A short add-on sleep intervention in the rehabilitation of individuals with acquired brain injury: A randomized controlled trial.

BACKGROUND: Sleep disturbances are common after acquired brain injury (ABI) and have a negative impact on functioning. OBJECTIVE: This study examines whether a short add-on therapy for sleep disturbances in individuals with ABI is effective in addition to rehabilitation treatment as usual. METHODS: In the randomized-controlled study, 54 adults with ABI and self-reported sleep disturbances receiving outpatient rehabilitation services were randomized in two groups: one receiving a sleep intervention (based on cognitive behavioural therapy for insomnia (CBT-I)) in addition to their rehabilitation treatment (CBT-I + TAU group) and one receiving treatment as usual (TAU). The primary outcome was sleep quality, measured with the Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes included measures of anxiety, depression, fatigue and dysfunctional beliefs and attitudes about sleep. RESULTS: The short add-on sleep therapy resulted in improvements in sleep quality in the CBT-I + TAU group as compared to the TAU group (ES = 0.924). Furthermore, the CBT-I + TAU group reported less dysfunctional beliefs and attitudes about sleep and were better able to cope with fatigue compared to the TAU group. CONCLUSIONS: The application of this short add-on sleep intervention could be implemented in neuropsychological rehabilitation settings.

Treatments for sleep disturbances in individuals with acquired brain injury: A systematic review.

OBJECTIVE: To systematically review the evidence on the treatments of sleep disturbances in individuals with acquired brain injury. DATA SOURCES: PubMed, Embase, Web of Science, and PsycINFO were searched from inception to January 2021. REVIEW METHOD: Eligibility criteria were (1) participants with mild to severe acquired brain injury from traumatic brain injury and stroke (⩾three months post-injury), (2) individuals aged 16 years and older, (3) participants with self-reported sleep disturbances, (4) controlled group studies and single case (experimental) studies, and (5) interventions aimed at treatment of sleep disturbances. Two researchers independently identified relevant studies and assessed their study quality using the revised Cochrane assessment of bias tool (RoB 2.0) and the risk-of-bias in N-of-1 trials (RoBiNT) scale. RESULTS: The search yielded 655 records; 11 studies met the inclusion criteria and were included, with a total of 227 participants (207 individuals with traumatic brain injury, 20 stroke patients). Two studies included pharmacological therapy, six studies examined the effects of cognitive behavioral therapy and three studies investigated alternative interventions such as acupuncture. CONCLUSION: Although there was heterogeneity in the study quality of the included studies, their outcomes suggest that cognitive behavioral therapy is recommended as treatment of choice for improving sleep in individuals with acquired brain injury, especially for patients with mild to severe traumatic brain injury. Future research should examine the effects of cognitive behavioral therapy in more high-quality randomized controlled designs.

Memory Strategy Training in Older Adults with Subjective Memory Complaints: A Randomized Controlled Trial.

OBJECTIVES: Subjective memory complaints (SMC) in older adults are associated with a decline in everyday functioning and an increased risk for future cognitive decline. This study examines the effect of a memory strategy training compared to a control memory training on memory functioning in daily life. METHODS: This was a randomized controlled trial with baseline, post-treatment, and 6-month follow-up assessments conducted in 60 older adults (50-87 years) with SMC. Participants were randomly assigned to either seven sessions of memory strategy training or seven sessions of control memory training. Both interventions were given in small groups and included psycho-education. Primary outcome measure was memory functioning in daily life. Objective measures of memory performance and self-reported measures of strategy use were included as secondary outcome measures. RESULTS: Participants in each intervention group reported an improvement in personal memory goals (p<.0005), up to 6 months after training. An interaction effect showed that participants following memory strategy training reported a larger improvement in personal memory goals (p=.002). Both intervention groups improved on two memory tests (p<.001 and p<.01). In the memory strategy training group, an increase in strategy use in daily life was the strongest predictor (p<.05) of improvement in subjective memory functioning. CONCLUSIONS: Older adults with subjective memory complaints benefit from memory strategy training, especially in their memory functioning in daily life. (JINS, 2018, 24, 1110-1120).

The influence of cognitive reserve and age on the use of memory strategies.

BACKGROUND: Whether older adults use effective memory strategies to compensate for their memory decline partly depends on their executive functioning (EF). However, many studies have overlooked the role of cognitive reserve (CR). This study examines the effects of age, EF, and CR on memory strategy use. METHODS: A total of 83 participants (aged 18-85 years) were included. Strategy use was assessed using three measures: (1) self-reported strategy use in daily life, (2) self-reported and observed strategy use in a simulated daily life situation, and (3) self-reported strategy use during a word-pair task. RESULTS: Results showed that CR was the strongest predictor of strategy use, both in daily life and during memory tasks. Although effects of age and EF were found, most of these effects disappeared when CR was added to the model. Furthermore, a higher CR was related to the use of more complex strategies and to more effective strategies in relation to task performance. CONCLUSIONS: Higher levels of CR seem to enable individuals to use effective strategies. These results highlight the importance of the role of CR in compensating for the aging-related memory decline.

