Effects of a dual intervention (motor and virtual reality-based cognitive) on cognition in patients with mild cognitive impairment: a single-blind, randomized controlled trial.

BACKGROUND: The increase in cases of mild cognitive impairment (MCI) underlines the urgency of finding effective methods to slow its progression. Given the limited effectiveness of current pharmacological options to prevent or treat the early stages of this deterioration, non-pharmacological alternatives are especially relevant. OBJECTIVE: To assess the effectiveness of a cognitive-motor intervention based on immersive virtual reality (VR) that simulates an activity of daily living (ADL) on cognitive functions and its impact on depression and the ability to perform such activities in patients with MCI. METHODS: Thirty-four older adults (men, women) with MCI were randomized to the experimental group (n = 17; 75.41 ± 5.76) or control (n = 17; 77.35 ± 6.75) group. Both groups received motor training, through aerobic, balance and resistance activities in group. Subsequently, the experimental group received cognitive training based on VR, while the control group received traditional cognitive training. Cognitive functions, depression, and the ability to perform activities of daily living (ADLs) were assessed using the Spanish versions of the Montreal Cognitive Assessment (MoCA-S), the Short Geriatric Depression Scale (SGDS-S), and the of Instrumental Activities of Daily Living (IADL-S) before and after 6-week intervention (a total of twelve 40-minutes sessions). RESULTS: Between groups comparison did not reveal significant differences in either cognitive function or geriatric depression. The intragroup effect of cognitive function and geriatric depression was significant in both groups (p < 0.001), with large effect sizes. There was no statistically significant improvement in any of the groups when evaluating their performance in ADLs (control, p = 0.28; experimental, p = 0.46) as expected. The completion rate in the experimental group was higher (82.35%) compared to the control group (70.59%). Likewise, participants in the experimental group reached a higher level of difficulty in the application and needed less time to complete the task at each level. CONCLUSIONS: The application of a dual intervention, through motor training prior to a cognitive task based on Immersive VR was shown to be a beneficial non-pharmacological strategy to improve cognitive functions and reduce depression in patients with MCI. Similarly, the control group benefited from such dual intervention with statistically significant improvements. TRIAL REGISTRATION: ClinicalTrials.gov NCT06313931; https://clinicaltrials.gov/study/NCT06313931 .

Virtual reality applications based on instrumental activities of daily living (iADLs) for cognitive intervention in older adults: a systematic review.

BACKGROUND: In recent years, the use of virtual reality (VR) as a complementary intervention in treating cognitive impairment has significantly increased. VR applications based on instrumental activities of daily living (iADL-VR) could offer a promising approach with greater ecological validity for intervention in groups with cognitive impairments. However, the effectiveness of this approach is still debated. OBJECTIVE: This systematic review aims to synthesize the effects of iADL-VR interventions to rehabilitate, train, or stimulate cognitive functions in healthy adults and people with mild cognitive impairment (MCI) and different types of dementia. METHODS: A systematic search was performed in the Scopus, PubMed, IEEE Xplore, Web of Science, and APA PsycNet databases until September 2022 and repeated in April 2023. The selected studies met the search terms, were peer-reviewed, included an iADL-VR intervention, and were written in English. Descriptive, qualitative studies, reviews, cognitive assessment, non-intervention studies, those unrelated to VR or iADL, those focused on motor aspects, and non-degenerative disorders were excluded. The PEDro scale was used to assess the methodological quality of the controlled studies. To present and synthesize the results, we organized the extracted data into three tables, including PEDro scores, participant characteristics, and study characteristics. RESULTS: Nineteen studies that met the inclusion and exclusion criteria were included. The total sample reached 590 participants, mostly women (72.67%). Approximately 30% were diagnosed with Alzheimer's disease or dementia, and 20% had mild cognitive impairment. Variables such as authors and year of publication, study design, type of intervention and VR applied, duration of the intervention, main findings, and conclusions were extracted. Regarding demographic characteristics, the sample size, age, sex, years of education, neurological diagnosis, dropouts, and the city and country where the intervention took place were recorded. Almost all studies showed improvements in some or all the outcomes after the intervention, generally greater in the iADL-VR group than in the control group. CONCLUSION: iADL-VR interventions could be beneficial in improving the performance of cognitive functions in older adults and people with MCI and different types of dementia. The ecological component of these tasks makes them very suitable for transferring what has been learned to the real world. However, such transfer needs to be confirmed by further studies with larger and more homogeneous samples and longer follow-up periods. This review had no primary funding source and was registered with PROSPERO under registration ID: 375166.

Effectiveness of music-based interventions for cognitive rehabilitation in Parkinson's disease: a systematic review of randomized controlled clinical trials.

