Computerized Cognitive Training Research

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 Psychological Studies
Brain Injury/Stroke
ADD/ADHD
Age related cognitive decline

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 Psychological Studies

Neurocognitive Enhancement Therapy With Work Therapy:
Effects on Neuropsychological Test Performance

The purpose of this study was to determine whether computerized cognitive training combined with work therapy would improve performance on neuropsychological tests more effectively than work therapy alone in patients with schizophrenia. It was found that as many as 60% of the patients receiving the combined intervention approach improved on some measures, and these individuals were four to five times more likely to show large effect-size improvements. The number of patients with normal working memory performance increased from 45% to 77%, compared with a decrease from 56% to 45% for those receiving work therapy alone. These results demonstrate that the benefits of computerized cognitive training for cognitive dysfunction in patients with schizophrenia can generalize to independent outcome measures.

Patients with chronic psychiatric disorders have been found to have neuropsychological deficits. This study examined the effectiveness of computer administered cognitive rehabilitation on 69 inpatients diagnosed with psychotic disorders at a V.A. Medical Center. The treatment group (N = 40) showed significant improvement on most memory subtests of the Wechsler Memory Scale, as well as on the Trailmaking Test (Parts A and B), and reported significantly fewer cognitive complaints. Control subjects (N = 29) showed no changes on these variables. These results indicate that psychiatric patients can productively work with computers, and that computer-assisted cognitive rehabilitation can produce short-term improvements in psychiatric inpatients' cognitive performance.

Computer-Assisted Cognitive Rehabilitation Reduces Negative Symptoms in the Severely Mentally Ill
Reference: Schizophrenia Research,Volume 59, 2002, pages 225 - 232
Authors: Dona M. Bellucci, Kathryn Glaberman, and Nick Haslam
Summary by Joseph A. Sandford, Ph.D.

The authors of this article hypothesized that computer assisted cognitive rehabilitation (CACR) would lead to improvement in basic cognitive function in schizophrenics, and that these improvements were likely to lead to better functioning in general life, including improvements in social or vocational skills and psychosocial interactions with others. Thirty-four subjects who were attending a day treatment program for schizophrenics were selected for this study and were randomly assigned to two groups of 17. It was determined that each group had equivalent levels of dysfunction and impairment. Pre- and post-test measures included Trail Making Test from the Halstead-Reitan Neuropsychological Test Battery, the Wechsler Memory Scale - 3^rd Edition, a mini-mental status exam, the Scale for the Assessment of Negative Symptoms (SANS), and the Rosenberg Self-Esteem Scale. It is important to note that the tests administered were not the same as any of the training exercises.

The treatment group received a total of two ½-hour sessions per week of CACR training for 8 weeks, bringing the total training time to 8 hours. The programs used for training, selected from the Captain’s Log Cognitive Training System, required auditory discrimination of rhythm and tones, response inhibition, spatial orientation, visual memory, visual discrimination of abstract patterns and of relative size, numerical concepts involving distance and value, numerical sequencing, and concepts of relative numerical magnitude. Difficulty progression was based on specified improvements and performance. Progression to the next level of difficulty was based on achieving a preset performance goal.

The trainers, who were blind to the subject groups' status, provided general reinforcement and encouragement but did not help the individuals with any specific feedback.

Comparing the treatment to the non-treatment group, the researchers found eight significant effects including reduction of negative symptoms and significant changes in mental flexibility, memory, verbal conceptual learning, attention, and in testing involving functionality in real-life situations. No specific changes in self-esteem were found.

These research findings are important for two reasons. The cognitive improvements that were found are those that are likely to contribute to real-life functioning. Also, the reduction of negative symptoms in schizophrenics has now been demonstrated for the first time in a research study

Brain Injury/Stroke

Over 95% of rehabilitation facilities who serve individuals with brain injuries and strokes provide cognitive rehabilitation. This landmark, meta-analysis study, which reviewed 171 published articles, found compelling evidence of the effectiveness of cognitive rehabilitation for the remediation of attention, memory, functional communication and higher level executive skills. The article provides specific, evidence-based recommendations for cognitive rehabilitation to help guide clinicians in their work.