Memory strategy use in older adults with subjective memory complaints.

BACKGROUND: Subjective memory complaints (SMC) are common among older adults, but it is unclear to what extent adults with SMC spontaneously use memory strategies to compensate for their memory problems. As SMC may be a risk factor for memory decline later, it is important to extend our knowledge about spontaneous compensatory mechanisms in older adults with SMC. METHOD: Self-reported strategy use and observed strategy use were assessed in 38 adults with and 38 without SMC. RESULTS: Adults with SMC used more strategies in daily life than those without. In the SMC group, memory complaints were positively correlated with strategy use. Only in adults without SMC, a significant correlation was found between observed strategy use and task performance. CONCLUSION: Strategy use in older adults with SMC may be compensatory in nature, but did not increase their objective memory performance. Therefore, older adults with SMC might benefit from interventions aimed at optimizing strategy use.

Intelligence moderates the benefits of strategy instructions on memory performance: an adult-lifespan examination.

Whether older adults can compensate for their associative memory deficit by using memory strategies efficiently might depend on their general cognitive abilities. This study examined the moderating role of an IQ estimate on the beneficial effects of strategy instructions. A total of 142 participants (aged 18-85 years) received either intentional learning or strategy ("sentence generation") instructions during encoding of word pairs. Whereas young adults with a lower IQ benefited from strategy instructions, those with a higher IQ did not, presumably because they already use strategies spontaneously. Older adults showed the opposite effect: following strategy instructions, older adults with a higher IQ showed a strong increase in memory performance (approximately achieving the level of younger adults), whereas older adults with a lower IQ did not, suggesting that they have difficulties implementing the provided strategies. These results highlight the importance of the role of IQ in compensating for the aging-related memory decline.

Validity of an adapted scoring method for a Modified Six Elements Test in individuals with brain injury.

The Modified Six Elements Test (MSET) assesses several executive functions. We examined whether an adapted scoring method is appropriate for discriminating between brain-injured persons with and without executive deficits. A MSET was administered to 70 participants with acquired brain injury in the chronic phase. The group was divided into individuals with and without executive impairments based on several other executive tests. The discriminative value for both the conventional raw score and the adapted scoring method was evaluated using receiver operating characteristic analyses. Both scoring methods discriminated significantly between persons with impaired and unimpaired executive functions (raw score: area under the curve, AUC = 0.703, p = .004; adapted score: AUC = 0.780, p = .000). Only the adapted scoring method proved sensitive (81%) and specific (67%) within a clinically useful range. Within this range, an acceptable cut-off score could be determined. Altogether, the proposed MSET scoring index is a potentially clinically useful contribution to the measurement of executive functions.

Anti-epileptogenesis: Electrophysiology, diffusion tensor imaging and behavior in a genetic absence model.

The beneficial effects of chronic and early pharmacological treatment with ethosuximide on epileptogenesis were studied in a genetic absence epilepsy model comorbid for depression. It was also investigated whether there is a critical treatment period and treatment length. Cortical excitability in the form of electrical evoked potentials, but also to cortico-thalamo-cortical network activity (spike-wave discharges, SWD and afterdischarges), white matter changes representing extra cortico-thalamic functions and depressive-like behavior were investigated. WAG/Rij rats received either ethosuximide for 2 months (post natal months 2-3 or 4-5), or ethosuximide for 4 months (2-5) in their drinking water, while control rats drank plain water. EEG measurements were made during treatment, and 6 days and 2 months post treatment. Behavioral test were also done 6 days post treatment. DTI was performed ex vivo post treatment. SWD were suppressed during treatment, and 6 days and 2 months post treatment in the 4 month treated group, as well as the duration of AD elicited by cortical electrical stimulation 6 days post treatment. Increased fractional anisotropy in corpus callosum and internal capsula on DTI was found, an increased P8 evoked potential amplitude and a decreased immobility in the forced swim test. Shorter treatments with ETX had no large effects on any parameter. Chronic ETX has widespread effects not only within but also outside the circuitry in which SWD are initiated and generated, including preventing epileptogenesis and reducing depressive-like symptoms. The treatment of patients before symptom onset might prevent many of the adverse consequences of chronic epilepsy.