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[Modular memory training for elderly adults: concept and evaluation].

We present a modular concept of a cognitive training relevant to the demands of everyday life of community dwelling older adults. The concept has three major advantages. First, it takes into account the current performance levels and needs of the trainees. Second, the training is economical in aiming at selecting the most effective training elements. Third, the concept allows the evaluation of single elements of the training. The application of this concept points at the importance of training content being relevant to trainees' everyday lives. Results indicate that training effectiveness depends on the starting level of performance and the cognitive domain being trained. Overall, the results demonstrate the possibility to maximize training gains of older adults by designing adequate trainings for well-defined subgroups of normal older adults.

Activities of Daily Living↗

Patient-treatment matching for alcoholic men in communication skills versus cognitive-behavioral mood management training.

It would be helpful to be able to predict which alcoholics will be more likely to benefit from specific forms of treatment in order to optimize treatment resources. Certain hypothesized patient-treatment matching predictions were investigated with 52 alcoholics who received either communication skills training or cognitive behavioral mood management training in addition to a standard Veterans Administration inpatient alcoholism treatment program. Significant interaction effects showed that alcoholics had worse treatment outcomes in mood management training if they had higher initial anxiety or urge to drink in high-risk role plays or lower had higher initial anxiety or urge to drink in high-risk role plays or lower education. No significant interaction of treatment with irrational beliefs or marital status was found. Communication skills training seemed to be equally effective for alcoholics at any educational level, irrespective of initial coping skill, anxiety, urge to drink, alcohol dependence, or marital status. Thus, although mood management training seems to be as effective as communication skills training for alcoholics with higher education, less anxiety, and less urge to drink, communication skills training benefits a broader spectrum of patients, regardless of initial level of education, alcohol dependence, skill, anxiety, or beliefs.

Adult↗

Neuropsychology and multiple sclerosis: diagnostic and rehabilitative approaches.

The frequency of cognitive deficits in multiple sclerosis (MS) patients is rather high and the estimates vary between 43% and 72% depending on the patient samples studied as well as on the methods of cognitive assessment. Despite the great impact of cognitive dysfunction on several aspects of the quality of life, the importance of accurate assessment and rehabilitation of neuropsychological deficits in MS patients has long been ignored. In this article, we first describe tests for the assessment of impairments, disabilities and handicaps. We emphasize that after screening with brief assessment instruments, detailed testing of the basic target deficits is mandatory for the planning of special cognitive training programs. Second, the correlation of certain cognitive deficit patterns with important magnetic resonance imaging (MRI) variables such as total lesion area, size of the corpus callosum and specific lesion location is outlined in detail. Third, some recommendations are made with regard to general rehabilitation principles such as restitution, compensation and adaptation as well as for special rehabilitation techniques including cognitive retraining of basic deficits and/or training of activities of daily living. Finally, we emphasize that there is a need for the development of tailor-made neuropsychological rehabilitation techniques for MS patients, which take into account the course and stage of the disease as well as the specific psychosocial problems of the individual patient.

Adult↗

Brief cognitive and relaxation training increases tolerance for a painful clinical electromyographic examination.

We examined the effect of cognitive and/or relaxation training on the tolerance for a painful one and one-half hour clinical electromyographic (EMG) examination, which includes multiple electric shocks to nerves and multiple insertions of needle electrodes into muscles. Four groups of 10 males each received training as follows: (i) cognitive only, (ii) relaxation only, (iii) cognitive plus relaxation, and (iv) neither cognitive nor relaxation (control). The three trained groups tolerated the EMG study better than the control group as judged by assessments by "blind" observers, self-ratings, and measurements of heart rate. However, none of the training sessions was clearly superior to the other two types of training. We recommend cognitive relaxation training be used in the clinical setting to increase tolerance for painful medical procedures.

Attention↗

Cognitive flexibility but not cognitive coordination is affected in rats with toxic liver failure.

