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In a big psychiatric hospital we began 1987 to practice cognitive training with our patients after teaching this therapy to male and female nurses. Now we report how this project found its development, which overall experiences there were made and which corrections still have to be done.
OBJECTIVE: To systematically review the literature and summarize the effect of cognitive training (CT) for Alzheimer's disease (AD) patients on multiple functional domains. METHOD: Effect sizes (Cohen's d) were calculated for 17 controlled studies identified through a comprehensive literature review. RESULTS: An overall effect size of 0.47 was observed for all CT strategies across all measured outcomes. Mean effect sizes were higher for restorative (0.54) than for compensatory (0.36) strategies. Domain-specific effect sizes ranged from 2.16 (verbal and visual learning) to -0.38 (visuospatial functioning). Data are also presented on the relative impact of restorative and compensatory strategies for each domain of functioning. CONCLUSION: CT evidenced promise in the treatment of AD, with primarily medium effect sizes for learning, memory, executive functioning, activities of daily living, general cognitive problems, depression, and self-rated general functioning. Restorative strategies demonstrated the greatest overall effect on functioning. Several limitations of the published literature are discussed.
An experiment was conducted to investigate the influence of Captain's Log (a computerized cognitive-training system) on the behaviors and performance capabilities of 4 severely emotionally disturbed children with Attention Deficit Hyperactivity Disorder (ADHD), ages 7 to 11. Behavioral scales, spectral electroencephalograms, and intelligence and performance tests were assessed pre- and posttreatment. A behavioral point system and monitoring of progress on computer tasks were used throughout treatment to evaluate ongoing improvements. There were 64 training sessions administered over a 16-week period. Outcome of treatment was determined by computer advancement, changes in behavioral points, and pre- and postmeasures. Results support the expectation that children who were most successful in the training would demonstrate the highest levels of generalization of those skills that were the focus of treatment.
OBJECTIVE: The objective was to investigate the impact of a verbal memory training task on psychiatric symptoms and cognition in schizophrenia. METHOD: As part of a larger, 6-month cognitive remediation program, 57 patients with schizophrenia were randomly assigned to receive performance-based, hierarchical training on a verbal memory task based on a dichotic listening (DL) with distracter paradigm. These patients were compared with 68 patients who had been randomly assigned to a control condition. RESULTS: Training on the DL task was not associated with changes in general psychopathology or auditory hallucinations (AH) specifically. Training was associated with improvements in verbal memory, but not attention. CONCLUSION: The current investigation adds to the growing literature on the effectiveness of cognitive remediation training and indicates that training on the DL task enhances verbal episodic memory. The results do not support the use of DL training as a method for reducing AH.
The impressive developments in research on disturbances of information processing in schizophrenia initiated the effort directed toward correction of these deficits. Studies on cognitive rehabilitation have generated some promising findings regarding the improvements in patients' cognitive and clinical status. However, there are important questions concerning strategies of cognitive training that must be addressed before its large-scale application in rehabilitation programs for schizophrenic patients.
Empirically supported treatments for schizophrenia now include a variety of psychosocial interventions, such as social skills training, vocational rehabilitation, and psychotherapy. As awareness of the functional importance of neurocognitive impairments in schizophrenia has increased, interest in treatments to improve cognition has grown. We review the literature on cognitive training (CT), which has been studied in 17 published randomized, controlled trials to date. The differential effectiveness of noncomputerized and computer-assisted interventions, with and without strategy coaching, and an environmental adaptation intervention, is examined. We conclude that the different types of approaches, whether computer assisted or not, all have effective components that hold promise for improving cognitive performance, symptoms, and everyday functioning. Our recommendations for further research, including the use of functional outcome measures and long-term followup, highlight the importance of improving ecological validity in this area of treatment research.
Modifications and adjuncts to traditional therapy techniques appear to be necessary for successfully treating hospitalized adolescents with impaired social and verbal skills, and a history of acting-out behavior. Modified therapy groups were combined with a structured biofeedback and cognitive training program to help these adolescents control anger and modify their behavior. Used in conjunction with training and practice in relaxation techniques, this multimodal treatment approach appeared to be helpful in both reducing incidents of acting out on residential units, and in reaching individualized therapeutic goals. The present paper describes use of this multimodal approach within selected residential settings, and outlines the structured materials developed by the authors.
