilitation course in control group. In the rTMS and IRMT groups, a decrease in the BDNF concentration was also recorded in dynamics, which, however, did not reach a significant level. There was no decrease in BDNF levels in the BAC group. There was an increase of this level in the PCT group. The use of different types of NIBS in the program of cognitive rehabilitation of patients with PSCI syndrome contributes to an increase in the rehabilitation potential due to the activation of neurotrophin-mediated synaptic neuroplasticity. Green light PCT and BAC have the greatest effect on increasing neuroplasticity after ischemic stroke.

Ascertaining Design and Implementation Requirements for a Perioperative Neurocognitive Training Intervention for the Prevention of Persistent Pain After Surgery.

Persistent postsurgical pain (PPSP) is a common complication that impacts quality of life, often necessitating long-term opioid treatment. Certain neurocognitive factors, including reduced performance on cognitive flexibility tasks, are associated with increased risk of PPSP. We examine the perceptions of surgical patients and clinicians with regard to perioperative pain management activities and needs; patient acceptance and use of a perioperative neurocognitive training intervention; and implementation feasibility. We conducted both individual and focus group interviews with patients undergoing thoracic surgery and clinicians in an academic medical center. The Consolidated Framework for Intervention Research guided the development of interview questions related to the adoption and implementation of a neurocognitive intervention to mitigate PPSP. A thematic analysis was used to analyze the responses. Forty patients and 15 clinicians participated. Interviews revealed that there is minimal discussion between clinicians and patients about PPSP. Most participants were receptive to a neurocognitive intervention to prevent PPSP, if evidence demonstrating its effectiveness were available. Potential barriers to neurocognitive training program adoption included fatigue, cognitive overload, lack of familiarity with the technology used for delivering the intervention, and immediate postoperative pain and stress. Implementation facilitators would include patient education about the intervention, incentives for its use, and daily reminders. The study identified several guiding principles for addressing patients' and clinicians' barriers to effectively implementing a neurocognitive training intervention to mitigate PPSP after surgery. To ensure the sustainability of neurocognitive interventions for preventing PPSP, such interventions would need to be adapted to meet patients' and clinicians' needs within the perioperative context.

Comparing the Transfer Effects of Three Neurocognitive Training Protocols in Children With Attention-Deficit/Hyperactivity Disorder: A Single-Case Experimental Design

AbstractThe current study used behavioural and electroencephalograph measures to compare the transferability of three home-based interventions — cognitive training (CT), neurofeedback training (NFT), and CT combined with NFT — for reducing symptoms in children with attention-deficit/hyperactivity disorder (AD/HD). Following a multiple-baseline single-case experimental design, twelve children were randomised to a training condition. Each child completed a baseline phase, followed by an intervention phase. The intervention phase consisted of 20 sessions of at-home training. Tau-U analysis and standardised visual analysis were adopted to detect effects. Results showed that CT improved inhibitory function and NFT improved alpha EEG activity and working memory. The combined condition, which was a reduced ‘dose’ of CT and NFT, did not show any improvements. The three conditions did not alleviate AD/HD symptoms. While CT and NFT may have transfer effects on executive functions, considering the lack of improvement in symptoms, this study does not support CT and NFT on their own as a treatment for children with AD/HD.

EEG Neurofeedback for Anxiety Disorders and Post-Traumatic Stress Disorders: A Blueprint for a Promising Brain-Based Therapy.