Rehabilitation of Persons with Traumatic Brain Injury

"Cognitive exercises, including computer-assisted strategies, have been used to improve specific neuropsychological processes, predominantly attention, memory, and executive skills. Both randomized controlled studies and case reports have documented the success of these interventions using intermediate outcome measures. Certain studies using global outcome measures also support the use of computer-assisted exercises in cognitive rehabilitation."

ADD/ADHD

This case study was one of the first to find cognitive training to be an effective non-drug treatment approach for individuals with ADHD. This research involved a 13-year-old Caucasian male who was diagnosed with ADHD. The researchers used the Captain’s Log^® cognitive training system to systematically train the subject for a total of 35 sessions. Informal verbal reports from the parents and teacher of the youth indicated that this individual’s behavior had significantly improved. According to his teacher, he was able to stay on task longer and was less disruptive in class. His grades also significantly improved from failing grades to above average performance. His mother noticed that she did not have to spend as much time monitoring his behavior.

These researchers reported that computerized cognitive training was well received by this young man. He enjoyed the tasks and liked the intrinsic rewards that were associated with completing the tasks. In addition, the researchers stated that computer-assisted cognitive training programs such as Captain’s Log^® can be easily adapted into classroom settings, since most school systems make computers available to pupils.

For this individual the traditional treatments used to treat ADHD, which included medication, along with individual and group therapy, had not proven to be helpful. Cognitive training did lead to improvements in school and home functioning. These improvements were generally maintained seven months after the treatment was concluded. Sufficient functional improvement was obtained that it was possible to successfully mainstream this student. On followup he was still in regular classes and was reported by his mother to be coping well and meeting the demands of his schoolwork.

Reference for this study:

Kotwal, D.B., Burns, W.J., & Montgomery, D.D. (1996). Computer-assisted cognitive training for ADHD. Behavior Modification, 20, 85-96.

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 post-treatment. 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 post-measures. 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.

A study conducted at the Center for the Study of Special Populations (See note below.) was designed to evaluate the effectiveness of commercially available computerized cognitive training (Captain's Log) and neurofeedback (EEG brain wave biofeedback) treatment in helping to improve the functioning of children diagnosed as having an ADHD disorder. A total of 67 participants (85% males) between the ages of 8 and 11, and diagnosed by either a physician or a psychologist as having ADHD, completed the study. The volunteers were randomly assigned to the following three groups: 1) Cognitive Training, 2) Neurofeedback or 3) No Treatment. Each person in the two treatment groups was provided 20 half- hour sessions over a 10 week period. A battery of tests and parent rating scales were administered at the beginning and end of the study using test examiners who were "blind" to group affiliation.

These tests supported the efficacy of the Captain's Log computerized cognitive training system in helping to significantly improve the ability to focus and sustain attention, to encode and retrieve visual and auditory information and to increase the speed of mental processing. Cognitive training also significantly improved emotional and psychological functioning by apparently decreasing ADHD symptoms. One test rating scale of Hyperactivity also showed significant decreases in ADHD symptoms. On another scale of Hyperactivity no decreases were observed, possibly because this group's mean scale score to start was already below the clinical cut-off level for Impulsive-Hyperactive behaviors.

Neurofeedback treatment was found to be more specific in its benefits, and the evidence indicates that this treatment helped to reduce impulsive, hyperactive, and off-task behaviors for individuals who initially presented as significantly more impaired than the other two treatment groups in terms of Impulsive-Hyperactive behaviors. At the end of treatment for this group of individuals, the mean score, which was initially clinically elevated based on the Conner's Impulsive- Hyperactive scale, decreased to below the clinical cut-off level. However, only the one area of memory related to an increased ability for immediate auditory recall showed improvement, and verbal recall of a story significantly declined. Thus, the neurofeedback treatment did not seem as reliable or broadly effective in improving attention, concentration and memory skills as cognitive training. While our understanding of who will best benefit from cognitive training and neurofeedback and how these new techniques may best be used is limited at this time, it is hoped that these findings will encourage further controlled research in these areas.

