Long-term improvements in cognitive performance through computer-assisted cognitive training: a pilot study in a residential home for older people

The aim of the present pilot study was to investigate the effects of computer-assisted cognitive training on aging-associated memory deficits, information processing speed, learning, and interference tendency in older people. Residents of a home for older people (15 women, four men; mean age 83.5; range 75-91) participated in a 14-week computer-assisted cognitive training program. The Niirnberg Aging Inventory and the California Verbal Learning Test were administered prior to the program, immediately after the program and after a period of five months to assess the effectiveness of the cognitive training. After the cognitive training program there were significant improvements in primary working memory and also secondary working memory (for verbal and visual stimuli), on parameters of information processing speed, learning and interference tendency. Improvements in the last two cognitive parameters were maintained five months after completion of the training program. The present study indicates that computerized cognitive training programs can be used in older people to achieve long-term improvements in some important aspects of fluid intelligence. It is suggested that computers could be employed more extensively to prevent and treat cognitive deficits in older people.     

Remédiation cognitive de la schizophrénie. Présentation du programme RECOS

The importance of neurocognitive deficits in schizophrenia has motivated the Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois in Lausanne (DP-CHUV) to develop a cognitive remediation program for patients with a schizophrenia spectrum disease (RECOS). This program investigates cognitive deficits using a detailed neuropsychological battery and contains targeted training modules for their remediation. RECOS particularly investigates the cognitive deficits that may be implicated in the development of clinical symptoms. Functional outcome and psychoeducation are also important elements of the program. The progresses of the different stages of the program are presented.     

A cognitive, behaviorally based program for patients with persistent mental illness and a history of aggression, crime, or both: structure and correlates of completers of the program

Standard psychiatric treatment programs have limited success in reducing recidivistic violent and criminal behavior in patients with persistent mental illness. A specialized, cognitive behavioral treatment program was developed for such a population. The purpose of this study was to identify factors that contribute to the patients' completing the program and to improve the selection criteria for program admission, so that those who participate are more likely to complete the program and be discharged. One hundred eighty-one patients with persistent mental illness with histories of aggression, crime, or both participated in a cognitive skills inpatient treatment program adapted for use with psychiatric patients. Ninety patients were able to complete the program and were discharged into the community. In comparison with the 91 who did not complete the program, those who did were less cognitively impaired and less impulsive. We present a new, intensive treatment program and define the predictors of successful completion of the program.     

Cognitive training for supported employment: 2-3 year outcomes of a randomized controlled trial

OBJECTIVE: To address cognitive impairments that limit the effectiveness of supported employment services for patients with schizophrenia, a cognitive training program, the Thinking Skills for Work Program, was developed and integrated into supported employment services. METHOD: Patients with severe mental illness (N=44) and prior histories of job failures who were enrolled in supported employment programs at two sites in New York City were randomly assigned to receive either supported employment alone or supported employment with cognitive training. Measures at baseline and 3 months included a brief cognitive and symptom assessment. Work outcomes were tracked for 2-3 years. RESULTS: Patients in the supported employment with cognitive training program demonstrated significantly greater improvements at 3 months in cognitive functioning, depression, and autistic preoccupation. Over 2-3 years, patients in the supported employment with cognitive training program were more likely to work, held more jobs, worked more weeks, worked more hours, and earned more wages than patients in the program offering supported employment alone. CONCLUSIONS: The findings support the feasibility of integrating cognitive rehabilitation into supported employment programs and suggest that more research is warranted to evaluate the effects of the Thinking Skills for Work Program.     

A controlled randomized treatment study: the effects of a cognitive remediation program on adolescents with early onset psychosis

OBJECTIVE: To examine if a cognitive remediation program could be a positive supplement to a psychoeducational treatment program for adolescents with early onset psychosis. METHOD: Twenty-six subjects, randomly assigned to cognitive remediation (n = 14) or control group (n = 12), were assessed on cognitive, clinical, psychosocial and behavioural measures. RESULTS: No significant between-group differences in pre- and post-treatment scores were found. This may be due to low statistical power. Exploratory within-group analyses showed that the training group improved on five of the 10 cognitive, and three of the five functioning outcome measures, while the control group improved on three of the cognitive, and one functioning outcome variable. CONCLUSION: Based on these results we cannot conclude that the addition of this cognitive remediation program, yields better results than psychoeducation alone. However, within-group analyses indicate that on specific cognitive functions, as well as on some functioning outcome measures, the remediation program may have a positive effect.     