BACKGROUND: Music-based interventions are promising for cognitive rehabilitation in Parkinson's disease; however, systematic reviews covering the topic are scarce. OBJECTIVE: To analyze the effectiveness of music-based interventions for cognitive rehabilitation in PD. METHOD: Systematic review study based on PRISMA criteria. The descriptors Parkinson's disease, Parkinson's disease, idiopathic Parkinson's disease, music-based interventions, music therapy, music training, auditory stimulation, music, rhythm, rhythmic, cognition, and cognitive were used. Five databases were searched PubMed/MEDLINE, PsycInfo, Scopus, Web of Science, and Cochrane in May 2022. Only randomized controlled trials with no limit on publication date or language were included. Risk of bias was assessed following Cochrane Collaboration criteria for development of systematic intervention reviews. RESULTS: Nine hundred nineteen articles were found by the descriptors; 266 were excluded for being repeated; 650 for not meeting the inclusion criteria. The remaining three articles were included and analyzed. The interventions consisted of practices with emphasis on rhythm and were conducted in groups. Risks of important biases were observed, such as lack of blinding in the allocation of participants and in the assessment of outcomes, as well as incomplete data for some outcomes. CONCLUSION: Overall, the results showed no evidence of efficacy of music-based interventions for cognitive outcomes in PD.

Effectiveness of music-based interventions for cognitive rehabilitation in Parkinson's disease: a systematic review of randomized controlled clinical trials

Abstract Background Music-based interventions are promising for cognitive rehabilitation in Parkinson's disease; however, systematic reviews covering the topic are scarce. Objective To analyze the effectiveness of music-based interventions for cognitive rehabilitation in PD. Method Systematic review study based on PRISMA criteria. The descriptors Parkinson's disease, Parkinson's disease, idiopathic Parkinson's disease, music-based interventions, music therapy, music training, auditory stimulation, music, rhythm, rhythmic, cognition, and cognitive were used. Five databases were searched PubMed/MEDLINE, PsycInfo, Scopus, Web of Science, and Cochrane in May 2022. Only randomized controlled trials with no limit on publication date or language were included. Risk of bias was assessed following Cochrane Collaboration criteria for development of systematic intervention reviews. Results Nine hundred nineteen articles were found by the descriptors; 266 were excluded for being repeated; 650 for not meeting the inclusion criteria. The remaining three articles were included and analyzed. The interventions consisted of practices with emphasis on rhythm and were conducted in groups. Risks of important biases were observed, such as lack of blinding in the allocation of participants and in the assessment of outcomes, as well as incomplete data for some outcomes. Conclusion Overall, the results showed no evidence of efficacy of music-based interventions for cognitive outcomes in PD.

Rehabilitation programs of executive functions in young and middle adulthood based on computational systems: a scoping review

Introduction: The use of computational systems has ventured into different healthcare areas, such as rehabilitation and stimulation of cognitive processes. To this date, it is possible to identify some reviews collecting studies on the efficacy and effects of those programs in groups such as older adults, children, and teenagers; there is a lack of academic literature giving an account of young and middle-aged adults. Objective: To identify empirical studies that measured the feasibility and effect of computer-based stimulation and rehabilitation programs for cognitive functions in young and middle-aged adults. Materials and methods: The PRISMA ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) extension was used as a base for a scoping review, as suggested by Cochrane Collaboration. Five databases -Science Direct, Scopus, Springer, PubMed, and Taylor & Francis- were used to trace information. The data registry and synthesis of the results was carried out independently by two reviewers. Results: 896 registries were found between 2015 and 2022, of which 91 met the eligibility principles, which evaluated the effects of programs based on computational systems on executive functions on young and middle-aged adults. Conclusion: Most of the interventions based on computational systems showed to be feasible and had moderate to significant effects on executive functions in young and middle-aged adults.

Introducción: El uso de los sistemas computacionales ha incursionado de forma notable en diferentes áreas de la salud, como la rehabilitación y estimulación de los procesos cognitivos. Si bien a la fecha se pueden identificar algunas revisiones que recopilan estudios sobre la eficacia y efectos de estos programas en grupos como adultos mayores, niños y adolescentes, existe poca literatura orientada a la adultez joven y la adultez media. Objetivo: Identificar estudios empíricos que midieron la viabilidad y el efecto de los programas de estimulación y rehabilitación de las funciones ejecutivas basados en computadora en la población adulta joven y media. Materiales y métodos: Se realizó revisión de alcance basado en la extensión PRISMA ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extensión for Scoping Reviews) sugerido por Cochrane Collaboration. Para el rastreo de información se seleccionaron cinco bases de datos: Science Direct, Scopus, Springer, PubMed y Taylor & Francis. El proceso de registro de datos y la síntesis de los resultados fue realizada por dos revisores de forma independiente. Resultados: Se encontraron 896 registros desde el 2015 al 2022, de los cuales 91 cumplieron los principios de elegibilidad, en los que se evaluaron los efectos de programas basados en sistemas computacionales sobre las funciones ejecutivas en adultos jóvenes y adultos medios. Conclusión: La mayoría de las intervenciones basadas en sistemas computacionales mostraron ser viables y tener efectos favorables de moderados a significativos sobre las funciones ejecutivas de adultos jóvenes y medios.

