Functional Living Skills in Patients with Major Neurocognitive Disorder Due to Degenerative or Non-Degenerative Conditions: Effectiveness of a Non-Immersive Virtual Reality Training.

Virtual reality has gained attention as an effective tool for cognitive, motor, and daily activity rehabilitation in patients with major neurocognitive disorder (M-NCD). The first objective of this study was to check for differences between M-NCD caused by degenerative and non-degenerative conditions (DC and NDC, respectively) in terms of relearning four functional living skills (FLSs), by means of a non-immersive virtual reality training (VRT). The second purpose was to verify whether spontaneous transfer from the virtual environment to the real environment occurred. Four FLS apps were developed in our institute (Information, Suitcase, Medicine, and Supermarket). A nonrandomized interventional study was carried out, comparing experimental and control groups (EG and CG, respectively). The study included three phases: in vivo test at T1; VRT at T2 only for EG; in vivo test at T3. During the in vivo test, the four FLSs were assessed in their natural environments. Both EG-DC and EG-NDC significantly improved in all of the VRT variable scores (the EG-NDC group seemed to show better outcomes than the EG-DC group). Moderate-to-high satisfaction with the VRT was reported. EG-DC and EG-NDC also enhanced their performances in the in vivo test. No statistically significant differences between them were found. CG-DC and CG-NDC improved only in the execution time of Information in the in vivo test. These findings confirm the ecological validity of VRT for FLSs.

Functional Living Skills: A Non-Immersive Virtual Reality Training for Individuals with Major Neurocognitive Disorders.

The loss of functional living skills (FLS) is an essential feature of major neurocognitive disorders (M-NCD); virtual reality training (VRT) offers many possibilities for improving FLS in people with M-NCD. The aim of our study was to verify the effectiveness of a non-immersive VRT on FLS for patients with M-NCD. VRT was carried out for 10 to 20 sessions, by means of four 3D apps developed in our institute and installed on a large touch screen. The experimental group (EG) and the control group (CG) included 24 and 18 patients with M-NCD, respectively. They were administered the in vivo test (in specific hospital places reproducing the natural environments) at T1 (pre-training) and T3 (post-training); at T2, only EG was administered VRT. Statistically significant differences between EG and CG in all the in vivo tests were found in the number of correct responses; during VRT, the number of correct responses increased, while the execution times and the number of clues decreased. The improvement in the in vivo tests appeared to be related to the specific VRT applied. The satisfaction of participants with the VRT was moderate to high.

Telephone-Based Reality Orientation Therapy for Patients With Dementia: A Pilot Study During the COVID-19 Outbreak.

IMPORTANCE: When in-person rehabilitation is not feasible, interventions delivered in remote telephone-based sessions may be an option. OBJECTIVE: To determine whether telephone-based reality orientation therapy (T-ROT) can improve cognition, mood, and neuropsychiatric symptoms among patients with major neurocognitive disorders (NCDs) who are forced to isolate and also whether T-ROT can relieve the burden of distress among their caregivers. DESIGN: Nonrandomized interventional comparison study. SETTING: Individual telephone calls between practitioners and patients and their caregivers. PARTICIPANTS: Twenty-seven patients (14 in the experimental group, 13 in the control group) with a major NCD and their primary caregivers. INTERVENTION: Ten T-ROT sessions and a pretest-posttest neuropsychological evaluation over 4 wk. OUTCOMES AND MEASURES: Outcomes measured included cognitive and behavioral symptoms of patients with major NCDs and correlations between changes in patient clinical condition and caregiver stress. Primary outcome measures were two measures of depressive symptoms, the Neuropsychiatric Inventory Questionnaire and the Telephone Mini-Mental State Examination, administered at baseline and program discharge. RESULTS: T-ROT significantly outperformed nontreatment on all measures of depression, behavior, cognition, and caregiver burden. CONCLUSIONS AND RELEVANCE: T-ROT combined with emotional support appears to be an effective intervention for monitoring and managing the behavioral symptoms of patients with major NCDs who are forced to isolate. WHAT THIS ARTICLE ADDS: Occupational therapy practitioners can use T-ROT or similar procedures not only during a pandemic but also when it is not possible to treat patients in person at a hospital or at home. Telephone-based treatment may also represent a good practice to be integrated into traditional rehabilitation programs.

A brief essay on non-pharmacological treatment of Alzheimer's disease.