Computer-assisted attention training in schizophrenics

Summary The evaluation of a computer-assisted attention training program is compared with a cognitive group training program. Both programs were devised to reduce cognitive deficits in schizophrenics. The training programs were given to 30 acute schizophrenics and 30 healthy subjects. Both were shown to be effective in reducing distraction of schizophrenics in reaction-time tasks. By means of training, schizophrenics may attain the same results in reaction time tasks as healthy individuals. The results are discussed under theoretical, methodical and practical aspects.     

Treatment of cognitive dysfunctions and behavioral deficits in schizophrenia.

Integrated Psychological Therapy (IPT) is a structured intervention program that prescribes steps to remediate cognitive and behavioral dysfunctions that are characteristic of the psychopathology of schizophrenia. Evaluative studies of IPT indicated that the program improved schizophrenic patients' elementary cognitive processes such as attention, abstraction, and concept formation but that patients' performance was still below the normal range. The clinical utility of IPT will depend on studies that document the hierarchical generalization of improvements from the cognitive to the social and symptomatic levels of functioning.     

Comparison of community-based verbal behavior and pivotal response treatment programs for young children with autism spectrum disorder

This research compared the outcomes of a community-based group program based on the verbal behavior approach to early intervention (Sautter and LeBlanc, 2006, Sundberg and Michael, 2001) to the outcomes of a program based on Pivotal Response Treatment (Bryson et al., 2007, Koegel and Koegel, 2006). Fourteen preschool children with autism spectrum disorder in each program were matched by baseline chronological age and cognitive score. Assessments were conducted at the initiation of treatment and 12 months later to measure cognitive, receptive and expressive language, and adaptive behavior skills, as well as problem behavior and parenting stress. Results for both groups showed statistically significant changes in cognitive scores, receptive and expressive language age equivalents, and problem behavior scores. Significant results were not found for either adaptive behavior or parenting stress scores. Changes in cognitive and adaptive behavior scores were similar to those reported in published studies of applied behavior analytic programs of similar intensity. Study limitations and recommendations for future research are provided. Although additional research is needed to examine the long-term effectiveness of the programs examined in this study, it appears that both hold promise as effective early intervention approaches that are also relatively cost-effective.     

Effectiveness of the cognitive differentiation program of the integrated psychological therapy: group versus individual treatment

The aim of the current pilot study was to compare two strategies in the application of the cognitive differentiation program of Integrated Psychological Therapy for people with schizophrenia. Twenty-six outpatients were randomly assigned to the application of the program in group sessions (CDg), or to its application in individualized sessions (CDi). The program provides cognitive exercises to promote better performance in cognition, and both groups of participants completed the same number of exercises following the same number of sessions per week. Outcomes were assessed on neuropsychological measures of attention, executive functioning and everyday memory, and everyday functioning. Effect sizes showed the absence of effects in everyday memory and social functioning, higher improvements in the CDi group in attention, and a higher improvement in the CDg condition in executive functioning. The results suggest that the program application model could be individualized, depending on patient-specific cognitive deficits.     

A controlled trial of cognitive remediation in schizophrenia

A randomized, controlled trial of a 3-month cognitive remediation program was examined for its efficacy at ameliorating deficits in social and emotion perception in 42 hospitalized patients with schizophrenia. Generalization of training effects to attention, memory, and executive functioning was also examined. The program included an eclectic mix of self-instruction, memory enhancement, inductive reasoning, and compensatory training procedures, while the control condition included participation in a leisure group that was matched to the experimental group for staff involvement time. Patient care management, including type and dose of antipsychotic medication, remained constant throughout the study period. The results indicated that the cognitive training program improved emotion perception, with some evidence of generalization to measures of executive functioning; other areas of neurocognitive functioning were largely unaffected. While cognitive training programs may improve targeted areas of neurocognitive processing, broad generalization effects to domains outside those targeted for intervention are not likely concomitants.     