Impacto de la rehabilitación neuropsicológica computarizada en un paciente con anemia de células falciformes y TDAH. Estudio experimental de caso único

Introducción: La anemia de células falciformes (ACF) es una enfermedad genética que provoca una malformación en el glóbulo rojo, volviéndolo más frágil y desencadenando su lisis. Por su forma anómala predispone a eventos oclusivos en vasos de menor tamaño, incluyendo aquellos en el sistema nervioso central. La literatura documenta presencia de infartos cerebrales silentes y no silentes asociados a ACF, con sus respectivas alteraciones cognitivas. En los últimos años se ha reportado que existe compromiso cognitivo y mayor presencia de trastornos del neurodesarrollo, como el trastorno por déficit de atención e hiperactividad (TDAH) en aquellos niños con ACF que aún no han tenido eventos cerebrales isquémicos. Método: Se llevó a cabo un estudio experimental y prospectivo de caso único, que consistió en un programa de rehabilitación por medio de la plataforma de entrenamiento cognitivo para la atención y concentración de CogniFit. Durante 45 sesiones, se realizaron mediciones de respuestas en atención y control inhibitorio, utilizando la Batería de Evaluación Cognitiva para la Atención (CAB-AT). Resultados: Se observó que la intervención tuvo un impacto significativo en el componente de atención, el cual se mantuvo por encima de la línea de base, incluso después de suspender la intervención. Sin embargo, no se encontró un impacto importante en el control inhibitorio. Conclusión: Aunque la intervención mejoró la atención, no lo hizo con el control inhibitorio. Se recomienda complementar la rehabilitación con manejo farmacológico y diseñar nuevos estudios con poblaciones heterogéneas.

Introduction: Sickle cell anemia (SCA) is a genetic disease that causes a malformation in red blood cells, making them more fragile and leading to their lysis. Due to their abnormal shape, they predispose to occlusive events in smaller blood vessels, including those in the central nervous system. Literature documents the presence of silent and non-silent cerebral infarctions associated with SCA, along with respective cognitive impairments. In recent years, cognitive impairment and a higher prevalence of neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD) have been reported in children with SCA who have not experienced ischemic brain events. Method: An experimental and prospective single-case study was conducted, consisting of a rehabilitation program using the CogniFit platform for cognitive training in attention and concentration. Measurements of attention and inhibitory control responses were taken during 45 sessions, using the Cognitive Assessment Battery for Attention (CAB-AT). Results: It was observed that the intervention had a significant impact on the attention component, which remained above the baseline even after discontinuing the intervention. However, no significant impact was found on inhibitory control. Conclusion: Although the intervention improved attention, it did not have the same effect on inhibitory control. Complementing rehabilitation with pharmacological management and designing new studies involving heterogeneous populations are recommended.

Systematic review on post-stroke computerized cognitive training: Unveiling the impact of confounding factors.

Background: Stroke is a highly incapacitating disease that can lead to disabilities due to cognitive impairment, physical, emotional, and social sequelae, and a decrease in the quality of life of those affected. Moreover, it has been suggested that cognitive reserve (patients' higher levels of education or having a skilled occupation), for instance, can promote faster cognitive recovery after a stroke. For this reason, this review aims to identify the cognitive, functional, and behavioral effects of computerized rehabilitation in patients aged 50 years or older who had a stroke, considering cognitive reserve proxies. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-PRISMA, and performed the search for peer-reviewed randomized controlled trials without a date restriction on CINAHL, LILACS, PubMed, Scopus, and Web of Science databases were chosen. Results: We screened 780 papers and found 19 intervention studies, but only 4 met the inclusion criteria and shared data. These studies included computerized tools for motor and cognitive rehabilitation in the experimental groups. In all studies, computerized training was combined with other interventions, such as standard therapy, occupational therapy, and aerobic exercises. There were 104 participants affected by ischemic or hemorrhagic stroke, predominantly male (57.69%), and all with cognitive impairment. Conclusion: Despite a limited number of studies, varied methods and insufficient information available, schooling as a CR proxy combined with high-intensity computerized cognitive training was key to mediating cognitive improvement. The systematic review also identified that the associated ischemic stroke and shorter time of onset for rehabilitation contribute to the cognitive evolution of patients. Findings do not support a greater benefit of computerized cognitive training compared to conventional cognitive therapies. Systematic review registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=296193], identifier [CRD42022296193].

Rehabilitación neuropsicológica en pacientes pre y posquirúrgicos de lobectomía temporal por epilepsia fármaco resistente / Neuropsychological rehabilitation in pre- and post-surgical temporal lobectomy patients for drug-resistant epilepsy

Introducción. La epilepsia del lóbulo temporal suele producir déficits mnésicos, atencionales y del lenguaje. En la mayoría de los casos, se trata con fármacos an-tiepilépticos, pero falla en un tercio de ellos. Por tal razón, una opción terapéutica es la lobectomía temporal, que contribuye a menguar las crisis. Sin embargo, los procedimientos quirúrgicos pueden conllevar secuelas, entre ellas consecuencias a nivel cognitivo. Para contrarrestar dichos efectos, se acostumbra llevar a cabo una rehabilitación neuropsicológica que va en pro de recuperar, fortalecer y sostener en el tiempo habilidades que ya venían afectándose desde antes de la cirugía. Objetivo. Brindar una reflexión en torno a la intervención neuropsicológica de la epilepsia en el lóbulo temporal. Método. La reflexión sobre el tema parte de un interés clínico y posteriormente se fue ampliando a partir de la revisión de la literatura en diferentes bases de datos como PubMed, Medline y Scopus entre los años 2000 y 2021. Reflexión. Son amplias las opciones terapéuticas a nivel neuropsicológico y pueden contribuir de manera positiva en la recuperación del paciente, por lo cual los profe-sionales requieren conocer las posibilidades de ello para poder utilizar las estrategias más adecuadas según cada caso y brindar opciones que beneficien la calidad de vida, teniendo en cuenta que ninguna es más efectiva que otra. Conclusión. Como resultado, se presenta un panorama general de la rehabilitación neuropsicológica en pacientes pre y posquirúrgicos con lobectomía, haciendo énfasis en la rehabilitación neuropsicológica tradicional y la rehabilitación basada en inteli-gencia artificial, realidad virtual y computación

