RESUMO
BACKGROUND: "Cancer Related Cognitive Impairment" (CRCI) defines cognitive disorders related to cancer and its treatments. Many people with breast cancer experience signs of CRCI (incidence between 20 and 30 %) and, although several intervention options exist, there is no established standard of care. Our main objective was to provide a detailed description of the methods and results of randomized controlled trials of interventions for CRCI in breast cancer survivors, paying particular attention to the timing of the interventions within the care pathway. METHODS: We conducted a systematic literature review following the PRISMA guidelines from 01 to 01-2019 to 16-07-2023 and included randomized controlled trials of interventions for CRCI after breast cancer with at least one objective cognitive assessment as a primary or secondary outcome. RESULTS: Among 228 identified studies, 35 (including 2821 participants) were retained for inclusion. The interventions were classified into 4 categories: cognitive rehabilitation, physical activity, complementary therapy and pharmacological treatment. Our analysis revealed that pharmacological interventions have no effect, whereas physical activity interventions proposed in the months following the initial cancer treatment improve Quality of Life and Speed of Information Processing while interventions proposed later improve Memory and Attention (Cognitive Rehabilitation) and Perceived Cognitive Function and Depression/Anxiety/Mood (Complementary Therapies). CONCLUSION: CRCI is multifactorial and affected individuals frequently experience high levels of fatigue, pain, anxiety and depression and are most likely to benefit from holistic approaches that include cognition, physical activity, relaxation, psychoeducation, group support and/or psychological counselling. Thus, rehabilitation programs should be designed on multi-modal approaches, using innovative, cost-effective delivery methods that increase access to treatment, and intervention outcomes should be evaluated using measures of participation. DATABASE REGISTRATION: The review was recorded on Prospero (01-03-2020), with the registration number 135,627.
Assuntos
Neoplasias da Mama , Disfunção Cognitiva , Feminino , Humanos , Neoplasias da Mama/reabilitação , Neoplasias da Mama/psicologia , Neoplasias da Mama/complicações , Sobreviventes de Câncer/psicologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/reabilitação , Terapias Complementares/métodos , Exercício Físico , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Non-pharmacological interventions effective for depressive mood and bilateral relationships among persons with cognitive impairment (PwCI) and their family caregivers (FCGs) have not been established. OBJECTIVE: To examine the feasibility of a newly developed group-based art appreciation and self-expression program (NCGG-ART) for dyads of PwCI and their FCGs. METHODS: This pilot randomized control trial included 34 dyads of PwCI diagnosed with mild to moderate Alzheimer's disease or mild cognitive impairment, and their FCGs, from an outpatient rehabilitation service (Holistic Physio-Cognitive Rehabilitation [HPCR]). Participants were randomly divided equally into the HPCR (control group) or NCGG-ART and HPCR (intervention group) groups. Both included 1-hour weekly, 6-week programs. The primary outcome was depressive symptoms among FCGs assessed using the Patient Health Questionnaire-9 (PHQ-9). Feasibility outcomes included participant satisfaction and motivation. FCGs were interviewed about their experiences and feelings regarding the program, which were analyzed using content analysis. RESULTS: Thirty-two dyads (intervention group:16; control group:16) completed the study period. High participation rates, satisfaction, and motivation were demonstrated throughout the intervention. Scores in the PHQ-9 among FCGs did not show positive effects: mean changes in the score were 1.3 for the intervention group and -0.8 for the control group (Cohen d:0.56). However, the qualitative analysis revealed favorable experiences and feelings of the FCGs, such as positive emotions, social interactions, and person-centered attitudes to and positive relationships with PwCI. CONCLUSIONS: This program demonstrated high feasibility with FCGs' favorable responses to emotions and relationships with PwCI, ensuring future investigations with a confirmatory study design.
Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Humanos , Cuidadores/psicologia , Disfunção Cognitiva/reabilitação , Emoções , Estudos de Viabilidade , Projetos PilotoRESUMO
INTRODUCTION: Vascular cognitive impairment (VCI) has an increasing prevalence worldwide, accounting for at least 20%-40% of all diagnoses of dementia. The decline in cognitive function seriously impairs patients' activities of daily living and social participation and reduces their quality of life. However, there is still a lack of advanced, definitive rehabilitation programmes for VCI. Hyperbaric oxygen therapy (HBOT) and repetitive transcranial magnetic stimulation (rTMS) are recognised treatments for improving cognitive impairment. The former can restore oxygen supply in the brain by increasing oxygen partial pressure in brain tissue, while the latter can enhance neuronal excitability and promote synaptic plasticity. However, no studies have explored the effect of HBO combined with rTMS on VCI. METHODS AND ANALYSIS: This study is designed as a single-centre, assessor-blind, randomised controlled clinical trial with four parallel arms. A total of 72 participants will be recruited and randomly assigned to the control group, HBOT group, rTMS group and HBOT combined with rTMS group at a ratio of 1:1:1:1. All enrolled participants will receive conventional treatment. The entire intervention period is 4 weeks, with a 3-week follow-up. Outcomes will be measured at baseline (T0), after a 4-week intervention (T1) and after an additional 3-week follow-up period (T2). The primary endpoint is the Montreal Cognitive Assessment score. The secondary endpoints are Mini-Mental State Examination score, Modified Barthel Index score, latency and amplitude of P300, cerebral cortical oxygenated haemoglobin (HbO2) and deoxygenated haemoglobin (HbR) concentrations as measured by task-state functional near-infrared spectroscopy. ETHICS AND DISSEMINATION: Ethics approval was obtained from the West China Hospital Clinical Trials and Biomedical Ethics Committee of Sichuan University (ethics reference: 2022 (1972)). The findings will be published in peer-reviewed journals and disseminated through scientific conferences and seminars. TRIAL REGISTRATION NUMBER: ChiCTR2300068242.