This review provides an overview of current knowledge and understanding of EEG neurofeedback for anxiety disorders and post-traumatic stress disorders. The manifestations of anxiety disorders and post-traumatic stress disorders (PTSD) are associated with dysfunctions of neurophysiological stress axes and brain arousal circuits, which are important dimensions of the research domain criteria (RDoC). Even if the pathophysiology of these disorders is complex, one of its defining signatures is behavioral and physiological over-arousal. Interestingly, arousal-related brain activity can be modulated by electroencephalogram-based neurofeedback (EEG NF), a non-pharmacological and non-invasive method that involves neurocognitive training through a brain-computer interface (BCI). EEG NF is characterized by a simultaneous learning process where both patient and computer are involved in modifying neuronal activity or connectivity, thereby improving associated symptoms of anxiety and/or over-arousal. Positive effects of EEG NF have been described for both anxiety disorders and PTSD, yet due to a number of methodological issues, it remains unclear whether symptom improvement is the direct result of neurophysiological changes targeted by EEG NF. Thus, in this work we sought to bridge current knowledge on brain mechanisms of arousal with past and present EEG NF therapies for anxiety and PTSD. In a nutshell, we discuss the neurophysiological mechanisms underlying the effects of EEG NF in anxiety disorder and PTSD, the methodological strengths/weaknesses of existing EEG NF randomized controlled trials for these disorders, and the neuropsychological factors that may impact NF training success.

Feasibility of Cognitive Training to Promote Recovery in Cancer-Related Cognitive Impairment in Adolescent and Young Adult Patients.

Background: Computer-based cognitive rehabilitation programs may help adolescent and young adult (AYA) patients with cancer-related cognitive impairment. This pilot study investigated the feasibility of cognitive rehabilitation as a preventive intervention for AYA patients receiving chemotherapy. Explorative objectives included the correlation of cognitive performance with serum brain-derived neurotrophic factor (BDNF). Methods: This pilot prospective study included English-speaking patients 12-25 years of age with a fist diagnosis of cancer requiring chemotherapy. Participants enrolled in the intervention arm participated in a computer-based neurocognitive training program for 20-30 minutes daily for 16 weeks. Outcome measures, including engagement with and completion of computerized neurocognitive testing and serum BDNF levels, were obtained within the first month following diagnosis, ∼16 and 24 weeks from enrollment. Results: Fourteen of 18 eligible patients provided consent, with 7 patients assigned to each the intervention arm and nonintervention arm. Seventy-one percent of the patients in the intervention arm completed at least 80% of the required activities. Compared to baseline, patients in the nonintervention arm demonstrated higher prevalence of impairment in four of the six cognitive domains (processing speed, visual attention, attention/working memory, and executive function) at the end of the study period. There was a nonstatistically significant reduction of serum BDNF levels over time, which was observed in both intervention and nonintervention arms. Conclusion: This pilot study provides some evidence that it is feasible for AYAs with new cancer diagnoses to receive standardized cognitive rehabilitation. Patients receiving cognitive activities experienced less impairment in numerous cognitive domains.

Impacts of Transcranial Direct Current Stimulation on the Action Observation Network and Sports Anticipation Task.

Effective anticipation skills in sporting cognition have been shown to facilitate expertise in sports. Transcranial direct current stimulation (tDCS) has shown to improve motor and cognitive functioning. Therefore, this study aimed to determine the assistive effects of tDCS on the action observer network in both novice and expert gamers during an occlusion task, as well as the related electroencephalographic spectral power response. Twenty-three novice and 23 expert video gamers received either sham or active tDCS with a right parietal anode and left frontal cathode. Only experts demonstrated a significant improvement in predicting ball direction for the overall and early occlusions after tDCS. Spectral power results revealed significant changes in theta, high-gamma, and delta frequencies. The findings indicate that tDCS was able to modulate anticipatory behavior and cortical activity in experts compared with novice participants, suggesting a facilitatory role for tDCS to improve anticipatory effects and assist as a neurocognitive training technique.

How Should Transcranial Direct Current Stimulation be Used in Populations With Severe Alcohol Use Disorder? A Clinically Oriented Systematic Review.

