Preserving cognitive vitality: Value of cognitive rehabilitation in addressing cognitive deficits in the elderly.

The recent advancements in medical sciences has resulted in not only increasing life expectancy of the elderly but has also improved survival rate in elderly with neurological disorders including those with head trauma . This has resulted in an increasing number of persons with cognitive deficits. Cognitive functions such as executive functioning and memory play an important role in success of a rehabilitation programme and therefore can positively contribute to public health goals. Considering cognitive decline at present has no cure and pharmacological therapies have a limited role, efforts are usually made to delay the onset and progression of cognitive decline and improve quality of life. Literature suggests that active life style, regular exercise, actively performing activities of daily living can have a significant impact on cognitive skills. In addition different models of cognitive rehabilitation and approaches can be integrated into practice to improve cognitive reserve and cause neuroplastic changes to facilitate cognitive function by providing cognitive stimulus and training. Moreover with technological advancements, the computerized cognitive intervention field is growing. This usually integrates conventional cognitive intervention with digital smart devices to provide an engaging and cost effective alternate approach. This review aims to highlight the importance of cognitive rehabilitation and suggest a few evidence based approaches that may be considered by rehabilitation professionals to promote and improve cognitive rehabilitation in Pakistan.

Virtual reality as a method of cognitive training of processing speed, working memory, and sustained attention in persons with acquired brain injury: a protocol for a randomized controlled trial.

BACKGROUND: Acquired brain injury (ABI) often leads to persisting somatic, cognitive, and social impairments. Cognitive impairments of processing speed, sustained attention, and working memory are frequently reported and may negatively affect activities of daily living and quality of life. Rehabilitation efforts aiming to retrain these cognitive functions have often consisted of computerized training programs. However, few studies have demonstrated effects that transfer beyond the trained tasks. There is a growing optimism regarding the potential usefulness of virtual reality (VR) in cognitive rehabilitation. The research literature is sparse, and existing studies are characterized by considerable methodological weaknesses. There is also a lack of knowledge about the acceptance and tolerability of VR as an intervention method for people with ABI. The present study aims to investigate whether playing a commercially available VR game is effective in training cognitive functions after ABI and to explore if the possible effects transfer into everyday functioning. METHODS: One hundred participants (18-65 years), with a verified ABI, impairments of processing speed/attention, and/or working memory, and a minimum of 12 months post injury will be recruited. Participants with severe aphasia, apraxia, visual neglect, epilepsy, and severe mental illness will be excluded. Participants will be randomized into two parallel groups: (1) an intervention group playing a commercial VR game taxing processing speed, working memory, and sustained attention; (2) an active control group receiving psychoeducation regarding compensatory strategies, and general cognitive training tasks such as crossword puzzles or sudoku. The intervention period is 5 weeks. The VR group will be asked to train at home for 30 min 5 days per week. Each participant will be assessed at baseline with neuropsychological tests and questionnaires, after the end of the intervention (5 weeks), and 16 weeks after baseline. After the end of the intervention period, focus group interviews will be conducted with 10 of the participants in the intervention group, in order to investigate acceptance and tolerability of VR as a training method. DISCUSSION: This study will contribute to improve understanding of how VR is tolerated and experienced by the ABI population. If proven effective, the study can contribute to new rehabilitation methods that persons with ABI can utilize in a home setting, after the post-acute rehabilitation has ended.

Evaluating remote delivery of cognitive remediation in people with psychosis.

