Disrupted cerebello-cerebral functional integration of triple core networks in major depressive disorder: A resting-state fMRI study.

Cognitive flexibility in adults with schizophrenia: A scoping review.

Neuropsychological performance is influenced by demographic/premorbid factors in addition to acquired cognitive impairment. This study examined relationships between educational attainment, reading ability, and executive functions in a clinical sample. We conducted a retrospective analysis of 71 adult native English-speaking neuropsychology outpatients who completed Color Trails Test (CTT), Trail Making Test (TMT), Wechsler Test of Adult Reading (WTAR), and Delis-Kaplan Executive Function System (D-KEFS) Color-Word Interference, Verbal Fluency, and Design Fluency subtests. Linear regressions and t-tests examined associations among education, WTAR scores, and executive performance. Both TMTB and CTT2 significantly predicted cognitive impairment ratings (CTT2 (B = .008, p < .001) and Trails B (B = .008, p < .001)), and their predictive strength did not differ significantly (z = –.86, p > .05). WTAR scores demonstrated stronger and more consistent associations with executive performance and impairment ratings than years of education. In patients with lower WTAR scores (WTAR≤ 85, N = 19), performance on CTT2 was significantly faster than TMTB (t[18] = –2.726, p = .014), while no significant difference was observed in the higher WTAR group. These preliminary findings from an exploratory retrospective study support further investigation of the influence of reading ability on executive functioning test performance. Future research should examine potential mechanisms, including educational quality, literacy-related factors, and premorbid cognitive ability.

This study aimed to explore fatigue and cognitive features as underrecognized non-motor dimensions in myasthenia gravis (MG), and to describe multidomain observations following initiation of ravulizumab in older adults with generalized myasthenia gravis (gMG). Three acetylcholine receptor antibody-positive older adults with gMG underwent a standardized multidomain evaluation, including clinical outcomes, patient-reported measures of fatigue and quality of life, and performance-based cognitive assessment. Clinical severity was assessed using the Myasthenia Gravis Activities of Daily Living (MG-ADL) scale and the Quantitative Myasthenia Gravis (QMG) score. Fatigue was assessed using the Neuro-QoL Fatigue scale and the Modified Fatigue Impact Scale (MFIS), and quality of life using the Myasthenia Gravis Quality of Life scale (MG-QoL). Cognitive performance was assessed using the Trail Making Test (TMT). Assessments were performed at baseline and repeated after approximately 12months and analyzed descriptively. Three patients were enrolled. At baseline, MG-ADL scores ranged from 9 to 10 and QMG scores from 10 to 17. Neuro-QoL Fatigue T-scores ranged from 66 to 70, and MFIS total scores from 18 to 43, with MFIS cognitive subscores ranging from 5 to 21. TMTpart B completion times ranged from 284 to 300s in two patients, while one patient was not evaluable. At follow-up, MG-ADL scores were 7, MG-QoL scores ranged from 10 to 14 (from baseline 22-25), Neuro-QoL Fatigue T-scores were lower by 13-17 points, and MFIS total scores were lower by 3, 20, and 9 points across patients. Changes in MFIS cognitive subscores varied, with one patient showing a slight increase (5 → 6) and others showing reductions. One patient transitioned from non-evaluable to evaluable TMTpart B performance, while switching cost showed heterogeneous changes across patients. This exploratory case series describes heterogeneous multidomain trajectories across clinical, fatigue, and cognitive measures in gMG. The findings highlight the feasibility of integrating multidomain assessment of non-motor symptoms in this population, without supporting causal inferences regarding treatment effects.

