Training the brain: fact and fad in cognitive and behavioral remediation

Optimizing Cognitive Function in Persons With Chronic Pain

OBJECTIVES

Cognitive functioning is commonly disrupted in people living with chronic pain, yet it is an aspect of pain that is often not routinely assessed in pain management settings, and there is a paucity of research on treatments or strategies to alleviate the problem. The purpose of this review is to outline recent research on cognitive deficits seen in chronic pain, to give an overview of the mechanisms involved, advocate cognitive functioning as an important target for treatment in pain populations, and discuss ways in which it may be assessed and potentially remediated.

METHODS

A narrative review.

RESULTS

There are several options for remediation, including compensatory, restorative, and neuromodulatory approaches to directly modify cognitive functioning, as well as physical, psychological, and medication optimization methods to target secondary factors (mood, sleep, and medications) that may interfere with cognition.

DISCUSSION

We highlight the potential to enhance cognitive functions and identify the major gaps in the research literature.

More than the Useful Field: Considering peripheral vision in driving

Applied research on driving and basic vision research have held similar views on central, fovea-based vision as the core of visual perception. In applied work, the concept of the Useful Field, as determined by the Useful Field of View (UFOV) test, divides vision between a "useful" region towards the center of the visual field, and the rest of the visual field. While compelling, this dichotomization is at odds with findings in vision science which demonstrate the capabilities of peripheral vision. In this paper, we examine driving research from this new perspective, and argue for the need for an updated understanding of how drivers acquire information about their operating environment using peripheral vision. The concept of the Useful Field and the UFOV test are not discarded; instead we discuss their strengths, limitations, and future directions. We discuss key findings from vision science on peripheral vision, and a theory that provides insights into its capabilities and limitations. This more complete basic science understanding of peripheral vision informs appropriate use of the UFOV and the Useful Field in driving research going forward.

Feasibility and efficacy of an extended trial of home-based working memory training for pediatric brain tumor survivors: a pilot study

BACKGROUND

Impaired working memory appears to play a key role in some of the neurocognitive late effects of pediatric brain tumor treatments, including declines in intellectual and executive functioning. Recent studies of pediatric cancer survivors suggest Cogmed® Working Memory Training is effective at improving working memory, although pediatric brain tumor survivors may demonstrate a less robust response than children with other cancers. The current study sought to determine if an extended course of Cogmed (35 sessions) was both feasible and efficacious for brain tumor survivors and if improvements were observable in near-transfer and far-transfer working memory measures as well as parent rating scores at 6 months post-treatment.

METHODS

Twenty pediatric brain tumor survivors ages 8 to 18 years with working memory deficits completed 35 sessions of Cogmed. Assessments of working memory and academic skills were completed at baseline, completion of training, and 6-month follow-up and parents completed questionnaires at baseline and 6-month follow-up.

RESULTS

Participants showed significant improvements in working memory at training completion and 6-month follow-up and math achievement at 6-month follow-up. Parents reported executive functioning improvements at follow-up as compared with baseline. Participants' program-based working memory skills did not change significantly between sessions 25 and 35, suggesting that extended training did not provide additional benefit.

CONCLUSIONS

This study replicates and extends previous research by: (1) demonstrating that brain tumor survivors at high risk for neurocognitive late effects can complete and benefit from working memory training, (2) identifying a point of diminished returns on training time investment, and (3) demonstrating benefits 6 months post-intervention.

Memory, Executive Skills, and Psychosocial Phenotype in Children with Pharmacoresponsive Epilepsy: Reactivity to Intervention

BACKGROUND

Recent studies on pharmacoresponsive epilepsies demonstrate specific memory, executive functions (EF), and psychosocial deficits in this group. These deficits are often undertreated, and little is known about the neuropsychological factors that may support moderation of the deficits through intervention. The aim of this study was to explore the effects of a structured cognitive behavioral group intervention on both memory and emotional domains and to evaluate the factors influencing its efficacy.

METHODS

The feasibility study implemented a newly designed intervention for children with pharmacoresponsive epilepsies (N = 33, aged 9-14 years, 51% girls), hypothesizing that memory and psychosocial symptoms in children with pharmacoresponsive epilepsies are sensitive to intervention using structured memory and psychosocial modules in a weekly group session setting. Comparable memory and psychosocial assessments were used to evaluate performance at baseline and post-intervention. Results were compared to age- and education-matched healthy controls (N = 27, aged 9-14 years).

RESULTS

Pre-post-intervention comparisons show improvements in STM (p < 0.01, η2 = 0.358), optimism (p < 0.05, η2 = 0.245), and self-efficacy (p < 0.05, η2 = 0.164). Unique negative relations between memory deficits and psychosocial phenotype were seen in epilepsy patients and not in controls in response to the intervention. EF moderated this intervention effect (p < 0.05, η2 = 0.252), whereas psychosocial status and pharmacological profile did not.

CONCLUSION

Cognitive behavioral therapy focusing on memory and psychosocial perceptions for children with pharmacoresponsive epilepsies seems promising, with greater improvement in memory and psychosocial functioning in children with more affected EF.

Brain training: hype or hope?