BACKGROUND: Cognitive Remediation (CR) is an evidence-based therapy targeting cognitive difficulties in people with psychosis to promote functional recovery, but it is rarely implemented routinely. To reach more individuals, CR is beginning to be delivered remotely, but there is limited evidence to support the acceptability of this method. AIMS: To evaluate the acceptability and feasibility of remote therapist-supported CR in people with psychosis and estimate its cost and potential benefits. METHODS: A case-series with all participants assessed before and after therapy with measures of personal goal attainment (main outcome), cognition, functioning and symptoms. Acceptability was assessed with post-therapy interviews. Feasibility was assessed using proportions and confidence intervals on pre-specified parameters. Indication of benefits was assessed with exploratory analyses comparing baseline and post-therapy scores on the pre-specified outcomes. The cost of providing remote CR was assessed from both healthcare and societal perspectives. RESULTS: Twenty-nine participants started therapy with two dropping out; on average participants attended 25.5 sessions. Interviews suggested that remote CR had good acceptability and led to perceived benefits. Significant and large improvements were observed on goal attainment. Cost analyses suggest that remote CR has the same health care cost as face-to-face therapy but a lower societal cost. CONCLUSIONS: Our results support the use of remote CR in psychosis services as an alternative delivery modality. This method may improve adherence, attendance and be more convenient for service users. Possible barriers such as poor digital literacy or appropriate device ownership should be addressed before starting therapy.

Network meta-analysis of the effects of different cognitive trainings on the cognitive function of patients with mild cognitive impairment.

OBJECTIVE: Examining the relationship between the responses of a number of different cognitive trainings on cognitive functioning in middle-aged and elderly patients with mild cognitive impairment. METHODS: Randomized controlled experimental studies published publicly from the time of inception to October 30, 2023 were searched through Web of Science, PubMed, Embase, and Cochrane library databases. Traditional and network meta-analyses were performed using Stata 17.0 software. RESULTS: Fifty papers on 4 types of cognitive training were included. Traditional meta-analysis showed that virtual reality training (SMD = 0.53, 95%CI: [0.36,0.70], P = 0.00), neuropsychological training (SMD = 0.44, 95%CI: [0.18,0.70], P = 0.00), cognitive strategy training (SMD = 0.26, 95%CI: [0.16,0.36], P = 0.00), and cognitive behavioral therapy (SMD = 0.25, 95%CI: [0.08,0.41], P = 0.00) all had significant improvement effects on the cognitive function of middle-aged and elderly patients with mild cognitive impairment. Network meta-analysis revealed neuropsychological training as the best cognitive training, and subgroup analysis of cognitive function subdimensions showed that neuropsychological training had the best effects on working memory, lobal cognitive function, memory, and cognitive flexibility improvement. Meanwhile, virtual reality training had the best effects on processing speed, verbal ability, overall executive function, spatial cognitive ability, and attention improvement. CONCLUSION: Cognitive training can significantly improve the cognitive function of middle-aged and elderly patients with mild cognitive impairment, and neuropsychological training is the best intervention, most effective in interventions lasting more than 8 weeks.

Cognitive remediation for schizophrenia: Clinician perspectives on implementation barriers and facilitators.

OBJECTIVES: Neurocognitive deficits in schizophrenia have a major impact on functioning; however, they remain poorly targeted by available treatment offerings. Cognitive remediation (CR) is effective in improving neurocognition and functioning. Despite clinical guidelines for schizophrenia recommending CR, it is still not readily available in clinical services and sizeable attrition rates are reported in clinical trials. METHOD: To elucidate the barriers and facilitators of CR access and engagement, we conducted a mixed methods qualitative-dominant study with 12 clinicians in Australia, in 2021, with 1 hr interviews and additional rating scales completed. RESULTS: Thematic analysis highlighted four themes (cognitive symptoms, CR intervention, motivation and engagement in CR, and CR implementation), and 14 subthemes. Clinicians emphasized the broad impact of cognitive deficits and outlined pros and cons of different CR approaches. Several factors were suggested as impacting engagement, including motivation assessments/techniques, neurocognitive insight, illness, and demographic factors. Lack of routine implementation in Australia was unanimously espoused and partly explained by a need for cost-effectiveness analyses, remote and flexible delivery, and increasing service resource provision and staff training in CR. CONCLUSIONS: This study offers key insights into CR access, while recommending methods for optimizing CR implementation and dissemination to improve recovery outcomes of people diagnosed with schizophrenia. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The importance of improving cognitive flexibility in adolescents with anorexia nervosa: The case for cognitive remediation therapy.

