Working Memory Training in Youth With Autism, Fragile X, and Intellectual Disability: A Pilot Study

This pilot study sought to identify potential markers of improvement from pre-post treatment in response to computerized working memory (WM) training for youth (ages 8-18) with autism spectrum disorder (ASD) and comorbid intellectual disability (ID) in a single arm, pre-post design. Participants included 26 children with ASD and 18 with comorbid ASD and fragile X syndrome (ASD+FXS). Analyses were adjusted for age and IQ. The ASD group demonstrated greater improvement on WM training relative to the ASD+FXS group. Participants improved on WM and far transfer outcomes, however, there were no significant group differences in improvement except for repetitive behavior. Higher hyperactivity/impulsivity ratings predicted lower performance on visuospatial WM. Findings suggest cognitive training may be beneficial for youth with ASD and ID, warranting further exploration.

Web-Based Intervention Effects on Mild Cognitive Impairment Based on Apolipoprotein E Genotype: Quasi-Experimental Study

BACKGROUND

Apolipoprotein E (APOE) ε4 allele is a major genetic risk factor for Alzheimer disease and mild cognitive impairment (MCI). Computer-based training programs can improve cognitive performance in elderly populations. However, the effects of computer-based interventions on MCI APOE ε4 carriers have never been studied before.

OBJECTIVE

The effects of different web-based interventions and the APOE isoform-specific differences in training outcomes are investigated.

METHODS

Using a quasi-experimental study design, 202 participants with MCI aged 60 years and older took part in three different intervention programs (physical and cognitive [Long-Lasting Memories, or LLM], cognitive [Active Control, or AC], or physical intervention [Physical Training Control, or PTC]) via an innovative information and communication technologies exergaming platform. Participants in each interventional group were subdivided into APOE ε4 carriers and non-APOE ε4 carriers. All participants underwent an extensive neuropsychological evaluation before and after the training, blood tests, and brain imaging.

RESULTS

All interventions resulted in multiple statistically significant cognitive benefits after the intervention. Verbal learning (California Verbal Learning Test: immediate recall test score-LLM: P=.04; AC: P<.001), working memory (digit span forward and backward test scores-AC: P=.03; PTC: P=.02 and P=.006, respectively), and long-term memory (California Verbal Learning Test: delayed recall test score-LLM: P=.02; AC: P=.002; and PTC: P=.02) were improved. There was no statistically significant difference among the intervention effects. APOE ε4 presence moderates intervention effects as the LLM intervention improved only their task-switching processing speed (Trail Making Test, Part B: P=.03) and the PTC intervention improved only the working memory (digit span backward: P=.03). No significant performance alteration was noted for the APOE ε4+ cognitive AC training group.

CONCLUSIONS

None of the applied interventions could be identified as the optimal one; it is suggested, however, that combined cognitive and physical training and physical training via exergaming may be more effective for the high-risk MCI ΑPOE ε4+ subgroup.

Neurocognition and social cognition training as treatments for violence and aggression in people with severe mental illness

Aggressive and violent behavior, including both verbal and physical aggression, have considerable adverse consequences for people with schizophrenia. There are several potential causes of violent behavior on the part of people with severe mental illness, which include intellectual impairments, cognitive and social-cognitive deficits, skills deficits, substance abuse, antisocial features, and specific psychotic features. This review explores the interventions that have been tested to this date. Computerized Cognitive Training (CCT) or Computerized Social-Cognitive Training (CSCT) have been associated with reductions in violence. Combined CCT and CSCT have been found to improve social cognition and neurocognition, as well as everyday functioning when combined with rehabilitation interventions. These interventions have been shown to reduce violence in schizophrenia patients across multiple environments, including forensic settings. The reductions in violence and aggression have manifested in various ways, including reduced violent thinking and behavior, reduced physical and violent assaults, and reduced disruptive and aggressive behaviors. Effects of cognitive training may be associated with improvements in problem-solving and the increased ability to deploy alternative strategies. The effect of social cognition training on violence reduction appears to be direct, with improvements in violence related to the extent of improvement in social cognition. There are still remaining issues to be addressed in the use of CCT and CSCT, and the benefits should not be overstated; however, the results of these interventions are very promising.