Brain training is topical yet controversial. Effects are often limited to trained tasks; and near and far effects to untrained tasks or everyday life measures are often small or lacking altogether. More recent approaches use evidence from cognitive neuroscience on neuroplasticity, resulting in novel cognitive interventions. This special issue encompasses the state of the art of these interventions. Two systematic reviews and nine experimental studies in a variety of patient groups or healthy participants are included, the results of which mostly confirm earlier findings: effects on trained tasks are consistently reported, but generalisation in terms of functional outcome is limited and little evidence is found of long-term effects. In general, the studies show promising, yet challenging training effects on cognition in healthy persons and patients with cognitive deficits. As such, they may be seen as positive "proof of principle" studies, highlighting that cognitive enhancement is possible. The field of brain training, however, is in urgent need of larger and more thoroughly designed studies. These future studies should also include outcome measures on daily functioning, self-efficacy and quality of life in addition to neuropsychological tests or tasks related to cognitive functioning.

Executive Function as a Mediator Between SES and Academic Achievement Throughout Childhood

Childhood socioeconomic status (SES), as measured by parental education and family income, is highly predictive of academic achievement, but little is known about how specific cognitive systems shape SES disparities in achievement outcomes. This study investigated the extent to which executive function (EF) mediated associations between parental education and family income and changes in reading and math achievement in a sample of 336 children between the ages of 6 and 15 years from the NIH MRI Study of Normal Brain Development. Verbal memory was simultaneously modeled as a comparison candidate mediator. SES predicted significant changes in reading and math achievement over a two-year time period. Furthermore, executive function, but not verbal memory, was found to partially mediate the relationship between SES variables and change in math achievement. Collectively, these results suggest that executive function may be an important link between childhood SES and academic achievement.

The Efficacy of Computerized Cognitive Training in Adults With ADHD: A Randomized Controlled Trial

OBJECTIVE

This is a randomized control trial examining the efficiency of computerized cognitive training (CCT) for adults with ADHD, comparing two training conditions with graded levels of executive cognitive demands.

METHOD

Adults with ADHD (n = 60) were randomized into study (n = 34) and control (n = 26) groups. Training was conducted with the computerized AttenFocus program. Control group received a simple, non-hierarchical version with less executive demands.

RESULTS

Significant positive changes in symptoms ratings, ecological measures of executive functions, and occupational performance were found in both groups. No significant changes were found in variables of neurocognitive performance battery and quality of life. No significant time by group interaction effects were found.

CONCLUSION

No benefits of the intervention were found relative to the control. Lack of interaction effects may be due to insufficient power, non-specific cognitive training or placebo effects. Results demonstrate some positive findings for general CCT, yet do not support the inclusion of specific higher level executive training.

Spiraling out of control: Stress generation and subsequent rumination mediate the link between poorer cognitive control and internalizing psychopathology

Poor cognitive control is associated with nearly every mental disorder and has been proposed as a transdiagnostic risk factor for psychopathology, including depression and anxiety. What specific mechanisms might cause individuals with poor cognitive control to experience higher levels of psychopathology? The current research tests a new process model linking poor cognitive control to depression and anxiety symptoms via increased dependent stress (i.e., self-generated stressors) and subsequent rumination. This model was supported across two studies in youth during the key period for emergence of internalizing psychopathology. Study 1 provides longitudinal evidence for prospective prediction of change in symptoms. Study 2 confirms this model using well-established executive function tasks in a cross-sectional study. These finding have potential implications for understanding why cognitive control impairments may be broadly associated with psychopathology, and suggest that interventions to prevent stress generation might be effective in preventing negative consequences of poor cognitive control.

Cognitive training and Bacopa monnieri: Evidence for a combined intervention to alleviate age associated cognitive decline

As the elderly population grows the impact of age associated cognitive decline as well as neurodegenerative diseases such as Alzheimer's disease and dementia will increase. Ageing is associated with consistent impairments in cognitive processes (e.g., processing speed, memory, executive function and learning) important for work, well-being, life satisfaction and overall participation in society. Recently, there has been increased effort to conduct research examining methods to improve cognitive function in older citizens. Cognitive training has been shown to improve performance in some cognitive domains; including memory, processing speed, executive function and attention in older adults. These cognitive changes are thought to be related to improvements in brain connectivity and neural circuitry. Bacopa monnieri has also been shown to improve specific domains of cognition, sensitive to age associated cognitive decline (particularly processing speed and memory). These Bacopa monnieri dependent improvements may be due to the increase in specific neuro-molecular mechanisms implicated in the enhancement of neural connections in the brain (i.e. synaptogenesis). In particular, a number of animal studies have shown Bacopa monnieri consumption upregulates calcium dependent kinases in the synapse and post-synaptic cell, crucial for strengthening and growing connections between neurons. These effects have been shown to occur in areas important for cognitive processes, such as the hippocampus. As Bacopa monnieri has shown neuro-molecular mechanisms that encourage synaptogenesis, while cognitive training enhances brain connectivity, Bacopa monnieri supplementation could theoretically enhance and strengthen synaptic changes acquired through cognitive training. Therefore, the current paper hypothesises that the combination of these two interventions could improve cognitive outcomes, over and above the effects of administrating these interventions independently, as an effective treatment to ameliorate age associated cognitive decline.

