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INTRODUCTION: Each year thousands of pilots are required to undergo neuropsychological evaluation, often due to a history of alcoholism (HIMS), CVA, TBI, MCI, SSRI use, or ADHD. Of these pilots, it is estimated 18 to over 30% are found to have some form of impairment that grounds them indefinitely. METHOD: An online, coached, fee-based cognitive training (CTr) program was examined in 192 pilots residing across the United States, following identified deficiencies by their HIMS neuropsychologist (NP). The 6 to 8 week CTr program included customized assembly of exercises with weekly management and feedback by a trained instructor via email; no exercises resembled presenting stimuli found in NP tests; no office visits were made. Target Training Levels (TTL's) were developed to identify pilots who were likely to be found normal upon follow-up NP re-evaluation (NPRe), using composite z-scores from proprietary training data (PTD) and an online aviator cognitive assessment battery (OA Assess). RESULTS: Of 77 pilots reporting NPRe results, 74% passed. One-way MANOVA indicated final PTD and OA Assess scores significantly predicted NPre results [F(1,30)=4.97, p=.014; Wilks Λ=.746)]; significance was lost when pre-training baseline OA Assess scores were used (p=.053). Posttraining PTD and OA Assess cut-off scores to establish TTL's were best fit at z=.77 and z=1.46 above non-aviator means, respectively. Logistic regression indicated combined PTD and OA Assess scores best predicted whether or not a pilot would pass NPRe, with 87% accuracy [df (30) Δχ²=5.67, p=.017). Chi-square analyses indicated pilots who reached combined TTL's had an 88% chance of passing their NPRe, while those that did not reach TTL's had a 33% chance of passing (χ²=7.41, p=.006); the OA Assess TTL alone was less robust but still acceptable (p=.024). DISCUSSION: Structured, coached CTr is an effective online-based intervention for use in pilots with neurocognitive defi ciency. In addition to strengthening abilities important to flight performance and safety, the program reliably and accurately predicted which pilots would likely succeed in passing far more expensive neuropsychological evaluations, which could reduce personal and organizational costs while hastening return to duty or training. Past CTr studies showed lasting effects and in the aviation environment CTr appears far more appropriate than neurofeedback, direct electrical stimulation, and traditional cognitive rehabilitation. Learning Objectives 1. Participants will become aware of the need for non-invasive, easily accessible neurocognitive interventions in pilots with known or suspected declines in mental sharpness or abilities. 2. Participants will identify components of online CTr important to a pilot's success. 3. Participants will understand the potential to strengthen cognitive functions in a reliable, long-lasting way that generalizes to neurocognitive testing and daily activities alike. [ABSTRACT FROM AUTHOR]

Objectives: Cognitive abilities have been implicated as predictors of mortality in older adults. This study examines the effects of cognitive training on mortality 20 years post-intervention. Methods: Data come from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized control trial (N = 2802). Participants were cognitively and physically healthy, community-dwelling adults aged 65 and older. Cox proportional hazard models were used to investigate (1) the association between baseline cognition and mortality risk and (2) the effect of ACTIVE cognitive training (memory, reasoning, and speed of processing) on mortality risk 20 years post-intervention. Results: Higher baseline cognition predicted lower mortality risk 20 years post-intervention. No significant effects of ACTIVE cognitive training in memory, reasoning, or speed of processing on mortality risk were observed. Discussion: More work is needed to identify cognitive training interventions that may lead to lower mortality risks in later adulthood. [ABSTRACT FROM AUTHOR]