OBJECTIVE: Inefficiencies in executive functioning (EF), more specifically cognitive flexibility and an overly detailed processing style, are frequently observed in individuals with Anorexia Nervosa (AN) and have been identified as potential targets in treatment. Cognitive Remediation Therapy (CRT) is an adjunctive treatment approach specifically designed to have a positive impact on EF. Mainly evaluated in adults, CRT has been criticized for its perceived ineffectiveness in promoting weight restoration or directly reducing eating disorder symptoms. METHOD: We argue that we need to refocus our conceptual framework for using CRT as an adjunctive treatment and specifically explore its potential benefit in adolescents. RESULTS: Adolescence is a critical window for EF development during which CRT has the potential to have the most impact. While it may not specifically ameliorate eating disorder symptoms and directly improve weight gain, CRT may mitigate the impact of malnutrition on adolescent brain development, reduce attrition rates in treatment, and improve cognitive flexibility and (indirectly) other maintaining factors, thereby improving global functioning. DISCUSSION: More research needs to be done to understand the development of EF in adolescents with AN and how best to employ CRT as an adjunctive treatment to support development and target maintaining factors. The current article broadly reviews findings on executive functioning inefficiencies in adolescents with AN and discusses the purpose and role of CRT in treating AN. Finally, we highlight key critiques of using CRT and pose questions for future research. PUBLIC SIGNIFICANCE: Treatments targeting executive functioning in adolescents with AN are limited. We need to better understand how CRT can benefit adolescents in treatment. Increasing treatment options, including adjunctive treatments, is necessary to reduce the long-term impact of AN.

Disseminating action-based cognitive remediation to an early psychosis network: Clinician perspectives on feasibility and implementation barriers.

AIM: Action-based cognitive remediation (ABCR) is a group cognitive remediation treatment that aims to improve neurocognitive impairments experienced in patients with severe mental illness. Developed in research settings, ABCR is not yet widely available in community settings. As such, this study examines the feasibility of implementing ABCR in community clinics in an early psychosis network. METHODS: Eighty-five allied health professionals who work within an early psychosis intervention network were trained in the provision of ABCR. They were surveyed 6-months after training to gather information regarding their experience implementing ABCR within their clinical settings (e.g., barriers, perceived helpfulness of the treatment, modifications made to the manualized treatment). Access to ongoing training supports (e.g., treatment manual, asynchronous digital communication, conference calls) was also assessed. RESULTS: Fifty-one clinicians responded to the survey. Staff time, manager support, and equipment were rated as organizational barriers. Geographic location, other responsibilities, and motivation were rated as patient barriers. Over half of the sample modified the overall dose of ABCR to offer fewer sessions and/or shorter duration of sessions than the manualized approach. Clinicians that reduced the dose of ABCR reported significantly higher barriers with manager support than staff who delivered ABCR as manualized but did not report worse patient outcomes. We found asynchronous learning opportunities (i.e., manual, online discussion forum) were perceived as the most accessible and helpful methods of ongoing training support. CONCLUSIONS: The results provide preliminary information about barriers to implementing time-intensive cognitive treatments into clinical settings and may inform future training practices to increase successful implementation of cognitive remediation treatments.

Moderators of functional improvement after integrative cognitive remediation in schizophrenia: Toward a personalized treatment approach.

Cognitive remediation is an effective intervention for improving functional outcome in schizophrenia. However, the factors that moderate this improvement are still poorly understood. The study aimed to identify moderators of functional outcome improvement after integrative cognitive remediation (REHACOP) in schizophrenia. This was a secondary analysis of data from two randomized controlled trials, which included 182 patients (REHACOP group=94; active control group=88). Hierarchical regression analyses were conducted to identify moderators of functional outcome improvement. Two baseline level groups (low-level and high-level) were created to analyze the moderating role of this baseline level cluster using repeated measures ANCOVA. The REHACOP was effective regardless of participants' baseline level, but regression analyses indicated that the effectiveness on functional outcome was higher among those who were older, had fewer years in education, lower scores in baseline cognition and functional outcome, and more negative symptoms. Repeated measures ANOVA showed that the baseline level cluster influenced the improvement in functional outcome, with the low-level group showing greater improvements. The results reinforced the need to implement cognitive remediation programs more broadly as a treatment for schizophrenia in healthcare services. Furthermore, they provided evidence for the development of personalized cognitive remediation plans to improve benefits in different schizophrenia profiles.

