Adherence of stroke patients with an online brain training program: the role of health professionals' support.

Background Computer-based cognitive rehabilitation is used to improve cognitive functioning after stroke. However, knowledge on adherence rates of stroke patients is limited. Objective To describe stroke patients' adherence with a brain training program using two frequencies of health professionals' supervision. Methods This study is part of a randomized controlled trial comparing the effect of the brain training program (600 min playtime with weekly supervision) with a passive intervention in patients with self-perceived cognitive impairments after stroke. Patients randomized to the control condition were offered the brain training after the trial and received supervision twice (vs weekly in intervention group). Adherence was determined using data from the study website. Logistic regression analyses were used to examine the impact of supervision on adherence. Results 53 patients allocated to the intervention group (group S8; 64% male, mean age 59) and 52 patients who were offered the intervention after the trial (group S2; 59% male, mean age 59) started the brain training. The median playtime was 562 min (range 63-1264) in group S8 vs. 193 min (range 27-2162) in group S2 (p < 0.001, Mann Whitney U). Conclusions The overall adherence of stroke patients with a brain training was low and there are some implications that systematic, regular interaction with a supervisor can increase training adherence of stroke patients with a restitution-focused intervention performed at home.

The effects of an 8-week computer-based brain training programme on cognitive functioning, QoL and self-efficacy after stroke.

Cognitive impairment after stroke has a direct impact on daily functioning and quality of life (QoL) of patients and is associated with higher mortality and healthcare costs. The aim of this study was to determine the effect of a computer-based brain training programme on cognitive functioning, QoL and self-efficacy compared to a control condition in stroke patients. Stroke patients with self-perceived cognitive impairment were randomly allocated to the intervention or control group. The intervention consisted of an 8-week brain training programme (Lumosity Inc.®). The control group received general information about the brain weekly. Assessments consisted of a set of neuropsychological tests and questionnaires. In addition, adherence with trained computer tasks was recorded. No effect of the training was found on cognitive functioning, QoL or self-efficacy when compared to the control condition, except for very limited effects on working memory and speed. This study found very limited effects on neuropsychological tests that were closely related to trained computer tasks, but no transfers to other tests or self-perceived cognitive failures, QoL or self-efficacy. These findings warrant the need for further research into the value of computer-based brain training to improve cognitive functioning in the chronic phase after stroke.

Dose dependent dopaminergic modulation of reward-based learning in Parkinson's disease.

Learning to select optimal behavior in new and uncertain situations is a crucial aspect of living and requires the ability to quickly associate stimuli with actions that lead to rewarding outcomes. Mathematical models of reinforcement-based learning to select rewarding actions distinguish between (1) the formation of stimulus-action-reward associations, such that, at the instant a specific stimulus is presented, it activates a specific action, based on the expectation that that particular action will likely incur reward (or avoid punishment); and (2) the comparison of predicted and actual outcomes to determine whether the specific stimulus-action association yielded the intended outcome or needs revision. Animal electrophysiology and human fMRI studies converge on the notion that dissociable neural circuitries centered on the striatum are differentially involved in different components of this learning process. The modulatory role of dopamine (DA) in these respective circuits and component processes is of particular relevance to the study of reward-based learning in patients diagnosed with Parkinson's disease (PD). Here we show that the first component process, learning to predict which actions yield reward (supported by the anterior putamen and associated motor circuitry) is impaired when PD patients are taken off their DA medication, whereas DA medication has no systematic effects on the second processes, outcome evaluation (supported by caudate and ventral striatum and associated frontal circuitries). However, the effects of DA medication on these processes depend on dosage, with larger daily doses leading to a decrease in predictability of stimulus-action-reward relations and increase in reward-prediction errors.

Deep brain stimulation of the subthalamic nucleus improves reward-based decision-learning in Parkinson's disease.

Recently, the subthalamic nucleus (STN) has been shown to be critically involved in decision-making, action selection, and motor control. Here we investigate the effect of deep brain stimulation (DBS) of the STN on reward-based decision-learning in patients diagnosed with Parkinson's disease (PD). We determined computational measures of outcome evaluation and reward prediction from PD patients who performed a probabilistic reward-based decision-learning task. In previous work, these measures covaried with activation in the nucleus caudatus (outcome evaluation during the early phases of learning) and the putamen (reward prediction during later phases of learning). We observed that stimulation of the STN motor regions in PD patients served to improve reward-based decision-learning, probably through its effect on activity in frontostriatal motor loops (prominently involving the putamen and, hence, reward prediction). In a subset of relatively younger patients with relatively shorter disease duration, the effects of DBS appeared to spread to more cognitive regions of the STN, benefiting loops that connect the caudate to various prefrontal areas importantfor outcome evaluation. These results highlight positive effects of STN stimulation on cognitive functions that may benefit PD patients in daily-life association-learning situations.

Error-related brain potentials are differentially related to awareness of response errors: evidence from an antisaccade task.