Assuntos
Disfunção Cognitiva , Oxigenoterapia Hiperbárica , Humanos , Estimulação Magnética Transcraniana , Atividades Cotidianas , Qualidade de Vida , Disfunção Cognitiva/reabilitação , Hemoglobinas , Oxigênio , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Severe traumatic brain injury residual cognitive impairments significantly impact the quality of life. EEG-based neurofeedback is a technique successfully used in traumatic brain injury and stroke to rehabilitate cognitive and motor sequelae. There are not individualized comparisons of the effects of EEG-based neurofeedback versus conventional neuropsychological rehabilitation. We present a case study of a traumatic brain injury subject in whom eight sessions of a neuropsychological rehabilitation protocol targeting attention, executive functions, and working memory as compared with a personalized EEG-based neurofeedback protocol focused on the electrodes and bands that differed from healthy subjects (F3, F1, Fz, FC3, FC1, and FCz), targeting the inhibition of theta frequency band (3 Hz-7 Hz) in the same number of sessions. Quantitative EEG and neuropsychological testing were performed. Clear benefits of EEG-based neurofeedback were found in divided and sustained attention and several aspects related to visuospatial skills and the processing speed of motor-dependent tasks. Correlative quantitative EEG changes justify the results. EEG-based neurofeedback is probably an excellent complementary technique to be considered to enhance conventional neuropsychological rehabilitation.
Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Disfunção Cognitiva/reabilitação , Remediação Cognitiva , Eletroencefalografia , Neurorretroalimentação , Reabilitação Neurológica , Adulto , Lesões Encefálicas Traumáticas/complicações , Ondas Encefálicas/fisiologia , Disfunção Cognitiva/etiologia , Humanos , Masculino , Realidade Virtual , Adulto JovemRESUMO
PURPOSE: This study evaluates the feasibility of delivering a virtual (online) falls prevention intervention for older adults with mild cognitive impairment (MCI). METHODS: Community-dwelling older adults with MCI (mean age = 76.2 years, 72% women) were randomized to either a Tai Ji Quan (n = 15) or stretching group (n = 15) and participated in 60-minute virtual exercise sessions, via Zoom, twice weekly for 24 weeks. The primary outcome was the incidence of falls. Secondary outcomes were the number of fallers and changes from baseline in the 4-Stage Balance Test, 30-second chair stands, and Timed Up and Go Test under both single- and dual-task conditions. RESULTS: The intervention was implemented with good fidelity, an overall attendance rate of 79%, and 13% attrition. Compared with stretching, Tai Ji Quan did not reduce falls (incidence rate ratio = 0.58; 95% confidence interval [CI], 0.32 to 1.03) or the number of fallers (relative risk ratio = 0.75; 95% CI, 0.46 to 1.22) at week 24. The Tai Ji Quan group, however, performed consistently better than the stretching group in balance (between-group difference in change from baseline, 0.68 points; 95% CI, 0.12 to 1.24), 30-second chair stands (1.87 stands; 95% CI, 1.15 to 2.58), and Timed Up and Go under single-task (-1.15 seconds; 95% CI, -1.85 to -0.44) and dual-task (-2.35; 95% CI, -3.06 to -1.64) conditions. No serious intervention-related adverse events were observed. CONCLUSION: Findings from this study suggest the feasibility, with respect to intervention fidelity, compliance, and potential efficacy, of implementing an at-home, virtual, interactive Tai Ji Quan program, delivered in real-time, as a potential balance training and falls prevention intervention for older adults with MCI. The study provides preliminary data to inform future trials.