Social skills and neurocognitive individualized training in schizophrenia: comparison with structured leisure activities

Cognitive impairment and deficits in social skills have been largely documented in patients with schizophrenia and are increasingly recognized as rate-limiting factors for recovery. Evidence has been provided that cognitive training and social skills training (SST) are effective to treat cognitive and social skills impairment in schizophrenia; however, the translation of improved performance on cognitive or social skills tasks into improved functional outcome is controversial. According to recent reviews, interventions providing cognitive training in conjunction with psychosocial rehabilitation have a greater impact on functional outcome than either intervention alone suggesting that the two treatment approaches may work together in a synergistic fashion. The present pilot study was designed to test the hypothesis that an integrated rehabilitation program, including individualized cognitive and SST, is more effective than the structured leisure activities (SLA) carried out in many Italian Mental Health Departments. The primary outcome measure was subjects’ personal and social functioning as assessed by the Interview for the assessment of disability. The study is based on a controlled design including randomization to treatment groups, blind assessments and stable pharmacological treatment. Subjects were recruited among patients attending three psychiatric facilities located in the Italian region Campania. Thirty patients were randomized to the experimental program “social skills and neurocognitive individualized training” (SSANIT), and 30 to SLA. The two programs were matched for the overall duration as well as frequency and duration of the sessions. The two groups of patients did not differ at baseline on psychopathology, neurocognitive and personal/social functioning. After 6 months of treatment, personal and social functioning was significantly better in patients assigned to SSANIT than in those assigned to usual rehabilitation activities practiced in Mental Health Departments. No advantage was observed for either program on psychopathological and cognitive outcome indices. As for other integrated programs, also for SSANIT further studies are needed to verify generalization and persistence of the observed gains, and to clarify most adequate length and doses of the therapeutic intervention as well as the relative contribution of each program component to its impact on subjects’ disability.     

The effects of neurocognitive remediation on executive processing in patients with schizophrenia.

Approaches to cognitive remediation have differed across studies. Most of the larger studies have concentrated on group treatments designed without the benefit of recent laboratory-based studies. The current study describes a randomized trial of an intensive cognitive remediation program involving individual daily sessions of 1 hour for up to 3 months. It targets executive functioning deficits (cognitive flexibility, working memory, and planning) that are known to be problematic in people with schizophrenia. Procedural learning, as well as the principles of errorless learning, targeted reinforcement, and massed practice, was the basis of the intervention. The program was compared with an alternative therapy (intensive occupational therapy) to control for some of the effects of therapeutic contact. Some improvements in cognition followed both therapies. A differential effect in favor of cognitive remediation therapy was found for tests in the cognitive flexibility and the memory subgroups. There was a trend for those receiving atypical antipsychotic medication to benefit more from cognitive remediation for tests of cognitive flexibility. Although there were no consistent changes in symptoms or social functioning between groups, if improvement in cognitive flexibility tasks reached a threshold then there is some evidence that social functioning improved, even over the short duration of the trial. In addition, cognitive remediation differentially improved self-esteem. This study supports the view that cognitive remediation can reduce cognitive deficits and that this reduction may affect social outcome, at least in the short term.     

Reducing aggressive behavior in boys with a social cognitive group treatment: results of a randomized, controlled trial

OBJECTIVE: To evaluate the effectiveness of a social cognitive intervention program for Dutch aggressive boys and to compare it with a social skills training and a waitlist control group. METHOD: A randomized, controlled treatment outcome study with 97 aggressive boys (aged 9-13 years) was presented. An 11-session group treatment, a social cognitive intervention program (n = 42) based on Dodge's social information-processing theory, was compared with social skills training (n = 40) and waitlist control group (n = 15). Measures of aggressive behavior, self-control, social cognitive skills, and appropriate social behavior were completed before and after the group treatment and at 1-year follow-up. RESULTS: The outcome of both treatment conditions indicated (1) a significant increase in appropriate social behavior, social cognitive skills, and self-control and (2) a significant decrease in aggressive behavior. There was a significant difference between treatment and no treatment and between the social cognitive intervention program and social skills training on various child, parent, and teacher measures. CONCLUSIONS: The expectation that focusing on the deficits and distortions in social cognitive processes (social cognitive intervention program) instead of merely focusing on social skills (social skills training) would enhance the effectiveness was supported on child, parent, and teacher measures. At 1-year follow-up, the mean effect sizes of the social cognitive intervention program and social skills training were 0.76 and 0.56, respectively.     