Adaptations are frequently made by hospital administrators, clinicians, and other staff to accommodate for the changing populations of state psychiatric hospitals in the United States. For example, many mental health treatments, including evidence-based treatments, have been adapted for use with forensic patients and in forensic settings. Specialized ethical guidance has also been developed for working with forensic patients. However, there is a gap in the literature regarding the logistics of safely conducting therapeutic interventions and assessments in environments that were not designed for forensic populations, or individuals with intellectual and developmental disabilities as primary diagnoses. Further, most training programs for mental health clinicians do not include specialized training for working in inpatient psychiatric settings, including state psychiatric hospitals, and so it often falls to training sites to provide that foundational knowledge. The current manuscript describes the context and practical challenges mental health clinicians across disciplines may face in providing services to clients in inpatient settings. Recommendations for maximizing safety of all persons, while simultaneously attempting to protect the privacy of the patient in the course of clinical interventions, and maintain the integrity of clinical interventions administered in inpatient settings, are also discussed. Recommendations are based on a review of the literature and the professional experiences of the interdisciplinary research team in several state hospitals across the United States. The target audience of this manuscript includes clinicians and trainees who are new to working in inpatient psychiatric settings, and seasoned clinicians adjusting to the changing demographics of state psychiatric hospitals. [ABSTRACT FROM AUTHOR]

Fetal alcohol spectrum disorder (FASD) affects 2–5% of the children in the United States. In the preschool age-range, inhibitory deficits frequently manifest as impaired ability to delay gratification, which is associated with deficits in cognitive flexibility in these children. The goal of this longitudinal study was to determine whether the ability to delay gratification in preschool children with FASD is (1) associated with broader manifestations in temperament and behavior; (2) predictive of later inhibitory control, cognitive flexibility and working memory in middle childhood; and (3) predictive of later parent-reported behavioral problems and school functioning in middle childhood. Forty-seven children with FASD, ages 2.5–5 years were administered a delay of gratification task in which they chose between receiving 2 snacks immediately or 10 snacks after waiting for 10 min. Two groups were defined based on a median split of waiting time. Four years later, 29 children completed measures of inhibitory control (Flanker task), cognitive flexibility (Dimensional Change Card Sort Test), and working memory (Stanford–Binet Intelligence Scales), and their parents completed the Child Behavior Checklist as a measure of the child's behavioral problems and school functioning. Children with longer wait times on the delay of gratification task in preschool showed better inhibitory control on the Flanker task in middle childhood and better parent-reported school functioning in English. These findings indicate that early inhibitory capacity persists into middle childhood in those with FASD, and may be a promising target for early intervention to improve later cognitive outcomes in these children. [ABSTRACT FROM AUTHOR]

There is a need to examine collaborative mental health practices in geographic regions serving high populations of under-represented minority and low socio-economic status youth in order to reduce the barriers in access to care and support. In response, a counselor education program at a large land-grant university in the Southwestern United States worked in collaboration with a local school district to create a school-based mental health program. The program provides no-cost and timely mental health counseling services to students and their families using a practicum training model. This article presents process evaluation data that examine program level functioning during the implementation stage of the training model. Implications for program improvements in the next phase of implementation are discussed as well as implications of this type of service delivery model within the context of counselor education and social justice. [ABSTRACT FROM AUTHOR]

Background: The beneficial effects of moderate‐intensity physical exercise on mood are well established. Students in higher education are a group vulnerable to stress who may benefit from aerobic exercise classes. The present study broadens existing findings by testing the impact on mood of a 45‐minute‐long aerobic training session, conducted in a naturalistic setting. Method: A three‐dimensional mood assessment that distinguished hedonic tone (pleasantness of mood) from energetic and tense arousal dimensions was used for assessment of pre‐ and post‐training mood in a sample of women (n = 120) taking part in a 45‐minute aerobic training. A control group (n = 120) performed cognitive tasks. Results: Physical but not cognitive activity elevated mood on all three dimensions, but the effect size was largest for energetic arousal. It was also found that mood improvements in terms of energy and tension change were strongest for individuals initially low in hedonic tone. Conclusions: The finding supports the hypothesis that successful completion of an exercise session in a naturalistic setting may enhance mood in female students. At a practical level, the study suggests that exercise classes may help students cope with the mood impairments resulting from demanding cognitive activities, leading to potential educational benefits. [ABSTRACT FROM AUTHOR]