Assuntos
Acidentes por Quedas/prevenção & controle , Disfunção Cognitiva/reabilitação , Equilíbrio Postural/fisiologia , Qualidade de Vida , Tai Chi Chuan/métodos , Idoso , Idoso de 80 Anos ou mais , Terapia por Exercício/métodos , Estudos de Viabilidade , Feminino , Humanos , Vida Independente , Masculino , Estudos de Tempo e MovimentoRESUMO
BACKGROUND: Neurodegenerative diseases are sporadic hereditary conditions characterized by progressive dysfunction of the nervous system. Among the symptoms, vestibulopathy is one of the causes of discomfort and a decrease in quality of life. Hereditary spastic paraplegia is a heterogeneous group of hereditary degenerative diseases involving the disorder of a single gene and is characterized by the progressive retrograde degeneration of fibers in the spinal cord. OBJECTIVE: To determine the benefits of vestibular rehabilitation involving virtual reality by comparing pre intervention and post intervention assessments in individuals with hereditary spastic paraplegia. METHODS: In this randomized controlled clinical trial from the Rebec platform RBR-3jmx67 in which allocation concealment was performed and the evaluators be blinded will be included. The participants will include 40 patients diagnosed with hereditary spastic paraplegia. The interventions will include vestibular rehabilitation with virtual reality using the Wii® console, Wii-Remote and Wii Balance Board (Nintendo), and the studies will include pre- and post intervention assessments. Group I will include twenty volunteers who performed balance games. Group II will include twenty volunteers who performed balance games and muscle strength games. The games lasted from 30 minutes to an hour, and the sessions were performed twice a week for 10 weeks (total: 20 sessions). RESULTS: This study provides a definitive assessment of the effectiveness of a virtual reality vestibular rehabilitation program in halting the progression of hereditary spastic paraplegia, and this treatment can be personalized and affordable. CONCLUSION: The study will determine whether a vestibular rehabilitation program with the Nintendo Wii® involving virtual reality can reduce the progressive effect of hereditary spastic paraplegia and serve as an alternative treatment option that is accessible and inexpensive. Rebec platform trial: RBR-3JMX67.
Assuntos
Terapia por Exercício , Equilíbrio Postural/genética , Paraplegia Espástica Hereditária/reabilitação , Medula Espinal/patologia , Adolescente , Adulto , Brasil , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/reabilitação , Feminino , Jogos Recreativos , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Dor/fisiopatologia , Dor/prevenção & controle , Qualidade de Vida , Paraplegia Espástica Hereditária/genética , Paraplegia Espástica Hereditária/fisiopatologia , Resultado do Tratamento , Realidade Virtual , Adulto JovemRESUMO
OBJECTIVE: To explore the potential rehabilitative effect of art therapy and its underlying mechanisms in Parkinson's disease (PD). METHODS: Observational study of eighteen patients with PD, followed in a prospective, open-label, exploratory trial. Before and after twenty sessions of art therapy, PD patients were assessed with the UPDRS, Pegboard Test, Timed Up and Go Test (TUG), Beck Depression Inventory (BDI), Modified Fatigue Impact Scale and PROMIS-Self-Efficacy, Montreal Cognitive Assessment, Rey-Osterrieth Complex Figure Test (RCFT), Benton Visual Recognition Test (BVRT), Navon Test, Visual Search, and Stop Signal Task. Eye movements were recorded during the BVRT. Resting-state functional MRI (rs-fMRI) was also performed to assess functional connectivity (FC) changes within the dorsal attention (DAN), executive control (ECN), fronto-occipital (FOC), salience (SAL), primary and secondary visual (V1, V2) brain networks. We also tested fourteen age-matched healthy controls at baseline. RESULTS: At baseline, PD patients showed abnormal visual-cognitive functions and eye movements. Analyses of rs-fMRI showed increased functional connectivity within DAN and ECN in patients compared to controls. Following art therapy, performance improved on Navon test, eye tracking, and UPDRS scores. Rs-fMRI analysis revealed significantly increased FC levels in brain regions within V1 and V2 networks. INTERPRETATION: Art therapy improves overall visual-cognitive skills and visual exploration strategies as well as general motor function in patients with PD. The changes in brain connectivity highlight a functional reorganization of visual networks.