Effects of a Computerized Training on Attentional Capacity of Young Soccer Players

The purpose of this work was to analyze the effects of a computerized training on attentional capacity in a group of young soccer players. Seventy-five male adolescents from two soccer clubs in the city of Malaga (Spain) and aged between 14 and 18 (15.45 ± 1.43 years) participated in the investigation. A quasi-experimental design was used, and the adolescents were divided into control (n = 38) and experimental (n = 37) groups. The experimental group underwent a computerized training (Rejilla 1.0) of their attention during 9 weeks and 27 sessions. In addition, the D2 attention test was used to analyze the evolution of participants after the intervention program. The results showed positive effects of the computerized intervention program on selective attention, observing changes both in the executions of the software used (p < 0.001, Cohen's d = 1.58, 95% CI [1.06, 2.11]) and in the main measures of the D2 test, total effectiveness (p < 0.001, Cohen's d = 0.62, 95% CI [0.15, 1.08]) and concentration (p < 0.01, Cohen's d = 0.48, 95% CI [0.02, 0.94]).

[Different types of cognitive rehabilitation in patients with type 2 diabetes]

AIM

Diabetes mellitus (DM) type 2 leads to the progression of cognitive impairment. The authors compared different types of cognitive rehabilitation in patients with type 2 diabetes.

MATERIAL AND METHODS

One hundred and twenty patients with type 2 diabetes were examined and randomized into 4 groups: the computerized training group, the exercise therapy group, the akatinol memantine group and the control group. The duration of rehabilitation was 6 months. All patients underwent general clinical examination and neuropsychological testing.

RESULTS AND CONCLUSION

All patients had impaired cognitive functions, especially in visual-constructive skills, speech, abstraction, and memory. Treatment with akatinol memantine was most effective compared to computerized training and exercise therapy. With the exception of the control group, all groups, in particular the exercise therapy group, showed the improvement in carbohydrate metabolism.

The efficacy of a training that combines activities on working memory and metacognition: Transfer and maintenance effects in children with ADHD and typical development

Introduction: It has been demonstrated that children with attention deficit and hyperactivity disorder (ADHD) have impairments in working memory (WM), and particularly its visuospatial component, responsible for academic underachievement. Furthermore, children with ADHD have difficulty in metacognition, and consequently use inappropriate strategies to control attention and impulsive behavior. The aim of the present study was to devise a training that combined individual exercises on visuospatial WM and group metacognitive activities capable of helping children with ADHD to ameliorate their performance in executive functioning tasks, and to contain their inattentive and hyperactive/impulsive behavior. Method: A combined training that focused on visuospatial WM and metacognition was administered to 12 children with a diagnosis of ADHD and 15 typically-developing children. Tasks on executive functions and questionnaires for parents and teachers were administered before and at the end of the training, and one month after the post-test. Specific short- and long-term training gains and transfer effects were examined. Effects of the training on parents' and teachers' ratings were also considered. Results: Specific gains and transfer effects were found at the post-test and long-term assessments in both typically-developing children and those with ADHD. Parents' and teachers' ratings also indicated an improvement in the symptomatic behavior of children with ADHD. Conclusion: The results of this study have clinical and educational implications. A training that combines individual computerized visuospatial WM activities with metacognitive group reflection about useful strategies seems to produce promising results, helping children with ADHD to improve their executive functioning and behavioral problems.

Evaluating Successful Aging in Older People Who Participated in Computerized or Paper-and-Pencil Memory Training: The Memoria Mejor Program

Background. The evaluation of successful aging includes objective criteria to measure cognitive function and psychological well-being and levels of functional capacity needed to perform daily activities related to the preservation of autonomy. In addition, the emergence of computerized cognitive training programs has allowed us to use a new class of tools to verify the theoretical postulates of neural plasticity in aging. Objective. The present study investigates subjective and objective criteria of successful aging in healthy older adults participating in a memory training program offered as two versions: computer and paper-and-pencil. Method. Fifty-four healthy older adult participants recruited for the study were organized into two training groups. Group 1 (G1) used the computer program and Group 2 (G2) used the paper-and-pencil program. Results. The analysis revealed no significant differences in psychological well-being between the two training groups. However, the groups did differ significantly in objective evaluations of successful aging, as measured by attention and everyday memory, and brain activity as measured by sLORETA, with G1 outperforming G2 on both measures. Conclusion. Computerized memory training programs show promise for restoring cognitive and cerebral functioning in older adults, and consequently, may be better suited to achieving the objective criteria of successful aging than paper-and-pencil memory training programs. However, this conclusion should be taken with caution since differences in age and educational level may have influenced the results.

Construction of an Arabic computerized battery for cognitive rehabilitation of children with specific learning disabilities

PURPOSE

The aim of this study was to design an Arabic computerized battery of cognitive skills for training children with specific learning disabilities (SLD).

