Treatment Of Cognitive Dysfunction Research Articles

Classification of Neurocognition in Japanese Patients with Schizophrenia: A Cluster Analysis

Objectives. Cognitive functions in almost all domains are lower in patients with schizophrenia than those in healthy controls, with the severity of impairment differing between domains. Treatments are being developed to improve cognitive impairment in patients with schizophrenia. However, the pattern of cognitive impairment must be clarified to facilitate treatment. Therefore, this study aimed to classify the patterns of cognitive impairment in individuals and provide treatment suggestions. Methods. Patients with schizophrenia were recruited from two psychiatric hospitals in Japan. Demographic and psychopathological symptoms were assessed using the Positive and Negative Symptoms Scale for Schizophrenia and neurocognitive functions, using the CogHealth battery. The following domains were assessed: processing speed, visual attention, working memory, visual learning, and spatial attention. The scores were standardised and assigned as the same-aged average score. Hierarchical cluster analysis using Ward’s method was performed based on CogHealth scores. Subsequently, one-way analysis of variance (ANOVA) and Tukey’s multiple comparisons were performed to compare the variables in each cluster. Results. In total, 133 participants were classified into four clusters: Cluster 1 (n = 16), with severe cognitive impairment and psychiatric symptoms and the longest stay; Cluster 2 (n = 44), with moderate cognitive impairment and psychiatric symptoms; Cluster 3 (n = 42), with preserved cognitive function, except for spatial perception, and mild psychiatric symptoms; and Cluster 4 (n = 31), with only memory and spatial perception impairment and mild psychiatric symptoms. Implications. The clusters indicate that impairment may occur in all or selective domains. Selective domain impairments may be in spatial perception or in spatial perception and memory. Therefore, it is recommended that treatments for cognitive dysfunction are developed into four subsets considering an individual’s cognitive features.

COMPARATIVE STUDY ON NEUROCOGNITIVE DEFICITS IN PATIENTS OF SCHIZOPHRENIA AND BIPOLAR AFFECTIVE DISORDER

Objective: Cognitive impairments are central features of schizophrenia and are related to functional status and other aspects of the illness. Aim of this study is to assess and compare neurocognitive impairment in schizophrenia and bipolar affective disorder patients.
 Methods: It was a comparative study. 50 consecutive patients of schizophrenia and 50 consecutive patients of bipolar affective disorder were included. We used PANSS for schizophrenia patients and Hamilton Rating Scale for Depression (HRSD) and Young Mania Rating scale (YMRS) were administered for bipolar patients. Neuropsychological testing was used to compare the cognitive impairment of schizophrenia and bipolar affective disorder.
 Results: The mean age of schizophrenic patients was 37 y and the mean age of BPAD patients was 37.32 y The COWT mean score for schizophrenic patients was 6.98(SD±1.84) and for BPAD patients was 8.44(SD±2.61). The score for schizophrenic patients was-21.21(SD±8.83) and for BPAD patients was-25.43(SD±9.34). The score for schizophrenic patients was 27.10(SD±1.26) and for BPAD patients was 27.52(SD±1.43).
 Conclusion: Compared to bipolar patients, patients with schizophrenia had more cognitive dysfunction. Timely assessment and treatment of cognitive dysfunction should be part of standard management protocols in both schizophrenia and bipolar disorder.

Communication Regarding the Myocardial Ischemia/Reperfusion and Cognitive Impairment: A Narrative Literature Review.