A cognitive traning program that taught both self-instructional and self-management skills was used with three 7- to 8-year-old hyperactive children. A muultiple baseline across individuals design was used to evaluate the effects of training on on-task behavior and math accuracy. There were significant changes in math accuracy for all subjects, and two subjects showed significant improvements in on-task behavior. Evidence suggesting generalization to untrained behaviors was shown by an increase in self-correction or oral reading for all subjects. The results suggest that cognitive training specifically designed to promote generalization of classroom tasks can improve the classroom behavior and academic achievement of hyperactive children.
The paper deals with the evaluation of a computer-based cognitive group training programme for schizophrenic patients. The evaluation of the training results of 100 patients who participated in an earlier training scheme showed ceiling effects in up to 46% of the cases. In the remaining cases the improvements varied in a wide range between 1.6 and 20%. These results implied that the training had to be adapted more closely to the specific needs of the individual patient. To this end we developed criteria for each task to decide whether training in this task is necessary or the performance is sufficient. This approach limits training to those tasks in which patients display deficits. Satisfactory improvement terminating training for the specific task, is defined as an increase in correct responses of at least 10%. For those tasks in which reaction times are used as performance measure, the criterion is a 10% increase in percentile rank. An analysis of the new training programme with the data of 20 patients revealed that 27% of the tasks showed ceiling performance with no further training need. In the remaining tasks the patients' performance attained the training criterion in 68%, at instances mostly even after one additional session. These preliminary results indicate that the new training scheme is able to provide more flexibility, individualization and an enhanced focus on the patients' deficits.
Memory rehabilitation in dementia patients is gaining importance. Among the increasing number of people affected by Alzheimer's dementia (AD), the number detected in early stages of the disease is growing disproportionately quickly. The reasons are obvious: improved clinical assessment in the initial disease stage, increased sensitization of the elderly towards cognitive deficits, and the prescription of drugs retarding cognitive decline. Given the limited success of early training programs in the 1980s, skepticism towards cognitive training in dementia is still common among clinicians. However, recent international studies in the field give reason for cautious optimism. Memory therapy in the early-to-moderate stages of AD can be successful, if it is tailored to patients' individual daily problems and based on their residual cognitive capacities. The present paper gives an overview of recent findings in clinical and cognitive neuroscience which have led to a conceptual change in the memory rehabilitation of patients with dementia. Based on a review of general principles and rehabilitation techniques proven successful in recent research, recommendations are formulated for future studies evaluating cognitive therapy in dementia.
The significance of training programmes was assessed in reducing cognitive deficits in schizophrenics. In a controlled clinical trial, which included 15 experimental and 15 comparison subjects, training was shown to be effective with regard to more complex cognitive functions rather than on an elementary level. Results are discussed with regard to theoretical and practical implications.
This study evaluated the efficacy of two different group procedures of non-pharmacological treatment in mild-to-moderate Alzheimer's disease (AD). Thirty-two patients entered the study and were divided in groups of four subjects. We compared recreational activities ('global' stimulation) with a combination of procedural memory training on activities of daily living and neuropsychological rehabilitation of 'residual' functions ('cognitive-specific'). All patients and caregivers were ensured psychological support. Both group treatments were delivered for six weeks. Multidimensional efficacy assessment of functional, behavioural and neuropsychological aspects was performed. Patients receiving 'global' stimulation showed a substantial reduction in behavioural disturbances (Neuropsychiatric Inventory [NPI]: frequency p = 0.034; severity p = 0.012); Revised Memory Behaviour Problems Checklist (frequency p = 0.008; reaction p = 0.027), and better performance in the Functional Living Skills Assessment (FLSA), a standardized direct measure of performance in everyday life (p = 0.021) and Verbal Fluency for Letters (p = 0.000). Patients receiving 'cognitive-specific' treatment improved only on the scale evaluating functional competence in daily living (Nurses' Observation Scale for Geriatric Patients [NOSGER] p = 0.018). At follow-up (six months later), compared with baseline, patients following the 'global' stimulation treatment showed an improvement at caregiver distress on NPI (p = 0.04). No other significant difference was detected. Our results support the contention that a 'global' treatment can lead to a significant improvement in AD patients, both for behavioural and functional aspects. The 'cognitive-specific' treatment we used in this research did not show better efficacy.