SUBJECTS AND METHODS

Nineteen students from fourth grade primary schools in Assiut, Egypt, who were previously diagnosed with SLD, agreed to participate in the rehabilitation program. The study passed through four stages: first stage, detailed analysis of the cognitive profile of students with SLD (n=19), using a previously constructed diagnostic cognitive skill battery, to identify deficits in their cognitive skills; second stage, construction of an Arabic computerized battery for cognitive training of students with SLD; third stage, implementation of the constructed training program for the students, each tailored according to his/her previously diagnosed cognitive skill deficit/deficits; and fourth stage, post-training re-evaluation of academic achievement and cognitive skills' performance.

RESULTS

Students with SLD have a wide range of cognitive skill deficits, which are more frequent in auditory cognitive skills (68.4%) than in visual cognitive skills (64.1%), particularly in phonological awareness and auditory sequential memory (78.9%). Following implementation of the training program, there was a statistically significant increase (P<0.001) in the mean scores of total auditory and visual cognitive skills, as well as in academic achievement (P<0.001) of the study group.

CONCLUSION

Remediation-oriented diagnosis of cognitive skills, when tailored according to previously diagnosed cognitive deficits, leads to the improvement in learning abilities and academic achievement of students with SLD.

Protecting cognition from aging and Alzheimer's disease: a computerized cognitive training combined with reminiscence therapy

OBJECTIVE

The aim of this paper was to assess the efficacy of process-based cognitive training (pb-CT) combined with reminiscence therapy (RT) in patients with mild Alzheimer's disease (mAD) and mild cognitive impairment (MCI) and in healthy elderly (HE) subjects.

METHODS

This multicenter, randomized, controlled trial involved 348 participants with mAD, MCI, and HE from four European countries. Participants were randomly assigned to two arms of a crossover design: those in arm A underwent 3 months of computerized pb-CT for memory and executive functions combined with RT and 3 months of rest; those in arm B underwent the reverse. The primary outcome was the effect of the training on memory and executive functions performance. The secondary outcome was the effect of the training on functional abilities in mAD assessed with the instrumental activities of daily living.

RESULTS

We found a significant effect of the training for memory in all three groups on delayed recall of the Rey Auditory Verbal Learning Test and for executive functions in HE on the phonological fluency test. MCI and HE participants maintained these effects at follow-up. MCI and mAD participants also showed a significant effect of the training on the Mini-mental state examination scale. Participants with mAD showed more stable instrumental activities of daily living during the training versus the rest period.

CONCLUSIONS

Our results corroborate the positive effect of pb-CT and its maintenance primarily on memory in HE and MCI participants that did not seem to be potentiated by RT. Moreover, our results are very promising for the mAD participants.

A pilot study on the benefit of cognitive rehabilitation in Parkinson's disease

PURPOSE

Patients with Parkinson's disease (PD) show inefficiencies in cognitive performance including working memory functions. Since these problems impact on quality of life and overall well-being, the current study was aimed at improving patients' situations by evaluating the computerized cognitive training tool, BrainStim.

METHOD

A total of 19 healthy controls (HCs) and six patients with PD were included in the study. While all PD patients received cognitive training, the HC sample was subdivided into 12 subjects with training (HC-T) and 10 subjects without (HC-NT). Participants underwent a double baseline assessment, a post-training assessment, and a 3-month follow up on neuropsychological tests and self-report measures on fatigue and depression. Training was administered between the second baseline and postassessment. It comprised 16 supervised sessions according to a standardized training protocol over 4 weeks.

RESULTS

Significant improvements in verbal and visuospatial short-term and long-term memory were found in both training groups. In addition, the HC-T improved on mental speed, and verbal and visuospatial working memory. Both training groups showed stable results for all short-term visuospatial measures after 3 months. Further, the HC-T showed stable results for working memory, verbal, and visuospatial short-term and long-term memory.

CONCLUSIONS

The efficacy of the applied computerized cognitive training tool BrainStim could be verified in patients with PD and healthy age-matched controls. The preliminary findings highlighted the suitability of a specific cognitive intervention to improve cognitive inefficiencies in patients with PD as well as in healthy older people. Further research on cognitive training in combination with PD drug therapy is needed to better understand the mutual interaction and to offer optimal therapeutic approaches to patients.

Feasibility and acceptability of a remotely administered computerized intervention to address cognitive late effects among childhood cancer survivors

BACKGROUND

Childhood cancer survivors frequently develop working memory (WM) deficits as a result of disease and treatment. Medication-based and therapist-delivered interventions are promising but have limitations. Computerized interventions completed at home may be more appealing for survivors. We evaluated the feasibility and acceptability of a remotely administered, computerized WM intervention (Cogmed) for pediatric cancer survivors using a single-blind, randomized, wait-list control design.