Cognitive predictors of young children's readiness for powered mobility

Independent mobility in early childhood has been associated with the development of various cognitive and psychosocial skills. However, children with physical disabilities are not always able to move independently and may be at risk for delays in these areas. Early provision of powered mobility can offer young children an opportunity for independent mobility. Despite this, there is little information to help determine when a young child has the cognitive skills necessary to operate a powered wheelchair safely. This current research aims to identify these skills. A cognitive assessment battery and a wheelchair mobility training and assessment program were developed. Twenty-six children with physical disabilities between the ages of 20 and 36 months were evaluated on the cognitive assessment and participated in the wheelchair training and assessment program. A stepwise regression analysis was used to determine which of the cognitive skills predicted wheelchair mobility performance. The cognitive domains of spatial relations and problem solving were found to be significant and accounted for 57% of the variance in wheelchair skills. Developmental cut-off points on these scales as they relate to wheelchair skills are presented and clinical applications are discussed.     

Cognitive intervention for community-dwelling older persons with memory problems: telemedicine versus face-to-face treatment

BACKGROUND: Memory complaints and decline in cognitive function are common in the elderly. Cognitive intervention has been shown to be beneficial in Alzheimer's disease (AD). However, few community-based cognitive intervention programs are available in Hong Kong. The aim of this project is to examine and compare the feasibility, acceptability, and clinical outcome of a cognitive intervention program for older patients with mild cognitive impairment and mild dementia using telemedicine versus a conventional face-to-face method. METHODS: Community-dwelling older subjects with mild dementia or mild cognitive impairments were recruited from a community center. A total of 12 sessions of assessment and cognitive intervention were conducted via videoconferencing or by face-to-face method. Assessment included: Cantonese version of Mini Mental State Examination (C-MMSE), Cantonese version of Rivermead Behavioural Memory test (C-RBMT) and Hierarchic Dementia Scale (HDS). RESULTS: Twenty-two clients were recruited. There was significant and comparable cognitive improvement in clients in both treatment arms. The videoconference arm was highly accepted by the clients and the community center. Overall compliance rate of participants was above 95%. CONCLUSIONS: Telemedicine was a feasible, effective and acceptable means in providing cognitive assessment and intervention to older persons with mild cognitive deficits. Promoting such a program to other community settings would further enhance the accessibility of dementia service to the community.     

Dissociating self-reported cognitive complaint from clinical insight in schizophrenia

Whereas new pharmacological treatments are developed for cognitive impairments in schizophrenia, self-assessment of cognitive dysfunctioning besides their objective validity could be of interest in evaluating patients' motivation to engage in rehabilitation program. Nevertheless insight into symptoms is severely impaired in schizophrenia and is negatively linked with poor compliance. But it is yet unknown if patients with poor insight into their symptoms could have some insight into their cognitive impairments. The aim of this study was to explore the relationships existing between the cognitive complaint and the level of awareness of the disease in patients with schizophrenia. A total of 101 patients with DSM-IV schizophrenia or schizoaffective disorder and 60 control participants were recruited. Insight was assessed using the Scale to assess Unawareness of Mental Disorder (SUMD) and cognitive complaint intensity was assessed with the Scale to Investigate Cognition in Schizophrenia (SSTICS). Participants with schizophrenia displayed the same level of cognitive complaint when compared to healthy controls. Strong correlations were observed between SSTICS total score and duration of illness, levels of depression and state anxiety. Patients with a good insight into the therapeutic effects achieved with medication expressed a more important cognitive complaint. No correlations were found between the four others SUMD insight dimensions and total SSTICS score. The partial overlap of insight into illness and cognitive complaint suggests that insight is modular in schizophrenia. Assessment of cognitive complaint and awareness of illness need to be assessed before engagement in rehabilitation program.     