Assuntos
Arteterapia , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/reabilitação , Conectoma , Rede Nervosa/fisiopatologia , Reabilitação Neurológica , Doença de Parkinson/fisiopatologia , Doença de Parkinson/reabilitação , Idoso , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/etiologia , Tecnologia de Rastreamento Ocular , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Rede Nervosa/diagnóstico por imagem , Avaliação de Resultados em Cuidados de Saúde , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico por imagemRESUMO
OBJECTIVE: To determine the effectiveness of Baduanjin exercise in improving cognition and memory in patients with mild cognitive impairment. DATA SOURCES: Relevant English- and Chinese-language studies published until 15th September 2020 were retrieved from the PubMed, Web of Science, Cochrane Library, Embase, EBSCOhost, OVID, National Knowledge Infrastructure, WANFANG DATA, VIP Information, and SinoMed databases. REVIEW METHODS: Randomized controlled trials assessing Baduanjin exercise in patients with mild cognitive impairment were included. Two researchers independently identified eligible studies and extracted data. Risk-of-bias assessment was performed using the Cochrane Risk of Bias Tool. RESULTS: This study included 16 randomized controlled trials (1054 participants) from China that used Chinese versions of standardized tests. Most studies had no significant bias, and only one study had a high risk of bias in the random allocation category. Compared with conventional therapy alone, Baduanjin plus conventional therapy significantly improved the Montreal Cognitive Assessment and Mini-Mental State Examination scores after 6 months of treatment (P < 0.00001 for both), significantly decreased the tau/Aß1-42 ratio in the cerebrospinal fluid (P < 0.00001), and significantly improved some dimensional scores on the Wechsler Memory Scale and the auditory verbal learning test scores at 6 months (P < 0.05 for all). CONCLUSION: Compared with conventional therapy, Baduanjin plus conventional therapy significantly improved cognitive and memory function in patients with mild cognitive impairment.
Assuntos
Disfunção Cognitiva/psicologia , Disfunção Cognitiva/reabilitação , Qigong , Cognição , Exercício Físico , Humanos , Memória , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Between 17 and 75% of breast cancer survivors (BCS) experience long-term cognitive deficits such as deficits in memory, attention, processing speed, and executive function. AIMS: This study aimed to (a) compare effects of a standard computer-assisted cognitive training (CACT) program to a CACT program enhanced with music (CACT+A) to improve focus and concentration on BCS' memory, cognition, quality of life (QOL), and participation in everyday activities; and (b) garner participants' perspectives of effects of the programs to determine best practice. METHODS: An embedded design was employed in this mixed methods study. Participants who reported cognitive problems were recruited through breast cancer support groups. Four pre and post-tests were used followed by a qualitative interview. RESULTS: Twenty-five BCS, ages 31 to 72 years participated. The CACT group demonstrated significantly improved pre to post-test scores for working memory, QOL, and three subscales of the Model of Human Occupation Screening Tool (MOHOST) measuring participation in everyday activities. The CACT+A group had significant improvement for four FACT-Cog cognitive function subscales and the total score. Five themes emerged from the interview: Cognitive skill, Strategy learned, No change, QOL factors, and Participation in everyday activities. The CACT+A group expressed experiencing a larger ratio of improvements, most notably for memory and QOL factors. CONCLUSION: CACT+A is an auspicious intervention option for BCS who self-report cognitive issues. It is convenient to participate in at home and allows BCS to safely self-isolate if need be. This study is a registered clinical trial protocol: TexasWU record 19 959.
Assuntos
Neoplasias da Mama/reabilitação , Sobreviventes de Câncer/psicologia , Terapia Cognitivo-Comportamental/métodos , Disfunção Cognitiva/reabilitação , Música/psicologia , Adulto , Idoso , Neoplasias da Mama/complicações , Neoplasias da Mama/mortalidade , Sobreviventes de Câncer/estatística & dados numéricos , Cognição , Disfunção Cognitiva/etiologia , Função Executiva , Feminino , Humanos , Memória de Curto Prazo , Pessoa de Meia-Idade , Pesquisa Qualitativa , Qualidade de Vida , Autorrelato/estatística & dados numéricos , Participação Social , Resultado do TratamentoRESUMO
OBJECTIVE: Previous studies suggest that daily music listening can aid stroke recovery, but little is known about the stimulus-dependent and neural mechanisms driving this effect. Building on neuroimaging evidence that vocal music engages extensive and bilateral networks in the brain, we sought to determine if it would be more effective for enhancing cognitive and language recovery and neuroplasticity than instrumental music or speech after stroke. METHODS: Using data pooled from two single-blind randomized controlled trials in stroke patients (N = 83), we compared the effects of daily listening to self-selected vocal music, instrumental music, and audiobooks during the first 3 poststroke months. Outcome measures comprised neuropsychological tests of verbal memory (primary outcome), language, and attention and a mood questionnaire performed at acute, 3-month, and 6-month stages and structural and functional MRI at acute and 6-month stages. RESULTS: Listening to vocal music enhanced verbal memory recovery more than instrumental music or audiobooks and language recovery more than audiobooks, especially in aphasic patients. Voxel-based morphometry and resting-state and task-based fMRI results showed that vocal music listening selectively increased gray matter volume in left temporal areas and functional connectivity in the default mode network. INTERPRETATION: Vocal music listening is an effective and easily applicable tool to support cognitive recovery after stroke as well as to enhance early language recovery in aphasia. The rehabilitative effects of vocal music are driven by both structural and functional plasticity changes in temporoparietal networks crucial for emotional processing, language, and memory.