Mild traumatic brain injury (mTBI) affects millions worldwide, with cognitive impairment substantially affecting daily functioning. Despite this burden, evidence-based nonpharmaceutical interventions remain lacking in clinical practice. Emerging evidence suggests aerobic exercise may improve post-mTBI cognition; however, the methodological limitations, particularly inadequate control groups, prevent definitive conclusions. This pilot randomized controlled trial examined the feasibility and preliminary efficacy of a 12-week virtual exercise intervention for community-dwelling adults aged 18-55 years with mTBI within 1 year of injury. Thirty-seven participants were randomized to either symptom-guided aerobic exercise or active balance control; both delivered virtually 3 times weekly for 30 minutes over 12 weeks. Primary outcomes assessed feasibility metrics; secondary outcomes examined cognitive function including Trail Making Test (TMT) Part A and Part B. Of enrolled participants, 75% completed the intervention with 94.2% session adherence and zero adverse events, demonstrating excellent feasibility and safety. The aerobic group demonstrated greater improvements in executive function compared with balance controls, with large effect sizes for TMT B-A difference scores in both postintervention comparisons (Hedges' g = 1.20, 95% CI [0.00-2.41]) and Group × Time interactions (Hedges' g = 1.38, 95% CI [0.27-2.49]). In addition, the aerobic group self-reported fewer sleep disturbances postintervention (g = 1.65, 95% CI [0.22-3.09]). These findings establish that virtual, supervised, symptom-guided exercise interventions are feasible and safe for mTBI populations, with preliminary evidence suggesting aerobic exercise specifically benefits cognitive flexibility and sleep quality after mTBI. A fully powered randomized controlled trial is warranted to confirm these effects.

BackgroundDeciding whether to continue driving or transition to alternative means of transportation is a challenging issue for older adults in preventive care settings. This study aimed to identify potential associations between the Japanese version of the Montreal Cognitive Assessment (MoCA-J) and driving as the primary mode of transport among older adults.MethodsThe participants of this cross-sectional study were community-dwelling older adults participating in a long-term preventive care program. Participants were divided into two groups (DRIVING or OTHER) based on their questionnaire response regarding the main mode of transport used when going out, where the OTHER group included all participants who selected any other mode than a car driven by themselves. Cognitive function was measured using 13 MoCA-J tasks. Binary logistic regression analysis was used to identify associations between MoCA-J results and inclusion in the DRIVING group.ResultsAmong the 199 participants, 156 were categorized into DRIVING group and 43 into OTHER group. The DRIVING group showed significantly higher task achievement rates than the OTHER group in trail-making, digit span, and phonemic verbal fluency tests. Of these, only the trail-making test results were associated with inclusion in the DRIVING group (odds ratio, 2.82; 95% confidence interval, 1.22–6.51; p =.016).ConclusionsThe trail-making task of MoCA-J may assist health-care professionals in providing driving guidance to older adults.

Progressive supranuclear palsy (PSP) is a neurodegenerative disorder characterized by motor, oculomotor and cognitive impairments. Yet disentangling cognitive deficits from motor and oculomotor dysfunction remains a diagnostic and methodological challenge. This study aims to evaluate how cognitive, motor, and oculomotor impairments contribute to performance in the Trail Making Test (TMT) in PSP patients. Eighty-one patients with PSP-Richardson's syndrome underwent the Toronto Cognitive Assessment, the Movement Disorder Society Unified Parkinson's Disease Rating Scale-part III and the PSP rating scale. Structural equation modeling was used to examine associations between TMT performance, cognitive function, and motor/oculomotor measures derived from these assessments. TMT performance was mainly driven by cognitive factors, particularly executive function, with no significant influence from motor or oculomotor deficits. These findings suggest that the TMT is a valuable tool for assessing cognitive impairment in PSP, reflecting fronto-striatal (associative loop) dysfunction rather than motor or oculomotor impairments.

Prediabetes is a serious health condition characterized by blood glucose levels that are higher than normal but not high enough for a diagnosis of type 2 diabetes. It remains unclear whether alterations in cortical morphology occur during the prediabetic stage. This study aimed to investigate changes in cortical thickness and gyrification in individuals with prediabetes, and to explore whether these changes can predict cognitive performance using a machine learning approach. T1-weighted MRI scans were acquired from 48 patients with prediabetes and 42 healthy controls. Surface-based morphometric analyses, including cortical thickness and the local gyrification index (LGI), were performed using FreeSurfer. Group comparisons were conducted. Neuropsychological assessments included the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Trail Making Test (TMT) Parts A and B. Pearson correlation analyses were conducted to examine associations between morphometric changes and cognitive performance. Furthermore, PyCaret, a machine learning framework, was applied to evaluate the predictive power of cortical features and clinical variables in predicting cognitive performance. Compared with controls, individuals with prediabetes exhibited significantly reduced cortical thickness in the left inferior temporal gyrus (ITG) and decreased LGI in the left precentral gyrus. TMT-A and TMT-B scores were significantly higher in the prediabetes group, indicating poorer cognitive performance. Cortical thickness in the left ITG was negatively correlated with TMT-B performance (r = -0.54, 95 % CI: -0.71 to -0.31, p = 0.0001). Machine learning analysis identified the Extreme Gradient Boosting classifier as the best-performing model (AUC = 0.87, accuracy = 0.80). Our findings suggest that cortical alterations in the ITG and precentral gyrus are evident during the prediabetic stage and relate to early cognitive dysfunction. These results highlight the potential of combining neuroimaging biomarkers and AI models for early detection and intervention in prediabetes-associated cognitive decline.