The effects of a computer-based cognitive and physical training program in a healthy and mildly cognitive impaired aging sample

Objectives: The Long Lasting Memories (LLM) program concerns a newly integrated platform which combines cognitive exercises with physical activity within the context of advanced technologies. The main objective of this study was to present the preliminary results that determine the possible effectiveness of the LLM program in the improvement of cognitive functions and symptoms of depression in healthy elderly and subjects with mild cognitive impairment (MCI). Method: Fifty healthy and MCI subjects participated in the study. All of them received one hour's physical training and 35 minutes’ cognitive training, 3 times a week, during the 12 weeks of the program. Before and after the intervention all participants were assessed using a battery of neuropsychological tests.Results: The results showed a significant improvement after the LLM training in global cognitive function, in verbal memory, in attention, in episodic memory and symptoms of depression. Conclusion: This study indicates that LLM is a promising solution for older adults with and without cognitive impairment, maintaining their wellbeing with few professional and technical requirements.     

Effects of a goal-oriented rehabilitation program in mild cognitive impairment: a pilot study

BACKGROUND: Memory disturbance, deficient concentration, and fatigue are symptoms seen in amnestic mild cognitive impairment (MCI) as well as in mild traumatic brain injury (TBI). The aim of this study was to assess if an established rehabilitation program commonly used in TBI can aid MCI patients to develop compensatory memory strategies that can improve their cognition, occupational performance, and quality of life (QoL). METHODS: Fifteen patients with MCI participated in the program 2 days per week for 8 weeks. Cognitive function, occupational performance, and self-perceived QoL were assessed at baseline, at the end of the intervention, and at follow-up after 6 months. RESULTS: Significant improvements were seen in cognitive processing speed, occupational performance, and in some of the QoL domains. CONCLUSION: As this goal-oriented rehabilitation program in MCI resulted in some improvements in cognition, occupational performance, and QoL, further randomized controlled studies are warranted.     

Memory rehabilitation for the working memory of patients with multiple sclerosis (MS)

Objective: The main cognitive impairments in multiple sclerosis (MS) affect the working memory, processing speed, and performances that are in close interaction with one another. Cognitive problems in MS are influenced to a lesser degree by disease recovery medications or treatments,but cognitive rehabilitation is considered one of the promising methods for cure. There is evidence regarding the effectiveness of cognitive rehabilitation for MS patients in various stages of the disease. Since the impairment in working memory is one of the main MS deficits, a particular training that affects this cognitive domain can be of a great value. This study aims to determine the effectiveness of memory rehabilitation on the working memory performance of MS patients.

Method: Sixty MS patients with cognitive impairment and similar in terms of demographic characteristics, duration of disease, neurological problems, and mental health were randomly assigned to three groups: namely, experimental, placebo, and control. Patients’ cognitive evaluation incorporated baseline assessments immediately post-intervention and 5 weeks post-intervention. The experimental group received a cognitive rehabilitation program in one-hour sessions on a weekly basis for 8 weeks. The placebo group received relaxation techniques on a weekly basis; the control group received no intervention.

Results: The results of this study showed that the cognitive rehabilitation program had a positive effect on the working memory performance of patients with MS in the experimental group. These results were achieved in immediate evaluation (post-test) and follow-up 5 weeks after intervention. There was no significant difference in working memory performance between the placebo group and the control group.

Conclusions: According to the study, there is evidence for the effectiveness of a memory rehabilitation program for the working memory of patients with MS. Cognitive rehabilitation can improve working memory disorders and have a positive effect on the working memory performance of these patients.     

Establishing a pediatric cognitive rehabilitation program: insurance issues and clinical rationale

Technological and medical advances have greatly improved survival rates for many disorders; therefore, more attention is being given to functional outcomes in individuals who have been diagnosed with neurological diseases or disorders. One example of such an endeavor consists of a cognitive rehabilitation program to improve attentional abilities. The current study uses a modification of the original Cognitive Remediation Program to address attentional deficits in children with a variety of neurological disorders. The abbreviated program is designed as a focused, time-limited program that can be easily implemented in inpatient, partial day, or outpatient medical settings using third party payment to fund the program. This article seeks to inform psychologists about how to establish a cognitive rehabilitation program with emphasis placed on providing information about insurance reimbursement and billing procedures. Information is presented regarding billing codes, materials required for reimbursement, the denial/approval process, and percent of the Usual Customary Reasonable charge that was covered. Recommendations to improve the timeliness and efficiency of the reimbursement process, as well as to increase the amount of reimbursement, are highlighted. Directions for future research, including continued documentation of the effectiveness of cognitive rehabilitation programs to establish credibility for procurement of third party payment, are also offered.