Introduction. Temporal lobe epilepsy usually produces mnestic, attentional, and language deficits. In most cases, it is treated with antiepileptic drugs, but one third of them fail, so one therapeutic option is temporal lobectomy, which helps to reduce seizures. However, surgical procedures can have sequelae, including cognitive con-sequences. To counteract these effects, neuropsychological rehabilitation is usually carried out in order to recover, strengthen, and sustain in time skills that were already affected before the surgery. Objective. To provide a reflection on the neuropsychological intervention of tem-poral lobe epilepsy. Method. The reflection on the subject starts from a clinical interest and was sub-sequently expanded from the review of the literature in different databases such as PubMed, Medline, and Scopus between 2000 and 2021. Reflection. There are many therapeutic options at the neuropsychological level and they can contribute positively to the patient's recovery, so professionals need to know the possibilities in order to use the most appropriate strategies according to each case and provide options that benefit the quality of life, taking into account that none is more effective than the other one.Conclusion. As a result, an overview of neuropsychological rehabilitation in pre- and post-surgical patients with lobectomy is presented, with emphasis on traditional neuropsychological rehabilitation and rehabilitation based on artificial intelligence, virtual reality, and computation

Cognitive Intervention Strategies Directed to Speech and Language Deficits in Primary Progressive Aphasia: Practice-Based Evidence from 18 Cases.

BACKGROUND: Practice-based evidence can inform and support clinical decision making. Case-report series about the implementation of programs in real-world clinical settings may contribute to verifying the effectiveness of interventions for treating PPA in specific contexts, as well as illustrating challenges that need to be overcome. OBJECTIVE: To describe and provide practice-based evidence on the effectiveness of four cognitive rehabilitation programs designed for individuals with PPA and directed to speech and language impairments, which were implemented in a specialized outpatient clinic. METHODS: Multiple single-case study. Eighteen individuals with different subtypes of PPA were each assigned to one out of four training programs based on comprehensive speech and language assessments. The treatments targeted naming deficits, sentence production, speech apraxia, and phonological deficits. Pre- and post-treatment assessments were undertaken to compare trained and untrained items. Gains were generalized to a different task in the first two types of intervention (naming and sentence production). A follow-up assessment was conducted 1-8 months after treatment among 7 participants. RESULTS: All individuals presented better performance in the trained items at the post-test for each rehabilitation program accomplished, demonstrating that learning of the trained strategies was achieved during the active phase of treatment. For 13 individuals, statistical significance was reached; while for five, the results were maintained. Results about untrained items, generalization to other tasks, and follow-up assessments are presented. CONCLUSIONS: The positive results found in our sample bring some practice-based evidence for the benefits of speech and language treatment strategies for clinical management of individuals with PPA.

Beneficial effects of a multidomain cognitive rehabilitation program for traumatic brain injury-associated diffuse axonal injury: a case report.

BACKGROUND: Neuropsychological rehabilitation is a crucial component of medical care for patients with diffuse axonal injury (DAI). However, current cognitive intervention programs directed to favor the training of specific domains individually have shown controversial results. Here, we evaluated the effectiveness of a neuropsychological rehabilitation program directed to favor training of attention, memory, visuospatial abilities, and executive functioning together in a patient with severe traumatic brain injury (TBI)-associated DAI. CASE PRESENTATION: A 26-year-old Hispanic woman with a recent history of a severe TBI attended our center complaining of memory problems, dysarthria, and difficulty in planning. A comprehensive cognitive assessment revealed dysfunction in sustained, selective, and divided attention, alterations in memory, planning, and organization of executive behavior, as well as impairment of visuospatial cognitive functions. The patient underwent a 24-week neuropsychological rehabilitation program directed to favor attention, memory, visuospatial abilities, and executive functioning together. After the cognitive intervention, we observed a better patient's performance in tasks requiring sustained, selective, and divided attention, improvement of encoding and retrieval memory problems, use of spatial relationships, planning, and organization of behavior skills. We also observed generalization effects on other domains, such as learning, mental flexibility, inhibition functions, and language. CONCLUSIONS: In conclusion, our results suggest that neuropsychological rehabilitation programs favoring multiple domains together are useful in reestablishing cognitive deficits in patients with severe DAI.