Background and rationale. Severe alcohol use disorder (SAUD) is a major public health concern, given its massive individual, interpersonal, and societal consequences. The available prevention and treatment programs have proven limited effectiveness, as relapse rates are still high in this clinical population. Developing effective interventions reducing the appearance and persistence of SAUD thus constitutes an experimental and clinical priority. Among the new therapeutic approaches, there is a growing interest for noninvasive neuromodulation techniques, and particularly for transcranial direct current stimulation (tDCS) as an adjunctive treatment in neuropsychiatric disorders, including SAUD. Methods. We propose a systematic review, based on preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, evaluating the available evidence on the effectiveness of tDCS to improve clinical interventions in SAUD. Results. We provide an integrative overview of studies applying tDCS in clinical populations with SAUD, together with a standardized methodological quality assessment. We show that the currently available data remain inconsistent. Some data suggested that tDCS can (1) reduce craving, relapse or alcohol-cue reactivity and (2) improve cognitive control and inhibition. However, other studies did not observe any beneficial effect of tDCS in SAUD. Conclusions. Capitalizing on the identified strengths and shortcomings of available results, we present evidence-based clinical guidelines to integrate tDCS in current clinical settings and to combine it with neurocognitive training.

Programmed neurocognitive training: proposal of a new approach

Purpose The efficacy studies of neurocognitive training have focused on the components of the programmes and general methodological questions, not presenting a rationale for the individualization of the intervention, even though this is an essential factor for efficacy. The main objective of this manuscript is to propose a framework for the individual planning of neurocognitive training sessions based on the results of neuropsychological assessment. Methods The proposed framework is coined Branched Programmed Neurocognitive Training (BPNT). BPNT is based on the programmed learning approach and inspired on the Luria’s neurocognitive model. The main premises of this framework are the interdependence and hierarchical organization of the cognitive functions, and the individualization of neurocognitive training with multiple patient-tailored paths. Results The BPNT framework provides guidelines for planning an individualized neurocognitive training in four stages. Conclusions The potential advantages of this proposal are discussed at various levels, including the role of reward in neurocognitive training and the potential effects of the model on the maintenance and generalization of intervention results. The BPNT framework can be used as an algorithm for the development and adaptation of paper and pencil programmes, as well as computerized rehabilitation platforms. Studies are in place to examine the feasibility of this framework. Implications for rehabilitation Individualized neurocognitive training guided by neuropsychological assessment is most likely to be effective. Branched Programmed Neurocognitive Training (BPNT) model provides guidelines to organize the neurocognitive training based on the results of neuropsychological assessment. BPNT is based on the programmed learning model and the Luria neurocognitive model, addresses the role of reward in neurocognitive training and considers the fundamental principle of Errorless Learning. BPNT can be used as an algorithm for the development and adaptation of paper and pencil programmes and computerized rehabilitation platforms.

Verbal Learning Mediates the Relationship Between Executive Functions and a Laboratory Task of Medication Management in HIV Disease.

Impairments in executive functions and learning are common in HIV disease and increase the risk of nonadherence to antiretroviral therapy. The mixed encoding/retrieval profile of HIV-associated deficits in learning and memory is largely driven by dysregulation of prefrontal systems and related executive dysfunction. This study tested the hypothesis that learning may be one pathway by which executive dysfunction disrupts medication management in people living with HIV (PLWH). A total of 195 PLWH completed a performance-based laboratory task of medication management capacity and clinical measures of executive functions, verbal learning and memory, and motor skills. Executive functions were significantly associated with verbal learning and medication management performance. In a model controlling for education, learning significantly mediated the relationship between executive functions and medication management, and this mediation was associated with a small effect size. In particular, executive dysfunction was associated with diminished use of higher-order learning strategies. Alternate models showed that executive functions did not mediate the relationship between learning and medication management nor did motor skills mediate the relationship between executive functions and medication management. PLWH with executive dysfunction may demonstrate difficulty in learning new information, potentially due to ineffective strategy use, which may in turn put them at a higher risk for problems managing their medications in the laboratory. Future studies may wish to investigate whether compensatory neurocognitive training (e.g., using more effective learning strategies) may improve medication management among PLWH.

Gender differences in the effect of gamification on weight loss during a daily, neurocognitive training program.