Cognitive research on the plasticity of fluid intelligence has demonstrated that older adults benefit markedly from guided practice in cognitive skills and problem-solving strategies. We examined to what degree older adults are capable by themselves of achieving similar practice gains, focusing on the fluid ability of figural relations. A sample of 72 healthy older adults was assigned randomly to three conditions: control, tutor-guided training, self-guided training. Training time and training materials were held constant for the two training conditions. Posttraining performances were analyzed using a transfer of training paradigm in terms of three indicators: correct responses, accuracy, and level of item difficulty. The training programs were effective and produced a significant but narrow band of within-ability transfer. However, there was no difference between the two training groups. Older adults were shown to be capable of producing gains by themselves that were comparable to those obtained following tutor-guided training in the nature of test-relevant cognitive skills.
By systematic training, 14 psychogeriatric patients (aged 70 to 95 years and admitted to day care because of dementia) were taught the first names of 8 members of staff of the day care center. Treatment duration was one month, twice weekly. The therapist introduced the names by a step-by-step approach, beginning with two name-face combinations, and adding one new name (and photograph of that person's face) every next training session. Treatment consisted of a combination of several cognitive strategies: organisation and directed attention, rehearsal, first letter cueing and vanishing cue techniques, and paired-associate learning based on rhymes, pictures and visual imagery. Patients were assigned at random to a treatment and a control group (waiting list condition). Patients in the control group received their training after the waiting period of one month. Using this pretest-posttest-control-group design, we were able to objectively evaluate treatment effects. Treatment caused a significant enhancement of knowledge of staff members names. Gains achieved using this program persisted over at least one month, as could be demonstrated by a follow-up evaluation.
Research has demonstrated that older adults' cognitive performance can be enhanced via formal intervention, as well as more informal intervention including collaboration or working with a partner. The current study investigated the effects of an inductive reasoning training program adapted for in-home use among older adults assigned to individual training (n = 30), collaborative training (n = 34), or a no-treatment control group (n = 34). The training consisted of 10 sessions, and all participants completed a pretest followed by a post-test 6 weeks later. Findings suggest that older adults could effectively "train themselves" without the guidance of a formal instructor. The results, however, did not indicate immediate added benefit in reasoning performance for collaborative versus individual training using the current reasoning program.
The present paper presents data from ten patients suffering from mild to moderate Alzheimer's disease (AD), all of whom were trained to use an interactive computer-based program. Using photographs of the patient and his or her personal surroundings, an everyday task of relevance to the patient was simulated on a PC-touch screen, which the patient was trained to operate. After three weeks of training (three to four sessions a week), the patients needed less help in performing the programs, they became faster, and eight out of ten made fewer mistakes. The results were most pronounced in patients with a poor performance at the beginning, and there was no difference between early-onset (EO) and late-onset (LO) AD patients. Although the training was generally well received, there was no evidence of a general cognitive improvement, and it remains an open question whether the results achieved with PC training can be transferred to real-life situations.
Modeling, self-verbalization, and self-reinforcement techniques were used to train hyperactive children in more effective and less impulsive strategies for approaching cognitive tasks, academic problems, and social situations. Eighteen hyperactive children took part in the training program. The control group, which received no training, consisted of 11 children, matched with the experimental group on age, IQ, and measures of hyperactivity and impulsivity. Several tests and measures, some of which have been shown to differentiate between hyperactive and normal children, were administered prior to training at the end of the 3-month training period, and after a further 3-month period in which no training took place. The trained group showed significantly greater improvement on several of the measures, both at the time of posttesting and on the follow-up evaluation.
The present study evaluated the relationship between skin-temperature biofeedback training for a nonclinical child population and several cognitive and developmental factors. 49 children were randomly assigned to control, standard feedback, or novel feedback conditions. State-anxiety, trait-anxiety, and depression scores improved for all groups. Health locus of control scores improved significantly for children receiving standard feedback. Children receiving biofeedback increased skin temperature regardless of their age, sex, or intellectual functioning.