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Transcranial direct current stimulation (tDCS) is a possible neurotherapeutic alternative to psychostimulants in Attention-Deficit/Hyperactivity Disorder (ADHD). However, very little is known regarding the mechanisms of action of tDCS in children and adolescents with ADHD. We conducted the first multi-session, sham-controlled study of anodal tDCS over right inferior frontal cortex (rIFC), a consistently under-functioning region in ADHD, combined with cognitive training (CT) in 50 children/adolescents with ADHD. This study investigated the underlying mechanisms of action on resting and Go/No-Go Task-based QEEG measures in a subgroup of 23 participants with ADHD (n, sham=10; anodal tDCS=13). We found no significant sham versus anodal tDCS group differences in QEEG spectral power during rest and Go/No-Go Task performance, no correlation between the QEEG and Go/No-Go Task performance, and no effect on clinical and cognitive outcome measures. These findings extend the null clinical or cognitive effects in our whole sample of 50 children/adolescents with ADHD. Our findings do not indicate multi-session anodal tDCS with CT over rIFC as a treatment for children/adolescents with ADHD. Larger RCTs should explore different protocols titrated to the individual and using comprehensive measures to assess cognitive, clinical, and neural effects of tDCS and its underlying mechanisms of action in ADHD.

Contains fulltext : 248888.pdf (Publisher’s version ) (Open Access) BACKGROUND: Poor working memory, lower IQ and maladaptive behaviour form a triple disability known to have negative effects on the academic and social development of children with borderline intellectual functioning (BIF; IQ: 70

Mild cognitive impairment (MCI) is a clinical syndrome of mild memory or other cognitive impairment without dementia and is a clinical transition state between normal aging and dementia. Careful and meticulous nursing intervention can improve the clinical symptoms of MCI and delay the progression of the disease.This research aimed to evaluate the efficacy of cognitive function training interventions in elderly patients with MCI.106 patients were randomized into the intervention group or the control group. They received conventional nursing intervention and those in the intervention group received additional cognitive training program for 6 weeks. The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), activities of daily living (ADL) scales, and Barthel index (BI) were evaluated before and 6 weeks after the intervention, as well as the serum levels of S100β and neuron-specific enolase (NSE) at two time points.After intervention, the MMSE scores and MoCA scores in both groups were significantly increased and the score in the intervention group was significantly higher. In the intervention group, the performance of conventional nursing intervention and cognitive training program significantly increased the scores of ADL and BI (p 0.001). The serum levels of NSE and S100β in the intervention group were significantly lower.The performance of cognitive training program alleviated the brain tissue damage in elderly patients with MCI.The performance of cognitive training program in elderly patients with MCI improved their cognitive ability and daily living ability.

Bilingualism has been linked to improved executive function and delayed onset of dementia, but it is unknown whether similar benefits can be obtained later in life through deliberate intervention. Given the logistical hurdles of second language acquisition in a randomized trial for older adults, few interventional studies have been done thus far. However, recently developed smartphone apps offer a convenient means to acquire skills in a second language and can be compared with brain training apps specifically designed to improve executive function. In a randomized clinical trial, 76 adults aged 65-75 were assigned to either 16 weeks of Spanish learning using the app Duolingo 30 minutes a day, an equivalent amount of brain training using the app BrainHQ, or a waitlist control condition. Executive function was assessed before and after the intervention with preregistered (NCT03638882) tests previously linked to better performance in bilinguals. For two of the primary measures: incongruent Stroop color naming and 2-back accuracy, Duolingo provided equivalent benefits as BrainHQ compared to a control group. On reaction time for N-back and Simon tests, the BrainHQ group alone experienced strong gains over the other two groups. Duolingo was rated as more enjoyable. These results suggest that app-based language learning may provide some similar benefits as brain training in improving executive function in seniors but has less impact on processing speed. However, future advancements in app design may optimize not only the acquisition of the target language but also the side benefits of the language learning experience.

Background: Stroke is among the leading causes of death and disability worldwide. Interventions for stroke rehabilitation aim to minimize sequelae, promote individuals’ independence and potentially recover functional damage. The role of aerobic exercise as a facilitator of post-stroke neuroplasticity in humans is still questionable. Objective: To investigate the impact of aerobic exercise on neuroplasticity in patients with stroke sequelae. Methods: A systematic review of randomized clinical trials and crossover studies was performed, with searches for human studies in the following databases: PUBMED, EMBASE, LILACS and PeDRO, only in English, following the PRISMA protocol. The keywords used for selecting articles were defined based on the PICO strategy. Results: This systematic review evaluated the impacts of aerobic exercise on neuroplasticity through assessment of neural networks and neuronal excitability, neurotrophic factors, or cognitive and functional assessment. Studies that evaluated the effects of aerobic exercise on neuroplasticity after stroke measured through functional resonance (fMRI) or cortical excitability have shown divergent results, but aerobic exercise potentially can modify the neural network, as measured through fMRI. Additionally, aerobic exercise combined with cognitive training improves certain cognitive domains linked to motor learning. Studies that involved analysis of neurotrophic factors to assess neuroplasticity had conflicting results. Conclusions: Physical exercise is a therapeutic intervention in rehabilitation programs that, beyond the known benefits relating to physical conditioning, functionality, mood and cardiovascular health, may also potentiate the neuroplasticity process. Neuroplasticity responses seem more robust in moderate to high-intensity exercise training programs, but dose-response heterogeneity and non-uniform neuroplasticity assessments limit generalizability. RESUMO Antecedentes: O acidente vascular cerebral (AVC) é a segunda causa principal de morte no mundo. Intervenções para reabilitação dos pacientes com AVC visam minimizar sequelas, promover sua independência e potencialmente recuperar danos funcionais. O papel do exercício aeróbico como facilitador da neuroplasticidade pós-AVC em humanos ainda é questionável. Objetivo: Investigar o impacto do exercício aeróbico na neuroplasticidade em pacientes com sequelas de AVC. Métodos: Foi realizada revisão sistemática de literatura, pesquisando nas seguintes bases de dados: PUBMED, EMBASE, LILACS e PeDRO. Foram selecionados trabalhos em língua inglesa, realizados apenas com humanos, seguindo o protocolo PRISMA. As palavras-chave utilizadas para a seleção de artigos foram definidas com base na estratégia PICO. Resultados: Esta revisão sistemática avaliou os impactos do exercício aeróbico na neuroplasticidade através da avaliação das redes neurais e da excitabilidade neuronal, por meio de fatores neurotróficos, por meio da avaliação cognitiva e funcional. Estudos que avaliaram os efeitos do exercício aeróbico sobre neuroplasticidade após o AVC medido através de ressonância funcional ou excitabilidade cortical, são controversos, mas há dados sugerindo uma modificação da rede neural na ressonância funcional após o exercício aeróbico. Há evidências de que, associar exercício aeróbico com treinamento cognitivo melhora certos domínios cognitivos ligados à aprendizagem motora. Estudos que envolveram a análise de fatores neurotróficos, como avaliação da neuroplasticidade, tiveram resultados conflitantes. Conclusões: Exercício aeróbico é uma intervenção terapêutica em programas de reabilitação, pois, além de proporcionar os benefícios no condicionamento físico, funcionalidade, humor e saúde cardiovascular, pode potencializar a neuroplasticidade.

Objectives Cognitive decline is one of the most prevalent health problems and is associated with increased healthcare utilization and economic burden. Physical and cognitive training both have positive effects on cognition but have been less applied in combination. We hypothesized that simultaneous cognitive-physical components would yield greater cognitive benefits than single-domain interventions in rats. Methods A total of 40 male Wistar rats were divided into four treatment groups: the control, enriched environment (EE), exercise (EX), and EE + EX. Animals in EE groups housed in the large cages (50 × 50 × 50 cm) contained differently shaped objects for 3 weeks. EX animals were forced to run on a treadmill once daily for 3 consecutive weeks. Morris water maze test was used for the assessment of spatial learning and memory. Real-time PCR was performed to assess the expression of nestin, and Sox2 in the hippocampus. Results EX and EE animals separately did not show a significantly enhanced function in spatial memory in comparison with the control group. When animals were treated with EE and EX simultaneously, they exhibited significantly superior performance in spatial memory than control, EX, or EE groups separately. The hippocampal expression of Sox2 was significantly higher in EE + EX group than in the control, EX, and EE alone. Conclusions These results may have clinical implications for behavioral interventions in conditions with cognitive deficiencies.