The error negativity (Ne/ERN) and error positivity (Pe) are two components of the event-related brain potential (ERP) that are associated with action monitoring and error detection. To investigate the relation between error processing and conscious self-monitoring of behavior, the present experiment examined whether an Ne and Pe are observed after response errors of which participants are unaware. Ne and Pe measures, behavioral accuracy, and trial-to-trial subjective accuracy judgments were obtained from participants performing an antisaccade task, which elicits many unperceived, incorrect reflex-like saccades. Consistent with previous research, subjectively unperceived saccade errors were almost always immediately corrected, and were associated with faster correction times and smaller saccade sizes than perceived errors. Importantly, irrespective of whether the participant was aware of the error or not, erroneous saccades were followed by a sizable Ne. In contrast, the Pe was much more pronounced for perceived than for unperceived errors. Unperceived errors were characterized by the absence of posterror slowing. These and other results are consistent with the view that the Ne and Pe reflect the activity of two separate error monitoring processes, of which only the later process, reflected by the Pe, is associated with conscious error recognition and remedial action.

The ability to activate and inhibit speeded responses: separate developmental trends.

When children grow older they respond faster and are less susceptible to interference caused by task-irrelevant information. These observations suggested the hypothesis that a global mechanism may account for developmental change in the speed of responding and that inhibitory function may underlie the ability to activate speeded responses. The current study examined these issues by comparing the performance of 4 age groups (5-, 8-, and 11-year-olds and young adults) on a battery of 6 speeded performance tasks, 4 of which required the inhibition of response activation. An analysis of reaction and inhibition times supported a hypothesis of generalized developmental changes in response activation, but revealed a less pronounced development of inhibition. A nonselective mechanism of response inhibition seems to be fully developed during early childhood.

Age effects on response monitoring in a mental-rotation task.

A mental-rotation task was presented to young (18-28 years) and old (60-76 years) adults to simultaneously assess age-related changes in performance, response monitoring and adaptive behavior. Relative to young participants, older adults were less inclined to adjust their speed at the expense of accuracy. They displayed a larger number of slow errors, smaller error potentials (Ne and Pe), more immediate corrections of errors when detected, and a larger speed reduction on trials following an error. The data suggest that for older adults an increase of task complexity sometimes caused a radical failure in determining the correct response, rather than a gradual reduction of efficiency.

Inhibitory motor control in stop paradigms: review and reinterpretation of neural mechanisms.

What is the neurophysiological locus of inhibition when preparation for a manual response is countermanded? This paper evaluates data and models that pertain to inhibitory mechanisms operating in stop paradigms. In a model of De Jong, Coles and Logan (1995), (Strategies and mechanisms in nonselective and selective inhibitory motor control. Journal of Experimental Psychology: Human Perception and Performance, 21, 3, 498-511), a mechanism for nonselective inhibition operates peripheral to the motor cortex, while a selective mechanism operates at a central cortical level. We argue, however, that a peripheral mechanism of inhibition is incorrectly inferred from inhibition data available to date. Neurophysiological and psychophysiological data suggest that inhibitory processes always involve the cortex, and inhibitory effects are exerted upstream from the primary motor cortex. The prefrontal cortex and basal ganglia are candidate agents of response inhibition, whereas possible sites of inhibition are the thalamus and motor cortex.

Sources of interference from irrelevant information: a developmental study.

The present study investigated the mechanisms underlying reductions in the susceptibility to interference from irrelevant information that are evident in the developing child. In the first experiment, where the task was to focus on one stimulus dimension and to ignore a second dimension, variations in the degree of spatial integration in multidimensional stimulus configurations did not influence interference effects. Developmental trends in selective attention could not be attributed to age changes in the accessibility of dimensional structure. The second experiment, where the task was to focus on a central arrow stimulus and to ignore flanking arrows, allowed further examination of the mechanisms involved in developmental changes in interference effects. The primary source of the developmental decrease in interference from irrelevant information was found to be in the rate at which the output of perceptual analysis is coupled to the preparation and execution of a motor response, rather than in perceptual filtering or in response preparation. The combined results suggest that age changes in selective attention are mediated to an important extent by changes in the speed and efficiency of stimulus-response translation processes. These findings are discussed in terms of developmental theories of interference control.

Mental rotation interferes with response preparation.

Reaction times (RTs) and lateralized readiness potentials (LRPs) were studied to find out whether response preparation begins after mental rotation finishes, as assumed by discrete-stage models. Stimuli were disoriented normal or mirror-image characters, with character name determining which hand would respond. In Experiment 1, the normal/mirror-image information determined whether the response was to be executed (go) or withheld (no-go), and LRPs indicated that responses were weakly prepared before the end of mental rotation. Mental rotation was not required in Experiment 2, and significantly more response preparation was observed. In Experiment 3, probe RT trials embedded in the mental rotation task indicated that hand information is available to the response preparation process during rotation. Apparently, some response preparation occurs before mental rotation finishes, but rotation interferes with response preparation.