The evolution of general intelligence

The presence of general intelligence poses a major evolutionary puzzle, which has led to increased interest in its presence in nonhuman animals. The aim of this review is to critically evaluate this question and to explore the implications for current theories about the evolution of cognition. We first review domain-general and domain-specific accounts of human cognition in order to situate attempts to identify general intelligence in nonhuman animals. Recent studies are consistent with the presence of general intelligence in mammals (rodents and primates). However, the interpretation of a psychometric g factor as general intelligence needs to be validated, in particular in primates, and we propose a range of such tests. We then evaluate the implications of general intelligence in nonhuman animals for current theories about its evolution and find support for the cultural intelligence approach, which stresses the critical importance of social inputs during the ontogenetic construction of survival-relevant skills. The presence of general intelligence in nonhumans implies that modular abilities can arise in two ways, primarily through automatic development with fixed content and secondarily through learning and automatization with more variable content. The currently best-supported model, for humans and nonhuman vertebrates alike, thus construes the mind as a mix of skills based on primary and secondary modules. The relative importance of these two components is expected to vary widely among species, and we formulate tests to quantify their strength.

A preliminary study of the effects of working memory training on brain function

Working memory (WM) training improves WM ability in Attention-Deficit/Hyperactivity Disorder (ADHD), but its efficacy for non-cognitive ADHD impairments ADHD has been sharply debated. The purpose of this preliminary study was to characterize WM training-related changes in ADHD brain function and see if they were linked to clinical improvement. We examined 18 adolescents diagnosed with DSM-IV Combined-subtype ADHD before and after 25 sessions of WM training using a frequently employed approach (Cogmed™) using a nonverbal Sternberg WM fMRI task, neuropsychological tests, and participant- and parent-reports of ADHD symptom severity and associated functional impairment. Whole brain SPM8 analyses identified ADHD activation deficits compared to 18 non-ADHD control participants, then tested whether impaired ADHD frontoparietal brain activation would increase following WM training. Post hoc tests examined the relationships between neural changes and neurocognitive or clinical improvements. As predicted, WM training increased WM performance, ADHD clinical functioning, and WM-related ADHD brain activity in several frontal, parietal and temporal lobe regions. Increased left inferior frontal sulcus region activity was seen in all Encoding, Maintenance, and Retrieval Sternberg task phases. ADHD symptom severity improvements were most often positively correlated with activation gains in brain regions known to be engaged for WM-related executive processing; improvement of different symptom types had different neural correlates. The responsiveness of both amodal WM frontoparietal circuits and executive process-specific WM brain regions was altered by WM training. The latter might represent a promising, relatively unexplored treatment target for researchers seeking to optimize clinical response in ongoing ADHD WM training development efforts.

Barriers, Benefits, and Beliefs of Brain Training Smartphone Apps: An Internet Survey of Younger US Consumers

Background: While clinical evidence for the efficacy of brain training remains in question, numerous smartphone applications (apps) already offer brain training directly to consumers. Little is known about why consumers choose to download these apps, how they use them, and what benefits they perceive. Given the high rates of smartphone ownership in those with internet access and the younger demographics, we chose to approach this question first with a general population survey that would capture primarily this demographic.

Method: We conducted an online internet-based survey of the US population via mTurk regarding their use, experience, and perceptions of brain training apps. There were no exclusion criteria to partake although internet access was required. Respondents were paid 20 cents for completing each survey. The survey was offered for a 2-week period in September 2015.

Results: 3125 individuals completed the survey and over half of these were under age 30. Responses did not significantly vary by gender. The brain training app most frequently used was Lumosity. Belief that a brain-training app could help with thinking was strongly correlated with belief it could also help with attention, memory, and even mood. Beliefs of those who had never used brain-training apps were similar to those who had used them. Respondents felt that data security and lack of endorsement from a clinician were the two least important barriers to use.

Discussion: Results suggest a high level of interest in brain training apps among the US public, especially those in younger demographics. The stability of positive perception of these apps among app-naïve and app-exposed participants suggests an important role of user expectations in influencing use and experience of these apps. The low concern about data security and lack of clinician endorsement suggest apps are not being utilized in clinical settings. However, the public’s interest in the effectiveness of apps suggests a common theme with the scientific community’s concerns about direct to consumer brain training programs.

Conclusions about interventions, programs, and approaches for improving executive functions that appear justified and those that, despite much hype, do not

The 'Executive Functions' (EFs) of inhibitory control, working memory, and cognitive flexibility enable us to think before we act, resist temptations or impulsive reactions, stay focused, reason, problem-solve, flexibly adjust to changed demands or priorities, and see things from new and different perspectives. These skills are critical for success in all life's aspects and are sometimes more predictive than even IQ or socioeconomic status. Understandably, there is great interest in improving EFs. It's now clear they can be improved at any age through training and practice, much as physical exercise hones physical fitness. However, despite claims to the contrary, wide transfer does not seem to occur and 'mindless' aerobic exercise does little to improve EFs. Important questions remain: How much can EFs be improved (are benefits only superficial) and how long can benefits be sustained? What are the best methods for improving EFs? What about an approach accounts for its success? Do the answers to these differ by individual characteristics such as age or gender? Since stress, sadness, loneliness, or poor health impair EFs, and the reverse enhances EFs, we predict that besides directly train EFs, the most successful approaches for improving EFs will also address emotional, social, and physical needs.