Coronary artery disease is a prevalent ischemic disease that results in insufficient blood supply to the heart muscle due to narrowing or occlusion of the coronary arteries. Various reperfusion strategies, including pharmacological thrombolysis and percutaneous coronary intervention, have been developed to enhance blood flow restoration. However, these interventions can lead to myocardial ischemia/reperfusion injury (MI/RI), which can cause unpredictable complications. Recent research has highlighted a compelling association between MI/RI and cognitive function, revealing pathophysiological mechanisms that may explain altered brain cognition. Manifestations in the brain following MI/RI exhibit pathological features resembling those observed in Alzheimer's disease (AD), implying a potential link between MI/RI and the development of AD. The pro-inflammatory state following MI/RI may induce neuroinflammation via systemic inflammation, while impaired cardiac function can result in cerebral under-perfusion. This review delves into the role of extracellular vesicles in transporting deleterious substances from the heart to the brain during conditions of MI/RI, potentially contributing to impaired cognition. Addressing the cognitive consequence of MI/RI, the review also emphasizes potential neuroprotective interventions and pharmacological treatments within the MI/RI model. In conclusion, the review underscores the significant impact of MI/RI on cognitive function, summarizes potential mechanisms of cardio-cerebral communication in the context of MI/RI, and offers ideas and insights for the prevention and treatment of cognitive dysfunction following MI/RI.

Comparable Efficacy of Repeated Transcranial Direct Current Stimulation, Cognitive Behavioral Therapy, and Their Combination in Improvement of Cold and Hot Cognitive Functions and Amelioration of Depressive Symptoms.

This study aimed to evaluate the effectiveness of repeated transcranial direct current stimulation (rtDCS), cognitive behavioral therapy (CBT), and their combination (rtDCS-CBT) in the treatment of cognitive dysfunction, social cognition, and depressive symptoms in women diagnosed with major depressive disorder (MDD). A total of 40 female participants with MDD were randomly assigned to one of four groups: rtDCS, CBT, rtDCS-CBT, and a control group. The participants' depressive symptoms, executive functions, and social cognition were assessed at baseline, preintervention, postintervention, and during a 1-month follow-up. The rtDCS group received 10 sessions of anodal dorsolateral and cathodal ventromedial prefrontal cortex (2 mA for 20 minutes). The CBT group received 10 sessions of traditional CBT, whereas the combined group received CBT after the tDCS sessions. The results of the analysis of variance indicated that all intervention groups demonstrated significant improvements in depressive symptoms, cognitive dysfunction, and social cognition compared with the control group (all p < 0.001). Furthermore, the rtDCS-CBT group exhibited significantly greater reductions in depressive symptoms when compared with each intervention alone (all p < 0.001). Notably, working memory improvements were observed only in the rtDCS group ( p < 0.001). In conclusion, this study suggests that both CBT and tDCS, either individually or in combination, have a positive therapeutic impact on enhancing executive functions, theory of mind, and depressive symptoms in women with MDD.

Screening Targets for Diagnosis and Treatment of Cognitive Dysfunction in Stroke through Transcriptome Combined with Machine Learning

Screening Targets for Diagnosis and Treatment of Cognitive Dysfunction in Stroke through Transcriptome Combined with Machine Learning

QOL-10. MULTIDISCIPLINARY MEDICAL CARE SYSTEM FOR BRAIN TUMOR SURVIVORS IN JAPAN

Abstract INTRODUCTION: Brain tumor patients suffer from psychological distress and various aftereffects. Although the number of "brain tumor survivors" has been increasing due to improved outcomes of brain tumor treatment, the support system for them is inadequate in Japan. Therefore, we are examining issues affecting the QOL faced by brain tumor patients and their families, with the aim of establishing a fulfilling medical care system with a multidisciplinary approach. Here, we report on the current status of the multidisciplinary medical care system. METHODS: The EORTC QLQ-C30, 14-item resilience scale, PHQ-9, and Pittsburgh Sleep Quality Index are used to assess QOL. Based on these, an optimal care plan for brain tumor patients was developed through multidisciplinary team of professionals among physicians, nurses, clinical neuropsychologists, speech-language pathologists, occupational therapists, pharmacists, and nutritionists. A brain tumor survivorship program designed to support brain tumor patients, survivors, and care givers was developed, and this program was launched in December 2021. RESULTS AND DISCUSSION: Quality of life assessment of brain tumor patients revealed their problems and unmet needs, which enabled the development of optimal care plans in collaboration with multiple disciplines. In addition, neuropsychological approaches and cognitive behavioral therapy have been utilized as interventions for cognitive dysfunction. The Brain Tumor Survivorship Program has 18 participants as of May 31, 2023. In addition to providing online resources, patient support meetings were held virtually, providing an opportunity for participants to communicate directly with each other. CONCLUSION: We believe it is essential to establish a long-term follow-up system specifically for brain tumor patients. Through the multidisciplinary medical care system, we plan to continue to scientifically investigate and develop a support system for the various survivorship issues that brain tumor patients and their families experience across the trajectory of the illness.