Objective To determine the effects of an integrated training device for strength and balance on extremity muscle strength, postural balance, and cognition in older adults using a combination with various rehabilitation training games, in which balance, strength, and cognitive training were configured in a single device.Methods This prospective study included 20 healthy participants aged 65–85 years. Participants trained for 30 minutes daily, 3 days weekly, for 6 weeks with an integrated training device for strength and balance (SBT-120; Man&Tel Inc., Gumi, Korea). Main outcomes were measured using the Korean Mini-Mental State Examination (K-MMSE), Korean version of the Montreal Cognitive Assessment (K-MoCA), Timed Up and Go Test (TUG), Functional Reach Test (FRT), Berg Balance Scale (BBS), and Manual Muscle Test. Measurements were taken at three time points: T0 (pretreatment), T1 (immediately after treatment), and T2 (4 weeks after treatment).Results All 20 patients completed the training, and TUG, FRT, and BBS scores significantly improved at T1 and T2 compared to T0. Mean TUG scores decreased by 0.99±2.00 at T1 and 1.05±1.55 at T2 compared to T0. Mean FRT scores increased by 6.13±4.26 at T1 and 6.75±4.79 at T2 compared to T0. BBS scores increased by 0.60±0.94 at T1 and 0.45±1.15 at T2 compared to T0. Moreover, muscle strength and cognition (K-MMSE and K-MoCA scores) increased after training.Conclusion Our findings suggest that an integrated training device for strength and balance can be a safe and useful tool for older adults.

Traumatic brain injury (TBI) remains a global health problem with cognitive impairments that can affect an individual’s life. Although there is still no effective treatment for TBI sequelae, virtual reality (VR) technology shows promising results as a training tool to improve cognitive functions. Nonetheless, using a head-mounted display (HMD) device can induce cybersickness. Objective. To assess the feasibility of immersive VR cognitive training on EF and provide insights for a definitive trial. We aimed to assess the tolerability of TBI patients after prolonged use of a HMD. Also, as an exploratory analysis, we evaluated changes in cognition, including executive function, memory, and processing speed after the intervention. Methods. A prospective, single-arm, quasi-experimental study was performed to analyze the feasibility of twelve 20-min sessions of immersive VR over four weeks in patients with sustained TBI. Neuropsychological assessment was applied at baseline (T1), post-intervention (T2), and a three-months follow-up (T3). The Simulator Sickness Questionnaire (SSQ) was administered at the end of each session to evaluate the safety of the intervention. Results. Thirteen participants of mean age 34.86 (11.12), with moderate to severe TBI and average of 305.23 (51.23) days post-trauma were included. Patients showed improvements in EF between T1 and T3 (p = 0.02) and low scores in the SSQ (mean score = 4.33, SD = 4.06). Conclusions. The present VR intervention showed to be feasible and safe for patients with TBI to use a HMD. We also observed positive effects on EF and future studies should consider a home-based approach.

Virtual reality (VR) is used to improve specific health needs by combining multiple technologies; it is increasingly being used in the medical field, showing satisfactory effects, especially in the management of chronic disease. The aim of this study was to assess the effects of VR cognitive training for individuals with mild cognitive impairment (MCI).Peer-reviewed articles were searched from the PubMed, Embase, Web of Science, the Cochrane Library, Science Direct, and EBSCOhost databases, as well as CNKI, Sinomed, Vip. and Wan Fang, through 23 May 2021. We only included randomized controlled trials (RCTs) enrolling participants with MCI.Seventeen RCTs were included, with a total of 744 participants. Evidence of moderate quality showed that VR cognitive training significantly enhanced MCI patients' global cognitive function, as measured by the Montreal Cognitive Assessment (standardized mean difference [SMD] = 0.42; 95% confidence interval [CI], 0.04-0.79; p = 0.03) and executive function, as measured by trail making test A (SMD = -0.58; 95% CI, -0.80 to -0.35; p 0.001). The meta-analysis indicated that the effects of VR cognitive training on delayed memory, immediate memory, attention and instrumental activities of daily living were not statistically significant (p 0.05).The available data showed that VR cognitive training might be beneficial for improving global cognitive function and executive function in individuals with MCI, although the effects were short term.

The objectives are to evaluate the effects of a sequential combination of aerobic exercise and cognitive training, compared with exercise or cognitive training alone, on cognitive function, physical function, daily function, quality of life, and social participation in stroke survivors with cognitive impairment.This is a single-blind, parallel, randomized controlled trial. Stroke patients with mild cognitive impairment (n = 56) were randomly assigned to aerobic exercise training (n = 18), computerized cognitive training (n = 18), and the sequential combination of aerobic exercise and computerized cognitive training (n = 20) group. All groups underwent training 60 min/day, 3 days/week, for a total of 12 weeks. The primary outcomes included Montreal Cognitive Assessment (MoCA), Wechsler Memory Scale-Third Edition, and the Stroop color-word test. Secondary outcomes were the Timed Up and Go test, 6-Minute Walk Test, Functional Independence Measure, Lawton Instrumental Activities of Daily Living Scale, Community Integration Questionnaire, and Stroke Impact Scale.56 participants completed the trial. Compared with a single type of aerobic exercise or cognitive training, the combined training group showed significant improvement in MoCA (The findings provide evidence for the potential synergistic intervention in stroke survivors. Future studies investigating the transfer effects and the optimal training parameters with a larger sample is needed.

This study aimed to assess the effects of combined cognitive training on prospective memory ability of older adults with mild cognitive impairment (MCI). A total of 113 participants were divided into a control group and three intervention groups. Over three months, the control group received only community education without any training, whereas for the first six weeks, an executive function training group received executive function training, a memory strategy training group received semantic encoding strategy training, and the combined cognitive training group received executive function training twice a week for the first six weeks, and semantic encoding strategy training twice a week for the next six weeks. The combined cognitive training group showed improvement on the objective neuropsychological testing (Montreal Cognitive Assessment scale). The memory strategy training group showed improvement on the self-evaluation scales (PRMQ-PM). Combined cognitive training improved the prospective memory and cognitive function of older adults with MCI.

Objective This study aimed to introduce a 4-week long fully immersive virtual reality-based cognitive training (VRCT) program that could be applied for both a cognitively normal elderly population and patients with mild cognitive impairment (MCI). In addition, we attempted to investigate the neuropsychological effects of the VRCT program in each group.Methods A total of 56 participants, 31 in the MCI group and 25 in the cognitively normal elderly group, underwent eight sessions of VRCT for 4 weeks. In order to evaluate the effects of the VRCT, the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet was administered before and after the program. The program’ s safety was assessed using a simulator sickness questionnaire (SSQ), and availability was assessed using the presence questionnaire.Results After the eighth session of the VRCT program, cognitive improvement was observed in the ability to learn new information, visuospatial constructional ability, and frontal lobe function in both groups. At the baseline evaluation, based on the SSQ, the MCI group complained of disorientation and nausea significantly more than the cognitively normal elderly group did. However, both groups showed a reduction in discomfort as the VRCT program progressed.Conclusion We conclude that our VRCT program helps improve cognition in both the MCI group and cognitively normal elderly group. Therefore, the VRCT is expected to help improve cognitive function in elderly populations with and without MCI.

Useful Field of View (UFOV) computerized cognitive training improves older adults’ gait speed and balance and reduces dementia risk. We investigated a new form of UFOV training requiring physical movement, Training Under Cognitive Kinematics (TUCK). We hypothesized TUCK would be acceptable, feasible, and potentially efficacious to improve UFOV Test and motor performance. Sixty-nine older adults were randomized to TUCK, computerized UFOV training, or an active control group. Cognitive and motor functions were assessed before and immediately after the intervention period. Participants rated TUCK as enjoyable, engaging, and satisfying, indicating acceptability. Eighty-five percent of participants completed TUCK, demonstrating feasibility. Overall, effect sizes for TUCK did not indicate greater efficacy than computerized UFOV training relative to controls. UFOV training showed effect sizes indicating improved balance as measured by Turn 360 (d = 0.37) and Optogait (d = 0.51–0.69) from pre- to post-training relative to controls. Incorporating movement into UFOV cognitive training did not enhance cognitive or motor functional gains. Future investigations are needed to elucidate the underlying mechanisms of UFOV cognitive training to enhance motor function. Research should continue to investigate the association of cognitive and motor function and interventions to improve these outcomes among older adults. The trial and analyses were pre-registered: https://osf.io/7utgw .