Assuntos
Córtex Cerebral/fisiologia , Córtex Cerebral/fisiopatologia , Disfunção Cognitiva/reabilitação , Conectoma , Rede de Modo Padrão/fisiopatologia , Musicoterapia , Música , Avaliação de Resultados em Cuidados de Saúde , Canto , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Idoso , Córtex Cerebral/diagnóstico por imagem , Disfunção Cognitiva/etiologia , Rede de Modo Padrão/diagnóstico por imagem , Feminino , Humanos , Idioma , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Acidente Vascular Cerebral/complicações , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/patologia , Lobo Temporal/fisiopatologia , Aprendizagem Verbal/fisiologiaRESUMO
PURPOSE OF REVIEW: Cognitive impairment leading to disability is increasingly seen in people living with human immunodeficiency virus (PLWH). Rehabilitation can alleviate the effects of cognitive impairment upon function. The aim of this paper is to discuss the strategies that have been used in cognitive and neurologic rehabilitation in PLWH. RECENT FINDINGS: Studies examining pharmacological and non-pharmacological strategies were analysed. Medical management of HIV and co-morbidities should be optimised. Non-pharmacological strategies, including nerve stimulation techniques, exercise-based interventions, and paper and computer-based cognitive rehabilitation, have some evidence supporting their use in PLWH either as stand-alone interventions or as part of a multidisciplinary approach. Both pharmacological and non-pharmacological rehabilitation strategies have been used with PLWH. More intervention trials are needed to assess cognitive and neurological rehabilitation strategies and further evaluate their potential benefit in PLWH.
Assuntos
Sistema Nervoso Central/virologia , Cognição/fisiologia , Disfunção Cognitiva/reabilitação , Infecções por HIV/psicologia , Reabilitação Neurológica/métodos , Sistema Nervoso Central/patologia , Disfunção Cognitiva/psicologia , Remediação Cognitiva/métodos , Comorbidade , Exercício Físico/fisiologia , Infecções por HIV/patologia , Humanos , Estimulação Elétrica Nervosa Transcutânea/métodosRESUMO
INTRODUCTION: Non-pharmacological interventions that promote quality of life in people with dementia are urgently needed. To accelerate development, evidence-based psychotherapies used in other populations can be considered. Mindfulness-based interventions with standardized protocols, namely mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR), may be effective in people with dementia, although tailoring for cognitive impairment may be needed. Evidence from other cognitive disorders can inform research. AREAS COVERED: The authors reviewed 12 studies of MBCT/MBSR conducted in people with cognitive impairments, including 10 in stroke, traumatic brain injury, and mild cognitive impairment; and two in dementia. Protocol modifications, outcomes, and evidence quality were analyzed. Common themes to address cognitive difficulties included: shortened session duration, use of memory aids, increase in repetition, simplified language, and omitted retreat sessions. EXPERT OPINION: MBCT and MBSR can be applied without drastic modifications in people with cognitive impairment. Their effectiveness in people with dementia remains unknown: empirical studies using/adapting evidence-based MBCT/MBSR protocols in this population is seriously lacking. Studies used a diverse range of outcome measures, which made direct comparison difficult. Further research with high methodological quality, sufficient power, and longer follow-up is urgently needed. Development of manuals would enhance the replicability of future studies.
Assuntos
Disfunção Cognitiva/reabilitação , Demência/reabilitação , Atenção Plena , Avaliação de Resultados em Cuidados de Saúde , Humanos , Atenção Plena/métodosRESUMO
OBJECTIVE: To investigate the effectiveness and safety of Baduanjin training on the cognitive function in stroke survivors with cognitive impairment. DESIGN: A randomized, two-arm parallel controlled trial with allocation concealment and assessors blinding. SETTING: Community centre of Fuzhou city, China. SUBJECTS: A total of 48 participants were recruited and randomly allocated into the Baduanjin exercise intervention or control group. INTERVENTIONS: The control group maintained original medication and rehabilitation treatment. The Baduanjin training group received 24-week Baduanjin training with a frequency of three days a week and 40 minutes a day based on original medication and rehabilitation treatment. MAIN OUTCOME MEASURES: The primary outcome was global cognitive function. Secondary outcome measures included the specific domains of cognition (i.e. memory, processing speed, execution, attention and visuospatial ability) and activities daily living. RESULTS: In total, 41 (Baduanjin n = 22, control n = 19) participants completed 24-week treatment and data collection. Mean differences between groups at 24-week treatment were statistically significant for global cognitive function (MoCA: 2.54 (0.91 to 4.16)), execution (TMT-A: -42.4 (-75.0 to -9.8); TMT-B: -71.3 (-130.6 to -12.1)), memory (immediate recall: 2.11 (0.49 to 3.73); short-term delayed recognition: 2.47 (0.58 to 4.35) and long-term delayed recognition: 1.68(0.18 to 3.17)), attention (response time of alertness: -245.5 (-387 to -104)) and activities of daily living (modified Barthel Index). CONCLUSION: Regular Baduanjin training is associated with less loss of cognitive function in patients after stroke.