Treatment of posttraumatic stress disorder (PTSD) is time and cost-intensive. New, readily implementable interventions are needed. Two parallel randomized clinical trials tested if cognitive/affective computerized training improves cognitive/affective functions and PTSD symptoms in acute (N = 80) and chronic PTSD (N = 84). Adults age 18–65 were recruited from an Israeli hospital emergency room (acute) or from across the United States (chronic). Individuals were randomized to an active intervention (acute N = 50, chronic N = 48) that adaptively trains cognition and an affective positivity bias, or a control intervention (acute N = 30, chronic N = 36) of engaging computer games. Participants, blind to assignment, completed exercises at home for 30 min/day over 30 days (acute) or 45 min/day over 45 days (chronic). Primary outcomes were computerized cognitive/affective function metrics. Secondary outcomes were Clinician-Administered PTSD Scale (CAPS) total scores. In chronic PTSD, the active arm demonstrated facilitated speed of fearful face identification (F = 20.96, q < 0.001; d = 1.21) and a trend towards improvement in total PTSD symptoms (F = 2.91, p = 0.09, d = 0.47), which was due to improvement in re-experiencing symptoms (F = 6.14, p = 0.015; d = 0.73). Better cognitive performance at baseline moderated the training effect and was associated with more favorable improvements on both metrics. Cognitive and affective training does not have widespread benefit on symptoms and cognitive/affective functions in PTSD. Future studies targeting re-experiencing a priori , stratifying on cognitive capacity, and with modified methods to infer on mechanisms and optimized training parameters may be warranted. ClinicalTrials.gov Identifiers: NCT01694316 & NCT02085512. • Computerized training of cognitive and affective processes in PTSD was investigated. • Two randomized clinical trials in acute and chronic PTSD were conducted. • Fearful facial affect identification speed in chronic PTSD became faster. • PTSD re-experiencing symptoms in chronic PTSD were attenuated. • Baseline cognitive capacity moderated the effect of the training on these outcomes. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2DM) is prevalent in the general United States population, and in the veteran population. T2DM has consistently been linked to increased risk for cognitive impairment, dementia, and Alzheimer's disease. Computerized cognitive training (CCT) is practical and inexpensive cognitive interventions that is an alternative to medication.Objective: To report the recruitment methods and challenges to date in an ongoing two-site randomized controlled trial (RCT) of CCT on cognitive function and T2DM management in an older non-demented veteran population.Methods: Veterans are recruited primarily by targeted mailings or by direct contact at clinics and presentations.Results: From 1,459 original contacts, 437 expressed initial interest, 111 provided informed consent, and 97 completed baseline assessments. Participants from the two VA Medical Centers differed in demographics and baseline characteristics. Comparing recruitment methods, the proportion of individuals contacted who were ultimately consented was significantly less from mailings (5%) than other sources (20%), primarily face- to-face clinic visits (χ2 (1) = 38.331, p < 0.001).Conclusions: Mailings are cost-effective, but direct contact improved recruitment. Not using or lacking access to computers and ineligibility were major reasons for non-participation. Within-site comparisons of demographically diverse sites can address confounding of demographic and other site differences. [ABSTRACT FROM AUTHOR]

Objectives. Multilevel models assessed the effects of cognitive speed of processing training (SPT) on older adults' selfreported driving using intention-to-treat (ITT, randomization to training or control conditions) and dosage (treatmentreceived via number of training sessions) analyses across 5 years. Method. Participants randomized to SPT (n = 598) were compared with those randomized to either the no-contact control (n = 598) or memory training, which served as an active control (n = 610). Driving mobility (frequency, exposure, and space) was assessed over time. Results. No significant effects were found within the ITT analyses. However, number of SPT sessions did affect driving mobility outcomes. In the full sample (N = 1,806), higher SPT doses were associated with maintained driving frequency as compared with both control groups, but no effects were found for driving exposure or space. Subsample analyses (n = 315) revealed that persons at-risk for mobility declines (i.e., poor initial processing speed) who received additional booster SPT sessions reported greater maintenance of both driving frequency and exposure over time as compared with the no-contact and active control groups. Discussion. These results and prior research indicate that cognitive SPT transfers to prolonged driving mobility among older adults. Future research should investigate the mechanisms behind transfer effects to real-world activities, such as driving. [ABSTRACT FROM AUTHOR]