Hepatic encephalopathy (HE), a consequence of liver damage, is associated with cognitive deficits. In this study, behavioral activity, non-associative learning, associative memory, cognitive coordination and flexibility were investigated in rats with subclinical HE evoked by thioacetamide treatment. Non-associative learning was studied in the open field (OF) set up in 12 HE and 8 saline-injected control rats (C). Memory was examined in spatial place avoidance tasks in 10 HE and 10 C rats. The Room+ Arena- task involved the selection of distal room stimuli from irrelevant arena stimuli (i.e. intramaze cues and/or self-motion information), which engages processes of cognitive coordination. Following the Room+ Arena- training, cognitive flexibility of rats was tested in the Arena+ place avoidance condition, which demands the previously ignored stimuli from arena. In the OF test HE and control rats behaved similar. They displayed high activity in the first block of each session and this pattern was stable. In both groups of rats darkness enhanced locomotor activity in comparison to light only in the first block. The HE and C rats avoided the to-be-avoided place in the Room+ Arena- task, whereas only HE rats were affected in the Arena+ task. In conclusion, these results demonstrate cognitive inflexibility in HE rats. We suggest that (1) the behavioral changes in the TAA model are typical of subclinical HE and (2) test for cognitive flexibility may be modified towards a routine use in patients with subclinical HE.

Adaptation, Psychological↗

Preventing cognitive decline.

Many studies of age-related cognitive decline have failed to distinguish between usual and successful aging. Although some degree of cognitive impairment is associated with aging, when one looks at average performance, there is great variability among individuals, with many showing little or no deleterious effects of aging on intellectual abilities. Many of the risk factors for dementia and for conditions associated with cognitive impairments can be treated or controlled. Among the preventable causes of cognitive decline are the following: AIDS, Alcohol and drug abuse, Cerebrovascular disease, Exposure to organic solvents or lead, Head trauma, Overmedication, Syphilis. Other conditions that may cause cognitive decline can be controlled or treated: Atherosclerosis, Depression, Diabetes, Emphysema, High blood pressure, Obesity, Sleep disorders, Thyroid dysfunction. In addition, it may be possible to enhance the cognitive performance of even healthy elderly people through changes in diet and lifestyle. Recent data raise the possibility that improved prenatal and perinatal care and greater access to educational opportunities may result in a decreased incidence of dementia in future generations of older adults. Although they are rapidly becoming more numerous, the efficacy of cognitive training programs in preventing or slowing cognitive decline has not yet been demonstrated. Nevertheless, such programs may ameliorate cognitive impairment by reducing the psychiatric disabilities associated with anxiety and depression. The general principle underlying these strategies for limiting cognitive impairment with age is to maximize brain reserve and minimize brain damage.

Aging↗

[Gedächtniszentrum Erlangen (Memory Centre Erlangen) - Gerontopsychiatric Day-Care]

Two years ago the multiprofessional team of the Memory Centre Erlangen took up its work. Besides complete diagnoses of the cause of memory impairment, the work of the Memory Centre focusses on a special cognitive stimulation intervention. After completing assessment, namely self- and non-self anamnesis, psychometric tests and medical examinations, an individual treatment program for every patient will be development. In most instances the treatment program includes the participation in a special cognitive training. Adapting the SIMA-Program, psychomotor exercises, encoding strategies, retrieval techniques, attention and general cognitive speed arc trained in a group of 10 memory-impaired patients. After the 12-week treatment period a postintervention assessment is conducted in the same order as the preintervention assessment to evaluate the efficacy of the treatment. The data of a first evaluating study limited by sample size (20 patients) reveale that this intervention effects in a positive way the patient's cognitive performance. Patients with MCI (Mild Cognitive Impairment) show significant improvement in attention, general cognitive speed and short-term memory. Even patients with a dementia-diagnosis appeare to benefit from the cognitive stimulating intervention: After a 12-week time period no deterioration of cognitive ability is observed. Besides in attention, general cognitive speed and short-term memory an improvement can be reported.