A major contributor to the obesity epidemic is the overconsumption of high-calorie foods, which is partly governed by inhibitory control, that is, the ability to override pre-prepotent impulses and drives. Computerized inhibitory control trainings (ICTs) have demonstrated qualified success at affecting real-world health behaviors, and at improving weight loss, particularly when repeated frequently over an extended duration. It has been proposed that gamification (i.e., incorporating game-like elements such as a storyline, sounds, graphics, and rewards) might enhance participant interest and thus training compliance. Previous findings from a mostly female sample did support this hypothesis; however, it might be expected that the effects of gamification differ by gender such that men, who appear more motivated by gaming elements, stand to benefit more from gamification. The present study evaluated whether gender moderated the effect of a gamified ICT on weight loss. Seventy-six overweight individuals received a no-sugar-added dietary prescription and were randomized to 42 daily and 2 weekly ICTs focused on sweet foods that were either gamified or nongamified. Results supported the hypothesis that gamification elements had a positive effect on weight loss for men and not women (p = .03). However, mechanistic hypotheses for the moderating effect (in terms of enjoyment, compliance, and improvements in inhibitory control) were generally not supported (p's > .20). These results suggest that gamification of ICTs may boost weight loss outcomes for men and not women, but further research is needed to determine the specific mechanisms driving this effect and to arrive at gamification elements that enhance effects for both men and women.

No Effects of Cognitive Remediation on Cerebral White Matter in Individuals at Ultra-High Risk for Psychosis-A Randomized Clinical Trial.

BackgroundIndividuals at ultra-high risk for psychosis (UHR) present with subtle alterations in cerebral white matter (WM), which appear to be associated with clinical and functional outcome. The effect of cognitive remediation on WM organization in UHR individuals has not been investigated previously.MethodsIn a randomized, clinical trial, UHR individuals aged 18 to 40 years were assigned to treatment as usual (TAU) or TAU plus cognitive remediation for 20 weeks. Cognitive remediation comprised 20 x 2-h sessions of neurocognitive and social-cognitive training. Primary outcome was whole brain fractional anisotropy derived from diffusion weighted imaging, statistically tested as an interaction between timepoint and treatment group. Secondary outcomes were restricted to five predefined region of interest (ROI) analyses on fractional anisotropy, axial diffusivity, radial diffusivity and mean diffusivity. For significant timepoint and treatment group interactions within these five ROIs, we explored associations between longitudinal changes in WM and cognitive functions/clinical symptoms. Finally, we explored dose-response effects of cognitive remediation on WM.ResultsA total of 111 UHR individuals were included. Attrition-rate was 26%. The cognitive remediation group completed on average 12 h of neurocognitive training, which was considerably lower than per protocol. We found no effect of cognitive remediation on whole-brain FA when compared to treatment as usual. Secondary ROI analyses revealed a nominal significant interaction between timepoint*treatment of AD in left medial lemniscus (P=0.016) which did not survive control for multiple comparisons. The exploratory test showed that this change in AD correlated to improvements of mental flexibility in the cognitive remediation group (p=0.001). We found no dose-response effect of neurocognitive training on WM.ConclusionsCognitive remediation comprising 12 h of neurocognitive training on average did not improve global or regional WM organization in UHR individuals. Further investigations of duration and intensity of cognitive training as necessary prerequisites of neuroplasticity-based changes are warranted.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT02098408.

Use of Virtual Reality Cognitive Training to Improve Executive and Complex Attentional Functions: Can Virtual Reality Performance PredictNeurorehabilitation Outcomes?