The majority of adults in the UK and US are overweight or obese due to multiple factors including excess energy intake. Training people to inhibit simple motor responses (key presses) to high-energy density food pictures reduces intake in laboratory studies. We examined whether online response inhibition training reduced real-world food consumption and weight in a community sample of adults who were predominantly overweight or obese (N = 83). Participants were allocated in a randomised, double-blind design to receive four 10-min sessions of either active or control go/no-go training in which either high-energy density snack foods (active) or non-food stimuli (control) were associated with no-go signals. Participants' weight, energy intake (calculated from 24-h food diaries), daily snacking frequency and subjective food evaluations were measured for one week pre- and post-intervention. Participants also provided self-reported weight and monthly snacking frequency at pre-intervention screening, and one month and six months after completing the study. Participants in the active relative to control condition showed significant weight loss, reductions in daily energy intake and a reduction in rated liking of high-energy density (no-go) foods from the pre-to post-intervention week. There were no changes in self-reported daily snacking frequency. At longer-term follow-up, the active group showed significant reductions in self-reported weight at six months, whilst both groups reported significantly less snacking at one- and six-months. Excellent rates of adherence (97%) and positive feedback about the training suggest that this intervention is acceptable and has the potential to improve public health by reducing energy intake and overweight. [ABSTRACT FROM AUTHOR]

An experiment was developed to determine if cognitive learning strategies improved standardized university business exam results. Previous studies revealed that factors such as prior ability, age, gender, and culture predicted a student's Major Field Test in Business (MFTB) score better than course content. The experiment control consisted of identical syllabi and faculty (except for the treatment). The analysis of covariance results were statistically significant (n = 134) with a 40% effect size (and a 74% effect size using multiple regression). The study demonstrated that cognitive learning strategies (accounting for gender and course level grade point average) can influence a student's MFTB exam score. An analysis of covariance can be used to accurately measure student learning gain regardless of prior ability. [ABSTRACT FROM AUTHOR]

Objectives To determine the effects of cognitive training on cognitive abilities and everyday function over 10 years. Design Ten-year follow-up of a randomized, controlled single-blind trial (Advanced Cognitive Training for Independent and Vital Elderly ( ACTIVE)) with three intervention groups and a no-contact control group. Setting Six U.S. cities. Participants A volunteer sample of 2,832 persons (mean baseline age 73.6; 26% African American) living independently. Intervention Ten training sessions for memory, reasoning, or speed of processing; four sessions of booster training 11 and 35 months after initial training. Measurements Objectively measured cognitive abilities and self-reported and performance-based measures of everyday function. Results Participants in each intervention group reported less difficulty with instrumental activities of daily living ( IADLs) (memory: effect size = 0.48, 99% confidence interval ( CI) = 0.12-0.84; reasoning: effect size = 0.38, 99% CI = 0.02-0.74; speed of processing: effect size = 0.36, 99% CI = 0.01-0.72). At a mean age of 82, approximately 60% of trained participants, versus 50% of controls ( P < .05), were at or above their baseline level of self-reported IADL function at 10 years. The reasoning and speed-of-processing interventions maintained their effects on their targeted cognitive abilities at 10 years (reasoning: effect size = 0.23, 99% CI = 0.09-0.38; speed of processing: effect size = 0.66, 99% CI = 0.43-0.88). Memory training effects were no longer maintained for memory performance. Booster training produced additional and durable improvement for the reasoning intervention for reasoning performance (effect size = 0.21, 99% CI = 0.01-0.41) and the speed-of-processing intervention for speed-of-processing performance (effect size = 0.62, 99% CI = 0.31-0.93). Conclusion Each Advanced Cognitive Training for Independent and Vital Elderly cognitive intervention resulted in less decline in self-reported IADL compared with the control group. Reasoning and speed, but not memory, training resulted in improved targeted cognitive abilities for 10 years. [ABSTRACT FROM AUTHOR]