Computerised cognitive training in acquired brain injury: A systematic review of outcomes using the International Classification of Functioning (ICF)

Computerised cognitive training (CCT) is an increasingly popular intervention for people experiencing cognitive symptoms. This systematic review evaluated the evidence for CCT in adults with acquired brain injury (ABI), focusing on how outcome measures used reflect efficacy across components of the International Classification of Functioning, Disability and Health. Database searches were conducted of studies investigating CCT to treat cognitive symptoms in adult ABI. Scientific quality was rated using the PEDro-P and RoBiNT Scales. Ninety-six studies met the criteria. Most studies examined outcomes using measures of mental functions (93/96, 97%); fewer studies included measures of activities/participation (41/96, 43%) or body structures (8/96, 8%). Only 14 studies (15%) provided Level 1 evidence (randomised controlled trials with a PEDro-P score ≥ 6/10), with these studies suggesting strong evidence for CCT improving processing speed in multiple sclerosis (MS) and moderate evidence for improving memory in MS and brain tumour populations. There is a large body of research examining the efficacy of CCT, but relatively few Level 1 studies and evidence is largely limited to body function outcomes. The routine use of outcome measures of activities/participation would provide more meaningful evidence for the efficacy of CCT. The use of body structure outcome measures (e.g., neuroimaging) is a newly emerging area, with potential to increase understanding of mechanisms of action for CCT.

Working Memory Training and CBT Reduces Anxiety Symptoms and Attentional Biases to Threat: A Preliminary Study

Research indicates that cognitive processes linked to the detection of threat stimuli are associated with poor attentional control, placing children and adolescents at increased risk for the development of anxious affect. The current study aimed to provide preliminary data to assess whether an intervention designed to improve attentional control (via working memory; WM) would lead to better performance in tests of WM and would be associated with positive changes in symptoms of trait and test anxiety, increased inhibitory control and reduced attention to threat. Forty adolescents aged 11-14 years who reported elevated anxiety and low attentional control were randomly allocated to a WM training or an active cognitive behavioural therapy (CBT) control group. Post intervention, WM training was associated with greater improvements (versus. CBT) in trained WM tasks. Both groups, however, reported fewer anxiety symptoms, demonstrated increased inhibitory control and a reduction in attentional biases to threat post intervention and these results were maintained at follow up. The study provides indicative evidence which suggests that WM training has similar benefits to a more traditional CBT intervention on reduced anxiety and attentional biases for threat. Future research should aim to replicate the findings in a large sample size and explore the broader impact of training on day-to-day functioning. In addition, further research is needed to identify which participants benefit most from different interventions (using baseline characteristics) on treatment compliance and outcome.

Incremental validity of Useful Field of View subtests for the prediction of instrumental activities of daily living

INTRODUCTION

The Useful Field of View Test (UFOV®) is a cognitive measure that predicts older adults' ability to perform a range of everyday activities. However, little is known about the individual contribution of each subtest to these predictions, and the underlying constructs of UFOV performance remain a topic of debate.

METHOD

We investigated the incremental validity of UFOV subtests for the prediction of Instrumental Activities of Daily Living (IADL) performance in two independent datasets, the SKILL (n = 828) and ACTIVE (n = 2426) studies. We then explored the cognitive and visual abilities assessed by UFOV using a range of neuropsychological and vision tests administered in the SKILL study.

RESULTS

In the four subtest variant of UFOV, only Subtests 2 and 3 consistently made independent contributions to the prediction of IADL performance across three different behavioral measures. In all cases, the incremental validity of UFOV Subtests 1 and 4 was negligible. Furthermore, we found that UFOV was related to processing speed, general nonspeeded cognition, and visual function; the omission of Subtests 1 and 4 from the test score did not affect these associations.

CONCLUSIONS

UFOV Subtests 1 and 4 appear to be of limited use to predict IADL and possibly other everyday activities. Future research should investigate whether shortening UFOV by omitting these subtests is a reliable and valid assessment approach.

The Potential for Literacy to Shape Lifelong Cognitive Health

In light of population aging, an understanding of factors that promote lifelong cognitive resilience is urgent. There is considerable evidence that education early in the life span, which promotes the development of literacy skills, leads to cognitive health and longevity, but the ways in which activity engagement in later adulthood affects long-term cognitive health is not well understood. The literature on cognitive training focusing on ability and skill training has not only demonstrated the existence of plasticity into late life but also shows that improvements are very tightly tied to the abilities trained. The rush to apply ability training to promote cognitive health has produced a vibrant “brain training” industry that neglects the very limited evidence for transfer to significant functional outcomes. Recent evidence on the neural substrates of reading, language comprehension, and discourse processing, as well as on the lifelong effects of literacy engagement in special populations, hints that reading may well be a “whole-brain exercise” with the potential to promote cognitive health. Such findings suggest promise for education-based approaches to promote lifelong cognitive health, calling for (a) societal investment in science at the interface of education and health, in particular to understand the mechanisms through which literacy engagement affects mind, brain, and physical health through the life span, and (b) innovation in developing models of life span education.