Background: VR has proven successful in simulating activities and settings that prove inaccessible or unsafe to rehabilitate patients in. Current VR rehabilitation studies largely focus on assessing cognitive skills, not on training cognitive deficits. The current study focused on repeated exposure with a VR-based cognitive intervention to improve deficits known to impact the ability to resume complex activities. Associations between the VR Stroop and neuropsychological, speech therapy, and global rehabilitation measures were examined. We included a brain injured control group to address this frequently cited methodological concern. Design: This was a mixed design study with quasi-experimental Intervention group (N = 12) and retrospective Control group (N = 12). Both groups comprised individuals with brain injury admitted to an outpatient day neurorehabilitation program. Results: Patients with higher level of education and shorter acute medical course deliberated longer before responding on specific Virtual Stroop indices. The brain injury group receiving Virtual Stroop intervention demonstrated a significant increase in level of independence in the home and in community participation by discharge from day neurorehabilitation, compared with the Control group. Increased independence of the virtual reality group was associated with improved attention and self-monitoring, and less disinhibition on the Virtual Stroop. Conclusion: Patients with brain injury demonstrated improvements in various executive functioning and attention indices on the Virtual Stroop, compared with patients who received standard neurorehabilitation. Neurocognitive training within an immersive real-world setting was associated with improved global and specific neurorehabilitation outcomes. Performance on the Virtual Stroop also demonstrated a relationship with cognitive flexibility on traditional neuropsychological testing.

S44. NEUROBIOLOGICAL FINGERPRINTS OF COGNITIVE SUBTYPES IN RECENT ONSET PSYCHOSIS PATIENTS

BackgroundNeurocognitive impairment plays a central role in pathogenesis and course of psychotic disorders. Patients suffering from psychosis or psychosis-related diseases show general and specific neurocognitive impairments that often precede the onset of manifest symptoms. Neurocognitive impairments are frequently associated with reduced psychosocial functioning along with altered brain morphology and function. Quantifying neurocognitive heterogeneity in impairment in schizophrenia patients, cluster analytic approaches differentiated several cognitive subtypes, including a generally impaired and generally spared subgroup. An independent set of findings provided evidence that neurocognitive subgroups of cognitively spared and impaired SZ patients can also be differentiated based on their brain morphology. The current study aims to (1) subtype a first episode psychosis sample based on neurocognitive performance using cluster analysis and (2) investigate grey matter (GM) differences between the obtained cognitive subtypes and healthy volunteers.Methods121 recent onset-psychosis (ROP) patients and 201 healthy controls (HC) were recruited within the framework of the Personalized Prognostic Tool for Early Psychosis Management (PRONIA) project. Patients fulfilled DSM-IV-TR criteria of a first affective or non-affective psychotic episode in the last 3 month with onset in the last 24 months. Cognitive subtypes of the ROP patients were derived from 83 variables of 10 neurocognitive tasks using a kmeans clustering algorithm. A resampling approach implemented in R was used to assess the statistical stability of the results. Neuropsychological and clinical cluster characteristics were assessed using t tests. GM volume of the obtained patient clusters was compared by means of intracranial volume corrected t tests with age, sex and site matched HCs using SPM.ResultsThe analysis reveals a stable two-cluster solution: A higher cognitive performance cluster (HCP; N=71) and a lower cognitive performance cluster (LCP; N=39). Patients assigned to HCP performed significantly (p < 0.01) worse in 4 out of 10 neuropsychological tasks. Patients assigned to LCP performed significantly (p < 0.01) worse in 9 out of 10 neuropsychological tasks. LCP patients show significantly lower premorbid IQ (p < 0.001) and General Assessment of Functioning score (GAF; p < 0.01), lower occupational functioning (p < 0.01) and higher values on the negative component of the Positive and Negative Syndrom Scale (PANSS; p < 0.05). They show no demographical differences regarding age, sex, education years and study site. LCP patients reveal widespread GM reductions in bilateral temporal, parietal and frontal brain regions as compared to healthy controls. GM reductions of the HCP cluster are more restricted and evident in temporal, occipital regions and in the anterior cingulum.DiscussionTwo homogeneous, neurocognitive subgroups of patients suffering from a recent psychotic episode were identified and show distinctive psychopathological and neuroanatomical patterns. The obtained GM reductions in LCP go in line with the neuro-developmental origin of the disease affecting premorbid cognitive and occupational functioning as well as the STG which was reported to be decreased in the early course of the disease. Finding subgroups within early stage psychotic patients with minimal intake of antipsychotic medication, suggests different underlying patho(-physio)logical mechanisms predating manifest illness expression. This evidence offers the opportunity for personalizing interventions like neurocognitive trainings to enhance patients’ odds for recovery after psychosis.