Aims Cognitive impairment in patients with alcohol use disorder (AUD) is highly prevalent, and it negatively impacts treatment outcome. However, this condition is neither systematically assessed nor treated. Thus, we aimed to explore the usability of a virtual reality-based protocol (‘Rehabilitation Gaming System’, RGS) for patients with AUD. Methods Twenty AUD patients (50% also cognitive impairment) underwent a single session of the RGS protocol (four cognitive training tasks, 10 minutes each). System Usability Scale (SUS) and Post-Study System Usability Questionnaire (PSSUQ) were applied to assess the RGS usability and patients’ satisfaction with it. Also, the Perceived Competence Scale was administered to assess the patients’ feelings of competence when using the training protocol. Comparisons of the responses to these questionnaires were performed between AUD patients with cognitive impairment and those without cognitive impairment. Results RGS usability was very positively rated (median SUS score = 80, Interquartile Range, IQR = 68.13–86-88). No significant differences were found in the median SUS scores for any of the sociodemographic or clinical variables, excepting for gender (women median score = 85; IQR = 80–94.38 vs. men median score = 71.25; IQR = 61.25–89.25; P-value = 0.035). The quality of the information provided by the RGS training scenarios and the usability were positively rated (PSSUQ), and patients experienced high feelings of competence. Conclusions The RGS has been found to be usable in the short term and patients with AUD stated to be satisfied with it. Future larger, randomized trials are needed to explore the effectiveness of this tool to help overcome the cognitive deficits in AUD patients.

See Whyte and Turkstra (doi:10.1093/brain/awab210) for a scientific commentary on this article. In a randomized controlled trial, Mahncke et al. show that a self-administered computerized cognitive training program drove significant and enduring improvements in cognitive function in people with a history of mild traumatic brain injury and cognitive impairment, compared to an active control (computer games)., Clinical practice guidelines support cognitive rehabilitation for people with a history of mild traumatic brain injury (mTBI) and cognitive impairment, but no class I randomized clinical trials have evaluated the efficacy of self-administered computerized cognitive training. The goal of this study was to evaluate the efficacy of a self-administered computerized plasticity-based cognitive training programmes in primarily military/veteran participants with a history of mTBI and cognitive impairment. A multisite randomized double-blind clinical trial of a behavioural intervention with an active control was conducted from September 2013 to February 2017 including assessments at baseline, post-training, and after a 3-month follow-up period. Participants self-administered cognitive training (experimental and active control) programmes at home, remotely supervised by a healthcare coach, with an intended training schedule of 5 days per week, 1 h per day, for 13 weeks. Participants (149 contacted, 83 intent-to-treat) were confirmed to have a history of mTBI (mean of 7.2 years post-injury) through medical history/clinician interview and persistent cognitive impairment through neuropsychological testing and/or quantitative participant reported measure. The experimental intervention was a brain plasticity-based computerized cognitive training programme targeting speed/accuracy of information processing, and the active control was composed of computer games. The primary cognitive function measure was a composite of nine standardized neuropsychological assessments, and the primary directly observed functional measure a timed instrumental activities of daily living assessment. Secondary outcome measures included participant-reported assessments of cognitive and mental health. The treatment group showed an improvement in the composite cognitive measure significantly larger than that of the active control group at both the post-training [+6.9 points, confidence interval (CI) +1.0 to +12.7, P = 0.025, d = 0.555] and the follow-up visit (+7.4 points, CI +0.6 to +14.3, P = 0.039, d = 0.591). Both large and small cognitive function improvements were seen twice as frequently in the treatment group than in the active control group. No significant between-group effects were seen on other measures, including the directly-observed functional and symptom measures. Statistically equivalent improvements in both groups were seen in depressive and cognitive symptoms.

Objective. This study characterized the electroencephalographic correlation (rEEG) between prefrontal and parietal cortices in young men while solving logical-mathematical problems after 18 sessions of cognitive training. Method. Two training groups were formed: one trained with gradually increased complexity (CT), the other with no increase in complexity (ST). Results. CT had a greater number of correct responses in the post-training evaluation than ST and showed a higher correlation between the left frontopolar-parietal cortices in almost all EEG bands, and between the dorsolateral-parietal cortices in the alpha1 band while solving math problems post-training. Results suggest that major functional synchronization between the left prefrontal and parietal cortices plays an important role in improving mathematical problem-solving after cognitive training. Objetivo. El presente estudio caracteriza la correlación electroencefalográfica (rEEG) entre las cortezas prefrontal y parietal en hombres jóvenes durante la resolución de problemas lógico-matemáticos después de 18 sesiones de entrenamiento cognitivo. Método. Se formaron dos grupos de entrenamiento: uno entrenado con un incremento gradual de complejidad (CT) y el otro sin incremento de complejidad (ST). Resultados. El grupo CT presentó un mayor número de respuestas correctas que el grupo ST en la evaluación post entrenamiento, a su vez mostró un incremento en la correlación entre las cortezas frontopolar y parietal izquierdas en la mayoría de las bandas, así como entre las cortezas dorsolateral y parietal en la banda alfa1 durante la resolución de problemas posterior al entrenamiento. Los resultados sugieren que el incremento en la sincronización funcional entre las cortezas prefrontal y parietal izquierdas juega un rol importante en la resolución de problemas matemáticos después del entrenamiento cognitivo. Objective. This study characterized the electroencephalographic correlation (rEEG) between prefrontal and parietal cortices in young men while solving logical-mathematical problems after 18 sessions of cognitive training. Method. Two training groups were formed: one trained with gradually increased complexity (CT), the other with no increase in complexity (ST). Results. CT had a greater number of correct responses in the post-training evaluation than ST and showed a higher correlation between the left frontopolar-parietal cortices in almost all EEG bands, and between the dorsolateral-parietal cortices in the alpha1 band while solving math problems post-training. Results suggest that major functional synchronization between the left prefrontal and parietal cortices plays an important role in improving mathematical problem-solving after cognitive training.

Background/Objectives The Japan-multimodal intervention trial for prevention of dementia (J-MINT) is intended to verify the effectiveness of multi-domain interventions and to clarify the mechanism of cognitive improvement and deterioration by carrying out assessment of dementia-related biomarkers, omics analysis and brain imaging analysis among older adults at high risk of dementia. Moreover, the J-MINT trial collaborates with partnering private enterprises in the implementation of relevant interventional measures. This manuscript describes the study protocol. Design/Setting Eighteen-month, multi-centered, randomized controlled trial. Participants We plan to recruit 500 older adults aged 65–85 years with mild cognitive impairment. Subjects will be centrally randomized into intervention and control groups at a 1:1 allocation ratio using the dynamic allocation method with all subjects stratified by age, sex, and cognition. Intervention The multi-domain intervention program includes: (1) management of vascular risk factors; (2) group-based physical exercise and self-monitoring of physical activity; (3) nutritional counseling; and (4) cognitive training. Health-related information will be provided to the control group every two months. Measurements The primary and secondary outcomes will be assessed at baseline, 6-, 12-, and 18-month follow-up. The primary outcome is the change from baseline to 18 months in a global composite score combining several neuropsychological domains. Secondary outcomes include: cognitive change in each neuropsychological test, incident dementia, changes in blood and dementia-related biomarkers, changes in geriatric assessment including activities of daily living, frailty status and neuroimaging, and number of medications taken. Conclusions This trial that enlist the support of private enterprises will lead to the creation of new services for dementia prevention as well as to verify the effectiveness of multi-domain interventions for dementia prevention. Electronic Supplementary Material Supplementary material is available for this article at 10.14283/jpad.2021.29 and is accessible for authorized users.

We aimed to evaluate the feasibility of multidomain intervention (MI) tailored to the Korean context. In an outcome assessor-blinded, randomized controlled trial, participants without dementia and with one or more modifiable dementia risk factors, aged 60-79 years, were randomly assigned to the facility-based MI (FMI; n=51), the home-based MI (HMI; n=51), or the control group receiving general health advice (n=50). The 24-week intervention comprised vascular risk management, cognitive training, social activity, physical exercise, nutrition guidance, and motivational enhancement. The FMI participants performed all intervention programs at a facility three times a week. The HMI participants performed some programs at a facility once every 1-2 weeks and performed others at home. The primary outcome was feasibility measured through retention, adherence, and at least no differences from the control group in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). In the FMI and HMI groups, the retention rates were 88.2% and 96.1%, and adherence to the intervention was 94.5% and 96.8%, respectively. The RBANS total scale index score improved significantly in the FMI (5.46 ± 7.50, P = 0.004) and HMI (5.50 ± 8.14, P = 0.004) groups compared to the control group (-0.74 ± 11.51). The FMI and HMI are feasible and there are indicators of efficacy.