Journal Article↗

[Erlangen Memory Center--a partial inpatient gerontopsychiatric facility].

Two years ago the multiprofessional team of the Memory Centre Erlangen took up its work. Besides complete diagnoses of the cause of memory impairment, the work of the Memory Centre focusses on a special cognitive stimulation intervention. After completing assessment, namely self- and non-self anamnesis, psychometric tests and medical examinations, an individual treatment program for every patient will be development. In most instances the treatment program includes the participation in a special cognitive training. Adapting the SIMA-Program, psychomotor exercises, encoding strategies, retrieval techniques, attention and general cognitive speed arc trained in a group of 10 memory-impaired patients. After the 12-week treatment period a postintervention assessment is conducted in the same order as the preintervention assessment to evaluate the efficacy of the treatment. The data of a first evaluating study limited by sample size (20 patients) reveal that this intervention effects in a positive way the patient's cognitive performance. Patients with MCI (Mild Cognitive Impairment) show significant improvement in attention, general cognitive speed and short-term memory. Even patients with a dementia-diagnosis appeare to benefit from the cognitive stimulating intervention: After a 12-week time period no deterioration of cognitive ability is observed. Besides in attention, general cognitive speed and short-term memory an improvement can be reported.

Adult↗

Reduction of cancer-specific thought intrusions and anxiety symptoms with a stress management intervention among women undergoing treatment for breast cancer.

OBJECTIVE: After surgery for breast cancer, many women experience anxiety relating to the cancer that can adversely affect quality of life and emotional functioning during the year postsurgery. Symptoms such as intrusive thoughts may be ameliorated during this period with a structured, group-based cognitive behavior intervention. METHOD: A 10-week group cognitive behavior stress management intervention that included anxiety reduction (relaxation training), cognitive restructuring, and coping skills training was tested among 199 women newly treated for stage 0-III breast cancer. They were then followed for 1 year after recruitment. RESULTS: The intervention reduced reports of thought intrusion, interviewer ratings of anxiety, and emotional distress across 1 year significantly more than was seen with the control condition. The beneficial effects were maintained well past the completion of adjuvant therapy. CONCLUSIONS: Structured, group-based cognitive behavior stress management may ameliorate cancer-related anxiety during active medical treatment for breast cancer and for 1 year following treatment. Group-based cognitive behavior stress management is a clinically useful adjunct to offer to women treated for breast cancer.

Adaptation, Psychological↗

Cognitive remediation in ADHD: effects of periodic non-contingent alerts on sustained attention to response.

Few studies have attempted direct cognitive remediation of attention deficits in attention-deficit hyperactivity disorder (ADHD). The present study investigated the efficacy of periodic non-informative alerting cues for improving sustaining attention in ADHD. This technique is known to improve sustained attention in right frontal injury patients and may be effective in ADHD, given that this disorder has also been linked with right frontal dysfunction. Fifteen children with ADHD and 15 matched controls completed four blocks of a modified version of the Sustained Attention to Response Task (SART). Eight random non-contingent alerts were introduced on two of these blocks as a cue for participants to adopt a more supervisory stance to their performance. While the alerting cues did not alter the total number of commission errors committed by ADHD children over a task block, they did produce a significant short-term reduction in commission errors in the period immediately following an alerting cue. Our data demonstrate that sustained attention performance can be enhanced in children with ADHD using a simple cognitive training strategy. Methods from the field of cognitive rehabilitation may be viably applied to the remediation of attention deficits in ADHD.

Adolescent↗

Family practice residents and the elderly: fostering positive attitudes.