Finally, of great interest is the surprising finding of this study that no treatment at all of children with ADHD during the summertime led to a pervasive worsening of their emotional and behavioral problems. The No Treatment group also showed no gains whatsoever in cognitive functioning on the objective tests. It is not clear to this researcher what kind of activities (e.g., camp, day care, summer school, vacations, etc.) these children participated in during the summer. However, the lack of regular tasks and exercises demanding focused attention, concentration, sitting still and increasing response inhibition clearly appears to be detrimental to the mental health and well being of ADHD children.

Based on this research, these new techniques show great promise as components in the multi-modal treatment of ADHD. It may prove beneficial to combine cognitive training and neurofeedback for some individuals. The traditional approaches of psychotherapy, behavior modification, school modifications, family therapy and parent education can all be integrated and combined with these new approaches. While our understanding of who will best benefit from cognitive training and neurofeedback and how these new techniques may best be used is limited at this time, it is hoped that these findings will encourage further controlled research in these areas.

Note: This analysis is based on independently conducted research completed during the Summer of 1993 at the Center for the Study of Special Populations, California State Polytechnic University, Pomona, California, by Drs. Aubrey Fine and Larry Goldman. The interpretation and views expressed in this analysis of the study's findings are those solely of Dr. Sandford who has the other authors' permission to disseminate their findings and his own analysis of the results.

Age related cognitive decline

In the first population-based study of cognitive impairment in the United States, nearly one in four older African Americans in Indianapolis were found to have measurable cognitive problems (short of dementia or Alzheimer's). The prevalence of cognitive impairment grew significantly with age, with rates increasing by about 10 percent for every 10 years of age after age 65. Of those aged 85 and older, 38% had some degree of cognitive impairment. Surveys in other countries (which cannot be directly compared due to differences in methodology, diagnostic criteria, etc) have reported results ranging from 10.7% in Italy to 26.6% in Finland.

Cognitive training programs can reverse cognitive impairment. The Seattle Longitudinal Studies of adult intelligence suggested that the observed decline in many mature adults is probably a function of disuse and is often reversible. It is heavily documented that cognitive function (memory, reasoning, problem-solving, etc) declines with age. However, age related memory decline by itself could sometimes be associated with physical factors.

It was found that some 2/3 of participants in cognitive training programs showed significant improvement, and 40% of those who had declined significantly were indeed returned to their earlier (pre-decline) level of cognitive functioning. These training gains were retained for over seven years.

Many of the cognitive deficits associated with advancing age are related to functions of the prefrontal cortex such as working memory, decision-making, planning, and judgment. Postmortem examination of 20 brains ranging in age from 25 to 83 years, confirm that prefrontal regions may be particularly sensitive to the effects of aging. It also appears that white matter decreases at a faster rate than grey matter with age.
The findings were presented to the annual Society for Neuroscience meeting in San Diego, US. August 2001

Studies of more than 350 men and women between the ages of 20 and 90 have found that cognitive decline starts as early as the twenties, and this decline in cognitive processing power appears to be constant - that is, the rate of decline is the same when you are in your twenties as when you are in your sixties. However, young adults do not notice this decline because the loss has not yet become great enough to affect everyday activities.
Denise Park, who directs the Center for Aging and Cognition at the University of Michigan Institute for Social Research (ISR) presented a paper on these studies on Aug. 24 in San Francisco at the annual meeting of the American Psychological Association.
http://www.umich.edu/~newsinfo/Releases/2001/Aug01/r081301a.html

Certainly, it seems that, cognitive decline is less in those who engage more frequently in cognitively stimulating activities. Cognitive training programs are the perfect stimulation to prevent or reverse cognitive impairment in many adults.

For additional reading click here (Training Improves Age-Related Memory Decline) . This article tells you why cognitive training works.

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