Effects of high-load, velocity-intentional variable resistance training combined with creatine supplementation on neuroplasticity, oxidative stress, inflammation, physical function, cognitive performance and quality of life in older adults: A randomized, double-blind, placebo-controlled trial.

BackgroundDespite the frequent decline in verbal fluency after STN-DBS surgery, the cause of decline remains unclear.ObjectiveThis study investigates whether mental speed and executive dysfunctions are underlying mechanisms of the phonemic verbal fluency decline after STN-DBS in Parkinson's patients.MethodsNeuropsychological assessments consisting of phonemic verbal fluency, Trail Making Test (TMT), and Stroop test were conducted before and 6 months after STN-DBS in 94 Parkinson's patients in the Galaxy Trial. A Reliable Change Index (RCI) pre- versus postoperative of verbal fluency was calculated, representing the magnitude of change. Content assessment of phonemic verbal fluency resulted in content profiles (clusters and switches).ResultsA statistically significant decline in postoperative phonemic verbal fluency was found, with statistically significant declined switching, while cluster size remained stable. Postoperative, statistically significant increases in time to perform TMT-B and all Stroop subtests was found. However, phonemic verbal fluency decline was correlated to change scores of Stroop I and II only. Comparisons of declined (N = 23) and improved (N = 11) patients, according to RCI's, revealed that decliners had higher preoperative phonemic verbal fluency scores.ConclusionsPostoperative phonemic verbal fluency decline could not be explained by the proposed underlying mechanisms of mental speed and executive dysfunction. However, the significant correlation of phonemic verbal fluency decline to Stroop I and II change scores suggests other possible underlying mechanisms, like slower speech.

Background/Objectives: This study aimed to evaluate the effect of adherence to the DASH and Mediterranean diets on cognitive performance in adults. Methods: In this study, the Mediterranean Diet Adherence Screener (MEDAS), DASH Diet Quality Scale (DASH-Q), Oktem Verbal Memory Processes Test (Oktem-VMPT), and Trail Making Test (TMT) were administered face-to-face to adult individuals living in Afyonkarahisar, Türkiye, together with a form assessing sociodemographic characteristics and dietary habits. The collected data were analyzed using SPSS v27 software. Results: As participants’ ages increased, DASH scores decreased (p < 0.05). As participants’ BMI and waist/hip width increased, a decrease in DASH and MEDAS scores was observed (p < 0.05). As participants’ ages increased, the IST-A, IST-B, and IST-Total scores increased (p < 0.05), but as their education level increased, the IST-A, IST-B, and IST-Total scores decreased (p < 0.05). As participants’ education level increased, the total recall score on the Oktem-SBST scale tended to increase (p < 0.05). As participants’ DASH scores increased, the “Immediate Memory” and “Spontaneous Recall” sub-components of the Oktem-SBST increased, while the “Learning Mistake Score,” “USB Mistake Score,” and “IST-A,” “IST-B,” and “IST Total” scores decreased (p < 0.05). As participants’ MEDAS scores increased, the sub-components of Oktem-SBST, namely “Criteria Achievement,” “Maximum Learning,” “Spontaneous Recall,” “Recognition,” and “Total Recall,” also increased, while the “Learning Mistake Score” decreased. (p < 0.05). Conclusions: Age, educational status, DASH, and MEDAS scores are associated with cognitive performance. The DASH and MEDAS diets have a positive impact on cognitive performance, highlighting the importance of healthy eating in public health strategies for maintaining cognitive health.

