The Feasibility of Web-Based Working Memory Training in Patients With Cancer Attending Inpatient Rehabilitation.

INTRODUCTION: Cognitive complaints are common late effects in patients with cancer, and no standard treatment exists. Recent studies with several patient populations have indicated that there is potential to improve working memory (WM) via web-based WM training. However, the feasibility of including web-based WM training as part of inpatient cancer rehabilitation, in combination with unprompted home-based training, has not been studied. The aim of this study was to assess the feasibility of including web-based WM training (using Cogmed QM) during inpatient rehabilitation and its subsequent unprompted completion in a home-based setting. METHODS: Patients with cancer who self-reported cognitive complaints were instructed to complete 25 Cogmed QM sessions during their 3-week inpatient multidisciplinary cancer rehabilitation and subsequently at home after discharge from rehabilitation. The feasibility was determined by assessing the study recruitment, adherence to the WM training, improvements in training tasks (compliance measure) and patient experiences by individual interviews. RESULTS: Twenty-nine (27 women) of 32 eligible patients (89.6%) started WM training, 1 declined participation and 2 patients withdrew before WM training started. Twenty-six of 29 (89.6%) participants adhered to the intervention during rehabilitation, while 19 of 29 (65.5%) also adhered to the subsequent unprompted home-based intervention. All participants who completed the Cogmed QM sessions demonstrated improvements in the training tasks, as defined by the Cogmed Improvement Index (MD = 24.05, SD = 9.38, range 2-44, P < .011). Interview data suggested that practical limitations, including a lack of time, technical difficulties, difficulties finding a suitable disturbance-free environment and low motivation were barriers to completing the training at home. CONCLUSION: The findings show that it is feasible to include web-based WM training during inpatient multidisciplinary rehabilitation for adult patients with cancer with cognitive complaints. However, patient adherence to unprompted web-based WM training after discharge from rehabilitation was not optimal. Thus, future studies should consider the barriers to adherence and the need for supervision and social support to reinforce home-based training.

The Effect of Insomnia on Neuropsychological Functioning in Patients with Comorbid Symptoms of Pain, Fatigue, and Mood Disorders.

OBJECTIVES: To examine if elevated symptoms of insomnia affects neuropsychological functioning in patients with concurrent symptoms of pain, fatigue, and mood disorders. METHODS AND RESULTS: A total of seventy-six subjects participated in this (cross-sectional) study. Based on the cut-off score guidelines from The Insomnia Severity Index subjects were assigned to either a clinical insomnia group (N = 35) or a comparison group (N = 41). Factors such as age, general cognitive functioning, and symptoms of pain, fatigue, depression, and anxiety did not differ between the groups. Both groups completed a questionnaire which assessed subjective memory functioning. In addition they completed a set of neuropsychological tests measuring general cognitive functioning, spatial and verbal working memory, and inhibitory control. Although the subjects with clinical insomnia did not report more memory problems than the comparison group, they presented significant deficiencies on the tests assessing spatial and verbal working memory. There was no difference between the groups in inhibitory control. CONCLUSIONS: This study shows that as the symptom severity of insomnia increases and become clinically significant, it has substantial effect on both spatial and verbal-numeric working memory functioning. By differentiating and testing different domains of working memory, this study provides a more detailed and nuanced characterization of working memory deficiencies than the previous studies within this field. The results need to be transferred to clinical practice so that neuropsychologists include assessments of sleep as part of their routine screenings.

Metacognitions Are Associated with Subjective Memory Problems in Individuals on Sick Leave due to Chronic Fatigue.