Assuntos
Disfunção Cognitiva/reabilitação , Terapia por Exercício , Qigong , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/psicologia , Atividades Cotidianas , Idoso , China , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
New/worsening cognitive and physical impairments following critical care pose significant problems. Multidisciplinary cardiac rehabilitation (CR) can improve physical function after cardiac intensive care (CIC). This observational study aimed to evaluate cognitive function in patients participating in multidisciplinary CR and to identify correlates of impaired cognitive function after CIC. We analyzed 111 consecutive patients admitted to our comprehensive care ward at least 7 days after CIC and assessed factors associated with cognitive function using the Functional Independence Measure (FIM). Patients were stratified into two groups based on the median FIM-Cognitive scores: impaired (n = 56) and preserved cognition (n = 55) groups. Multiple logistic regression analysis identified age [odds ratio (OR) 1.06; 95% confidence interval (CI) 1.00-1.13; p = 0.042], Mini-Nutrition Assessment-Short Form (MNA-SF; OR 0.73; 95% CI 0.56-0.95; p = 0.017), and FIM-Physical scores (OR: 0.94; 95% CI 0.90-0.99; p = 0.012) as significant and independent factors associated with impaired cognition. The median length of hospital stay was 28 (interquartile range: 18, 43) days. The FIM-Cognitive and FIM-Physical scores significantly increased from admission to discharge [32.0 (27.0, 35.0) vs. 34.0 (29.0, 35.0) points; p < 0.001; 67.0 (53.0, 75.0) vs. 85.0 (73.5, 89.0) points; p < 0.001, respectively]. On subgroup analysis within the impaired cognition group, increased FIM-Cognitive scores positively and significantly correlated with increased FIM-Physical scores (ρ = 0.450; p = 0.001). Multiple linear regression analysis identified atrial fibrillation (AF; ß = - 0.29; p = 0.016), ln(glycated hemoglobin; HbA1c) (ß = 0.29; p = 0.018), and ln(high-sensitivity C-reactive protein; hs-CRP) (ß = - 0.26; p = 0.034) as significant and independent factors correlated with increased FIM-Cognitive scores. In conclusion, advanced age, low MNA-SF score, and FIM-Physical score were independent factors associated with impaired cognition in post-CIC patients. Multidisciplinary CR improved both physical and cognitive functions, and AF, HbA1c, and hs-CRP were independent factors correlated with increased FIM-Cognitive score.
Assuntos
Reabilitação Cardíaca , Cognição , Disfunção Cognitiva/reabilitação , Cardiopatias/reabilitação , Idoso , Idoso de 80 Anos ou mais , Reabilitação Cardíaca/efeitos adversos , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Terapia Combinada , Dieta Saudável , Terapia por Exercício , Feminino , Estado Funcional , Cardiopatias/diagnóstico , Cardiopatias/fisiopatologia , Cardiopatias/psicologia , Humanos , Tempo de Internação , Masculino , Saúde Mental , Estado Nutricional , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Risco , Resultado do TratamentoRESUMO
BACKGROUND: Cancer-related cognitive impairment (CRCI), often called "chemo-brain" or "chemo-fog," is a common side effect among adults with cancer, which can persist well after treatment completion. Accumulating evidence demonstrates exercise can improve cognitive function in healthy older adults and adults with cognitive impairments, suggesting exercise may play a role in managing CRCI. PURPOSE: The purpose was to perform a systematic review of randomized controlled trials (RCTs) to understand the effect of exercise on CRCI. DATA SOURCES: Relevant literature was retrieved from CINAHL, Medline (Ovid), and EMBASE. STUDY SELECTION: Eligible articles were RCTs that prescribed aerobic, resistance, combined aerobic/resistance, or mind-body (eg, yoga or Qigong) exercise during or following cancer treatment and included cognitive function outcome measures. DATA EXTRACTION: Descriptive information and Cohen d effect sizes were directly extracted or calculated for included trials. DATA SYNTHESIS: Twenty-nine trials were included in the final analysis. A statistically significant effect of exercise on self-reported cognitive function, both during and postadjuvant treatment, was reported in 12 trials (41%) (Cohen d range: 0.24-1.14), most commonly using the EORTC QLQ-C30. Ten trials (34%) performed neuropsychological testing to evaluate cognitive function; however, only 3 trials in women with breast cancer reported a significant effect of exercise (Cohen d range: 0.41-1.47). LIMITATIONS: Few RCTs to date have evaluated the effect of exercise on CRCI as a primary outcome. Twenty-six trials (90%) in this review evaluated CRCI as secondary analyses. CONCLUSIONS: Evidence supporting exercise as a strategy to address CRCI is limited. Future research evaluating CRCI as a primary outcome, including self-reported and objective measures, is needed to confirm the possible role of exercise in preventing and managing cognitive impairments in adults with cancer.