The combination of pharmacotherapy and cognitive retraining (CRT) for the cognitive deficits of schizophrenia may be more efficacious than either approach alone, but this has not yet been tested. This study evaluated the feasibility, safety, tolerability, and efficacy of 12 weeks of D-serine, combined with CRT in the treatment of cognitive deficits in schizophrenia at two academic sites in parallel, in India and the United States. In a randomized, partial double-blind, placebo-controlled, parallel-group design, 104 schizophrenia subjects (US site=22, Indian site=82) were randomized to: (1) D-serine (30 mg/kg)+CRT (5 h/week), (2) D-serine+control CRT, (3) CRT+placebo D-serine, and (4) placebo+control CRT. Completion rates were 84 and 100% in the Indian and US samples, respectively. On various outcome measures of safety and tolerability, the interventions were well tolerated. D-Serine and CRT did not show any significant effect on the Global Cognitive Index, although both interventions showed differential site effects on individual test performance. CRT resulted in a significant improvement in Verbal Working Memory, and a trend toward improvement in Attention/Vigilance. This is the first study to demonstrating the feasibility, safety, and tolerability of combination pharmacotherapy and CRT in a multicenter international clinical trial. These preliminary findings provide support for future studies using higher doses of D-serine that have been shown to be efficacious or other pharmacotherapies, along with the newer cognitive remediation strategies that are individualized and that target basic information processing. [ABSTRACT FROM AUTHOR]

Objective: African Americans and Latinos/Hispanics have a higher prevalence of dementia compared to non-Latino Whites. This scoping review aims to synthesize non-pharmaceutical interventions to delay or slow age-related cognitive decline among cognitively healthy African American and Latino older adults., Design: A literature search for articles published between January 2000 and May 2019 was performed using the databases PubMed, CINAHL, PsycINFO and Web of Science. Relevant cited references and grey literature were also reviewed. Four independent reviewers evaluated 1,181 abstracts, and full-article screening was subsequently performed for 145 articles. The scoping review consisted of eight studies, which were evaluated according to the peer-reviewed original manuscript, non-pharmaceutical intervention, cognitive function as an outcome, separate reporting of results for African American and Latinos, minimum age of 40, and conducted in the US. A total of 8 studies were considered eligible and were analyzed in the present scoping review., Results: Eight studies were identified. Four studies focused on African Americans and four focused on Latinos. Through the analysis, results indicated cognitive training-focused interventions were effective in improving memory, executive function, reasoning, visuospatial, psychological function, and speed among African Americans. Exercise interventions were effective in improving cognition among Latinos., Conclusion: This scoping review identified effective non-pharmaceutical interventions among African American and Latinos. Effective interventions focused on cognitive training alone for African Americans and exercise combined with group educational sessions for Latinos. Future research should explore developing culturally appropriate non-pharmaceutical interventions to reduce disparities and to enhance cognition among older African American and Latinos.