Integración de las tecnologías de la información y la comunicación en la intervención neuropsicológica / Integration of information and communication technologies into neuropsychological interventions

El objetivo del presente artículo fue ofrecer una visión actualizada del uso de las tecnologías de la información y la comunicación en la intervención neuropsicológica de pacientes con daño cerebral. Para esto se realizó la revisión de la literatura publicada sin límite de fecha y hasta junio del año 2019, en las bases de datos MedLine, Embase, Hinari, Lilacs y SciELO, y se consideró la experiencia profesional de los autores en el tema. Las principales tecnologías de la información y la comunicación que se utilizan en la actualidad en la evaluación neuropsicológica y la rehabilitación de los procesos cognitivos en esta población son los softwares, la telerrehabilitación, la realidad virtual, los teléfonos inteligentes, las apps móviles y los videojuegos. Estas tecnologías se han empleado en el tratamiento de diferentes funciones cognitivas (atención, memoria, funciones ejecutivas, habilidades visoespaciales, lenguaje, entre otros) y en diferentes tipos de patologías (traumatismos craneoencefálicos, demencias, ictus, epilepsia, adultos mayores, etcétera). Uno de los retos para el futuro será la creación de tecnologías que demuestren su eficacia en la reintegración de estos pacientes a su vida cotidiana. En Cuba diversas instituciones han integrado la información y la comunicación a la investigación neuropsicológica y han confirmado su utilidad clínica(AU)

The purpose of the study was to provide an updated view of the use of information and communication technologies in the neuropsychological intervention of brain damage patients. To achieve such an end, a review was conducted of the literature published on any date prior to June 2019 in the databases MEDLINE, EMBASE, HINARI, LILACS and SciELO. The authors' professional experience in the subject was taken into account. The main information and communication technologies in current use for the neuropsychological evaluation and rehabilitation of cognitive processes in this population are software, telerehabilitation, virtual reality, smart phones, mobile apps and video games. These technologies have been used to treat a variety of cognitive functions (attention, memory, executive functions, visual-spatial abilities and language, among others) and conditions (traumatic brain injury, dementias, stroke, epilepsy, elderly patients, etcetera). One of the challenges to be faced in the future will be the creation of technologies proving their effectiveness in the reincorporation of these patients to their daily activities. Several Cuban institutions have integrated information and communication technologies into neuropsychological research, confirming their clinical usefulness(AU)

Efficacy of the Spanish modified Story Memory Technique in Mexicans with multiple sclerosis: A pilot randomized controlled trial.

BACKGROUND: Memory impairments commonly afflict individuals with MS. While evidence-based cognitive rehabilitation treatments are available in English, the lack of such interventions in Spanish is an important barrier to care for Hispanics with MS. There is class I evidence that the modified Story Memory Technique (mSMT) improves learning in English. This intervention has been translated and adapted into Spanish. OBJECTIVE: To examine the preliminary efficacy of the Spanish mSMT to improve learning in Mexicans with MS. METHODS: Twenty individuals with relapsing-remitting MS were randomized to treatment (n = 10) or placebo control (n = 10) groups. The Spanish mSMT is a 10-session intervention that teaches imagery and context to facilitate learning. The control condition was matched to the treatment condition in treatment duration, and stimulus content and presentation. Participants completed baseline and post-treatment neuropsychological assessments. RESULTS: Individuals who received the Spanish mSMT showed significant improvements in learning and life satisfaction relative to the control group. Also observed were a near-moderate effect size on perceived memory complaints and a moderate-to-large effect size on the family's perception of the patient's competency. CONCLUSIONS: The Spanish mSMT showed preliminary efficacy in improving learning deficits in Mexicans with MS, and such improvements may extend to other domains.

Therapeutic synergism: How can psychopharmacology improve cognitive rehabilitation?

Despite recent advances in cognitive rehabilitation of patients with cognitive disorders, there are many major obstacles to the optimized global use of this therapeutic resource. OBJECTIVE: The authors outline the concept of 'therapeutic synergism', i.e. the concurrent use of pharmacological and cognitive rehabilitation therapies to maximize functional benefits, addressing the optimization of therapeutic approaches for cognitive disorders. METHODS: Three psychopharmacological and rehabilitation interrelationship paradigms are presented in three different clinical settings. RESULTS: Paradigm 1: Behavioral and cognitive symptoms that hinder a cognitive rehabilitation program, but can be improved with psychopharmacology. Paradigm 2: Cognitive symptoms that hinder cognitive rehabilitation, but can be improved with anticholinesterases. Paradigm 3: Behavioral symptoms that hamper the use of cognitive rehabilitation, but can be improved by psychotropic drugs. CONCLUSION: Judicious use of psychotropic drugs in cognitive disorders can benefit, directly or indirectly, cognitive functions, thereby favoring other treatment modalities for cognitive impairment, such as neuropsychological rehabilitation.