Current pharmacological therapies for Alzheimer's disease (AD) do not modify its course and are not always beneficial. Therefore, the optimization of quality of life represents the best possible outcome achievable in all stages of the disease. Cognitive and behavioural rehabilitation represents the main therapeutic approach for this purpose, also in order to mitigate indirectly the burden of distress of family caregivers. The aim of this mini-review is to go through this theme by discussing cognitive activation, virtual reality and neuromodulation techniques. The practices summarized in this essay are not alternative but, often, complementary therapies to standardized pharmacological treatment. The present mini-review has found encouraging results but also the need for more conclusive evidence for all types of non-invasive/non-pharmacological treatment of AD.

Metacognitive and emotional/motivational executive functions in individuals with autism spectrum disorder and attention deficit hyperactivity disorder: preliminary results.

BACKGROUND: Deficits in executive functions (EF) are frequently observed in autism spectrum disorder (ASD) and in attention deficit hyperactivity disorder (ADHD). The aim of this study was to evaluate executive performances of children with ASD and ADHD, and then make between-group comparisons as well as comparisons with a control group. METHODS: A total of 58 subjects were recruited, 17 with ASD but without intellectual impairment, 18 with ADHD-combined presentation and 23 with typical development, matched on gender, chronological age and intellectual level. They were tested on some EF domains, namely planning, mental flexibility, response inhibition and generativity, which account for both metacognitive and emotional/motivational executive functions. Results. Results showed a large overlapping of EF dysfunctions in ASD and ADHD and were not indicative of the presence of two real distinct EF profiles. Nevertheless, in ADHD, a more severe deficit in prepotent response inhibition (emotional/motivational EF) was found. CONCLUSIONS: Results are partially consistent with those found in the literature. Further studies with larger samples are needed to determine how ASD and ADHD differ in terms of their strengths and weaknesses across EF domains.

Group Intensive Cognitive Activation in Patients with Major or Mild Neurocognitive Disorder.

BACKGROUND: No standard protocols are available for cognitive rehabilitation (CR) in conditions like Major or Mild Neurocognitive disorder (M-NCD or m-NCD, respectively); however, preliminary data seem to indicate that such interventions might have cost-effective beneficial effects and are free from side effect or adverse events. Three basic approaches are known: cognitive stimulation (CS), cognitive training (CT), and CR. OBJECTIVE: Aim of this study was to assess the efficacy of a protocol of group intensive cognitive activation (g-ICA) in patients with both M-NCD and m-NCD; the protocol was specifically arranged in our Research Institute, based on the principles of the central role of the patient and the mediation pedagogy. SUBJECTS AND METHODS: Sixteen patients with M-NCD and fifteen patients with m-NCD were enrolled, as well as eleven patients with M-NCD who were used as a control group (CG). The intervention was carried-out by a clinical neuropsychologist with daily group sessions over a period of 2 months. Neuropsychological assessment was performed at baseline and after the completion of the rehabilitative intervention. RESULTS: General cognitive functioning, attention, ideomotor praxis and visual memory scores were found to be significantly increased in all patients. Beneficial and significant effects were also found for constructive praxis in M-NCD and for executive functioning in m-NCD. All areas of the language function were significantly ameliorated in m-NCD, while this happened only for verbal repetition and syntax-grammar comprehension in M-NCD. No changes were detected for long- and short-term verbal memory, which were found to be worsened in controls without activation. CONCLUSION: Our findings seem to indicate that g-ICA might be effective in inducing beneficial changes on the general cognitive functioning and other specific functions in patients with both m-NCD and M-NCD. Moreover, the specific protocol proposed, even if susceptible of important improvement, is easy to carry out within hospital facilities and cost-effective.

The burden of distress and related coping processes in family caregivers of patients with Alzheimer's disease living in the community.

BACKGROUND: Many patients with dementia live in the community and depend on a family member for assistance. Taking care of non-self-sufficient people such as those with dementia causes distress. This study concerns factors contributing to feelings of burden and consequent coping strategies adopted by family caregivers of patients with Alzheimer's disease living in the community. METHODS: The severity of the caregiver burden (Caregiver Burden Inventory and the Neuropsychiatric Inventory Caregiver Distress Scale) was evaluated in relation to the cognitive, behavioral, functional, mood, motor and comorbidity status in 73 consecutive patients with Alzheimer's disease. The type of coping processes (Coping Orientation to Problem Experienced), and psychosocial and medical variables of caregivers were also investigated and correlated with the degree of their distress. RESULTS: The amount of burden for caregivers, was found to be positively correlated with several measures of cognitive, psychological, behavioral, and motor impairment of the patients. The severity of caregiver distress was correlated with specific coping strategies, such as seeking for social support, using avoidance behaviors and focusing on problems. Finally, caregivers needing higher levels of familial and/or social support had also higher levels of distress. CONCLUSIONS: Higher cognitive, psychological, behavioral, and motor impairment of patients with Alzheimer's disease are associated with increasing levels of burden and distress in their caregivers, who need to adopt adequate coping strategies and to seek for familial and social support.