METHODS

Of 80 qualifying patients, 12 were excluded or declined to participate. Participants randomized to intervention (n = 34/68) included survivors of childhood brain tumors (32%) or acute lymphoblastic leukemia (ALL; 68%) between the ages of 8 and 16 years ([Formula: see text] = 12.2) who were at least 1 year post therapy ([Formula: see text] = 5.0). The majority of brain tumor participants were treated with cranial radiation therapy (72.7%), whereas most of the ALL participants were treated with chemotherapy only (87%). Participants completed 25 WM training sessions over 5-9 weeks at home with weekly phone-based coaching.

RESULTS

Participants lived in 16 states. Compliance was strong, with 30 of the 34 participants (88%) completing intervention. Almost all participants completed pre- and postintervention neuroimaging exams (91% and 93%, respectively). Families had the necessary skills to utilize the computer program successfully. Caregivers reported they were generally able to find time to complete training (63%), viewed training as beneficial (70%), and would recommend this intervention to others (93%).

CONCLUSIONS

Cogmed is a feasible and acceptable intervention for childhood cancer survivors. It is a viable option for survivors who do not live in close proximity to cancer care centers. Efficacy and neural correlates of change are currently being evaluated.

Neural correlates of cognitive intervention in persons at risk of developing Alzheimer's disease

Cognitive training is an emergent approach that has begun to receive increased attention in recent years as a non-pharmacological, cost-effective intervention for Alzheimer’s disease (AD). There has been increasing behavioral evidence regarding training-related improvement in cognitive performance in early stages of AD. Although these studies provide important insight about the efficacy of cognitive training, neuroimaging studies are crucial to pinpoint changes in brain structure and function associated with training and to examine their overlap with pathology in AD. In this study, we reviewed the existing neuroimaging studies on cognitive training in persons at risk of developing AD to provide an overview of the overlap between neural networks rehabilitated by the current training methods and those affected in AD. The data suggest a consistent training-related increase in brain activity in medial temporal, prefrontal, and posterior default mode networks, as well as increase in gray matter structure in frontoparietal and entorhinal regions. This pattern differs from the observed pattern in healthy older adults that shows a combination of increased and decreased activity in response to training. Detailed investigation of the data suggests that training in persons at risk of developing AD mainly improves compensatory mechanisms and partly restores the affected functions. While current neuroimaging studies are quite helpful in identifying the mechanisms underlying cognitive training, the data calls for future multi-modal neuroimaging studies with focus on multi-domain cognitive training, network level connectivity, and individual differences in response to training.

Brain plasticity-based therapeutics

The primary objective of this review article is to summarize how the neuroscience of brain plasticity, exploiting new findings in fundamental, integrative and cognitive neuroscience, is changing the therapeutic landscape for professional communities addressing brain-based disorders and disease. After considering the neurological bases of training-driven neuroplasticity, we shall describe how this neuroscience-guided perspective distinguishes this new approach from (a) the more-behavioral, traditional clinical strategies of professional therapy practitioners, and (b) an even more widely applied pharmaceutical treatment model for neurological and psychiatric treatment domains. With that background, we shall argue that neuroplasticity-based treatments will be an important part of future best-treatment practices in neurological and psychiatric medicine.

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.

A novel, online social cognitive training program for young adults with schizophrenia: A pilot study

BACKGROUND

Pervasive social cognition deficits are evident early in the course of schizophrenia and are directly linked to functional outcome, making them an important target for intervention. Here, we tested the feasibility of use, and initiated the evaluation of efficacy, of a novel, neuroplasticity-based online training program (SocialVille) in young adults with schizophrenia.

METHODS

Schizophrenia patients (n=17) completed 24 hours of online SocialVille game play either from home or at a clinic, over a 6-10 week period. We examined training feasibility, gains on the SocialVille exercises relative to matched healthy controls (n=17), and changes on measures of social cognition, social functioning, global functioning and motivation.

RESULTS

Subjects adhered to training requirements, and rated SocialVille in the medium to high range in satisfaction, enjoyment, and ease of use. Subjects demonstrated significant, large improvements on the speeded SocialVille tasks, and small to moderate improvements on the working memory tasks. Post-training performance on the SocialVille tasks were similar to initial performance of the healthy controls. Subjects also showed improvements on standard measures of social cognition, social functioning, and motivation. No improvements were recorded for emotion recognition indices on the MSCEIT, or on quality of life scales.

CONCLUSION

This study provides an initial proof of concept for online social cognition training in schizophrenia. This form of training demonstrated feasibility and resulted in within-subject gains in social functioning and motivation. This pilot study represents a first step towards validating this training approach; randomized controlled trials, now underway, are designed to confirm and extend these findings.