Association of Handgrip Strength Weakness and Asymmetry With Incidence of Motoric Cognitive Risk Syndrome in the China Health and Retirement Longitudinal Study.

Motoric cognitive risk (MCR) syndrome is a type of pre-dementia. It is defined as the co-occurrence of subjective cognitive complaints and a slow gait speed. A recent study found that handgrip strength (HGS) asymmetry is associated with an increased risk of neurodegenerative disorders. We aimed to investigate the associations of HGS weakness and asymmetry separately and together with MCR incidence among older Chinese adults. Data from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study were used. HGS values <28 kg for male participants and <18 kg for female participants were considered HGS weaknesses. HGS asymmetry was assessed by the ratio of nondominant to dominant HGS. We used 3 different cutoff values of HGS ratio to define asymmetry, including 10%, 20%, and 30%. Specifically, HGS ratios <0.90 or >1.10 (10%), <0.80 or >1.20 (20%), and <0.70 or >1.30 (30%) were classified as asymmetry. The participants were classified into 4 groups: neither weakness nor asymmetry (neither), asymmetry only, weakness only, and weakness and asymmetry (both). The association between baseline HGS status and 4-year incidence of MCR was examined using logistic regression analyses. A total of 3,777 participants 60 years and older were included in the baseline analysis. The prevalence of MCR at the baseline was 12.8%. Participants with asymmetry only, weakness only, and both showed significantly increased risk of MCR. After excluding participants with MCR at baseline, 2,328 participants were included in the longitudinal analysis. There were 111 MCR cases (4.77%) over the 4-year follow-up period. Participants with HGS weakness and asymmetry together at baseline had increased odds of incident MCR (HGS ratio at 10%: odds ratio [OR] 4.48, p < 0.001; HGS ratio at 20%: OR 5.43, p < 0.001; HGS ratio at 30%: OR 6.02, p < 0.001). These results show that the presence of both HGS asymmetry and weakness is associated with MCR incidence. The early recognition of HGS asymmetry and weakness may be helpful in the prevention and treatment of cognitive dysfunction.

Dietary methionine restriction attenuates cognitive dysfunction associated with sleep deprivation by promoting production of hydrogen sulfide, upregulating expression of BDNF and suppressing neuro-inflammation in rats

IntroductionIn this study, we aimed to study the potential role of H2S and the application of dietary methionine restriction (DMR) in the treatment of cognitive dysfunction in sleep deprived rat models.Material and methodsThe rat groups were established as a Control group, a sleep deprivation (SD) group, a SD + NaSH group and a SD + DMR group. Behavioral data was studied via Morris water maze test. TUNEL assay, real-time PCR, immunohistochemistry (IHC) and enzyme-linked immunosorbent assay (ELISA) were performed to study the differences of cognitive impairment related genes and proteins in different rat groups.ResultsPath length and escape latency were higher in the sleep deprived rats compared with the control rats, which were subsequently recovered by the treatment of NaSH or DMR. Also, DMR most significantly recovered the cognitive impairment and neuron status of sleep deprived rats compared with the administration of NaSH. The elevated level of hippocampal Iba1 and H2S production was recovered by NaSH and DMR, and the expressions of hippocampal phenotypic-related genes including NOS, CD68, CD32 and CD206 mRNA also showed similar trend as hippocampal Iba1. Meanwhile, the increased relative expression of IL-6 and IL-4 were recovered by DMR in sleep deprived rats, while the reduced level of hippocampal brain-derived neurotrophic factor (BDNF) and cystathionine γ-lyase (CSE) were elevated by the treatment of NaSH and MDR, with MDR exhibiting the most significant effect.ConclusionsThe application of DMR could attenuate cognitive dysfunction in sleep deprivation rats by upregulating the production of H2S and BDNF expression and alleviating neuro-inflammation responses.