Perceptual and cognitive neural correlates of the useful field of view test in older adults

The Useful Field of View Test (UFOV) is often used as a behavioral assessment of age-related decline in visual perception and cognition. Poor performance may reflect slowed processing speed, difficulty dividing attention, and difficulty ignoring irrelevant information. However, the underlying neural correlates of UFOV performance have not been identified. The relationship between older adults' UFOV performance and event-related potential (ERP) components reflecting visual processing was examined. P1 amplitude increased with better UFOV performance involving object identification (subtest 1), suggesting that this task is associated with stimulus processing at an early perceptual level. Better performance in all UFOV subtests was associated with faster speed of processing, as reflected by decreases in P3b latency. Current evidence supports the hypothesis that the UFOV recruits both early perceptual and later cognitive processing involved in attentional control. The implications of these results are discussed.

Investigating the effectiveness of working memory training in the context of Personality Systems Interaction theory

Previous research has shown mixed results for the ability of working memory training to improve fluid intelligence. The aims of this study were first to replicate these improvements, and then to explore the moderating role of Personality Systems Interaction (PSI) personality factors. By using three different training methods and an active-contact control group, we examined the effects of 25 days of cognitive training on 142 participants. After examining our results in context of PSI theory, we found that different training methods yielded different IQ gains in participants, depending on their personality styles. In addition, these correlations suggested a meaningful pattern, indicating that PSI theory may be able to account for the different outcomes of cognitive training studies. Our findings may facilitate tailor-made cognitive training interventions in the future, and can contribute to explaining the mechanisms underlying the far transfer of working memory training to fluid intelligence.

An ecological approach to cognitive enhancement: complex motor training

Cognitive training has received a lot of attention recently, yielding findings that can be conflicting and controversial. In this paper, we present a novel approach to cognitive training based on complex motor activities. In a randomized controlled design, participants were assigned to one of three conditions: aerobic exercise, working memory training or designed sport--an intervention specifically tailored to include both physical and cognitive demands. After training for eight weeks, the designed sport group showed the largest gains in all cognitive measures, illustrating the efficacy of complex motor activities to enhance cognition. Designed sport training also revealed impressive health benefits, namely decreased heart rate and blood pressure. In this period of skepticism over the efficacy of computerized cognitive training, we discuss the potential of ecological interventions targeting both cognition and physical fitness, and propose some possible applications.

Learning from the past and looking to the future: Emerging perspectives for improving the treatment of psychiatric disorders

Modern neuropsychopharmacology commenced in the 1950s with the serendipitous discovery of first-generation antipsychotics and antidepressants which were therapeutically effective yet had marked adverse effects. Today, a broader palette of safer and better-tolerated agents is available for helping people that suffer from schizophrenia, depression and other psychiatric disorders, while complementary approaches like psychotherapy also have important roles to play in their treatment, both alone and in association with medication. Nonetheless, despite considerable efforts, current management is still only partially effective, and highly-prevalent psychiatric disorders of the brain continue to represent a huge personal and socio-economic burden. The lack of success in discovering more effective pharmacotherapy has contributed, together with many other factors, to a relative disengagement by pharmaceutical firms from neuropsychiatry. Nonetheless, interest remains high, and partnerships are proliferating with academic centres which are increasingly integrating drug discovery and translational research into their traditional activities. This is, then, a time of transition and an opportune moment to thoroughly survey the field. Accordingly, the present paper, first, chronicles the discovery and development of psychotropic agents, focusing in particular on their mechanisms of action and therapeutic utility, and how problems faced were eventually overcome. Second, it discusses the lessons learned from past successes and failures, and how they are being applied to promote future progress. Third, it comprehensively surveys emerging strategies that are (1), improving our understanding of the diagnosis and classification of psychiatric disorders; (2), deepening knowledge of their underlying risk factors and pathophysiological substrates; (3), refining cellular and animal models for discovery and validation of novel therapeutic agents; (4), improving the design and outcome of clinical trials; (5), moving towards reliable biomarkers of patient subpopulations and medication efficacy and (6), promoting collaborative approaches to innovation by uniting key partners from the regulators, industry and academia to patients. Notwithstanding the challenges ahead, the many changes and ideas articulated herein provide new hope and something of a framework for progress towards the improved prevention and relief of psychiatric and other CNS disorders, an urgent mission for our Century.

Internet-based brain training games, citizen scientists, and big data: ethical issues in unprecedented virtual territories

Internet brain training programs, where consumers serve as both subjects and funders of the research, represent the closest engagement many individuals have with neuroscience. Safeguards are needed to protect participants' privacy and the evolving scientific enterprise of big data.