Analyzing structural and functional brain changes related to an integrative cognitive remediation program for schizophrenia: A randomized controlled trial.

Cognitive remediation has been shown to improve cognition in schizophrenia, but little is known about the specific functional and structural brain changes related to the implementation of an integrative cognitive remediation program. This study analyzed the functional and structural brain changes identified after implementing an integrative cognitive remediation program, REHACOP, in schizophrenia. The program combined cognitive remediation, social cognitive training, and functional and social skills training. The sample included 59 patients that were assigned to either the REHACOP group or an active control group for 20 weeks. In addition to a clinical and neuropsychological assessment, T1-weighted, diffusion-weighted and functional magnetic resonance images were acquired during a resting-state and during a memory paradigm, both at baseline and follow-up. Voxel-based morphometry, tract-based spatial statistics, resting-state functional connectivity, and brain activation analyses during the memory paradigm were performed. Brain changes were assessed with a 2 × 2 repeated-measure analysis of covariance for group x time interaction. Intragroup paired t-tests were also carried out. Repeated-measure analyses revealed improvements in cognition and functional outcome, but no significant brain changes associated with the integrative cognitive remediation program. Intragroup analyses showed greater gray matter volume and cortical thickness in right temporal regions at post-treatment in the REHACOP group. The absence of significant brain-level results associated with cognitive remediation may be partly due to the small sample size, which limited the statistical power of the study. Therefore, further research is needed to clarify whether the temporal lobe may be a key area involved in cognitive improvements following cognitive remediation.

Use of conditional-discrimination training in remembering relatives in a man with Alzheimer’s Disease

In this study, a 72-year-old man with Alzheimer’s disease and a Mini-Mental Status (MMS) score of 25 participated. The participant was presented for class-formation sorting tests and conditionaldiscrimination training sequences and tests with portraits of close family members, their names, and family relationships as stimuli. The purpose of the study was to identify intact relations between stimuli, stimulus control issues and thereafter reestablish relations between stimuli. In the sorting tests, intact and weakened stimulus relations were identified. In addition, the results showed how correct stimulus control was reestablished after tailoring the conditional-discrimination training after the participant had shown systematical incorrect responding to some of the presented stimuli. Key words: conditional discrimination, matching-to-sample, dementia, sorting test, stimulus control (AU)

Factors Impacting Access and Engagement of Cognitive Remediation Therapy for People with Schizophrenia: A Systematic Review.

OBJECTIVES: Neurocognitive deficits are central in schizophrenia. Cognitive remediation has proven effective in alleviating these deficits, with medium effect sizes. However, sizeable attrition rates are reported, with the reasons still uncertain. Furthermore, cognitive remediation is not part of routine mental health care. We conducted a systematic review to investigate factors that influence access and engagement of cognitive remediation in schizophrenia. METHODS: We systematically searched the PubMed, Web of Science, and PsycINFO databases for peer-reviewed articles including a cognitive remediation arm, access, and engagement data, and participants with schizophrenia spectrum disorders aged 17-65 years old. Duplicates and studies without a distinct cognitive remediation component, protocol papers, single case studies, case series, and reviews/meta-analyses were excluded. RESULTS: We included 67 studies that reported data on access and engagement, and extracted quantitative and qualitative data. Access data were limited, with most interventions delivered on-site, to outpatients, and in middle- to high-income countries. We found a median dropout rate of 14.29%. Only a small number of studies explored differences between dropouts and completers (n = 5), and engagement factors (n = 13). Dropouts had higher negative symptomatology and baseline self-efficacy, and lower baseline neurocognitive functioning and intrinsic motivation compared to completers. The engagement was positively associated with intrinsic motivation, self-efficacy, perceived usefulness, educational level, premorbid intelligence quotient, baseline neurocognitive functioning, some neurocognitive outcomes, and therapeutic alliance; and negatively associated with subjective cognitive complaints. Qualitative results showed good acceptability of cognitive remediation, with some areas for improvement. CONCLUSIONS: Overall, access and engagement results are scarce and heterogeneous. Further investigations of cognitive remediation for inpatients, as well as remote delivery, are needed. Future clinical trials should systematically explore attrition and related factors. Determining influential factors of access and engagement will help improve the implementation and efficacy of cognitive remediation, and thus the recovery of people with schizophrenia.