Drug Abuse &amp; Cognitive Functioning

Extensive research has been conducted on cognitive impairments in substance use disorders, particularly with the advancements in cognitive and computational neuroscience as well as neuroimaging techniques over the past two decades. It has been noticed that, impaired cognition functioning is the common factor in person with substance abuse most precisely in case of attention, memory, recalling, decision making etc. Addiction has been showing basic impairment in brain and brain related processes through improper regulation and decreasing motivation and development of apathy. This special issue addresses cognitive impairment as a trans-diagnostic domain, highlighting the potential benefits of advancing the understanding and treatment of cognitive dysfunction in substance use disorders for various psychiatric conditions. In line with this overarching objective, we provide a summary of current findings in the fore mentioned cognitive domains of substance use disorders. Additionally, we propose an expansion of the scope to encompass precognition and social cognition, which are often overlooked but hold significant relevance to substance use disorders. While these two areas have received comparatively less attention, they are essential aspects of substance use disorders both phenomenologically and in other respects. The review concludes by suggesting avenues for further research and potential therapeutic interventions targeting both the well-established cognitive domains and this more comprehensive understanding of cognitive impairments associated with substance use disorders.

Clinical Observation of Sodium Oligomannate Capsules in the Treatment of Cognitive Dysfunction in Parkinson's Disease

Clinical Observation of Sodium Oligomannate Capsules in the Treatment of Cognitive Dysfunction in Parkinson's Disease

Ginsenoside Rg1 treatment protects against cognitive dysfunction via inhibiting PLC–CN–NFAT1 signaling in T2DM mice

BackgroundAs a complication of Type II Diabetes Mellitus (T2DM), the etiology, pathogenesis, and treatment of cognitive dysfunction are still undefined. Recent studies demonstrated that Ginsenoside Rg1 (Rg1) has promising neuroprotective properties, but the effect and mechanism in diabetes-associated cognitive dysfunction (DACD) deserve further investigation. MethodsAfter establishing the T2DM model with a high-fat diet and STZ intraperitoneal injection, Rg1 was given for 8 weeks. The behavior alterations and neuronal lesions were judged using the open field test (OFT) and Morris water maze (MWM), as well as HE and Nissl staining. The protein or mRNA changes of NOX2, p-PLC, TRPC6, CN, NFAT1, APP, BACE1, NCSTN, and Aβ1-42 were investigated by immunoblot, immunofluorescence or qPCR. Commercial kits were used to evaluate the levels of IP3, DAG, and calcium ion (Ca2+) in brain tissues. ResultsRg1 therapy improved memory impairment and neuronal injury, decreased ROS, IP3, and DAG levels to revert Ca2+ overload, downregulated the expressions of p-PLC, TRPC6, CN, and NFAT1 nuclear translocation, and alleviated Aβ deposition in T2DM mice. In addition, Rg1 therapy elevated the expression of PSD95 and SYN in T2DM mice, which in turn improved synaptic dysfunction. ConclusionsRg1 therapy may improve neuronal injury and DACD via mediating PLC–CN–NFAT1 signal pathway to reduce Aβ generation in T2DM mice.

Possible manifestations of cognitive impairment in children suffering from pancreatic dysfunction

The article investigates possible manifestations of cognitive impairment in children suffering from pancreatic dysfunction. The authors point out that improving blood glucose control in patients with type I diabetes mellitus is an important factor in reducing cognitive impairment, especially in children. At the present stage, the treatment of cognitive dysfunction has become an interdisciplinary multidisciplinary complex treatment, which in the future will not only improve the quality of life of patients, but also minimize the above-mentioned dysfunction as such.

Researches on cognitive sequelae of burn injury: Current status and advances.