Advancing understanding of executive function impairments and psychopathology: bridging the gap between clinical and cognitive approaches

Executive function (EF) is essential for successfully navigating nearly all of our daily activities. Of critical importance for clinical psychological science, EF impairments are associated with most forms of psychopathology. However, despite the proliferation of research on EF in clinical populations, with notable exceptions clinical and cognitive approaches to EF have remained largely independent, leading to failures to apply theoretical and methodological advances in one field to the other field and hindering progress. First, we review the current state of knowledge of EF impairments associated with psychopathology and limitations to the previous research in light of recent advances in understanding and measuring EF. Next, we offer concrete suggestions for improving EF assessment. Last, we suggest future directions, including integrating modern models of EF with state of the art, hierarchical models of dimensional psychopathology as well as translational implications of EF-informed research on clinical science.

Memory outcomes following cognitive interventions in children with neurological deficits: A review with a focus on under-studied populations

Given the primary role of memory in children's learning and well-being, the aim of this review was to examine the outcomes of memory remediation interventions in children with neurological deficits as a function of the affected memory system and intervention method. Fifty-seven studies that evaluated the outcome of memory interventions in children were identified. Thirty-four studies met the inclusion criteria, and were included in a systematic review. Diverse rehabilitation methods for improving explicit and implicit memory in children were reviewed. The analysis indicates that teaching restoration strategies may improve, and result in the generalisation of, semantic memory and working memory performance in children older than 7 years with mild to moderate memory deficits. Factors such as longer protocols, emotional support, and personal feedback contribute to intervention efficacy. In addition, the use of compensation aids seems to be highly effective in prospective memory tasks. Finally, the review unveiled a lack of studies with young children and the absence of group interventions. These findings point to the importance of future evidence-based intervention protocols in these areas.

Neuroplasticity Changes of Rat Brain by Musical Stimuli during Fetal Period

OBJECTIVE

Fetal development of the central nervous system is an important and sensitive stage which is affected by many external and internal stimuli. This study aimed to investigate effect of musical stimuli on fetal rat brain.

MATERIALS AND METHODS

In this experimental study, twelve female Wistar rats were selected and evenly assigned to control and musical groups. The females were mated with a male rat of the same genotype. Musical group was exposed to classic music with 60 dB power for 90 minutes twice per day from 2(nd) to 20(th) day of gestation. The control rats were handled similar to the musical group, but were not exposed to music. Before parturition, all the dams were anesthetized, and their blood samples were obtained and used for corticosterone (COS) measurement. They were transcardially perfused by electron microscope (EM) fixative agent. The fetal brains were extracted intact and used for slice preparation. Horizontal slices were made for electron microscope preparation, and images were taken and analyzed in terms of cell density and morphological changes.

RESULTS

EM observation indicated significant morphological difference in cellular and intercellular spaces between the two groups. Music-treated fetuses had significantly higher cell density in parietal cortex and music-treated dams had lower COS level.

CONCLUSION

It was concluded that prenatal music would have a great impact on neuroplasticity of fetal rat brain, at least indirectly. Although the rat fetuses cannot hear until birth, music-induced reduction in COS blood level of dams might be the reason for neuroplasticity of fetal brain.

Bilingual children with primary language impairment: 3 months after treatment

BACKGROUND

Evidence on the treatment effectiveness for bilingual children with primary language impairment (PLI) is needed to advance both theory and clinical practice. Of key interest is whether treatment effects are maintained following the completion of short-term intense treatments.

AIMS

To investigate change in select language and cognitive skills in Spanish-English bilingual children with PLI 3 months after children have completed one of three experimental treatment conditions. There are two main study aims. First, to determine if skills in Spanish, English and cognitive processing decline, improve or are maintained after treatment has been completed. Second, to determine if differential rates of change are a function of the type of treatment children received.

METHODS & PROCEDURES

Participants were 48 children, aged 5:6-11:3, who spoke Spanish and English and were diagnosed with moderate to severe PLI. Participants received 6 weeks of treatment focused on English only (EO), bilingual skills in Spanish and English (BI) or nonlinguistic cognitive processing (NCP). Treatment effects reported in a previous study were determined by comparing pre- and post-treatment performance on a variety of language and cognitive measures. Here we re-administered each measure 3 months after completion of the experimental treatments. Hierarchical linear models were calculated for each measure using pre-, post- and follow-up testing scores to estimate change trajectories and compare outcomes between treatment conditions.

OUTCOMES & RESULTS

Participants in all three treatment conditions either maintained skills or showed improvement even after treatment was discontinued for 3 months. Main findings included (1) comparable, positive rates of change on all English language outcomes for EO and BI conditions; (2) maintenance of Spanish language skills, and (3) modest improvements in NCP following the discontinuation of treatment.

CONCLUSIONS & IMPLICATIONS

This study is the first to examine longer-term treatment effects for bilingual school-age children with PLI. Differences in rates of change between languages and between treatment conditions are discussed in terms of social and cognitive processes that impact children's language systems. The main findings have at least two implications for clinical practice: (1) therapy that emphasizes focused practice in language and cognitive processing skills may promote gains in children's language learning abilities; and (2) bilingual treatment does not detract from outcomes in English, the language of the majority community for study participants.