The population of elderly patients is steadily growing. Because physician attitudes toward caring for elderly patients are often negative, it is important to identify aspects of training that lead to favorable attitudes toward the practice of geriatrics. This study investigated the relationships among past casual experiences, educational experiences, level of training, faculty attitudes, and current resident attitudes. All Louisiana family practice residents (72) and program faculty members (35) were surveyed, with response rates of 69% and 86%, respectively. Residents generally held positive attitudes toward the elderly. Variables associated with positive resident attitudes were the amount of didactic training and faculty attitudes. No differences were found among the attitudes of residents at different levels of training. These findings highlight the importance of cognitive training and role modeling in geriatrics. Educational settings in which training occurs--classrooms, ambulatory care facilities, hospitals, and nursing homes--deserve careful consideration.

Aged↗

Fitness, aging and neurocognitive function.

In this manuscript we provide a brief review of the recent literature that has examined the relationship among fitness training, cognition and brain. We began with a discussion of the non-human animal literature that has examined the relationship among these factors. Next we discuss recent epidemiological studies of the relationship between physical activity and fitness and cognition and age-related disease such as Alzheimer's dementia. We then discuss the results of randomized clinical trials of fitness training on human cognition. Finally, we conclude with a review of the nascent literature that has begun to employ neuroimaging techniques to examine fitness training effects on human brain. In general, the results are promising and suggest that fitness may serve a neuroprotective function for aging humans.

Aging↗

Good wine may need to mature: a critique of accelerated higher specialist training. Evidence from cognitive neuroscience.

CONTEXT: Higher specialist training in the UK is to be further shortened in the absence of any valid educational evidence for the wisdom of this move. Some practitioners/teachers are becoming increasingly concerned at this. THESIS AND DISCUSSION: Whereas the optimum length of time for such training is as yet undetermined, there is much in medical practice that resonates with the thinking of recent authors, who recommend slow incubation and facilitated reflection on experience, which steeps the learner in a hidden curriculum of practice, and entrains intuitive, "slow mode" thinking. This engagement necessarily takes time. The author has surveyed some of the recent literature on problem solving, cognitive neuroscience, artificial intelligence and learning for practice, and discusses his conclusions. These are unsettling. CONCLUSION: Further truncation of the length of higher specialist training must be supported by robust educational evidence that supports this reduction. The author advises caution.

Education, Medical↗

BRAIN-Diabetes: Acceptability of an adapted FINGER multidomain intervention among adults living with type 2 diabetes in rural border regions across the island of Ireland.

BackgroundIndividuals with type 2 diabetes mellitus (T2DM) face increased risk of cognitive decline and dementia. Multidomain lifestyle interventions offer a non-pharmacological strategy to support brain health in this high-risk group.ObjectiveThis study examined the acceptability of a culturally adapted FINGER-based intervention among adults living with T2DM in rural border regions of Ireland (BRAIN-Diabetes Trial).MethodsA 6-month pilot randomized controlled trial was conducted. The intervention group received a multidomain program targeting diet, physical activity, and computerized cognitive training (CCT). The control group received standard care. Acceptability was assessed using questionnaires (all participants) and semi-structured interviews (intervention participants). Quantitative data were analyzed descriptively and qualitative data using template analysis, guided by four a-priori themes: trial participation and engagement, dietary behavior change, exercise behavior change, and CCT behavior change.ResultsQuestionnaire data (intervention: n = 28; control: n = 36) indicated high overall acceptability. Dietary and exercise components were rated most positively, while CCT component was less well received. Interviews (n = 25) highlighted facilitators to trial engagement, including perceived health improvements, and social connection, with time constraints and limited personalization as barriers. Dietary change was supported by tailored guidance but hindered by cost and availability. Facilitators for exercise included accessible resources and perceived benefits, with barriers including competing priorities. CCT engagement was mixed, with challenges including digital access and repetitiveness.ConclusionsThe Brain-Diabetes intervention was acceptable and feasible among adults with T2DM. Personalized support and accessible resources were key to engagement. Future work should refine delivery to enhance scalability and long-term adherence among high-risk groups.