T18. EFFECTS OF COGNITIVE REMEDIATION ON WHITE MATTER IN INDIVIDUALS AT ULTRA-HIGH RISK FOR PSYCHOSIS – A RANDOMIZED, CONTROLLED CLINICAL TRIAL

BackgroundIndividuals at ultra-high risk for psychosis (UHR) present with subtle white matter alterations, which have been associated with clinical and functional outcome. The effect of cognitive remediation on white matter (WM) in UHR-individuals has not been investigated.MethodsIn a randomized, clinical intervention-trial (FOCUS), UHR-individuals aged 18–40 years were assigned to treatment as usual (TAU) or TAU plus cognitive remediation (CR) for 20 weeks. CR comprised 20 x 2-hour sessions of neurocognitive and social-cognitive training (SCIT). Primary outcome was whole brain fractional anisotropy (FA) derived from diffusion weighted imaging. Secondary outcomes pertained to regions of interest analyses. Planned post-hoc analyses explored dose-response effects of CR on WM. Main analyses of treatment effect of CR on primary and secondary outcomes were conducted using linear mixed models, assessing the interaction of timepoint by group (CR and TAU). Analyses were conducted according to the intention-to-treat principle.Results111 UHR-individuals and 59 healthy controls were included. Attrition-rate was 30% at 6 months post-treatment follow-up. The CR group completed a mean of 12 hours of neurocognitive training.We found no effect of CR on whole-brain or regional FA. Planned post-hoc analyses revealed significant time*group (high- and low-attendance to CR) interactions in left superior corona radiata (p<0.01), left cingulum cingulate gyrus (P=0.03), and right superior longitudinal fasciculus (P<0,01), corrected. Specifically, when compared to UHR-individuals with high attendance (UHR-high >12 hours), those with low attendance (UHR-low <12 hours) had more co-morbid diagnoses, larger recreational smoking (nicotine and cannabis), more depressive and negative symptoms, and had significantly lower global FA at baseline, and showed a significant increase in FA after treatment. Furthermore, UHR-low displayed large effect-size (ES) improvements on depressive and negative symptoms, and moderate to large ES improvements in several cognitive functions (verbal fluency, verbal working memory, and processing speed). In contrast, UHR-high displayed large ES improvements in UHR-symptoms, and moderate ES improvement on social and occupational functioning.DiscussionContradicting our main hypothesis, we found no effect of CR on whole-brain or regional FA after six months. This may be explained by both the low number of neurocognitive training sessions and the attrition rate. The average of 12 hours of neurocognitive training is considerably lower than the recommended dosage of 25–30 hours necessary for cognitive improvements. The continuous need to develop feasible interventions and enhance adherence is stressed.Nevertheless, non-specific treatment may improve WM-integrity in UHR-individuals with lower global baseline FA in those with more severe psychopathology. The UHR-low subgroup exhibited improvements with large ES in levels of depressive and negative symptoms, as well as cognitive functions. We speculate, whether our results reflect that UHR-individuals with higher baseline FA (approaching the healthy controls), present with a preserved structural capacity for increased demands and new learning, while UHR-individuals characterized by lower FA at baseline may be more amendable to neuroplastic treatment-effects. The results support the value of subgrouping in a clinically heterogenous UHR-population, which also applies to examining WM integrity.