The effects of theta transcranial alternating current stimulation (tACS) on fluid intelligence

The objective of the study was to explore the influence of transcranial alternating current stimulation (tACS) on resting brain activity and on measures of fluid intelligence. Theta tACS was applied to the left parietal and left frontal brain areas of healthy participants after which resting electroencephalogram (EEG) data was recorded. Following sham/active stimulation, the participants solved two tests of fluid intelligence while their EEG was recorded. The results showed that active theta tACS affected spectral power in theta and alpha frequency bands. In addition, active theta tACS improved performance on tests of fluid intelligence. This influence was more pronounced in the group of participants that received stimulation to the left parietal area than in the group of participants that received stimulation to the left frontal area. Left parietal tACS increased performance on the difficult test items of both tests (RAPM and PF&C) whereas left frontal tACS increased performance only on the easy test items of one test (RAPM). The observed behavioral tACS influences were also accompanied by changes in neuroelectric activity. The behavioral and neuroelectric data tentatively support the P-FIT neurobiological model of intelligence.

Web-based cognitive training: patient adherence and intensity of treatment in an outpatient memory clinic

Background

Cognitive training has been playing an increasing role in the treatment of patients with cognitive deficits. This type of intervention, namely its intensity, can be optimized by incorporating information technology-based systems.

Objective

The intent of the study was to determine the treatment intensity and patient adherence to home-based cognitive training strategies (Web-based cognitive training).

Methods

A cohort of 45 patients with neurologic and psychiatric diseases attending an outpatient memory clinic (average age 50.7 years, SD 17.0; average education 7.8 years, SD 4.9) was followed over 18 months. Participants were challenged to use a Web-based cognitive training system, “COGWEB”, on a daily basis, and fulfilled at least four weeks of training supervised remotely. Additionally, 11 patients attended face-to-face sessions.

Results

The average duration of continuous cognitive training was 18.8 weeks (SD 18.9). Each patient performed on average 363.5 minutes/week (SD 136.6). At 6-month follow-up, 82.8% complied with their treatment plan. The average proportion of complete weeks was 0.75 (SD 0.22). Patients with dementia trained more intensively (444.6 minutes/week), followed by patients with static brain lesion (414.5 minutes/week; P=.01). The group that held face-to-face sessions performed more training overall (481.4 vs 366.9 minutes/week), achieving a stronger expression and statistical significance in the last week of training (652.6 versus 354.9 minutes/week, P=.027).

Conclusions

Overall, the weekly training intensity was high. Patients with dementia and static lesions performed more cognitive training. Face-to-face sessions were associated with higher intensities. The combination of classical methods with information technology systems seems to ensure greater training intensity.

Indestructible plastic: the neuroscience of the new aging brain

In recent years, research on experience-dependent plasticity has provided valuable insight on adaptation to environmental input across the lifespan, and advances in understanding the minute cellular changes underlying the brain's capacity for self-reorganization have opened exciting new possibilities for treating illness and injury. Ongoing work in this line of inquiry has also come to deeply influence another field: cognitive neuroscience of the normal aging. This complex process, once considered inevitable or beyond the reach of treatment, has been transformed into an arena of intense investigation and strategic intervention. However, important questions remain about this characterization of the aging brain, and the assumptions it makes about the social, cultural, and biological space occupied by cognition in the older individual and body. The following paper will provide a critical examination of the move from basic experiments on the neurophysiology of experience-dependent plasticity to the growing market for (and public conception of) cognitive aging as a medicalized space for intervention by neuroscience-backed technologies. Entangled with changing concepts of normality, pathology, and self-preservation, we will argue that this new understanding, led by personalized cognitive training strategies, is approaching a point where interdisciplinary research is crucial to provide a holistic and nuanced understanding of the aging process. This new outlook will allow us to move forward in a space where our knowledge, like our new conception of the brain, is never static.

On methodological standards in training and transfer experiments

The past two decades have seen a tremendous surge in scientific interest in the extent to which certain types of training-be it aerobic, athletic, musical, video game, or brain trainer-can result in general enhancements in cognitive function. While there are certainly active debates regarding the results in these domains, what is perhaps more pressing is the fact that key aspects of methodology remain unsettled. Here we discuss a few of these areas including expectation effects, test-retest effects, the size of the cognitive test battery, the selection of control groups, group assignment methods, difficulties in comparing results across studies, and in interpreting null results. Specifically, our goal is to highlight points of contention as well as areas where the most commonly utilized methods could be improved upon. Furthermore, because each of the sub-areas above (aerobic training through brain training) share strong similarities in goal, theoretical framework, and experimental approach, we seek to discuss these issues from a general perspective that considers each as members of the same broad "training" domain.

A rehabilitation tool designed for intensive web-based cognitive training: description and usability study

Background

Cognitive deficits are among the most disabling of neurological diseases and have a serious impact on the quality of life of patients and families. Cognitive training has been proven successful in improving or compensating for neuropsychological deficits after acute brain injury, but its efficacy highly depends on the intensity of treatment over an extended period of time. Therefore, cognitive training indicates expensive human resources and renders the rehabilitation process vulnerable to physical and economic barriers for the majority of patients.