Objective: This article examined older adults' performance on two components of a mental rotation task (reaction time and rotation rate) in a home-based intervention study of videogame (Crazy Taxi [CT]) and computerized cognitive training (PositScience InSight). Materials and Methods: Participants were randomized to one of three groups: one group played an off-the-shelf videogame (i.e., CT), the second group engaged in a computerized training program focused on fast perceptual comparisons, visuospatial working memory, rapid scanning of a visual array and pattern recognition, visual discrimination, and selective and divided attention and processing speed (i.e., InSight), and the third (control) group received no training. Training in the two intervention conditions consisted of 60 training sessions of 1 hour each, which were completed in 3 months (5 hours a week). As part of a larger study, participants received mental rotation testing, which was administered immediately before (baseline), after (post-test), and 3 months after (follow-up) training. Results: Although the InSight group showed greater improvements in rotation rate at the immediate post-test, by the 3-month follow-up, the combined treatment groups (CT and InSight) had improved more than controls. Conclusion: The improvements in mental rotation performance found at 3-month follow-up add additional support to previous research, showing visuospatial benefits of both videogame play and cognitive training in older adults. Common elements of both interventions may include expansion of the attentional field of view and faster visual comparison efficiency.

This study assesses the effectiveness of a multicomponent Longitudinal Cognitive Training (CT) program plus physical exercise (PE) for people with Mild Cognitive Impairment (MCI). 155 people with MCI, completed a 3 years (3Y) CT+PE, whilst 133 were control. Neuropsychological assessment was performed at baseline and 3 years later, whilst CT+PE had additional annual assessments. According to the results, the 3Y CT+PE outperformed control in cognitive abilities ( p < 0.002), and Activities of Daily Living (ADL) ( p < 0.001), stabilized their functional performances between 1st and 2nd year, but worsened in working and verbal memory between 2nd and 3 rd year ( p < 0.002). Control deteriorated in cognitive functions ( p < 0.001) and ADL ( p < 0.001) after 3 years, whilst 1.33% of the experimental and 13.53% of the control group progressed to dementia ( p < 0.001). Longitudinal CT+PE improves cognitive performance and ADL in MCI and delay the progression to dementia.

Nowadays, the novel coronavirus infection (COVID-19) pandemic is one of the most important global health problems. There is increasing evidence that COVID-19 affects central and peripheral nervous system as well. The paper presents a clinical case of a 47 old patient with the ApoE ε4 haplotype and family history of Alzheimer’s disease who developed cognitive impairment after acute COVID-19. Before the infection the patient has no cognitive complaints and preserved everyday activity. After novel coronavirus infection, which was observed in mild form, the patient had started to complain on constant excessive forgetfulness. Neuropsychological assessment confirmed the presence of pre-mild cognitive impairment of predominantly single domain amnestic type. However, brain MRI showed only subtle periventricular white matter changes usually attributed to small vessel disease. Memory complaints were observed for 3 months of follow up despite intensive cognitive training, optimization of lifestyle and therapy with choline alphoscerate. Probable links between coronavirus infectious and cognitive impairment manifestation are discussed. There is data that ApoE ε4 haplotype is associated with increase of microglia mediated neuro-inflammation and it can be significant for accelerating of progression of neurodegenerative diseases after COVID-19. Further follow up of the patient is necessary for determination of nosological diagnosis explaining manifested predominantly amnestic type pre-mild cognitive impairment.

Risks of falls among older adults are multifactorial in nature. A combined training program might be beneficial on fall-related outcomes. This study aimed to explore the effects of group-based physical-cognitive trainings on physical and psychological outcomes among older adults with type 2 diabetes mellitus (T2DM) and balance impairment. Fall incidence were also determined. Thirty-seven older adults with T2DM and balance impairment were randomly assigned to control and intervention groups. The intervention program comprised of 24 training sessions of 45–60 min exercise for 8 weeks. The exercise consisted of warm-up, aerobic exercise by nine square stepping, resistance exercise combined with cognitive training and cool down. All participants were assessed at baseline, 4 and 8 weeks after intervention, and 1-year follow-up. Both groups reported similar rates of falls. Global cognition, depressive symptoms, and fear of falling did not differ between groups at any time. The Timed Up & Go (TUG) test, alternate stepping test (AST), knee extensors, ankle plantarflexors, and dorsiflexors strength differed at 4 weeks. TUG, AST, hip abductors, knee flexors, ankle plantarflexors, and dorsiflexors strength differed at 8 weeks. The activity of daily living (ADL), TUG test (P=0.002) and AST, hip extensors and abductors, knee extensors and flexors, ankle plantarflexors and dorsiflexors were different at 1-year follow-up. The group-based physical-cognitive training could benefit older adults with T2DM in terms of maintaining ADL. The intervention could reduce fall risk factors by improving balance and lower limb muscle strength among older adults with T2DM and balance impairment.

Cognitive intervention includes cognitive stimulation, cognitive training, and cognitive rehabilitation. This systematic review was performed to re-assess the efficacy of cognitive intervention for the patients with Alzheimer’s disease (AD). Twenty studies (2012 participants) were eventually included. For global cognitive function, the combined mean difference (MD) in eight studies was 1.67 (95% Confidence Interval: 0.45, 2.89, p = 0.007; Q = 33.28, df = 8, p

ObjectiveYouth with sickle cell disease (SCD) are at risk for neurocognitive deficits including problems with working memory (WM), but few interventions to improve functioning exist. This study sought to determine the feasibility and efficacy of home-based, digital WM training on short-term memory and WM, behavioral outcomes, and academic fluency using a parallel group randomized controlled trial design.Methods47 children (7–16 years) with SCD and short-term memory or WM difficulties were randomized to Cogmed Working Memory Training at home on a tablet device (N = 24) or to a standard care Waitlist group (N = 23) that used Cogmed after the waiting period. Primary outcomes assessed in clinic included performance on verbal and nonverbal short-term memory and WM tasks. Secondary outcomes included parent-rated executive functioning and tests of math and reading fluency.ResultsIn the evaluable sample, the Cogmed group (N = 21) showed greater improvement in visual WM compared with the Waitlist group (N = 22; p = .03, d = 0.70 [CI95 = 0.08, 1.31]). When examining a combined sample of participants, those who completed ≥10 training sessions exhibited significant improvements in verbal short-term memory, visual WM, and math fluency. Adherence to Cogmed was lower than expected (M = 9.07 sessions, SD = 7.77), with 19 participants (41%) completing at least 10 sessions. Conclusions: Visual WM, an ability commonly affected by SCD, is modifiable with cognitive training. Benefits extended to verbal short-term memory and math fluency when patients completed a sufficient training dose. Additional research is needed to identify ideal candidates for training and determine whether training gains are sustainable and generalize to real-world outcomes.

Gait speed is a measure of health and functioning. Physical and cognitive determinants of gait are amenable to interventions, but best practices remain unclear. We investigated the effects of a 12-month physical and cognitive training (PTCT) on gait speed, dual-task cost in gait speed, and executive functions (EFs) compared with physical training (PT) (ISRCTN52388040). Community-dwelling older adults, who did not meet physical activity recommendations, were recruited (n = 314). PT included supervised walking/balance (once weekly) and resistance/balance training (once weekly), home exercises (2-3 times weekly), and moderate aerobic activity 150 min/week in bouts of >10 min. PTCT included the PT and computer training (CT) on EFs 15-20 min, 3-4 times weekly. The primary outcome was gait speed. Secondary outcomes were 6-min walking distance, dual-task cost in gait speed, and EF (Stroop and Trail Making B-A). The trial was completed by 93% of the participants (age 74.5 [SD3.8] years; 60% women). Mean adherence to supervised sessions was 59%-72% in PT and 62%-77% in PTCT. Home exercises and CT were performed on average 1.9 times/week. Weekly minutes spent in aerobic activities were 188 (median 169) in PT and 207 (median 180) in PTCT. No significant interactions were observed for gait speed (PTCT-PT, 0.02; 95%CI -0.03, 0.08), walking distance (-3.8; -16.9, 9.3) or dual-task cost (-0.22; -1.74, 1.30). Stroop improvement was greater after PTCT than PT (-6.9; -13.0, -0.8). Complementing physical training with EFs training is not essential for promotion of gait speed. For EF's, complementing physical training with targeted cognitive training provides additional benefit.