BACKGROUND: Subjective cognitive impairments are frequent, but poorly understood in patients with chronic fatigue. We hypothesized that maladaptive metacognitive beliefs at baseline were associated with baseline subjective cognitive impairments, that they predict subjective cognitive impairments at treatment termination, and that a reduction in maladaptive metacognitive beliefs was associated with less subjective cognitive impairments at treatment termination, independent of changes in fatigue, pain, insomnia, depression, and anxiety. METHODS: In this non-controlled study, patients (n = 137) on sick leave due to chronic fatigue received a 3.5-week inpatient RTW rehabilitation program. Of these patients 69 (50.4%) was referred with a ICPC-2 diagnosis of chronic fatigue. Patients completed questionnaires about metacognitive beliefs, somatic complaints, psychological complaints, and cognitive impairments before and after treatment. To test the hypotheses we performed paired t-tests of change, as well as seven hierarchical linear regressions. RESULTS: RESULTS showed that baseline maladaptive metacognitive beliefs were significantly associated with subjective cognitive impairments at baseline, controlling for symptoms. Score on baseline metacognitive beliefs did not predict impairments post-treatment. Testing specific maladaptive beliefs, pre-treatment scores on cognitive confidence were associated with subjective cognitive impairments both pre and post-treatment, controlling for symptoms. Post-treatment metacognitive beliefs and post-treatment cognitive confidence were associated with post-treatment subjective cognitive impairments, controlling for pre-treatment impairments and pre-treatment metacognitive beliefs, as well as pre and post-scores on symptom measures. CONCLUSION: This study reports associations between maladaptive metacognitive beliefs and subjective cognitive impairments in patients with chronic fatigue. Targeting metacognitive beliefs could prove an effective therapeutic intervention for subjective cognitive impairments in these patients.

Effectiveness of Working Memory Training among Subjects Currently on Sick Leave Due to Complex Symptoms.

Introduction: The current study examined if adaptive working memory training (Cogmed QM) has the potential to improve inhibitory control, working memory capacity, and perceptions of memory functioning in a group of patients currently on sick leave due to symptoms of pain, insomnia, fatigue, depression and anxiety. Participants who were referred to a vocational rehabilitation center volunteered to take part in the study. Methods: Participants were randomly assigned to either a training condition (N = 25) or a control condition (N = 29). Participants in the training condition received working memory training in addition to the clinical intervention offered as part of the rehabilitation program, while participants in the control condition received treatment as usual i.e., the rehabilitation program only. Inhibitory control was measured by The Stop Signal Task, working memory was assessed by the Spatial Working Memory Test, while perceptions of memory functioning were assessed by The Everyday Memory Questionnaire-Revised. Results: Participants in the training group showed a significant improvement on the post-tests of inhibitory control when compared with the comparison group (p = 0.025). The groups did not differ on the post-tests of working memory. Both groups reported less memory problems at post-testing, but there was no sizeable difference between the two groups. Conclusions: Results indicate that working memory training does not improve general working memory capacity per se. Nor does it seem to give any added effects in terms of targeting and improving self-perceived memory functioning. Results do, however, provide evidence to suggest that inhibitory control is accessible and susceptible to modification by adaptive working memory training.

Subjective memory complaints among patients on sick leave are associated with symptoms of fatigue and anxiety.

OBJECTIVE: The aim of this study was to identify symptoms associated with subjective memory complaints (SMCs) among subjects who are currently on sick leave due to symptoms of chronic pain, fatigue, depression, anxiety, and insomnia. METHODS: This was a cross-sectional study, subjects (n = 167) who were currently on sick leave were asked to complete an extensive survey consisting of the following: items addressing their sociodemographics, one item from the SF-8 health survey measuring pain, Chalder Fatigue Questionnaire, Hospital Anxiety and Depression Scale, Insomnia Severity Index, and Everyday Memory Questionnaire - Revised. General linear modeling was used to analyze variables associated with SMCs. RESULTS: Symptoms of fatigue (p-value < 0.001) and anxiety (p-value = 0.001) were uniquely and significantly associated with perceived memory failures. The associations with symptoms of pain, depression, and insomnia were not statistically significant. CONCLUSIONS: Subjective memory complaints should be recognized as part of the complex symptomatology among patients who report multiple symptoms, especially in cases of fatigue and anxiety. Self-report questionnaires measuring perceived memory failures may be a quick and easy way to incorporate and extend this knowledge into clinical practice.