Humans↗

Learning potential as a predictor of readiness for psychosocial rehabilitation in schizophrenia.

It has been suggested that learning potential (LP), a patient's ability to benefit from training and practice, may mediate the relationship between cognition and functional outcome. Aims of this study were to (1) assess whether performance on a verbal memory-based measure of LP is associated with readiness for psychosocial rehabilitation; and (2) assess whether explicit cognitive training in memory strategies improves task performance beyond any implicit learning of organizational strategies that occurs with repeated exposure to to-be-learned material. Fifty outpatients with schizophrenia or schizoaffective disorder were administered three different versions of a list-learning test, the California Verbal Learning Test (CVLT-II). Some patients also received explicit training in semantic memory strategies before administration of the second word list. Based on performance across the three assessments, participants were categorized as "learners", "high scorers", and "non-learners". Participants were also administered the Micromodule Learning Test (MMLT), a measure that predicts performance in manualized skill training groups. LP categorization was associated with performance on the MMLT. High scorers performed better than the other two groups, and as found in earlier studies, education level was associated with performance for the learners. Explicit semantic clustering training was associated with increases in the use of the trained strategy.

Adult↗

Comparison of cognitive therapy and relaxation training for panic disorder.

Current approaches to the treatment of panic disorder (PD) include a treatment package consisting of relaxation training (RT), cognitive therapy (CT), and exposure-based components. In an examination of the separate effects of RT and CT without formally taught exposure of any form, 64 PD patients were assigned randomly to one of these treatment protocols or to a minimal-contact control (MCC) condition. Both RT and CT were superior to the MCC condition on a variety of measures pertaining to panic, global psychological functioning, agoraphobic fear, and other associated fears. A significantly greater percentage of patients were classified as treatment responders (based on a composite index) after CT (82%) and RT (68%), compared with the control group (36%). On measures of agoraphobic fear, CT patients fared slightly better than RT patients. Some support was demonstrated for specific cognitive changes after CT, although treatment specificity was not strongly supported overall. These results are discussed in light of current theories of PD and the presumed importance of exposure in its treatment.

Adolescent↗

[Early intervention in increased risk for schizophrenic illnesses. Multimodal psychotherapy--antipsychotic drugs only in treatment failure].

Interventional strategies for the prodromal phase of schizophrenia are based largely on treatment concepts that have already been shown to be effective for the prevention of relapses. Such a multimodal concept for early psychotherapeutic intervention has been developed at the psychiatric department of the University of Cologne. This model emphasizes individual symptom-oriented cognitive/behavioral treatment and psychoeducation directed both to the patient and his/her contact person(s). In addition, stress and symptom management, training of social skills and computer-aided cognitive training tailored to individual needs are also offered. In contrast, pharmacological treatment is considered only when, despite the above-mentioned strategy, the clinical picture worsens appreciably and attenuated psychotic symptoms have appeared.

Antipsychotic Agents↗

[Social phobia: clinical and therapeutic approach].

Although social phobia is a real pathological condition, it has often been neglected. In fact, social phobia is among the least studies of the major anxiety disorders. This is quite surprising, as approximately 2% of the population suffer from debilitating social phobia with devastating effects on career and quality of life, and as this disorder can now be considered as a treatable condition. After defining social phobia, the authors will describe the prevalence, clinical features and etiology of social phobia. Effective psychopharmacological and psychological treatments of social phobia will also be reviewed. The drugs that have been most studied are monoamine oxidase inhibitors and beta-blockers. Several controlled studies have also concluded that behavioral and cognitive therapies (exposure in vivo therapy, social skills training, cognitive restructuring) are beneficial for social phobics. The combination of psychopharmacotherapy and psychological interventions also seems promising. Finally, as it is necessary to distinguish among various subtypes of social phobia, further studies will have to investigate whether specific subtypes do better or worse with specific treatments.

Cognitive Behavioral Therapy↗