Acceptability of cognitive remediation for schizophrenia: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Acceptability is an important factor for predicting intervention use and potential treatment outcomes in psychosocial interventions. Cognitive remediation (CR) improves cognition and functioning in people with a diagnosis of schizophrenia, but its acceptability, and the impact of participants and treatment characteristics, remain to be investigated. Few studies provide a direct measure of acceptability, but treatment drop-out rates are often available and represent a valid surrogate. METHOD: The systematic search conducted for the most comprehensive CR outcomes database for schizophrenia was updated in December 2020. Eligible studies were randomized clinical trials comparing CR with any other control condition in patients diagnosed with schizophrenia spectrum disorders and that also reported drop-out in treatment and control arms separately. Acceptability was measured as odd-ratios (OR) of drop-out. RESULTS: Of 2119 identified reports, 151 studies, reporting 169 comparisons between CR and control interventions with 10 477 participants were included in the analyses. The overall rate of drop-out was 16.58% for CR programs and 15.21% for control conditions. In the meta-analysis, no difference emerged between CR interventions and controls [OR 1.10, 95% confidence interval (CI) 0.96-1.25, p = 0.177]. Factors improving acceptability were: inpatient only recruitment, participants with fewer years of education and lower premorbid IQ, the presence of all CR core elements, and the presence of techniques to transfer cognitive gains into real-world functioning. CONCLUSIONS: CR for people diagnosed with schizophrenia is effective and has a good acceptability profile, similar to that of other evidence-based psychosocial interventions.

Vocational rehabilitation augmented with cognitive behavioral therapy or cognitive remediation for individuals with schizophrenia: a 5-year follow-up study.

INTRODUCTION: Although employment is an important part of recovery for individuals with schizophrenia spectrum disorders, the employment rate for this group remains low. Increasing evidence supports the use of augmented vocational rehabilitation (VR) programs to improve occupational outcome. The aim of this study is to explore 5-year follow-up registry data from the JUMP study, a VR program for individuals with schizophrenia spectrum disorders, specifically with regard to competitive employment outcome and predictors of competitive employment. The VR was augmented with either cognitive remediation (CR) or elements from cognitive behavior therapy (CBT). METHODS: One hundred and forty eight participants with schizophrenia spectrum disorders from six Norwegian counties received 10 months VR augmented with either CR (n = 64) or CBT (n = 84). Both competitive and sheltered workplaces were used. Assessments were conducted at baseline, at post intervention and at 2-year follow-up. Data on employment status at 5-year follow-up was obtained by registry. RESULTS: At 5-year follow-up 55.4% were engaged in working activity, of which 22.3% had obtained competitive employment. A further 18.2% had work placements in competitive workplaces. Number of received intervention hours and competitive employment at 2-year follow-up emerged as significant predictors of competitive employment. IQ and intervention type in marginal favor of CBT were predictors on trend level. CONCLUSION: To the best of our knowledge, this is the first study investigating competitive employment at 5-year follow-up for individuals with schizophrenia spectrum disorders. The results add to existing evidence that competitive employment is attainable for this group.

The cognitive remediation of attention in HIV-associated neurocognitive disorders (HAND): A meta-analysis and systematic review.