Apesar dos recentes avanços na reabilitação cognitiva de pacientes com distúrbios cognitivos, existem muitos e graves obstáculos ao uso otimizado globalmente desse recurso terapêutico. OBJETIVO: Os autores destacam o conceito de 'sinergismo terapêutico', ou seja, o uso simultâneo de terapias de reabilitação farmacológica e cognitiva, maximizando os benefícios funcionais, a fim de abordar a otimização da abordagem terapêutica dos distúrbios cognitivos. MÉTODOS: Três paradigmas de inter-relacionamento psicofarmacológico e de reabilitação são apresentados em três contextos clínicos diferentes. RESULTADOS: Paradigma 1: sintomas comportamentais e cognitivos que dificultam um programa de reabilitação cognitiva, mas podem ser melhorados com a psicofarmacologia. Paradigma 2: sintomas cognitivos que dificultam a reabilitação cognitiva, mas podem ser melhorados com anticolinesterásicos. Paradigma 3: sintomas comportamentais que dificultam o uso da reabilitação cognitiva melhorada por drogas psicotrópicas. CONCLUSÃO: O uso criterioso das drogas psicotrópicas nos distúrbios cognitivos pode beneficiar, direta ou indiretamente, as funções cognitivas, favorecendo, portanto, outras modalidades de tratamento para o comprometimento cognitivo, como a reabilitação neuropsicológica.

Therapeutic synergism: How can psychopharmacology improve cognitive rehabilitation? / Sinergismo terapêutico: como a psicofarmacologia pode melhorar a reabilitação cognitiva?

ABSTRACT Despite recent advances in cognitive rehabilitation of patients with cognitive disorders, there are many major obstacles to the optimized global use of this therapeutic resource. Objective: The authors outline the concept of 'therapeutic synergism', i.e. the concurrent use of pharmacological and cognitive rehabilitation therapies to maximize functional benefits, addressing the optimization of therapeutic approaches for cognitive disorders. Methods: Three psychopharmacological and rehabilitation interrelationship paradigms are presented in three different clinical settings. Results: Paradigm 1: Behavioral and cognitive symptoms that hinder a cognitive rehabilitation program, but can be improved with psychopharmacology. Paradigm 2: Cognitive symptoms that hinder cognitive rehabilitation, but can be improved with anticholinesterases. Paradigm 3: Behavioral symptoms that hamper the use of cognitive rehabilitation, but can be improved by psychotropic drugs. Conclusion: Judicious use of psychotropic drugs in cognitive disorders can benefit, directly or indirectly, cognitive functions, thereby favoring other treatment modalities for cognitive impairment, such as neuropsychological rehabilitation.

RESUMO Apesar dos recentes avanços na reabilitação cognitiva de pacientes com distúrbios cognitivos, existem muitos e graves obstáculos ao uso otimizado globalmente desse recurso terapêutico. Objetivo: Os autores destacam o conceito de 'sinergismo terapêutico', ou seja, o uso simultâneo de terapias de reabilitação farmacológica e cognitiva, maximizando os benefícios funcionais, a fim de abordar a otimização da abordagem terapêutica dos distúrbios cognitivos. Métodos: Três paradigmas de inter-relacionamento psicofarmacológico e de reabilitação são apresentados em três contextos clínicos diferentes. Resultados: Paradigma 1: sintomas comportamentais e cognitivos que dificultam um programa de reabilitação cognitiva, mas podem ser melhorados com a psicofarmacologia. Paradigma 2: sintomas cognitivos que dificultam a reabilitação cognitiva, mas podem ser melhorados com anticolinesterásicos. Paradigma 3: sintomas comportamentais que dificultam o uso da reabilitação cognitiva melhorada por drogas psicotrópicas. Conclusão: O uso criterioso das drogas psicotrópicas nos distúrbios cognitivos pode beneficiar, direta ou indiretamente, as funções cognitivas, favorecendo, portanto, outras modalidades de tratamento para o comprometimento cognitivo, como a reabilitação neuropsicológica.

Los juegos serios en el entrenamiento y la rehabilitación cognitiva / Serious Games in Training and Cognitive Rehabilitation

El uso de programas de entrenamiento y rehabilitación cognitiva asistido por computadora facilita abordar dificultades del funcionamiento cognitivo con precisión y consistencia. Este tipo de asistencia ha estado basado en los últimos años en juegos serios de tecnologías web, Realidad Virtual y Realidad Aumentada. En el presente trabajo se realizó una revisión bibliográfica de los juegos serios con estas tecnologías para el entrenamiento y la rehabilitación cognitiva, valorándose su incidencia en la motivación y las implicaciones de sus métodos y dispositivos de interacción en personas tratadas con estos juegos. Se exponen evidencias de individuos que han sido atendidos bajo este tipo de tratamiento no farmacológico(AU)

The use of computer-assisted cognitive training and rehabilitation programs facilitates addressing cognitive functioning difficulties with greater precision and consistency. This type of assistance has been based in recent years on serious games of web, Virtual Reality and Augmented Reality technologies. In the present paper, a bibliographic review of serious games with these technologies was carried out for training and cognitive rehabilitation, evaluating their incidence in the motivation and the implications of their methods and interaction devices in people treated with these games. Evidence is presented of individuals who have been treated under this type of non-pharmacological treatment(AU).