The current pilot study investigated if interference control can be improved by a three-week at-home training comprising a flanker and a n-back task in healthy adults, thus exploring the training's suitability for future clinical application, i.e. as a treatment augmentation for psychological disorders. As training gains are assumed to be modulated by the amount of mismatch between task demands and brain resources, an adaptive and a non-adaptive training were contrasted in separate experiments. In the adaptive training, task difficulty was continuously adapted to participants' performance. In the non-adaptive training procedure, task difficulty remained stable on the lowest difficulty level. As deficits in interference control in psychological disorders often predominantly manifest on the electrophysiological level, the impact of the training procedures on medio-frontal negativities (N2, CRN, ERN) was investigated in addition to behavioral measures. The adaptive training led to significant improvements in interference control, as reflected in reduced response times and error rates in incompatible trials. This was accompanied by specific and complementary changes in medio-frontal negativities: After the adaptive training the N2 in incompatible trials was larger and the CRN in incompatible trials was reduced. The non-adaptive training procedure led to generally faster response times but also an increased error rate, indicating a speed-accuracy trade-off. This was accompanied by global changes to medio-frontal negativities irrespective of compatibility, possibly indicating task disengagement. Taken together, the current studies demonstrate that an adaptive training procedure can improve interference control thereby opening up possible clinical applications.

Pharmacological treatments for mild cognitive impairment (MCI), are lacking, and alternative approaches have been implemented, including cognitive training (CT). Objective: To determine the impact of CT on cognitive and quality of life measures in patients with Parkinson’s disease (PD) who were seen a hospital neurorehabilitation program. Methods: Thirty-nine individuals with MCI-PD, according to the Movement Disorder Society, were randomly distributed into two groups: experimental and control group, matched for demographic and clinical characteristics. Both groups were assessed for cognition and quality of life at the beginning of the study and at the end of the intervention protocol. The following instruments were used to assess cognition and quality of life: Addenbrooke’s Cognitive Examination III, Digit Span, Trail Making Test (TMT, A and B) and Parkinson disease quality of life questionnaire. The experimental group (EG) engaged in CT, whereas the control group (CG) underwent activities of the general rehabilitation program. Results: No baseline evaluation differences were found. Intergroup analysis showed differences in measures, such as total score (1.977, p=0.0480) and visuospatial domain (-2.636, p=0.0084) of the ACE-III, with the EG performing better, in addition to better performance in TMT-B mistakes (-1.928, p=0.0439). Intragroup analysis revealed that the EG showed significant improvement in almost all the cognitive variables, well as in self-reported quality of life (total score and mobility, activities of daily living, body discomfort dimensions). Conclusions: Engagement in cognitive activities was associated with better cognitive abilities in PD-MCI. Future studies should consider the long-term effect of this type of intervention and impact on functional activities. RESUMO. A falta de evidência de tratamentos farmacológicos, especificamente para pacientes com comprometimento cognitivo leve na doença de Parkinson (CCL-DP), leva à implementação de abordagens alternativas, incluindo a reabilitação cognitiva. Objetivo: Determinar o impacto do treino cognitivo (TC) em medidas cognitivas e da qualidade de vida em pacientes com DP, que participavam de um programa de reabilitação neurológica hospitalar. Métodos: Total de 39 indivíduos com CCL-DP, de acordo com a Sociedade de Distúrbios do Movimento, foram distribuídos aleatoriamente em dois grupos: experimental e controle, pareados por características demográficas e clínicas. Ambos os grupos foram avaliados quanto à cognição e qualidade de vida no início do estudo e ao final do protocolo de intervenção. Os seguintes instrumentos foram utilizados para avaliar a cognição e a qualidade de vida: Exame Cognitivo III de Addenbrooke, teste de dígitos, TMT (A e B) e questionário de qualidade de vida da doença de Parkinson. O grupo experimental foi submetido ao treino cognitivo, ao passo que o grupo controle passou por atividades do programa de reabilitação. Resultados: Não foram encontradas diferenças na avaliação basal. A análise intergrupo mostrou diferenças em medidas, como escore total (1,977, p=0,0480) e domínio visuoespacial (-2,636, p=0,0084) da ACE-III, tendo o grupo experimental melhor desempenho, além de desempenho superior em TMT-B erros (-1,928, p=0,0439). A análise intragrupo revelou que o grupo experimental mostrou melhora significativa em quase todas as variáveis cognitivas, assim como na percepção de qualidade de vida (escore total e dimensões de mobilidade, atividades da vida diária e desconforto corporal). Conclusões: O envolvimento em atividades cognitivas foi associado a melhores habilidades cognitivas em pacientes com CCL-DP. Estudos futuros devem considerar o efeito a longo prazo desse tipo de intervenção e o impacto nas atividades funcionais.

Individuals with depression show an attentional bias toward negatively valenced stimuli and thoughts. In this proof-of-concept study, we present a novel closed-loop neurofeedback procedure intended to remediate this bias. Internal attentional states were detected in real time by applying machine learning techniques to functional magnetic resonance imaging data on a cloud server; these attentional states were externalized using a visual stimulus that the participant could learn to control. We trained 15 participants with major depressive disorder and 12 healthy control participants over 3 functional magnetic resonance imaging sessions. Exploratory analysis showed that participants with major depressive disorder were initially more likely than healthy control participants to get stuck in negative attentional states, but this diminished with neurofeedback training relative to controls. Depression severity also decreased from pre- to posttraining. These results demonstrate that our method is sensitive to the negative attentional bias in major depressive disorder and showcase the potential of this novel technique as a treatment that can be evaluated in future clinical trials.

Functional recovery after stroke is dose-dependent on the amount of rehabilitative training. However, rehabilitative training is subject to motivational hurdles. Decision neuroscience formalizes drivers and dampers of behaviour and provides strategies for tipping motivational trade-offs and behaviour change. Here, we used one such strategy, upfront voluntary choice restriction (‘precommitment’), and tested if it can increase the amount of self-directed rehabilitative training in severely impaired stroke patients. In this randomized controlled study, stroke patients with working memory deficits (n = 83) were prescribed daily self-directed gamified cognitive training as an add-on to standard therapy during post-acute inpatient neurorehabilitation. Patients allocated to the precommitment intervention could choose to restrict competing options to self-directed training, specifically the possibility to meet visitors. This upfront choice restriction was opted for by all patients in the intervention group and highly effective. Patients in the precommitment group performed the prescribed self-directed gamified cognitive training twice as often as control group patients who were not offered precommitment [on 50% versus 21% of days, Pcorr = 0.004, d = 0.87, 95% confidence interval (CI95%) = 0.31 to 1.42], and, as a consequence, reached a 3-fold higher total training dose (90.21 versus 33.60 min, Pcorr = 0.004, d = 0.83, CI95% = 0.27 to 1.38). Moreover, add-on self-directed cognitive training was associated with stronger improvements in visuospatial and verbal working memory performance (Pcorr = 0.002, d = 0.72 and Pcorr = 0.036, d = 0.62). Our neuroscientific decision add-on intervention strongly increased the amount of effective cognitive training performed by severely impaired stroke patients. These results warrant a full clinical trial to link decision-based neuroscientific interventions directly with clinical outcome.

Few studies have comprehensively described changes in blood biomarkers of the physiological responses underlying sarcopenia reduction associated with lifestyle interventions. In this study, we performed secondary analyses of data in a randomized controlled trial of multi-domain lifestyle interventions (6-month duration physical exercise, nutritional enrichment, cognitive training, combination and standard care control) among 246 community-dwelling pre-frail and frail elderly, aged ≥65 years, with and without sarcopenia. Appendicular lean mass (ALM), lower limb strength, gait speed, and blood levels of markers of muscle metabolism, inflammation, anti-oxidation, anabolic hormone regulation, insulin signaling, tissue oxygenation were measured at baseline, 3-month and 6-month post-intervention. Multi-domain interventions were associated with significant (p < 0.001) reduction of sarcopenia at 3-month and 6-month post-intervention, improved gait speed, enhanced lower limb strength, and were equally evident among sarcopenic participants who were slower at baseline than non-sarcopenic participants. Active intervention was associated with significantly reduced inflammation levels. Sarcopenia status and reduction were associated with blood biomarkers related to muscle metabolism, steroid hormone regulation, insulin-leptin signaling, and tissue oxygenation. Physical, nutritional and cognitive intervention was associated with measures of sarcopenia reduction, together with changes in circulating biomarkers of anabolic and catabolic metabolism underlying sarcopenia.