Background: Despite medical advances in Highly Active Antiretroviral Therapy (HAART), patients living with HIV continue to be at risk for developing HIV-associated neurocognitive disorders (HAND). The optimization of non-HAART interventions, including cognitive rehabilitation therapy (CRT), shows promise in reversing the impact of HAND. No data exist indicating the efficacy of CRT in remediating attention skills following neuroHIV. This paper presents a meta-analysis of randomised and non-randomised controlled trials (RCTs) to remediate attention skills following HIV CRT. Methods: The database search included literature from Google Scholar, ERIC, Cochrane Library, ISI Web of Knowledge, PubMed, PsycINFO, and grey literature published between 2013 and 2022. Inclusion criteria included studies with participants living with HIV who had undergone CRT intervention to remediate attention skills following neuroHIV. Exclusion criteria included case studies, non-human studies, and literature reviews. To assess study quality, including, randomisation, allocation concealment, participant and personnel blinding, the Cochrane Collaboration ratings system was applied. Results: A total of 14 studies met the inclusion criteria (n = 532). There were significant pre- to post-intervention between-group benefits due to CRT in the experimental group relative to control conditions for the remediation of attention skills following HIV acquisition (Hedges g = 0.251, 95% CI = 0.005 to 0.497; p < 0.05). No significant effects (p > 0.05) were demonstrated for subgroup analysis. Conclusions: To the author's knowledge, this is the first meta-analysis that exclusively analyses the remediation of attention skills in the era of HAART and neuroHIV, where all studies included participants diagnosed with HIV. The overall meta-analysis effect indicates the efficacy of CRT in remediating attention skills in HIV and HAND. It is recommended that future cognitive rehabilitation protocols to remediate attention skills should be context and population-specific and that they be supplemented by objective biomarkers indicating the efficacy of the CRT. Registration: Protocols.io (01/03/2023).

Clinical and Cognitive Effects of Computer Assisted Cognitive Remediation Method in Turkish Men with Opioid Use Disorder: A Randomized Controlled Trial.

Objective: Substance use disorders are associated with significant cognitive impairments causing many individual or social problems besides poor treatment outcomes. The cognitive remediation method is effective in so many neuropsychiatric disorders. This study aimed to evaluate the effects of this method among individuals with opioid use disorder. Method:60 patients diagnosed with opioid use disorder under buprenorphine-naloxone treatment and who accepted the informed consent were included. Seven patients left the study initially. 53 male patients were randomly assigned to receive treatment in the usual control or cognitive remediation-intervention group. The intervention group completed 3 to 4 sessions a week, 8 different exercises in each session, for 4 weeks, a total of 12 sessions, individually. Addiction Profile Indeks, Barrat Impulsivity Scale-SF, CGI, and Delay Discounting scores were measured before and after the 1 month cognitive Remediation practices. Three months later, patients were contacted, and their remission status was evaluated. Results: In the intervention group; 17(89.5%) people had remission and 2(10.5%) people had relapse. In the control group, 7(31.8%) individuals had remission, and 15(68.2%) had relapsed at the end of the 3 months. It was determined that craving, addiction severity, and self-reported and behavioral impulsivity values decreased while the improvement in treatment response was higher in the intervention group. Conclusion: Our results showed that the computer-assisted cognitive remediation method, in addition to buprenorphine-naloxone treatment, improves treatment response, increases remission, and has positive clinical and cognitive effects on individuals with opioid use disorder. It suggests that cognitive remediation practices can be added to the treatment programs for addiction.