Eficácia da reabilitação cognitiva na melhoria e manutenção das atividades de vida diária em pacientes com doença de Alzheimer: uma revisão sistemática da literatura / Efficacy of cognitive rehabilitation in improving and maintaining daily living activities in patients with Alzheimer's disease: a systematic review of literature

RESUMO Objetivo Avaliar a eficácia da reabilitação cognitiva em pacientes com a doença de Alzheimer em estágio leve a moderado por meio de uma revisão sistemática. Métodos O levantamento de artigos se deu pelas bases de dados MEDLINE (acessado via PubMed), EMBASE e LILACS, seguindo a Colaboração Cochrane e a recomendação PRISMA, por meio dos critérios de elegibilidade: ensaios clínicos randomizados e que apresentaram o uso da reabilitação cognitiva como intervenção não farmacológica em pacientes com a doença de Alzheimer em estágio leve a moderado, devendo haver pelo menos um grupo de intervenção e um grupo de comparação. Resultados Foram selecionados seis ensaios clínicos randomizados para a realização desta revisão. Em todos os estudos analisados, foi observada melhora no desempenho dos pacientes nos instrumentos de avaliação, principalmente no que diz respeito à realização de atividades da vida diária. Conclusão A reabilitação cognitiva é capaz de prolongar a independência do paciente na realização de atividades da vida diária e de gerar alterações funcionais e estruturais. Como consequência da constatação de poucos trabalhos que atingiram os critérios de elegibilidade, também se constatou a necessidade de se realizarem mais estudos controlados e com maior controle de aplicação, considerando o alto risco de viés nos estudos utilizados.

ABSTRACT Objective To evaluate the efficacy of Cognitive Rehabilitation in patients with mild to moderate Alzheimer's disease through a systematic review. Methods The survey of articles was done by MEDLINE (accessed via PubMed), EMBASE and LILACS, following the Cochrane Collaboration and the PRISMA recommendation, using the following eligibility criteria: randomized clinical trials that presented the use of cognitive rehabilitation as non-pharmacological intervention in patients with mild to moderate Alzheimer's disease, with at least one intervention group and one comparison group. Results Six randomized controlled trials were selected for this review. In all of the studies analyzed, improvement in the performance of patients in the assessment instruments was observed, mainly in relation to the performance of activities of daily living. Conclusion Cognitive rehabilitation is able to prolong the independence of the patient in performing activities of daily living and generate functional and structural changes. As a consequence of the finding of few studies that met the eligibility criteria, we also verified the need for more controlled studies and greater application control, considering the high risk of bias in the studies used.

Intervenção neuropsicológica com crianças e adolescentes - uma revisão da literatura / Neuropsychological intervention with children and adolescents - a review of the literature / Intervención neuropsicológica con niños y adolescentes - una revisión de la literatura

Este artigo teve como objetivo realizar uma revisão literária sobre os estudos científicos publicados nos últimos dez anos em reabilitação/intervenção neuropsicológica com crianças e adolescentes, buscando identificar como os programas com abordagens voltadas para as dificuldades acadêmicas e executivas se articulam com as demandas familiares e escolares. As principais bases de dados utilizadas foram PubMed, SciELO e Redalyc. Dentre os 89 artigos encontrados, dez foram selecionados por englobarem métodos para o ensino de estratégias que facilitassem a aprendizagem escolar e os comportamentos adaptativos. Os resultados dos estudos sugerem que a intervenção neuropsicológica em crianças e adolescentes promove o desenvolvimento de habilidades cognitivas e dos processos de aquisição de linguagem. Entretanto, em face da distância entre o contexto clínico de intervenção e o educacional, mais estudos precisam ser promovidos em busca de um olhar mais integrado sobre esses espaços de promoção de desenvolvimento.

This article aimed to carry out a literary review of the scientific studies published in the last ten years in neuropsychological rehabilitation/ intervention with children and adolescents, seeking to identify how programs with approaches focused on academic and executive difficulties are articulated with family and school demands . The main databases used were PubMed, SciELO and Redalyc. Among the 89 articles found, ten were selected because they included methods for teaching strategies that facilitated school learning and adaptive behaviors. The results of the studies suggest that neuropsychological intervention in children and adolescents promotes the development of cognitive abilities and the processes of language acquisition. However, in view of the distance between the clinical context of intervention and the educational context, more studies need to be promoted in search of a more integrated view on these spaces for promoting development.

Este artículo tuvo como objetivo realizar una revisión literaria sobre los estudios científicos publicados en los últimos diez años en rehabilitación/ intervención neuropsicológica con niños y adolescentes, buscando identificar cómo los programas con enfoques orientados hacia las dificultades académicas y ejecutivas se articulan con las demandas familiares y escolares. Las principales bases de datos utilizadas fueron PubMed, SciELO y Redalyc. Entre los 89 artículos encontrados, diez fueron seleccionados por englobar métodos para la enseñanza de estrategias que facilitar el aprendizaje escolar y los comportamientos adaptativos. Los resultados de los estudios sugieren que la intervención neuropsicológica en niños y adolescentes promueve el desarrollo de habilidades cognitivas y de los procesos de adquisición de lenguaje. Sin embargo, en vista de la distancia entre el contexto clínico de intervención y el educativo, más estudios necesitan ser promovidos en busca de una mirada más integrada sobre estos espacios de promoción de desarrollo.