The present study aimed to assess executive functions (inhibition, planning, and mental flexibility) in patients with multiple sclerosis. The study used a sample consisting of three cases selected intentionally, applying the case study method. The researcher applied the following study tools, taken from the Brief Cognitive Assessment Battery for patients with multiple sclerosis (BC COG SEP): the Go/No-Go test, the Trail Making Test (TMT), and the Clock Drawing Test (CDT). The results of the study concluded that: - Patients with multiple sclerosis suffer from cognitive impairment at the level of inhibition function. - Patients with multiple sclerosis suffer from cognitive impairment at the level of planning function. - Patients with multiple sclerosis suffer from cognitive impairment at the level of mental flexibility function.

Objective: Explore daily touchscreen use (e.g., messaging, internet browsing) and performance (e.g., tapping and dragging), and their associations with cognitive ability and upper limb function in people with Parkinson’s disease (PWP). Methods: Thirty-four participants who reported daily touchscreen use completed a touchscreen daily use questionnaire, Touchscreen Assessment Tool, Trail Making Test (TMT) A and B, Montreal Cognitive Assessment (MoCA), Coin Rotation Task (CRT) and the Movement Disorder Society-Unified PD Rating Part II and III (upper limb items). Results: Messaging, internet browsing, and navigation were the most frequently used applications. A logistic regression model explained 60% of the variance in daily touchscreen use (χ 2(4) = 19.89, p < 0.001), with executive function (EF) emerging as the significant predictor. Touchscreen performance was more strongly associated with cognitive ability than motor function. In particular, better keyboard typing was significantly correlated with all cognitive measures, most strongly with EF (r = 0.64, p < 0.001). Conclusions: These findings suggest that people with PD primarily engage with touchscreens for social communication and that both daily use and performance are closely tied to cognitive ability. Cognitive function should therefore be a central consideration when designing evaluations, accessibility modifications and interventions to support touchscreen use in this population.

People with opioid use disorder (OUD) who are in safety-sensitive occupations are often not allowed to work if taking methadone or buprenorphine due to concerns about cognitive impairment from opioid agonist effects. Naltrexone, an antagonist which lacks opioid agonist effects, has fewer restrictions. However, comparisons of neurocognitive effects across treatments are limited. This post hoc analysis examined observed Trailmaking Test (TMT) difference scores and Stroop Color-Word accuracy and interference scores at 4, 8, 16, and 24 weeks after treatment initiation with either extended-release injection naltrexone (XR-NTX) (N=283) or sublingual buprenorphine-naloxone (BUP-NX) (N=287) in a randomized, nonblinded, trial of patients with OUD. Scores were compared between medication groups across time points with linear mixed-effects regression. There were no significant effects of medication group or time for either the TMT or the Stroop tests. TMT difference scores at baseline were 48.40±24.12 (XR-NTX) and 48.26±25.45 seconds (BUP-NX), with model-estimated means (SE) across post-initiation time points: XR-NTX: 37.53 (1.62); BUP-NX: 37.80 (1.51); difference: -0.26 (1.59), P=0.87; 95% CI [-3.38, 2.86]. Stroop Color-Word accuracy and interference scores at baseline were 49.65 (XR-NTX) versus 50.88 (BUP-NX) and 51.11 (XR-NTX) versus 51.68 (BUP-NX), respectively. Model estimated means (SE) across post-initiation timepoints were: accuracy: XR-NTX: 56.54 (0.90); BUP-NX: 56.22 (0.75); difference: 0.33 (0.73), P=0.65; 95% CI [-1.1, 1.76]; interference: XR-NTX: 54.15 (0.76); BUP-NX: 54.67 (0.73); difference: -0.52 (0.62), P=0.41; 95% CI [-1.74, 0.70]. Neurocognitive performance did not significantly differ between patients with OUD treated with XR-NTX or BUP-NX. These results suggest that absolute restrictions on buprenorphine use in safety-sensitive occupations may be unwarranted. Individual cognitive assessments may still be appropriate based on specific job demands.