Burn injury is a devastating disease with high incidence of disability and mortality. The cognitive dysfunctions, such as memory defect, are the main neurological sequelae influencing the life quality of burn-injured patients. The post-burn cognitive dysfunctions are related to the primary peripheral factors and the secondary cerebral inflammation, resulting in the destruction of blood-brain barrier (BBB), as is shown on Computed Tomography (CT) and magnetic resonance imaging examinations. As part of the neurovascular unit, BBB is vital to the nutrition and homeostasis of the central nervous system (CNS) and undergoes myriad alterations after burn injury, causing post-burn cognitive defects. The diagnosis and treatment of cognitive dysfunctions as burn injury sequelae are of great importance. In this review, we address the major manifestations and interventions of post-burn cognitive defects, as well as the mechanisms involved in memory defect, including neuroinflammation, destruction of BBB, and hormone imbalance.

Cognitive impairments in schizophrenia and their impact on oxidative stress

The article is devoted to modern concepts of cognitive disorders in schizophrenia. Neurocognitive deficits can be expressed in impaired attention, auditory memory, motor skills, working memory, processing speed and executive function. The attention of researchers is currently being paid to the violation of the speed of information processing and character encoding that can lead to impaired social functioning in patients with schizophrenia. Two hypotheses about the dynamics of neurocognitive impairments in schizophrenia are also considered: the theory of «static encephalopathy» and progressive impairment of cognitive functions.This review evaluates the results of a comparative analysis of the effectiveness of first and second generation antipsychotics in the treatment of cognitive dysfunction. As a result of the analysis of the available data, it was concluded that first-generation antipsychotics most likely do not directly impair cognitive abilities, but they can do so indirectly, due to the simultaneous use of anticholinergic drugs that compromise some neurocognitive abilities. Second-generation antipsychotics have an advantage over first-generation drugs, however, it has been argued that most antipsychotics lead to a slight improvement in cognitive functioning, and there is no specific effect on its specific domains.An analysis of data on the relationship between oxidative stress markers and psychopathological characteristics and cognitive profile of patients with schizophrenia was carried out. In particular, the mechanism of stress-induced cell death in the prefrontal and anterior frontal regions and a decrease in brain volume in these regions, leading to a decrease in cognitive and executive functions, are considered. In addition, the mechanisms of association of redox imbalance with brain-derived neurotrophic factor (BDNF) depletion, hypofunction of the NMDA receptor, changes in the level of pro-inflammatory cytokines, neurogenesis, and cell apoptosis were considered.

Analysis of the Efficacy of Acupuncture Combined with Rehabilitation Training in the Treatment of Upper Limb Spasm after Stroke: A Systematic Review and Meta-Analysis.

Objective Systematic evaluation of the efficacy of acupuncture combined with cognitive rehabilitation training in the treatment of upper limb spasm after cerebral apoplexy. Methods The data of CNKI, CBM, CQVIP, Wanfang, and the libraries of Pubmed and Cochrane were searched by computer, and the related literatures about acupuncture combined with cognitive rehabilitation training in the treatment of cognitive dysfunction after stroke were searched. The search time is from January 1, 1995 to January 1, 2022. All data segments were independently analyzed and extracted by two evaluators. After evaluating the quality of the methodology, meta-analysis was carried out by using the RevMan5.4 software. Results Finally, 11 studies were included, with a total of 789 subjects. The results of meta-analysis indicated that acupuncture combined with cognitive rehabilitation training was superior to simple cognitive rehabilitation training or drugs in the following aspects, the difference exhibited statistically significant, the total effective rate (RR = 1.58, 95% CI), latency of P300 (MD = −18.46, 95% CI), amplitude of P300 (MD = 1.23, 95% CI (0.82), P < 0.00001, 95% CI (0.31)), and activity of daily living (ADL), respectively, were significantly higher compared to the control group (P < 0.00001), and the difference was statistically significant (P < 0.05). Based on the results of systematic evaluation, the GRADE system recommendation classification method is used to evaluate the quality of evidence. The results show that the level of evidence is low and the intensity of recommendation is weak. Conclusion The results of this meta-analysis suggest that the curative effect of acupuncture combined with cognitive rehabilitation training is better compared to simple cognitive rehabilitation training or drugs. However, due to the low quality of the original literature, it needs to be confirmed by multicenter, high-quality, large-sample randomized blind controlled trials in the future.