Cognitive behavioral rehabilitation for bipolar disorder patients: A randomized controlled trial.

OBJECTIVES: Bipolar disorder is frequently associated with cognitive impairment even during euthymia. Previous studies have reported significant impairments in functional and quality of life outcomes and a possible relationship between these variables and cognitive performance. Cognitive rehabilitation interventions have been proposed to address these outcomes but positive results are still scarce. The objective of the present study is to evaluate the efficacy of a new intervention developed to address both cognitive and functional impairment. METHODS: Thirty-nine individuals were included in this randomized controlled trial. All participants were evaluated by the Cambridge Neuropsychological Test Automated Battery (CANTAB) and completed functional and quality of life (QOL) scales. Patients were randomized to either treatment as usual (TAU) or Cognitive Behavior Rehabilitation (CBR), an add-on treatment delivered in 12 weekly group sessions. All individuals were revaluated after 12 weeks. RESULTS: A total of 39 bipolar type I or II patients were included in the analysis, 19 in the TAU group and 20 in the CBR condition. At the entrance of the study, both groups were statistically similar regarding clinical, socio-demographics and cognitive variables. After the end of the intervention, CBR individuals had significantly improved reaction time, visual memory and emotion recognition. In contrast, individuals in the CBR did not present a statistically change in functional and QOL scores after the 12-week intervention. CONCLUSIONS: CBR intervention showed promising results in improving some of the commonly impaired cognitive domains in BD. A longer follow-up period may be necessary to detect changes in functional and QOL domains.

Efectividad de los programas computorizados en rehabilitación cognitiva de pacientes con esquizofrenia / Effectiveness of Computerized Programs in Cognitive Rehabilitation of Patients with Schizophrenia / Efetividade dos programas computorizados em reabilitação cognitiva de pacientes com esquizofrenia

Resumen Objetivo. Establecer la eficacia de los programas computarizados en la rehabilitación cognitiva de pacientes con esquizofrenia. Método. Se revisaron los materiales bibliográficos publicados en las bases de datos Medline, PubMed, Assia, PsycInfo y Journals@Ovid, entre 2005 y 2017, que incluyeran las palabras clave plataforma virtual o programa computarizado y rehabilitación cognitiva o rehabilitación neuropsicológica y esquizofrenia. Resultados. De un total de 356 artículos, solo 20 de ellos cumplieron los criterios de inclusión. Se encontró que la intervención con programas computarizados suele generar mejorías tanto en los procesos de atención, memoria, velocidad de procesamiento y funciones ejecutivas como en la dimensión de cognición social y la esfera afectiva. Conclusión. Si bien la rehabilitación cognitiva a través de programas computarizados parece efectiva para mejorar el funcionamiento cognitivo de pacientes con esquizofrenia, no es clara la transferencia y generalización de esta mejora a la cotidianidad de los pacientes.

Abstract Objective. The cognitive deficits present in schizophrenia have been intervened through cognitive rehabilitation, and the use of computerized software is a current trend. This intervention has been the focus of attention of several studies, so, this investigation aims to give an account of the effectiveness of computerized software in the cognitive rehabilitation of patients with schizophrenia. Method. To do this, the databases of MEDLINE, PUBMED, ASSIA, PsycINFO and Journals@Ovid were examined from 2005 until 2017, in a search for papers that include in their keywords virtual platforms or computers software and cognitive rehabilitation or neuropsychological rehabilitation and Schizophrenia. Results. Of a total of 356 research papers, only 20 of them met inclusion criteria. These studies included cognitive rehabilitation that uses software improved attention, memory, processing speed, executive functions, as well as social cognition, and affective functioning. Conclusion. Even though the use of software in cognitive rehabilitation had proved to improve general cognitive functioning of patients with schizophrenia, it is not clear that this kind of intervention assures the transfer of learning and generalization of this improvement in the daily life of patients.

Resumo Escopo. Os déficits cognitivos presentes na esquizofrenia tem sido intervindos com a reabilitação cognitiva, sendo o uso de programas computorizados uma tendência nos últimos tempos. Em esta pesquisa, foi importante estabelecer a eficácia de estes programas na reabilitação cognitiva de pacientes com esquizofrenia. Metodologia. Para isto, foram revisados os materiais bibliográficos publicados nas bases de dados MEDLINE, PUBMED, ASSIA, PsycINFO e Journals@Ovid, entre 2005 e 2017, que incluíram nas suas palavras-chave plataforma virtual ou programa computorizado e reabilitação cognitiva ou reabilitação neuropsicológica e esquizofrenia. Resultados. De um total de 365 artigos, só 20 de eles cumpriram os critérios de inclusão. Sua revisão encontrou que a intervenção com programas computorizadas normalmente gera melhoras nos processos de atenção, memória, velocidade de processamento, funções executivas, assim como na dimensão de cognição social e a esfera afetiva. Conclusão. Embora a reabilitação cognitiva a través de programas computorizadas parece efetiva para melhorar o funcionamento cognitivo de pacientes com esquizofrenia, não é clara a transferência e generalização de esta melhora na cotidianidade dos pacientes.