Half of people with HIV (PWH) have HIV-associated neurocognitive disorder (HAND). This study examined whether cognition can be improved using a framework targeting impaired individual cognitive domains in PWH with HAND. In this two-group pre-post experimental design study, 88 adults with HAND were randomized to either: (1) a no-contact control group (n = 40) or (2) the Individualized-Targeted Cognitive Training group (n = 48). Baseline cognitive performance was assessed on eight cognitive domains. A theoretical framework was used to determine the two cognitive domains selected for training. With priority on speed of processing (SOP) and attention impairments, participants received SOP and/or attention training if such impairments were detected; if not, participants were assigned to cognitive training in one/two of the least impaired cognitive domains contributing to their HAND diagnosis. Global cognitive score was slightly improved following training (p = 0.256; d = − 0.21), but it was not significant. Significant improvements were observed on SOP following training in that domain (SOP; d = − 0.88; p = 0.011). SOP training also improved functioning in other cognitive domains. This individualized cognitive intervention did not change HAND status, but it did result in improved SOP, in turn yielding improvement in other cognitive domains.

To evaluate the effectiveness of cognitive training in improving tinnitus bother and to identify predictors of patient response.Prospective open-label randomized controlled trial.Online.Participants were adults with subjective idiopathic nonpulsatile tinnitus causing significant tinnitus-related distress. The intervention group trained by using auditory-intensive exercises for 20 minutes per day, 5 days per week, for 8 weeks. The active control group trained on the same schedule with non-auditory intensive games. Surveys were completed at baseline, 8 weeks, and 12 weeks.A total of 64 participants completed the study. The median age was 63 years (range, 25-69) in the intervention group and 61 years (34-68) in the control group. Mixed model analysis revealed that within-subject change in Tinnitus Functional Index in the intervention group was not different than the control group, with marginal mean differences (95% CI): 0.24 (-11.20 to 10.7) and 2.17 (-8.50 to 12.83) at 8 weeks and 2.33 (-8.6 to 13.3) and 3.36 (-7.91 to 14.6) at 12 weeks, respectively. When the 2 study groups were compared, the control group had higher Tinnitus Functional Index scores than the intervention group by 10.5 points at baseline (95% CI, -0.92 to 29.89), 8.1 at 8 weeks (95% CI, -3.27 to 19.42), and 9.4 at 12 weeks (95% CI, -2.45 to 21.34).Auditory-intensive cognitive training was not associated with changes in self-reported tinnitus bother. Given the potential for neuroplasticity to affect tinnitus, we believe that future studies on cognitive training for tinnitus remain relevant.

Objective Cognitive impairment has a critical impact on functional outcomes in patients with schizophrenia. Compensatory cognitive training (CCT) has shown promise as a cognitive rehabilitation tool but little is known about its effectiveness when combined with medication self-management skills training (MSST) in patients with schizophrenia. Thus, this study compared the effects of a combined CCT and MSST with CCT and treatment as usual (TAU) on cognitive function, symptoms, and medication adherence. Method Eighty-seven inpatients with schizophrenia were randomly assigned to the TAU, CCT, or CCT + MSST groups. Assessments of cognitive function using the Brief Assessment of Cognition in Schizophrenia, symptoms using the Positive and Negative Syndrome Scale, and medication adherence using the Medication Adherence Questionnaire, were administered to all participants at baseline and at post-intervention. Results Compared with the TAU group, the CCT group had significant improvements in verbal fluency, total cognitive function and medication adherence, and the CCT + MSST group had significant improvements in verbal fluency, total cognitive function, positive symptoms, and medication adherence. Compared with the CCT group, the CCT + MSST group had significant improvements in total cognitive function. Conclusions These results indicate that the integrated intervention may be more advantageous than CCT alone in improving total cognitive function and positive symptoms. Future research should seek to further explore the long-term effects of such a joint intervention.

Background 27-Hydroxycholesterol (27-OH), the main circulating oxysterol in humans and the potential missing link between peripheral hypercholesterolemia and Alzheimer’s disease (AD), has not been investigated previously in relation to cognition and neuroimaging markers in the context of preventive interventions. Methods The 2-year Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) included older individuals (60–77 years) at increased risk for dementia but without dementia or substantial cognitive impairment from the general population. Participants were randomized to a multidomain intervention (diet, exercise, cognitive training, and vascular risk management) or control group (general health advice) in a 1:1 ratio. Outcome assessors were masked to group allocation. This FINGER exploratory sub-study included 47 participants with measures of 27-OH, cognition, brain MRI, brain FDG-PET, and PiB-PET. Linear regression models were used to assess the cross-sectional and longitudinal associations between 27-OH, cognition, and neuroimaging markers, considering several potential confounders/intervention effect modifiers. Results 27-OH reduction during the intervention was associated with improvement in cognition (especially memory). This was not observed in the control group. The intervention reduced 27-OH particularly in individuals with the highest 27-OH levels and younger age. No associations were found between changes in 27-OH levels and neuroimaging markers. However, at baseline, a higher 27-OH was associated with lower total gray matter and hippocampal volume, and lower cognitive scores. These associations were unaffected by total cholesterol levels. While sex seemed to influence associations at baseline, it did not affect longitudinal associations. Conclusion 27-OH appears to be a marker not only for dementia/AD risk, but also for monitoring the effects of preventive interventions on cholesterol metabolism. Trial registration ClinicalTrials.gov, NCT01041989. Registered on 4 January 2010

Cross-sectional studies show an association of decline in mental flexibility and inhibitory control with reduced gait speed and falls, as well as divided attention deficit and difficulty in initiating gait. Objective: To investigate the relationships between cognitive function and gait performance in patients with Parkinson’s disease (PD) who participated in a hospital neurorehabilitation program. Methods: A total of 107 patients (79 males, 28 females; mean age 61.00±8.2 years; mean schooling 11.7±4.1 years) with idiopathic PD (mean disease duration 5.5±4.1 years) were recruited for this study. Among them, 78.50% were in stages I and II of the Hoehn & Yahr Scale. Cognitive functions were evaluated through the Digit Span test, Trail Making Test, and Addenbrooke’s Cognitive Examination III. Motor function was assessed with the 10-Meter Walk Test, the short version of the Balance Evaluation Systems Test (Mini-BESTest), and the Timed Up and Go Test. Results: Balance skills were significantly correlated with global cognition and specific domains, including divided attention, verbal fluency, and visuospatial function. Functional mobility showed a significant association with all cognitive tests, except for the number of errors on TMT-A. Gait speed presented a significant correlation with global cognition scores, memory, and attention, including divided attention. Conclusions: These findings might help early identification of cognitive deficits or motor dysfunctions in PD patients who may benefit from rehabilitation strategies, as well as facilitate fall risk assessments and strategies to prevent falls. Future prospective studies are needed to investigate the effects of cognitive training on motor performance, since the difficulty in motor rehabilitation may be more related to cognitive loss than to motor damage. RESUMO. Estudos transversais mostram associação entre declínio da flexibilidade mental e controle inibitório com redução da velocidade de marcha e quedas, assim como déficit de atenção dividida e dificuldade para iniciar a marcha. Objetivo: Investigar as relações entre a função cognitiva e o desempenho da marcha em pacientes com Doença de Parkinson (DP) que participaram de um programa de reabilitação hospitalar. Métodos: Um total de 107 pacientes (79 homens, 28 mulheres; idade média de 61,00±8,2 anos, média de escolaridade 11,7±4,1) apresentando DP idiopática (duração média da doença: 5,5±4,1 anos) foram recrutados para o estudo. Desses, 78,50% estavam nos estágios I e II da Hoehn e Yahr. As funções cognitivas foram avaliadas por meio do teste de Dígitos Spam, Teste de Trilhas e Exame Cognitivo de Addenbrooke (terceira versão). A função motora foi examinada por meio do teste de caminhada de 10 metros, Mini BESTest e teste Timed Up and Go. Resultados: As análises de correlação mostraram que as habilidades de equilíbrio estavam significativamente correlacionadas com a cognição global e com domínios específicos, incluindo atenção dividida, fluência verbal e função visuoespacial. Além disso, a mobilidade funcional apresentou correlação significativa com todos os testes cognitivos, exceto TMT-A (erro). A velocidade da marcha mostrou correlação significativa com escores globais de cognição, memória e atenção, incluindo atenção dividida. Conclusões: Esses achados podem ajudar na identificação precoce de déficits cognitivos ou disfunções motoras em pacientes com DP que podem se beneficiar de estratégias de reabilitação, facilitar avaliações de risco de queda e estratégias de prevenção de queda. Estudos prospectivos futuros são necessários para investigar os efeitos do treino cognitivo no desempenho motor, uma vez que a dificuldade na reabilitação motora pode estar mais relacionada à perda cognitiva do que aos prejuízos motores.