Attentional Demands of Postural Control in Chronic Ankle Instability, Copers and Healthy Controls: A Controlled Cross-sectional Study

BackgroundIt has been shown that cognitive loading affects postural control in different populations. However, there is limited and conflicting information about dual task challenges on postural control in chronic ankle instability (CAI). Research QuestionDoes cognitive task performance change standing postural control in individuals with CAI, copers and healthy subjects? MethodsA descriptive, analytic, and controlled cross-sectional study was conducted on 75 individuals. They were assigned into three matched groups, including CAI, copers, and healthy controls. Postural control variables were collected during single leg standing on a force plate with and without vision and cognition. Parameters of center of pressure (COP), including mean COP area, range, sway index and velocity, were measured. Additionally, cognitive task performance by auditory stroop was assessed by calculating the reaction time and error ratio. Mixed model ANOVAs were used to determine the effects of group and testing conditions. ResultsThe CAI group demonstrated greater COP sway parameters compared to other groups under all testing conditions. The main significant effect of vision was observed for all COP parameters with greater COP sway during eyes closed compared to eyes open (P < 0.05). The main effect of a cognitive task was significant with reduced COP sway while performing the secondary cognitive compared to a single task in all three groups (P < 0.05). The cognitive task results revealed significantly longer reaction times in the CAI group compared to copers and healthy individuals (p < 0.05). SignificanceConsidering postural control deficits in CAI, especially in eye-closed condition and effects of cognitive loading, may guide us to improve postural control in those with CAI with neurocognitive training. Furthermore, no difference between coper and healthy groups may imply a successful compensatory postural control mechanism in copers.

Multimodal pathway for brain tumor-related epilepsy patients: Observational study.

Brain tumor-related epilepsy patients (BTRE) have a complex profile due to the simultaneous presence of two pathologies: brain tumor and epilepsy. That illness and their treatments could induce physical, cognitive, emotional disturbances, and possible social isolation, with detrimental effect on patients' quality of life (QoL). Aim of this observational pilot study is to evaluate whether a multimodal rehabilitation pathway (MRP) consisting of epileptological follow-up, neurocognitive training, emotional support, and social support could produce an improvement in perceived quality of life of 33 patients with BTRE. Basal (T0) and 6month (T1) evaluation with epileptological, neuropsychological, psychological state (Symptom checklist-SCL-90), social (Social questionnaire schedule-SQS), and QoL assessment (QOLIE 31-P). MRP consisted in epileptological follow-up, supportive meeting groups, social assistance; patients with cognitive deficits could also obtain a 12-week neurocognitive training. We observed at T1 significant improvements in mean seizure/month (P=.02), verbal memory (word list immediate recall, P=.01; word list delayed recall P=.003), social aspects with regard to assistencial network's efficacy (SQS network P=.001) and quality of social relations (SQS socialization P<.0001). QOLIE 31-P showed a significant improvement in cognitive scale (P=.04) and a significant decrease in cognitive related distress (P=.04). No psychopathological symptoms were detected. After 6months, MRP produced significant improvements in seizure control, cognitive performances, quality of social relations, patients' perception to be supported and patients' perceived quality of life related to cognitive efficacy. Future randomized trial with longer follow-up is needed to further evaluate the impact of this kind of pathway on patients' QoL.

Towards AI-based Interactive Game Intervention to Monitor Concentration Levels in Children with Attention Deficit

Preliminary results to a new approach for neurocognitive training on academic engagement and monitoring of attention levels in children with learning difficulties is presented. Machine Learning (ML) techniques and a Brain-Computer Interface (BCI) are used to develop an interactive AI-based game for educational therapy to monitor the progress of children’s concentration levels during specific cognitive tasks. Our approach resorts to data acquisition of brainwaves of children using electroencephalography (EEG) to classify concentration levels through model calibration. The real-time brainwave patterns are inputs to our game interface to monitor concentration levels. When the concentration drops, the educational game can personalize to the user by changing the challenge of the training or providing some new visual or auditory stimuli to the user in order to reduce the attention loss. To understand concentration level patterns, we collected brainwave data from children at various primary schools in Brazil who have intellectual disabilities e.g. autism spectrum disorder and attention deficit hyperactivity disorder. Preliminary results show that we successfully benchmarked (96%) the brainwave patterns acquired by using various classical ML techniques. The result obtained through the automatic classification of brainwaves will be fundamental to further develop our full approach. Positive feedback from questionnaires was obtained for both, the AI-based game and the engagement and motivation during the training sessions.