Abstract: The Association for Behavioral and Cognitive Therapies initiated an interorganizational task force to develop guidelines for integrated education and training in cognitive and behavioral psychology at the doctoral level in the United States. Fifteen task force members representing 16 professional associations participated in a yearlong series of conferences, and developed a consensus on optimal doctoral education and training in cognitive and behavioral psychology. The recommendations assume solid foundational training that is typical within applied psychology areas such as clinical and counseling psychology programs located in the United States. This article details the background, assumptions, and resulting recommendations specific to doctoral education and training in cognitive and behavioral psychology, including competencies expected in the areas of ethics, research, and practice. [Copyright &y& Elsevier]

Cognitive adaptation training (CAT) improves functional outcome in outpatients with schizophrenia living in the United States of America. The efficacy of CAT has never been demonstrated for patients living in a residential facility. We describe how CAT was delivered to two chronically hospitalized patients with schizophrenia living in The Netherlands. CAT was delivered for 8 months, and consisted of weekly home visits by a psychiatric nurse. Both patients improved on measures of functional outcome used in the US studies. These results indicate that CAT may improve outcomes, even in patients that have been hospitalized for several years. [ABSTRACT FROM AUTHOR]

Objective. The present study sought to predict changes in everyday functioning using cognitive tests. Methods. Data from the Advanced Cognitive Training for Independent and Vital Elderly trial were used to examine the extent to which competence in different cognitive domains—memory, inductive reasoning, processing speed, and global mental status—predicts prospectively measured everyday functioning among older adults. Coefficients of determination for baseline levels and trajectories of everyday functioning were estimated using parallel process latent growth models. Results. Each cognitive domain independently predicts a significant proportion of the variance in baseline and trajectory change of everyday functioning, with inductive reasoning explaining the most variance (R2 = .175) in baseline functioning and memory explaining the most variance (R2 = .057) in changes in everyday functioning. Discussion. Inductive reasoning is an important determinant of current everyday functioning in community-dwelling older adults, suggesting that successful performance in daily tasks is critically dependent on executive cognitive function. On the other hand, baseline memory function is more important in determining change over time in everyday functioning, suggesting that some participants with low baseline memory function may reflect a subgroup with incipient progressive neurologic disease. [ABSTRACT FROM PUBLISHER]

Perioperative neurocognitive disorder (PND) is a growing concern, affecting several million elderly patients each year in the United States, but strategies for its effective prevention have not yet been established. Humeidan et al. recently demonstrated that preoperative brain exercise resulted in a decrease in postoperative delirium incidence in elderly surgical patients, suggesting the potential of presurgical cognitive optimization to improve postoperative cognitive outcomes. This brief review summarizes the current knowledge regarding preoperative cognitive optimization and highlights landmark studies, as well as current ongoing studies, as the field is rapidly growing. This review further discusses the benefit of cognitive training in non-surgical elderly populations and the role of cognitive training in patients with preexisting cognitive impairment or dementia. The review also examines preclinical evidence in support of cognitive training, which can facilitate understanding of brain plasticity and the pathophysiology of PND. The literature suggests positive impacts of presurgical cognitive optimization, but further studies are encouraged to establish effective cognitive training programs for elderly presurgical patients. [ABSTRACT FROM AUTHOR]

Older adults, the primary consumers of prescription medications in the United States, may be particularly prone to medication side effects. The present study examined the relation between change prescriptions and change in cognitive performance (i.e., inductive reasoning and everyday problem solving), as well as how three common classes of medication (i.e., cardiovascular, hormone/synthetic substitutes, and central nervous system agents) were related to cognitive performance. Data were collected from 78 community-dwelling older adults (M = 71.14 years, SD = 5.35 ) over an 18-month period. Results indicated that types of drugs were differentially related to cognitive change and that the total number of prescriptions was related to change in cognitive performance. Clinical and research advantages of using specific cognitive and prescription assessments, rather than more global measures, are discussed. [ABSTRACT FROM AUTHOR]