Objective Improving symptomology and cognitive deficits in neurodevelopmental disorders is a crucial challenge. We examined whether neurostimulation protocols, which have been shown to yield long-term effects when combined with cognitive training, could benefit children with Attention-deficit/hyperactivity-disorder (ADHD), the most common neurodevelopmental disorder in childhood. Methods We used a randomized double-blind active-controlled crossover study of 19 unmedicated children with ADHD, who received either anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (dlPFC) or random noise stimulation (tRNS) over the bilateral dlPFC, while completing executive functions training. Results For our primary outcome, tRNS yielded a clinical improvement as indicated by the reduced ADHD rating-scale score from baseline, and in comparison to the changes observed in tDCS. The effect of brain stimulation one week after completion of treatment yielded further improvement, suggesting a neuroplasticity-related effect. Finally, tRNS improved working memory compared to tDCS, and a larger tRNS effect on ADHD rating-scale was predicted for those who showed the greatest improvement in working memory. Conclusions We found that our intervention can have a lasting effect, rather than a merely immediate effect as was shown for in previous medical interventions in ADHD. Significance Our results provide a promising direction toward a novel intervention in ADHD.

Background: With greying of nations, dementia becomes a public health priority. The rising dementia prevalence escalates both health care expenses and burden, placing the entire healthcare system and caregivers under huge stress. Cognition-oriented interventions have been shown to enhance the overall cognitive performance among healthy and cognitively impaired older adults. Objective: This article is assumed to be a steppingstone for the introduction and establishment of cognition- oriented interventions in Egypt. In addition, it aims to offer provisional guidance for health care providers in Arab speaking countries in a stepwise approach in order to establish cognition-oriented intervention services and help them to evaluate and monitor their efficacy. Methods: Aconsortium of Egyptian and Greek specialists developed a protocol for the operations of the Ain Shams Cognitive Training Lab and the provision of cognition-oriented interventions. This protocol is based on a previous successful protocol that has been implemented in Greece for more than 10 years and is co-designed to fit the needs of older adults in Arabic speaking countries. Results: The types of services offered, their objectives, recruitment of participants, delivery of interventions, measurement of outcomes and privacy policy are all outlined in the policy. Conclusion: Establishing the appropriate framework in which cognitive training strategies can be adapted and implemented in Arabic population, constitutes an inevitable achievement in healthy ageing and can be also assumed as a dementia prevention strategy. Moreover, setting up the first cognitive laboratory in Egypt older adults, can be a model of good practice across the Arabic countries.

Background: Although episodic memory impairment is one of the hallmarks of Alzheimer’s disease (AD), the relative decline in the components of episodic memory (What, Where, and When) and the effects of cognitive training on each of them are still unknown. Objective: We aimed to independently assess the impairment in each component of episodic memory in early to moderate AD and address whether it can be enhanced through active, spatiotemporal episodic training. Methods: A non-verbal scene-based episodic memory task was developed to assess the ability to remember What, Where, and When information. Experiment 1 tested whether this task can differentiate AD subjects (N = 16) from healthy controls (N = 16). In Experiment 2, 13 AD subjects underwent 16 training sessions, followed by a re-administration of the scene-based memory task. Experiment 3 tested 42 healthy older adults and 51 younger adults on the same task to investigate the effects of normal aging. Results: Of the three components, When memory had the highest predictive power in distinguishing AD from normal aging. Following training of AD subjects, only Where memory improved. Only What memory revealed a significant decline in healthy subjects from 65–85 years of age. Conclusion: These findings shed new light on the importance of the temporal component of episodic memory as a behavioral marker of AD. The selective improvement of spatial but not temporal memory through training further demonstrates the fragility of temporal memory even in early AD. Neuroscientific research is needed to distinguish whether the Where component was enhanced by improvements in hippocampal spatial representation or by other compensatory mechanisms.

Background Craving and cognitive deficits are potential treatment targets for methamphetamine use disorder (MUD). Previous studies implied that transcranial direct current stimulation (tDCS) and cognitive training respectively improve these symptoms, but the combined effect is unknown. In this study, we investigated the combined effects of tDCS over dorsolateral prefrontal cortex (DLPFC) and computerized cognitive addiction therapy (CCAT) on cue-induced craving and cognitive functions among female individuals with MUD. Methods Seventy-five patients with MUD were randomly assigned to three groups: CCAT + tDCS group, CCAT + sham tDCS group and the control group. The former two groups received 20 sessions of cognitive training combined 1.5 mA active/sham tDCS over DLPFC (20min/session, 5times/week), while the control group received usual care which includes routine medical care, health education, physical exercises and psychological support related to relapse prevention. The cue-induced craving and cognitive functions were tested at the baseline, the end of 2nd week and 4th week. Results The CCAT + tDCS group showed a significant reduction in cue-induced craving after 4-week intervention. Moreover, the craving score of the real CCAT + tDCS group was significantly lower than that of the CCAT + sham tDCS group and that of the control group at the end of 4th week. A significant improvement in accuracy of TWOB task was only observed in the CCAT + tDCS group at the end of 4th week when compared to baseline. Unexpectedly, participants who received CCAT plus active or sham tDCS did not change their discounting, whereas those in the control group performed more impulsively over time. Conclusions The study found that the intervention of tDCS over DLPFC combined with CCAT may have potential benefit in improving treatment outcome in patients with MUD. More research is needed to explore the underlying mechanism.

To address the paucity of research investigating the implementation of multi-domain dementia prevention interventions, we implemented and evaluated a 24-week, bi-weekly multi-domain program for older adults at risk of cognitive impairment at neighborhood senior centres (SCs). It comprised dual-task exercises, cognitive training, and mobile application-based nutritional guidance. An RCT design informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework was adopted. Outcome measures include cognition, quality of life, blood parameters, and physical performance. Implementation was evaluated through questionnaires administered to participants, implementers, SC managers, attendance lists, and observations. The program reached almost 50% of eligible participants, had an attrition rate of 22%, and was adopted by 8.7% of the SCs approached. It was implemented as intended; only the nutritional component was re-designed due to participants’ unfamiliarity with the mobile application. While there were no between-group differences in cognition, quality of life, and blood parameters, quality of life reduced in the control group and physical function improved in the intervention group after 24 weeks. The program was well-received by participants and SCs. Our findings show that a multi-domain program for at-risk older adults has benefits and can be implemented through neighborhood SCs. Areas of improvement are discussed.Trial registration: ClinicalTrials.gov NCT04440969 retrospectively registered on 22 June 2020.

Medulloblastoma is a malign posterior fossa brain tumor, mostly occurring in childhood. The CNS-directed chemoradiotherapy treatment can be very harmful to the developing brain and functional outcomes of these patients. However, what the underlying neurotoxic mechanisms are remain inconclusive. Hence, this review summarizes the existing literature on the association between advanced neuroimaging and neurocognitive changes in patients that were treated for pediatric medulloblastoma. The PubMed/Medline database was extensively screened for studies investigating the link between cognitive outcomes and multimodal magnetic resonance (MR) imaging in childhood medulloblastoma survivors. A behavioral meta-analysis was performed on the available IQ scores. A total of 649 studies were screened, of which 22 studies were included. Based on this literature review, we conclude medulloblastoma patients to be at risk for white matter volume loss, more frequent white matter lesions, and changes in white matter microstructure. Such microstructural alterations were associated with lower IQ, which reached the clinical cut-off in survivors across studies. Using functional MR scans, changes in activity were observed in cerebellar areas, associated with working memory and processing speed. Finally, cerebral microbleeds were encountered more often, but these were not associated with cognitive outcomes. Regarding intervention studies, computerized cognitive training was associated with changes in prefrontal and cerebellar activation and physical training might result in microstructural and cortical alterations. Hence, to better define the neural targets for interventions in pediatric medulloblastoma patients, this review suggests working towards neuroimaging-based predictions of cognitive outcomes. To reach this goal, large multimodal prospective imaging studies are highly recommended.