Objective

The aim of this study was to develop and test a new Web-based rehabilitation tool that provides intensive cognitive training at home under clinical prescription and monitoring, at affordable costs.

Methods

From a pool of 60 original exercises, designed and used over the past 10 years for cognitive training at our center, we developed 27 exercises on a computer game format, with automatic increase or decrease of difficulty levels. These exercises were assembled in a clean, user-friendly design and covered various cognitive domains such as attention (n=4), memory (n=11), language (n=3), calculus (n=3), praxis (n=2), and executive functions (n=3). A Web 2.0 platform was also designed to provide medical prescription of cognitive training sessions, performed at the patient’s home. These sessions included continuous monitoring of compliance, performance, and evolution; algorithms for automatic adjustment and long-term learning through use, and database recording of all activities. The end-user interaction test included 80 patients from our memory clinic from several groups including subjective memory complaints (n=20), traumatic brain injury (n=20), stroke and other static brain lesions (n=20), and mild Alzheimer’s disease (n=20). During a 1-hour session, patients and their relatives were taught to use the system and allowed to practice using it. At the end of the session, they were asked to complete a questionnaire.

Results

A total of 48/80 patients (60%) attended the training session. The mean age of the patients was 60 years (SD 13.3, range 41-78), and the mean level of formal education was 6 years (range 4-16). Of all the participants, 32/48 patients (66%) have previously used a computer. All patients and their relatives made a positive evaluation of the cognitive training tool. Only 2/48 patients (4%) were not interested in performing the exercises at home; 19/48 patients (39%) mentioned the need for further coaching from a relative or health care professional. The patients who mentioned difficulties in performing the exercises have not used the computer earlier.

Conclusions

This new Web-based system was very well accepted by patients and their relatives, who showed high levels of motivation to use it on a daily basis at home. The simplicity of its use and comfort were especially outlined. This tool will have an important effect on human resource management, in increasing the patient access to specialized health care and improving the quality and national health system costs of rehabilitation programs.

mHealth approaches to child obesity prevention: successes, unique challenges, and next directions

Childhood obesity continues to be a significant public health issue. mHealth systems offer state-of-the-art approaches to intervention design, delivery, and diffusion of treatment and prevention efforts. Benefits include cost effectiveness, potential for real-time data collection, feedback capability, minimized participant burden, relevance to multiple types of populations, and increased dissemination capability. However, these advantages are coupled with unique challenges. This commentary discusses challenges with using mHealth strategies for child obesity prevention, such as lack of scientific evidence base describing effectiveness of commercially available applications; relatively slower speed of technology development in academic research settings as compared with industry; data security, and patient privacy; potentially adverse consequences of increased sedentary screen time, and decreased focused attention due to technology use. Implications for researchers include development of more nuanced measures of screen time and other technology-related activities, and partnering with industry for developing healthier technologies. Implications for health practitioners include monitoring, assessing, and providing feedback to child obesity program designers about users' data transfer issues, perceived security and privacy, sedentary behavior, focused attention, and maintenance of behavior change. Implications for policy makers include regulation of claims and quality of apps (especially those aimed at children), supporting standardized data encryption and secure open architecture, and resources for research-industry partnerships that improve the look and feel of technology. Partnerships between academia and industry may promote solutions, as discussed in this commentary.

Effect of mindfulness meditation on brain-computer interface performance

Electroencephalogram based brain-computer interfaces (BCIs) enable stroke and motor neuron disease patients to communicate and control devices. Mindfulness meditation has been claimed to enhance metacognitive regulation. The current study explores whether mindfulness meditation training can thus improve the performance of BCI users. To eliminate the possibility of expectation of improvement influencing the results, we introduced a music training condition. A norming study found that both meditation and music interventions elicited clear expectations for improvement on the BCI task, with the strength of expectation being closely matched. In the main 12 week intervention study, seventy-six healthy volunteers were randomly assigned to three groups: a meditation training group; a music training group; and a no treatment control group. The mindfulness meditation training group obtained a significantly higher BCI accuracy compared to both the music training and no-treatment control groups after the intervention, indicating effects of meditation above and beyond expectancy effects.

The Efficacy of InSight Cognitive Training to Improve Useful Field of View Performance: A Brief Report

OBJECTIVE

It is well established that cognitive speed of processing training (SOPT) improves Useful Field of View (UFOV) performance and transfers to enhanced performance of instrumental activities of daily living, including driving. InSight is a recently developed version of SOPT formatted for self-administration by older adults with exercises translated into a gaming format. The goal was to examine whether InSight training improves UFOV performance.

METHOD

Participants ranged in age between 59-95 years and were randomized to InSight cognitive training or a control condition. Cognitive performance and self-perceptions were measured pre- and post-training, or for controls, after an equivalent delay. Participants completed training twice a week over a 12-week period with the goal of completing 20 sessions.

RESULTS

Participants randomized to InSight training experienced greater improvements in their UFOV performance relative to the control condition, F(1, 58) = 4.26, p = .043, but no changes in cognitive self-perceptions were found.

CONCLUSIONS

The InSight program is a viable tool for enhancing older adults' UFOV performance. Future research should examine if training gains from the program endure and transfer to improved everyday function.