Cognitive ability is a key selection criterion for entry into many elite professions. Herein, we investigate whether mindfulness training (MT) can enhance cognitive performance in elite military forces. The cognitive effects of a short-form 8-h MT program contextualized for military cohorts, referred to as Mindfulness-Based Attention Training (MBAT), were assessed. Servicemembers received either a 2-week (n=40) or 4-week (n=36) version of MBAT or no training (NTC, n=44). Sustained attention and working memory task performance along with self-reported cognitive failures were assessed at study onset (T1) and 8-weeks later (T2). In contrast to both the NTC and 2-week MT groups, the 4-week MT group significantly improved over time on attention and working memory outcome measures. Among the 4-week more so than the 2-week MBAT participants, working memory performance improvements were correlated with their amount of out-of-class MT practice. In addition to these group-wise effects, all participants receiving MBAT decreased in their self-reported cognitive failures from T1 to T2. Importantly, none of these improvements were related to self-reported task motivation. Together, these results suggest that short-form MT, when delivered over a 4-week delivery schedule, may be an effective cognitive training tool in elite military cohorts., (© 2019 Elsevier B.V. All rights reserved.)

Background: Developing non-pharmacological interventions with strong potential to prevent or delay the onset of Alzheimer's disease (AD) in high-risk populations is critical. Aerobic exercise and cognitive training are two promising interventions. Aerobic exercise increases aerobic fitness, which in turn improves brain structure and function, while cognitive training improves selective brain function intensively. Hence, combined aerobic exercise and cognitive training may have a synergistic effect on cognition by complementary strengthening of different neural functions. Few studies have tested the effects of such a combined intervention, and the findings have been discrepant, largely due to varying doses and formats of the interventions., Methods/design: The purpose of this single-blinded, 2 × 2 factorial phase II randomized controlled trial is to test the efficacy and synergistic effects of a 6-month combined cycling and speed of processing training intervention on cognition and relevant mechanisms (aerobic fitness, cortical thickness, and functional connectivity in the default mode network) in older adults with amnestic mild cognitive impairment. This trial will randomize 128 participants equally to four arms: cycling and speed of processing, cycling only, speed of processing only, or attention control for 6 months, and then follow them for another 12 months. Cognition and aerobic fitness will be assessed at baseline and at 3, 6, 12, and 18 months; cortical thickness and functional connectivity at baseline and at 6, 12, and 18 months; Alzheimer's disease (AD) conversion at 6, 12, and 18 months. The specific aims are to (1) determine the efficacy and synergistic effects of the combined intervention on cognition over 6 months, (2) examine the underlying mechanisms of the combined intervention, and (3) calculate the long-term effect sizes of the combined intervention on cognition and AD conversion. The analysis will use intention-to-treat and linear mixed-effects modeling., Discussion: This trial will be among the first to test the synergistic effects on cognition and mechanisms (relevant to Alzheimer's-associated neurodegeneration) of a uniquely conceptualized and rigorously designed aerobic exercise and cognitive training intervention in older adults with mild cognitive impairment. It will advance Alzheimer's prevention research by providing precise effect-size estimates of the combined intervention., Trial Registration: ClinicalTrials.gov, NCT03313895 . Registered on 18 October 2017.

Background: Severe, chronic, and impairing irritability is a common presenting clinical problem in youth. Indeed, it was recently operationalized as disruptive mood dysregulation disorder (DMDD) in the DSM-5. However, to date, there are no evidence-based treatments that were specifically developed for DMDD. The current randomized controlled trial assesses the efficacy of a computer-based cognitive training intervention (Interpretation Bias Training; IBT) in youth with DMDD. IBT aims to reduce irritability by altering judgments of ambiguous face-emotions through computerized feedback. IBT is based on previous findings that youth with irritability-related psychopathology rate ambiguous faces as more hostile and fear producing., Methods/design: This is a double-blind, randomized controlled trial of IBT in 40 youth with DMDD. Participants will be randomized to receive four IBT sessions (Active vs. Sham training) over 4 days. Active IBT provides computerized feedback to change ambiguous face-emotion interpretations towards happy interpretations. Face-emotion judgments are performed pre and post training, and for 2 weeks following training. Blinded clinicians will conduct weekly clinical ratings. Primary outcome measures assess changes in irritability using the clinician-rated Affective Reactivity Index (ARI) and Clinical Global Impressions-Improvement (CGI-I) scale for DMDD, as well as parent and child reports of irritability using the ARI. Secondary outcome measures include clinician ratings of depression, anxiety, and overall impairment. In addition, parent and child self-report measures of depression, anxiety, anger, social status, and aggression will be collected., Discussion: The study described in this protocol will perform the first RCT testing the efficacy of IBT in reducing irritability in youth with DMDD. Developing non-pharmacological treatment options for youth suffering from severe, chronic irritability is important to potentially augment existing treatments., Trial Registration: ClinicalTrials.gov, ID: NCT02531893 . Registered on 25 August 2015.