Assuntos
Disfunção Cognitiva/reabilitação , Exercício Físico , Neoplasias/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto , Neoplasias da Mama/terapia , Exercícios Respiratórios , Cognição , Disfunção Cognitiva/etiologia , Feminino , Humanos , Masculino , Qigong , Treinamento Resistido , Autorrelato , YogaRESUMO
BACKGROUND: Alzheimer's disease (AD) is an epidemic with tremendous public health impacts because there are currently no disease-modifying therapeutics. Randomized controlled trials (RCTs) for prevention of AD dementia often use clinical endpoints that take years to manifest (e.g., cognition) or surrogate endpoints that are costly or invasive (e.g., magnetic resonance imaging [MRI]). Blood biomarkers represent a clinically applicable alternative surrogate endpoint for RCTs that would be both cost-effective and minimally invasive, but little is known about their value as surrogate endpoints for treatment responses in the prevention of AD dementia. METHODS: The objective of this study is to investigate blood neuropathological, neurodegenerative, and neurotrophic biomarkers as surrogate endpoints for treatment responses to three interventions in older adults with amnestic mild cognitive impairment (aMCI, a prodromal stage of AD): aerobic exercise, cognitive training, and combined aerobic exercise and cognitive training (ACT). We chose these three sets of biomarkers for their unique mechanistic associations with AD pathology, neurodegeneration and neurogenesis. This study is built on the ACT Trial (1R01AG055469), a single-blinded, multi-site, 2 × 2 factorial phase II RCT that examines the synergistic effects of a 6-month ACT intervention on cognition and MRI biomarkers (AD-signature cortical thickness and hippocampal volume) (n = 128). In this ACT Trial blood biomarkers study, we will enroll 120 ACT Trial participants with aMCI and measure blood biomarkers at baseline and at 3, 6, 12, and 18 months. The goals are to (1) determine the effect of interventions on blood biomarkers over 6 months, (2) evaluate blood biomarkers as surrogate endpoints for predicting cognitive responses to interventions over 18 months, and (3, exploratory) examine blood biomarkers as surrogate endpoints for predicting brain MRI biomarker responses to interventions over 18 months. DISCUSSION: This study aims to identify new blood biomarkers that can track cognitive decline or AD-related brain atrophy among patients with aMCI subjected to a regimen of aerobic exercise and cognitive training. Findings from this study will drive the further use of blood biomarkers in developing effective prevention and treatment strategies for AD dementia. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03313895. Registered on 18 October 2017.
Assuntos
Doença de Alzheimer/reabilitação , Cognição/fisiologia , Disfunção Cognitiva/reabilitação , Demência/prevenção & controle , Terapia por Exercício/métodos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/sangue , Doença de Alzheimer/complicações , Biomarcadores/sangue , Disfunção Cognitiva/sangue , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Demência/sangue , Demência/diagnóstico , Demência/etiologia , Progressão da Doença , Exercício Físico/fisiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Testes Neuropsicológicos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVES: Interest in neurofeedback therapies (NFTs) has grown exponentially in recent years, encouraged both by escalating public interest and the financial support of health care funding agencies. Given NFTs' growing prevalence and anecdotally reported success in treating common effects of acquired brain injury (ABI), a systematic review of the efficacy of NFTs for the rehabilitation of ABI-related cognitive impairment is warranted. METHODS: Eligible studies included adult samples (18+ years) with ABI, the use of neurofeedback technology for therapeutic purposes (as opposed to assessment), the inclusion of a meaningful control group/condition, and clear cognitive-neuropsychological outcomes. Initial automated search identified n = 86 candidate articles, however, only n = 4 studies met the stated eligibility criteria. RESULTS: Results were inconsistent across studies and cognitive domains. Methodological and theoretical limitations precluded robust and coherent conclusions with respect to the cognitive rehabilitative properties of NFTs. We take the results of these systematic analyses as a reflection of the state of the literature at this time. These results offer a constructive platform to further discuss a number of methodological, theoretical, and ethical considerations relating to current and future NFT-ABI research and clinical intervention. CONCLUSIONS: Given the limited quantity and quality of the available research, there appears to be insufficient evidence to comment on the efficacy of NFTs within an ABI rehabilitation context at this time. It is imperative that future work increase the level of theoretical and methodological rigour if meaningful advancements are to be made understanding and evaluating NFT-ABI applications.