Cerebral Small Vessel Disease (CSVD) is one of the most common causes of vascular cognitive impairment and dementia, and there is still a lack of effective treatment options. High-Definition Transcranial Direct Current Stimulation (HD-tDCS) is a non-invasive neural regulation method with promising prospects in the treatment of cognitive impairment. Therefore, we explore whether HD-tDCS can improve cognitive function and potential mechanisms in patients with CSVD. This study was divided into two complementary parts. Part 1 involved 104 patients with CSVD and 36 matched Healthy Controls (HCs) to establish the optimal HD-tDCS stimulation target. Part 2 enrolled an additional 20 patients with CSVD who received a 2-week HD-tDCS intervention targeting the stimulation site identified in Part 1. Cognitive assessments and multimodal magnetic resonance imaging data were collected from all participants at both baseline and follow-up. In part 1 of the study, the patients with CSVD showed significant differences in Montreal Cognitive Assessment (MoCA), Auditory Verbal Learning Test (AVLT)-study, AVLT-immediate, AVLT-delay, AVLT-recognition, Trail Making Test (TMT)-A, TMT-B, and Verbal Fluency Test -fruits/vegetables compared with HCs. Meanwhile, left hippocampal subregions to whole-brain resting state-functional connectivity (rs-FC) analysis showed that the rs-FC strength between the hippocampal cognitive subregion (HIPc) and both the left dorsolateral superior frontal gyrus and the right medial superior frontal gyrus significantly altered in patients with CSVD compared with HCs, suggesting that the prefrontal cortex is a stimulation target of HD-tDCS. In part 2 of the study, performance on the MoCA, AVLT-study, AVLT-delay, SDMT, and digit span test improved in 20 patients with CSVD after 14 days of HD-tDCS targeting the left dorsolateral prefrontal cortex. At the same time, the rs-FC strength between HIPc and the alteration cluster found in the first part of the study, located in the left dorsolateral superior frontal gyrus, was decreased after treatment. HD-tDCS may help normalize brain network function and improve cognitive function in patients with CSVD by reducing rs-FC between the hippocampus and the left dorsolateral prefrontal cortex. Further research is needed to refine treatment plans and evaluate the long-term effects of HD-tDCS on cognitive function in patients with CSVD. The patients with CSVD exhibited altered rs-FC in the hippocampal-prefrontal circuit. HD-tDCS could modulate this circuit and improve cognitive function in patients with CSVD.

Dementia is a neurocognitive disorder that involves deterioration in cognitive and daily functioning, leading to loss of independence and reduced quality of life. While pharmacological treatments offer limited symptomatic relief, non-pharmacological approaches such as exercise have shown promise in improving cognitive and functional outcomes. However, evidence from community-based structured exercise interventions remains limited, particularly in low-resource settings. This trial aims to evaluate the effects of a community-based structured group exercise program on cognitive and physical function among older adults with dementia. This assessor-blinded, community-based randomized controlled trial will be conducted from February to September 2026 in Bangladesh. A total of 120 older adults diagnosed with dementia will be randomly allocated (1:1) to either the experimental group (structured group exercise program with healthy lifestyle advice) or the control group (healthy lifestyle advice alone). The intervention will consist of supervised sessions three times a week for 12 weeks, followed by a 12-week follow-up period. The outcome will be measured on both cognitive and physical function bases. Cognitive function will be evaluated using the Mini-Mental State Examination (MMSE), Addenbrooke's Cognitive Examination Revised (ACE-R), Trail Making Test (TMT) A-B, and Digit Span Test (DST). Physical function will be measured using the Senior Fitness Test (SFT), Berg Balance Scale (BBS), Timed Up and Go (TUG) Test, and Instrumental Activities of Daily Living scale (IADLs). All outcomes will be measured at baseline, posttest (12 weeks), and follow-up period (12 weeks). Data will be analyzed using SPSS following the intention-to-treat principle. The findings are expected to support the integration of physiotherapist-led, community-based exercise into dementia care, offering a feasible, safe, and cost-effective approach for improving cognitive and physical function in older adults with dementia. Despite potential limitations in generalizability, the study's community implementation and follow-up design will contribute valuable insights into sustainable rehabilitation practices in resource-limited settings. This trial is registered prospectively in the Clinical Trial Registry India; ID: CTRI/2025/10/096618; Registered on: 29/10/2025. Link: https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTQ0NDg3&Enc=&userName=.