Objective: This study focused on the efficacy of cognitive training for verbal learning and memory deficits in a population of older veterans with alcohol use disorders., Methods: Veterans with alcohol use disorders, who were in outpatient treatment at VA facilities and in early-phase recovery (N = 31), were randomized to receive a three-month trial of daily cognitive training plus work therapy (n = 15) or work therapy alone (n = 16), along with treatment as usual. Participants completed assessments at baseline and at three- and six-month follow-ups; the Hopkins Verbal Learning Task (HVLT) was the primary outcome measure., Results: Participants were primarily male (97%) and in their mid-50s (M = 55.16, SD = 5.16) and had been sober for 1.64 (SD = 2.81) months. Study retention was excellent (91% at three-month follow-up) and adherence to treatment in both conditions was very good. On average, participants in the cognitive training condition had more than 41 hours of cognitive training, and both conditions had more than 230 hours of productive activity. HVLT results at three-month follow-up revealed significant condition effects favoring cognitive training for verbal learning (HVLT Trial-3 T-score, p < .005, Cohen's d = 1.3) and verbal memory (HVLT Total T-score, p < .01, Cohen's d = 1.1). Condition effects were sustained at six-month follow-up. At baseline, 55.9% of participants showed a significant deficit in verbal memory and 58.8% showed a deficit in verbal learning compared with a premorbid estimate of verbal IQ. At three-month follow-up there was a significant reduction in the number of participants in the cognitive training condition with clinically significant verbal memory deficits (p < .01, number needed to treat = 3.0) compared with the work therapy alone condition and a trend toward significance for verbal learning deficits, which was not sustained at six-month follow-up., Conclusions: This National Institute on Drug Abuse-funded pilot study demonstrates that cognitive training within the context of another activating intervention (work therapy) may have efficacy in remediating verbal learning and memory deficits in patients with alcohol use disorder. Findings indicate a large effect for cognitive training in this pilot study, which suggests that further research is warranted. This study is registered on ClinicalTrials.gov (NCT 01410110).

Traumatic brain injury (TBI) can result in cognitive impairments and persistent postconcussive symptoms that limit functional recovery, including return to work. We evaluated a 12 wk compensatory cognitive training intervention (Cognitive Symptom Management and Rehabilitation Therapy [CogSMART]) in the context of supported employment for Veterans with mild to moderate TBI. Participants were randomly assigned to receive 12 wk of supported employment plus CogSMART or enhanced supported employment that controlled for therapist attention (control). CogSMART sessions were delivered by the employment specialist and included psychoeducation regarding TBI; strategies to improve sleep, fatigue, headaches, and tension; and compensatory cognitive strategies in the domains of prospective memory, attention, learning and memory, and executive functioning. Compared with controls, those assigned to supported employment plus CogSMART demonstrated significant reductions in postconcussive symptoms (Cohen d = 0.97) and improvements in prospective memory functioning (Cohen d = 0.72). Effect sizes favoring CogSMART for posttraumatic stress disorder symptom severity, depressive symptom severity, and attainment of competitive work within 14 wk were in the small to medium range (Cohen d = 0.35-0.49). Those who received CogSMART rated the intervention highly. Results suggest that adding CogSMART to supported employment may improve postconcussive symptoms and prospective memory. These effects, as well as smaller effects on psychiatric symptoms and ability to return to work, warrant replication in a larger trial.