Valoración de un programa de formación de cuidadores sobre la capacidad cognitiva de personas con demencia / Assessment of a caregiver training program on the cognitive capacity of people with dementia

Objetivos: El incremento de la población mayor ha hecho que se eleve el porcentaje de personas con demencia que requieren una atención especializada dirigida a mantener o retrasar su declive cognitivo y físico. El objetivo de esta investigación ha sido analizar si un grupo de personas con demencia mejoran cognitivamente al ser atendidos por cuidadores profesionales que han sido formados en un módulo de estimulación cognitiva del programa CUIDA-2 siguiendo los principios de la atención centrada en la persona. Metodología: La muestra estuvo formada por 47 personas con demencia (divididas en grupo tratamiento y grupo control) y 5 cuidadores formales de un centro de día de personas con demencia de Granada. El grupo tratamiento de personas mayores fue atendido durante 3 meses por cuidadores que recibieron el programa de formación. Todos los participantes fueron evaluados antes y después de la intervención con diversas pruebas de evaluación cognitiva. Resultados: Las personas con demencia que fueron atendidas por los cuidadores formados en el programa mantuvieron o mejoraron sus puntuaciones en todas las pruebas analizadas, si bien estas mejoras solo fueron significativas en diversas subescalas de los test empleados. Conclusiones: Se ha comprobado que el programa de formación de cuidadores aquí analizado produce un efecto positivo para las personas con demencia, ya que ayuda a mejorar y mantener sus funciones cognitivas. Esta investigación abre nuevas líneas de trabajo en el ámbito de la intervención cognitiva en personas con demencia que pueden ser de gran utilidad cuando se trabaje con esta población (AU)

Objectives: The increase in the elderly population has led to a rise in the percentage of people with dementia who require specialized attention aimed at maintaining or delaying their cognitive and physical decline. The aim of this research was to analyze whether a group of adults with dementia improve cognitively when being attended by professional caregivers who were trained in a cognitive stimulation module of the CUIDA-2 program following the principles of the person-centered-care model. Methodology: The sample consisted on 47 people with dementia (divided into treatment group and control group) and 5 professional caregivers of a day center for people with dementia in Granada. The older people treatment group was treated for three months by caregivers who received the training program. All participants were assessed before and after the intervention with various cognitive assessment tests. Results: People with dementia who were treated by caregivers trained in the program maintained or improved their scores in all the tests analyzed, although these improvements were only significant in various subtest. Conclusions: The caregiver training program produced a positive effect in the adults with dementia, as it helps to improve and maintain their cognitive functions. This research opens new lines of work in the field of cognitive intervention in people with dementia that can be very useful when working with this population (AU)

Randomized clinical trial of integral cognitive remediation program for major depression (INCREM).

BACKGROUND: Despite achieving clinical remission, patients with depression encounter difficulties to return to their premorbid psychosocial functioning. Cognitive dysfunction has been proposed to be a primary mediator of functional impairment. Therefore, the new non-pharmacological procognitive strategy INtegral Cognitive REMediation for Depression (INCREM) has been developed with the aim of targeting cognitive and psychosocial functioning. METHODS: This is a single-blind randomized controlled clinical trial with three treatment arms. Fifty-two depressed patients in clinical remission, with psychosocial difficulties and cognitive impairment, were randomly assigned to receive INCREM intervention, Psychoeducation programme, or treatment as usual. Patients were assessed before and after the study period, and six months after. The primary outcome was the change from baseline of patients' psychosocial functioning. Changes in cognitive functioning and other variables were considered secondary outcomes. RESULTS: The analysis showed a significant improvement in psychosocial functioning in the INCREM group, especially six months after the intervention, compared to patients who received the psychoeducation programme. An improvement in cognitive performance was also observed in the INCREM group. LIMITATIONS: This study includes a small sample size due to the anticipated end of the clinical trial because of the COVID-19 pandemic. DISCUSSION: These results provide preliminary evidence on the feasibility and potential efficacy of the INCREM program to improve not only cognitive performance but also psychosocial functioning in clinically remitted depressed patients, and such improvement is maintained six months after. It can be speculated that the maintenance is mediated by the cognitive enhancement achieved with INCREM.

Can neuroimaging-based biomarkers predict response to cognitive remediation in patients with psychosis? A state-of-the-art review.