Assuntos
Lesões Encefálicas/reabilitação , Disfunção Cognitiva/reabilitação , Neurorretroalimentação , Reabilitação Neurológica , Avaliação de Resultados em Cuidados de Saúde , Lesões Encefálicas/complicações , Disfunção Cognitiva/etiologia , Humanos , Neurorretroalimentação/métodos , Reabilitação Neurológica/métodosRESUMO
Background. In Parkinson disease (PD), gait impairments often coexist with nonmotor symptoms such as anxiety and depression. Biofeedback training may improve gait function in PD, but its effect on nonmotor symptoms remains unclear. This study explored the cognitive and global effects of Ambulosono, a cognitive gait training method utilizing step size to contingently control the real-time play of motivational music. Objective. This study examined the feasibility of music-contingent gait training and its effects on neuropsychological test performance and mood in persons with PD. Methods. A total of 30 participants with mild to moderate PD were semirandomized via sequential alternating assignment into an experimental training group or control music group. The training group received 12 weeks of music-contingent training, whereby music play was dependent on the user achieving a set stride length, adjusted online based on individual performance. The control group received hybrid training beginning with 6 weeks of noncontingent music walking, whereby music played continuously regardless of step size, followed by 6 weeks of music-contingent training. Global cognition, memory, executive function, attention, and working memory assessments were completed by blinded assessors at baseline, 6 weeks, and 12 weeks. Motor function, mood, and anxiety were assessed. Results. Average training adherence was 97%, with no falls occurring during training sessions. Improvements on cognitive measures were not clinically significant; however, significant decreases in depression and anxiety were observed in both groups over time (P < .05). Conclusions. Music-contingent gait training is feasible and safe in individuals with PD. Further investigation into potential therapeutic applications of this technology is recommended.
Assuntos
Disfunção Cognitiva/reabilitação , Terapia por Exercício/métodos , Transtornos Neurológicos da Marcha/reabilitação , Música , Avaliação de Processos e Resultados em Cuidados de Saúde , Doença de Parkinson/reabilitação , Desempenho Psicomotor , Estimulação Acústica , Idoso , Disfunção Cognitiva/etiologia , Estudos de Viabilidade , Feminino , Seguimentos , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Doença de Parkinson/complicações , Desempenho Psicomotor/fisiologia , Índice de Gravidade de Doença , Método Simples-CegoRESUMO
Yoga is a holistic practice that - when incorporated effectively into neurorehabilitation - has potential to meet the complex needs of persons with acquired brain injury (ABI). This systematic review, conducted in accordance with PRISMA guidelines, investigated cognitive, physical, and psychological outcomes following controlled trials of yoga for ABI. The search returned six eligible studies, four of which focused specifically on stroke rehabilitation. For persons with ABI broadly, within-group improvements were found after yoga for psychological and physical adjustment, quality of life, and respiratory functioning. For stroke specifically, physical and memory recovery was greater in the yoga group vs. exercise control, and within-group improvements were noted for motor functioning, self-efficacy, and quality of life outcomes. Lack of (1) between-group analyses despite the inclusion of control groups, and (2) a common yoga rehabilitation protocol including frequency, length, and duration of yoga must be addressed in future research to establish efficacy of these interventions. Considerations for psychophysiological outcome measures and cultural factors are presented in the context of future research and clinical directions.
Assuntos
Lesões Encefálicas/complicações , Lesões Encefálicas/reabilitação , Disfunção Cognitiva/reabilitação , Ajustamento Emocional , Reabilitação Neurológica , Avaliação de Resultados em Cuidados de Saúde , Qualidade de Vida , Autoeficácia , Yoga , Disfunção Cognitiva/etiologia , HumanosRESUMO
OBJECTIVES: Dementia interferes with older adults' functioning in cognitive, daily, psychosocial, and neuroendocrine domains. The present study examined the psychophysiological effects of dance movement therapy (DMT) and physical exercise for older adults with dementia. METHODS: This randomized controlled trial recruited 204 older adults diagnosed with mild dementia into the DMT, exercise, or waitlist control group. Both DMT and exercise interventions had similar intensity and comprised 24 hr of intervention that spanned over 12 weeks. All participants completed self-report questionnaires on psychosocial well-being, daily functioning, neurocognitive assessments, and salivary cortisol measures at baseline and 3 follow-up measurements more than 1 year. RESULTS: The DMT group showed significant decreases in depression, loneliness, and negative mood (d = 0.33-0.42, p < .05) and improved daily functioning (d = 0.40, p < .01) and diurnal cortisol slope (d = 0.30, p < .01). The effects on daily functioning and cortisol slope remained at 1-year follow-up. The exercise group of matched intensity showed no significant effects on the outcomes. DISCUSSION: The study findings support the potential utility of DMT as a multifaceted intervention for improving various aspects of functioning in older adults with declining cognitive abilities. The lack of beneficial effects for our exercise intervention and long-term DMT effects highlights the need to maintain persistent levels of exercise with adequate intensity and duration.