Evaluation of visual-motor reaction time and quality of response in rugby sevens players after the application of a neurocognitive training programme

ABSTRACTThis work proposes a neurocognitive training (NCT) programme that seeks to optimise the mechanisms of visual perception, the processing of information and decision making. Also, to evaluate the effects on visual-motor reaction time (VMRT) and effectiveness of response (ER). A system of analysis, evaluation and specific training was applied, followed by comparison using different tests to assess the players’ performance. We evaluated 8 male rugby seven players from the Chilean national team (age: 28.5 ± 2.2 years, height: 179.5 ± 6.5 cm, weight: 92.5 ± 7.8 kg). The results showed that in the two variables, the players show statistically significant average improvements in the RTs of the total actions (total VMRT: 5.1%, 95%CI: 17.3–69.24, p=0.006, ES: 0.49) and in the RTs of attempts that were considered effective (effectiveVMRT: 9.3%, 95%CI: 22.77–77.08, p=0.003, ES: 0.66). In the case of ER, a slight improvement in the quality of the actions is detected (4.1% increase in effectiveness and 4.3% decrease in failed attempts), although the changes are not statistically significant. In conclusion, it can be stated that the neurocognitive training programme used led to an improvement in the performance of the variables VMRT and ER, with a differing degree of effectiveness.

P: 29 Contributors to Balance Impairment in Adults With Cirrhosis and Hepatic Encephalopathy

BACKGROUND: Falls are common and associated with significant morbidity for persons with cirrhosis and hepatic encephalopathy. In order to intervene with targeted rehabilitation efforts to reduce and prevent falls, a better understanding of mechanisms underlying balance deficits is needed. To this end, unipedal stance time (UST) is a useful measure of balance as it requires the integration of sensory, neurocognitive, and muscular factors. METHODS: We prospectively enrolled 119 outpatients with cirrhosis and history of hepatic encephalopathy from the hepatology clinic at Michigan Medicine. The primary outcome was UST. Each patient was evaluated for demographic and clinical factors [Child Turcotte Pugh (CTP) class, MELD score], physical function (grip-strength and hip-strength using lateral plank time), neurocognitive factors [Numbers Connection Test (NCT) A and B, recognition reaction time accuracy - ability to catch or inhibit catching an instrumented stick under 'lights on' and 'lights off' conditions within 400 ms], and sensory factors (lower limb vibratory sensation and visual contrast). Falls self-efficacy, perceived ability to perform different tasks without falling, was also assessed. We evaluated bivariate Pearson correlations and developed a linear regression model to identify significant contributors to balance impairment. RESULTS: Participants were 50% female, aged 62.9 + 7.3 years, 80% CTP A, 18% CTP B, 2% CTP C, with MELD 11 + 5. The mean UST was 12.7 + 9.9 seconds (median = 9.42 seconds, IQR = 19.26). In bivariate analyses, UST was most highly correlated with lateral plank time (r = 0.61), followed by recognition reaction time accuracy [total, percent correct in lights on, and in lights off conditions (r = 0.47, r = .36, r = .33)] and NCT A and B tests (each r = 0.27). In multivariable regression, 54% of variance in UST was explained by significant factors of plank time, recognition reaction time accuracy, falls self-efficacy, age, and CTP. Based on standardized beta coefficients, plank time, CTP of B or C, and recognition reaction time accuracy were the strongest predictors. For every second increase of plank time, UST increases by 0.26 seconds on average. If classified by CTP of B or C, UST decreases by 5.8 seconds. For each additional percent correct on recognition reaction time accuracy, UST increases by 0.12 seconds. CONCLUSIONS: The strongest factors associated with diminished balance, as indicated by UST, in this high fall-risk cirrhosis population are hip strength, clinical disease severity, and neurocognitive capacity. These findings support a rehabilitation approach that targets strengthening as well as neurocognitive training to address balance impairment.