BACKGROUND: Cognitive Remediation (CR) is designed to halt the pathological neural systems that characterize major psychotic disorders (MPD), and its main objective is to improve cognitive functioning. The magnitude of CR-induced cognitive gains greatly varies across patients with MPD, with up to 40% of patients not showing gains in global cognitive performance. This is likely due to the high degree of heterogeneity in neural activation patterns underlying cognitive endophenotypes, and to inter-individual differences in neuroplastic potential, cortical organization and interaction between brain systems in response to learning. Here, we review studies that used neuroimaging to investigate which biomarkers could potentially serve as predictors of treatment response to CR in MPD. METHODS: This systematic review followed the PRISMA guidelines. An electronic database search (Embase, Elsevier; Scopus, PsycINFO, APA; PubMed, APA) was conducted in March 2021. peer-reviewed, English-language studies were included if they reported data for adults aged 18+ with MPD, reported findings from randomized controlled trials or single-arm trials of CR; and presented neuroimaging data. RESULTS: Sixteen studies were included and eight neuroimaging-based biomarkers were identified. Auditory mismatch negativity (3 studies), auditory steady-state response (1), gray matter morphology (3), white matter microstructure (1), and task-based fMRI (7) can predict response to CR. Efference copy corollary/discharge, resting state, and thalamo-cortical connectivity (1) require further research prior to being implemented. CONCLUSIONS: Translational research on neuroimaging-based biomarkers can help elucidate the mechanisms by which CR influences the brain's functional architecture, better characterize psychotic subpopulations, and ultimately deliver CR that is optimized and personalized.

Young people and parents' views towards individual cognitive remediation therapy-qualitative findings from a feasibility randomised controlled trial.

PURPOSE: Cognitive Remediation Therapy (CRT) has been used mostly in adults. Randomised Controlled Trials (RCTs) in anorexia nervosa (AN) have shown that CRT enhances cognitive flexibility, abstract thinking and is associated with quality-of-life improvement. More research is needed in younger populations. METHODS: A single-centre feasibility RCT with young people (YP) with AN was conducted in an inpatient setting. A secondary aim of this study was to explore patient satisfaction and parents' views towards CRT to inform further development and implementation of CRT in YP. YP were asked to complete a therapy feedback questionnaire and write a letter with their views on CRT. Parents were asked to complete a questionnaire exploring their perceptions of CRT. Data were analysed using inductive thematic and deductive content analysis. RESULTS: Both YP and parents valued CRT. Its engaging and pragmatic nature and its focus on thinking styles were perceived as a novel aspect. Parents expressed the need to be involved in the sessions to be able to continue to support their children at home. CONCLUSIONS: This study confirms previous qualitative findings. Should a fully powered RCT be conducted, it would be important to take into account these findings to further adapt the content of the CRT sessions to the YP needs and to consider their parents' involvement in the sessions, which could also increase the likelihood of parents' engagement in providing their feedback. LEVEL OF EVIDENCE: Level I: Evidence obtained from one randomized controlled trial.

An fMRI study of cognitive remediation in drug-naïve subjects diagnosed with first episode schizophrenia.

OBJECTIVE: The purpose of our functional magnetic resonance imaging (fMRI) study was to examine brain activity using a "1-back" paradigm as working memory task in drug-naïve subjects with first episode schizophrenia before and after cognitive remediation training. METHODS: In this study 15 drug-naïve first episode subjects who met DSM-IV criteria for schizophrenia were randomized to receive either atypical antipsychotics (AP, n = 8) or atypical antipsychotics in combination with cognitive remediation therapy (AP + CR, n = 7), 11 subjects had a follow-up fMRI examination after therapy (AP, n = 5; AP + CR, n = 6). RESULTS: In 4 of the 6 AP + CR subjects the number of activation clusters increased, whereas in 4 out of the 5 AP subjects the number of clusters decreased (mean number of clusters: AP + CR = 5.53, SD 12.79, AP = -5.8, SD 6.9). CONCLUSION: In this randomized study the number of activation clusters during a working memory task increased after cognitive remediation training. Our data show that neurobiological effects of cognitive remediation can be identified in the very early course of schizophrenia.