Background. Patients with Parkinson’s disease (PD) are highly vulnerable to develop cognitive dysfunctions, and the mitigating potential of early cognitive training (CT) is increasingly recognized. Predictors of CT responsiveness, which could help to tailor interventions individually, have rarely been studied in PD. This study aimed to examine individual characteristics of patients with PD associated with responsiveness to targeted working memory training (WMT). Methods. Data of 75 patients with PD (age: 63.99 ± 9.74 years, 93% Hoehn & Yahr stage 2) without cognitive dysfunctions from a randomized controlled trial were analyzed using structural equation modeling. Latent change score models with and without covariates were estimated and compared between the WMT group ( n = 37), who participated in a 5-week adaptive WMT, and a waiting list control group ( n = 38). Results. Latent change score models yielded adequate model fit (χ2-test p > .05, SRMR ≤ .08, CFI ≥ .95). For the near-transfer working memory composite, lower baseline performance, younger age, higher education, and higher fluid intelligence were found to significantly predict higher latent change scores in the WMT group, but not in the control group. For the far-transfer executive function composite, higher self-efficacy expectancy tended to significantly predict larger latent change scores. Conclusions. The identified associations between individual characteristics and WMT responsiveness indicate that there has to be room for improvement (e.g., lower baseline performance) and also sufficient “hardware” (e.g., younger age, higher intelligence) to benefit in training-related cognitive plasticity. Our findings are discussed within the compensation versus magnification account. They need to be replicated by methodological high-quality research applying advanced statistical methods with larger samples.

OBJECTIVE To preserve or improve independent functioning in older adults and those with neurocognitive impairments, researchers and clinicians need to address prospective memory deficits. To be effective, prospective memory interventions must restore (or circumvent) the underlying attention and memory mechanisms that are impaired by aging, brain injury, and neurodegeneration. We evaluated two decades of prospective memory interventions for efficacy, time/resource costs, and ecological validity. METHOD We systematically reviewed 73 prospective memory intervention studies of middle- to older-aged healthy adults and clinical groups (N = 3,749). We also rated the ecological validity of each study's prospective memory assessment/task using a newly developed scale. When possible (72% of studies), we estimated effect sizes using random-effects models and Hedges' g. RESULTS We identified four categories of prospective memory interventions, including mnemonic strategy, cognitive training, external memory aid, and combination interventions. Mnemonic strategy (g = .450) and cognitive training (g = .538) interventions demonstrated efficacy. Combination interventions showed mixed results (g = .254), underscoring that "more is not always better." External memory aids demonstrated very positive outcomes (g = .805), though often with small-sample, case-series designs. Prospective memory assessments had high ecological validity in external memory aid studies (84%), but not in mnemonic strategy (14%), cognitive training (20%), or combination intervention (50%) studies, p < .001, ηp2 = .33. CONCLUSIONS Everyday prospective memory can be meaningfully improved, perhaps particularly with external memory aids, but larger trials are required to optimize treatments, increase adherence, and broaden implementation in daily life. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Neurofeedback cognitive training is a promising tool used to promote cognitive functions effectively and efficiently. In this study, we investigated a novel functional near-infrared spectroscopy (fNIRS)-based frontoparietal functional connectivity (FC) neurofeedback training paradigm related to working memory, involving healthy adults. Compared with conventional cognitive training studies, we chose the frontoparietal network, a key brain region for cognitive function modulation, as neurofeedback, yielding a strong targeting effect. In the experiment, 10 participants (test group) received three cognitive training sessions of 15 min using fNIRS-based frontoparietal FC as neurofeedback, and another 10 participants served as the control group. Frontoparietal FC was significantly increased in the test group ( $p =0.03$ ), and the cognitive functions (memory and attention) were significantly promoted compared with the control group (accuracy of 3-back test: $p =0.0005$ , reaction time of 3-back test: $p =0.0009$ ). After additional validations on long-term training effect and on different patient populations, the proposed method exhibited considerable potential to be developed as a fast, effective, and widespread training approach for cognitive function enhancement.

Background: Cognitive impairment disproportionately affects older women with cardiovascular disease (CVD). Physical activity (PA) and cognitive training (CT) may have synergistic effects in combined interventions. However, no combined intervention has targeted women with CVD or utilized a sustainable and preferable lifestyle approach. The purpose was to test feasibility and acceptability of the 24-week MindMoves program, a lifestyle intervention that combined PA and CT developed for older women with CVD. Methods: The PA component included goal setting with Fitbits and 5 behavioral group meetings. The CT component was evidence-based BrainHQ delivered on a tablet in three 30-minute weekly sessions. Participants included 10 women aged ≥65 years with CVD. Exclusion criteria were cognitive impairment, regular PA, and CT use. Measures were feasibility (recruitment, attendance, participation, retention, and acceptability), change in PA (Fitbit min/steps), and change in cognitive function (NIH Toolbox®). Results: Of the 10 participants, 70% attended ≥4/5 group meetings, and overall attendance was 76%. Participants completed 2.3/3 CT sessions weekly. Participant retention was 100%. Over 90% of participants rated MindMoves with the highest levels of satisfaction. Participants had significant improvements in steps, light PA, and moderate PA, and there was a trend for improved cognition. Conclusions: Findings support testing MindMoves in an efficacy trial.

Purpose of review Neurocognitive disorders are associated with tremendous burden at the level of the individual, the care giver, and society at large. No effective treatments have been discovered to date. Recent findings Noninvasive brain stimulation (NIBS) comprises several promising interventions that have been studied in Alzheimer's disease and related dementias. Most recent studies have tested transcranial direct current stimulation or repetitive transcranial magnetic stimulation on their own or in combination with other interventions, particularly cognitive training. While most studies were proof-of-principle studies with small sample sizes, combination and long-duration protocols seem to be promising approaches to pursue. Some studies also investigated novel neurophysiological markers as predictors of response to NIBS. Summary NIBS presents several interventional options that are ready to be evaluated using well powered, long-duration trials. These future studies should build on the promising leads from the current literature, including the potential advantage of combining NIBS with other interventions; the delivery of interventions for long durations to assess long-term impact; and the use of neurophysiological markers that could optimize the personalization and efficacy of NIBS.

BACKGROUND Cognitive dysfunction contributes to poor learning and impaired self-care (SC) for patients with heart failure. OBJECTIVES The aims of this study were to (1) evaluate the feasibility and acceptability of a nurse-led, virtual home-based cognitive training and SC education intervention to support SC and (2) evaluate the relationship between improvements in SC and cognitive change and examine 30-day readmission rates. METHODS In this 2-phase pilot study, we used a prospective, exploratory design. In phase 1, recruitment criteria and retention issues threatened feasibility and acceptance. Significant modifications were made and evaluated in phase 2. RESULTS In phase 2, 12 participants were recruited (7 women and 5 men). Feasibility was supported. All participants and the study nurse positively evaluated acceptability of the intervention. Median SC scores improved over time. Thirty-day hospital readmission rates were 25%. CONCLUSION Phase 1 indicates the intervention as originally designed was not feasible or acceptable. Phase 2 supports the feasibility and acceptability of the modified intervention. Further testing is warranted.

Aim This study aimed to assess whether CogEvo, a computerized cognitive assessment and training tool, could distinguish patients with mild Alzheimer's disease and mild cognitive impairment from cognitively normal older people. Methods This cross‐sectional study enrolled 166 participants with Alzheimer's disease, mild cognitive impairment and cognitively normal older people. In CogEvo, five types of cognitive tasks were carried out, and the z‐scores were used as a composite score. Logistic regression and receiver operating characteristics analyses were then carried out to evaluate the usefulness of CogEvo in distinguishing between the three groups. Results CogEvo and Mini‐Mental State Examination scores showed excellent correlation, and could significantly differentiate between the Alzheimer's disease, mild cognitive impairment and cognitively normal older people groups (Mini‐Mental State Examination 20.4 ± 3.5, 25.5 ± 1.6 and 27.6 ± 2.0, respectively; CogEvo: −1.9 ± 0.9, −0.8 ± 0.8 and 0.0 ± 1.0, respectively; both P