Background A reduced-item version of the Frontal Assessment Battery (FAB) has been proposed in healthy populations. This study aimed to preliminarily evaluate the reliability of this reduced-item version and its associations with other assessments in patients with subacute stroke. Methods A total of 98 patients with subacute stroke participated in this observational study. The FAB, the Stroop Color Word Test (SCWT), and the Trail Making Test (TMT) were administered within a 10-day period. Associations with related executive function assessments were examined using correlation coefficients. Test-retest reliability (ICC, 2,1) and internal consistency (Cα) were calculated. Results The reduced-item FAB score was strongly correlated with the FAB score (ρ = 0.99), reflecting substantial overlap due to shared items. The reduced-item FAB also showed moderate correlations with SCWT Parts 1–4 (ρ = 0.65–0.79), TMT Part B (ρ = −0.73), and TMT Part B minus A (ρ = −0.71). Both the ICC (2,1) and Cα were 0.94. Conclusion The reduced-item FAB score demonstrated strong internal and temporal consistency, along with expected associations with related cognitive measures in patients with subacute stroke. However, this study is a preliminary evaluation of a score derived from the original FAB.

Papez circuit contributes memory formation. Papez circuit disorder is difficult to evaluate the severity, since the appropriate estimation tool is not established. Executive function is also supported by the memory dependent behaviors. The author found that trail making test (TMT), which is known to check the executive function, can contribute the evaluation of the severity of Papez circuit dysfunction. Case presentation: A 78-year-old man had ischemic infarction at the anterior nuclei of thalamus. He showed the decreased cognitive function without motor nor sensory disorders. Executive function including activity of daily living (ADL) was also impaired. TMT score was markedly increased than that score, that had been obtained at two years ago. Conclusion: Anterior nuclei of thalamus is a component of Papez circuit. Ischemic disorder of that region brings memory disturbance. Further, ADL has been influenced by declining memory. Because of executive function depends on retrieve the memory for the sequential activities, TMT score changes clearly showed the impairment of Papez circuit function.

[Purpose] We aimed to clarify the association between respiratory sarcopenia and attention function, assessed by the Trail Making Test (TMT), in community-dwelling older adults. [Participants and Methods] Fifty-nine older adults were assessed for body composition, respiratory function, and both TMT-A and TMT-B performance times. Respiratory sarcopenia was identified by a reduction in maximal oral pressure and a low skeletal muscle mass index; multiple regression analysis examined the association between respiratory sarcopenia and TMT performance times, adjusting for age and history of respiratory disease. [Results] Respiratory sarcopenia prevalence was 10.2%. This group had significantly lower body weight, body mass index, skeletal muscle mass index, and trunk muscle ratio than the non-respiratory sarcopenia group. We found that the presence of respiratory sarcopenia was significantly associated with a prolonged TMT-A performance time, as opposed to that of TMT-B. [Conclusion] These results indicate that respiratory sarcopenia in community-dwelling older adults was associated with a decline in attention, particularly reduced performance on the TMT-A (reflecting selective and sustained attention), whereas no significant association was found with the TMT-B (reflecting divided attention). We concluded that these findings suggest a potential association between respiratory sarcopenia and specific attention domains in older adults.

Background: Persistent post-concussion syndrome (PPCS) often presents long-lasting cognitive impairments such as memory and attention deficits, impacting daily life. Traditional cognitive rehabilitation faces challenges in patient engagement and personalization. Digital cognitive training games and culturally relevant traditional Indian games offer promising yet under-explored options for rehabilitation in PPCS patients. Objectives: This research study aims to compare the effectiveness of digital gaming and traditional Indian games in enhancing memory and attention among individuals with PPCS. Materials and methods: An experimental study was conducted with 10 PPCS patients aged 18-45 years, divided equally into two groups. Group A (N=5) received a digital gaming intervention, while group B (N=5) engaged in traditional Indian games. Both interventions consisted of 45-minute sessions, five days per week, over six weeks. Cognitive performance was evaluated using the Digit Span Test and Trail-Making Tests A and B. However, the sample size was small, within-group differences were analyzed using the Wilcoxon signed-rank test, and between-group comparisons were performed using the Mann–Whitney U test, with statistical significance set at p&lt;0.05. Results: Post-intervention analysis revealed that both groups experienced statistically significant gains in memory and attention performance (p&lt;0.05). However, Group A exhibited significantly greater gains than group B in post-Digit Span Test scores and Trail-Making Test performance, indicating superior efficacy of digital gaming. Conclusion: Digital gaming was more effective than traditional Indian games in improving attention and memory in PPCS patients. These findings support adopting technology-based cognitive training in rehabilitation while considering cultural relevance and patient preferences.