Mesenchymal stem cells for the treatment of cognitive impairment caused by neurological diseases.

Patients with neurological diseases often have cognitive impairment, which creates a substantial emotional and economic burden for patients and their families. This issue urgently needs to be addressed. The pathological mechanism of this cognitive impairment is a complicated process that involves a variety of cells and molecules, central nervous system inflammatory reactions, oxidative stress, free radical damage and nerve protection factor-related metabolic disorders. Traditional treatments include neuroprotective agents and analgesic therapy. However, analgesic therapy cannot improve cognitive function, and the blood-brain barrier (BBB) largely blocks neuroprotective agents from entering the central nervous system; therefore, it is very important to find a more effective treatment. Mesenchymal stem cells (MSCs) have anti-inflammatory, anti-apoptotic and immunomodulatory properties and have been proven to play an important role in the treatment of many neurodegenerative diseases. Most importantly, MSCs are likely to cross the BBB. Therefore, MSC therapy is regarded as an important means of ameliorating neurological impairment. The purpose of this review is to summarize recent researches on the treatment of cognitive dysfunction caused by neurological diseases with MSCs.

Potential Roles of Extracellular Vesicles as Diagnosis Biomarkers and Therapeutic Approaches for Cognitive Impairment in Alzheimer's Disease.

Cognitive dysfunction, the major clinical manifestation of Alzheimer's disease (AD), is caused by irreversible progressive neurological dysfunction. With the aging of the population, the incidence of AD is increasing year by year. However, there is neither a simple and accurate early diagnosis method, nor an effective method to alleviate or prevent the occurrence and progression of AD. Extracellular vesicles (EVs) are a number of heterogeneous membrane structures that arise from the endosome system or shed from the plasma membrane. In the brain, almost every kind of cell may have EVs, which are related to cell-cell communication and regulate cellular function. At present, an increasing body of evidence suggests that EVs play a crucial role in the pathogenesis of AD, and it is of great significance to use them as specific biomarkers and novel therapeutic targets for cognitive impairment in AD. This article reviews the potential role of EVs as diagnostic biomarkers and treatments for cognitive dysfunction in AD.

Application Value of Serum Hcy, TLR4, and CRP in the Diagnosis of Cerebral Small Vessel Disease.

Objective To evaluate the application value of combined detection of serum homocysteine (Hcy), Toll-like receptor 4 (TLR4), and C-reactive protein (CRP) in the diagnosis of cerebral small vessel disease (CSVD). Methods 90 patients with CSVD admitted to our hospital within the past year were identified as the research subjects, and the patients with cognitive dysfunction were assigned to the experimental group, and those with normal cognitive function were assigned to the control group according to the evaluation of cognitive dysfunction by the Montreal Cognitive Assessment (MoCA), with 45 cases in each group. Results The experimental group obtained remarkably elevated Hcy levels than the control group (P < 0.05). The patient's cognitive dysfunction is mainly attributed to the impact of serum Hcy. TLR4 and Hcy were negatively correlated with MoCA scores (P > 0.05). In comparison with the control group, the experimental group had significantly higher levels of Hcy, serum CRP, and interleukin (IL)-6 (P < 0.05). Conclusion The combined detection of serum Hcy, TLR4, and CRP features a high clinical value in the diagnosis of CSVD, which contributes to the prevention and treatment of cognitive dysfunction in patients.

Application of Butylphthalide and Sodium Cytophosphate Choline in the Treatment of Cognitive Dysfunction after Stroke

Application of Butylphthalide and Sodium Cytophosphate Choline in the Treatment of Cognitive Dysfunction after Stroke

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

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