Executive Functions and Adaptive Behaviour in Autism Spectrum Disorders with and without Intellectual Disability.

Executive functions (EF) in autism spectrum disorders (ASD) have been often investigated, although results seem to be rather inconsistent. The first aim of this study was to detect which EF components are common to the ASD continuum (from high- to low-functioning ASD) and identify a possible EF profile for ASD people. Planning, mental flexibility, inhibition of response, generativity, and ecologic EF were investigated. This study was extended not only to high-functioning ASD, but also to ASD with intellectual disability (ID). The second aim was to find EF aspects correlating with adaptive skills in ASD. A total of 61 children participated in the study (27 ASD with and without ID and 34 controls). Results highlight an executive profile characterised by impaired flexibility and deficient planning; these deficits are associated with decreased adaptive ability, particularly socialization, and a deficient shifting in ecologic conditions. These features are present in all ASD subgroups with and without ID; for this reason, they might be assumed as being specific features in ASD.

Effects of repetitive transcranial magnetic stimulation in performing eye-hand integration tasks: four preliminary studies with children showing low-functioning autism.

This report, based on four studies with children with low-functioning autism, aimed at evaluating the effects of repetitive transcranial magnetic stimulation delivered on the left and right premotor cortices on eye-hand integration tasks; defining the long-lasting effects of high-frequency repetitive transcranial magnetic stimulation; and investigating the real efficacy of high-frequency repetitive transcranial magnetic stimulation by comparing three kinds of treatments (high-frequency repetitive transcranial magnetic stimulation, a traditional eye-hand integration training, and both treatments combined). Results showed a significant increase in eye-hand performances only when high-frequency repetitive transcranial magnetic stimulation was delivered on the left premotor cortex; a persistent improvement up to 1 h after the end of the stimulation; better outcomes in the treatment combining high-frequency repetitive transcranial magnetic stimulation and eye-hand integration training. Based on these preliminary findings, further evaluations on the usefulness of high-frequency repetitive transcranial magnetic stimulation in rehabilitation of children with autism are strongly recommended.

Stability of auditory discrimination and novelty processing in physiological aging.

Complex higher-order cognitive functions and their possible changes with aging are mandatory objectives of cognitive neuroscience. Event-related potentials (ERPs) allow investigators to probe the earliest stages of information processing. N100, Mismatch negativity (MMN) and P3a are auditory ERP components that reflect automatic sensory discrimination. The aim of the present study was to determine if N100, MMN and P3a parameters are stable in healthy aged subjects, compared to those of normal young adults. Normal young adults and older participants were assessed using standardized cognitive functional instruments and their ERPs were obtained with an auditory stimulation at two different interstimulus intervals, during a passive paradigm. All individuals were within the normal range on cognitive tests. No significant differences were found for any ERP parameters obtained from the two age groups. This study shows that aging is characterized by a stability of the auditory discrimination and novelty processing. This is important for the arrangement of normative for the detection of subtle preclinical changes due to abnormal brain aging.

Cognitive evoked potentials in narcolepsy: a review of the literature.

Subtle cognitive deficits have been described in narcolepsy. They have been hypothesised to be related to changes in the hypocretin system. Event-related potential (ERP) paradigms are known to be useful tools in the investigation of information processing and seem to be sensitive to subtle neuropsychological changes. We review empirical articles on ERPs in narcolepsy in order to contribute to clarify the pattern of cognitive deficits that are specific to this disease and, possibly, to identify specific cognitive domains that improve with treatment. Fourteen peer-reviewed articles were selected for this review. These studies were conducted with passive and active oddball paradigms and support the existence of changes in cognitive attentive processing in narcolepsy, possibly in association with altered functioning of the prefrontal cortex. ERP low-resolution electromagnetic tomography revealed that modafinil improved information processing speed and increased energetic resources in prefrontal cortical areas. These findings suggest that it is worthwhile to further evaluate the usefulness of ERPs in the detection of cognitive dysfunction in this disorder before and after treatment.