One-year prediction of cognitive decline following cognitive-stimulation from real-world data.

Clinical evidence based on real-world data (RWD) is accumulating exponentially providing larger sample sizes available, which demand novel methods to deal with the enhanced heterogeneity of the data. Here, we used RWD to assess the prediction of cognitive decline in a large heterogeneous sample of participants being enrolled with cognitive stimulation, a phenomenon that is of great interest to clinicians but that is riddled with difficulties and limitations. More precisely, from a multitude of neuropsychological Training Materials (TMs), we asked whether was possible to accurately predict an individual's cognitive decline one year after being tested. In particular, we performed longitudinal modelling of the scores obtained from 215 different tests, grouped into 29 cognitive domains, a total of 124,610 instances from 7902 participants (40% male, 46% female, 14% not indicated), each performing an average of 16 tests. Employing a machine learning approach based on ROC analysis and cross-validation techniques to overcome overfitting, we show that different TMs belonging to several cognitive domains can accurately predict cognitive decline, while other domains perform poorly, suggesting that the ability to predict decline one year later is not specific to any particular domain, but is rather widely distributed across domains. Moreover, when addressing the same problem between individuals with a common diagnosed label, we found that some domains had more accurate classification for conditions such as Parkinson's disease and Down syndrome, whereas they are less accurate for Alzheimer's disease or multiple sclerosis. Future research should combine similar approaches to ours with standard neuropsychological measurements to enhance interpretability and the possibility of generalizing across different cohorts.

Validation of Cognitive Rehabilitation as a Balance Rehabilitation Strategy in Patients with Parkinson's Disease: Study Protocol for a Randomized Controlled Trial.

Background: Parkinson's disease (PD) is the second most common neurodegenerative disorder. This disease is characterized by motor symptoms, such as bradykinesia, tremor, and rigidity. Although balance impairment is characteristic of advanced stages, it can be present with less intensity since the beginning of the disease. Approximately 60% of PD patients fall once a year and 40% recurrently. On the other hand, cognitive symptoms affect up to 20% of patients with PD in early stages and can even precede the onset of motor symptoms. There are cognitive requirements for balance and can be challenged when attention is diverted or reduced, linking a worse balance and a higher probability of falls with a slower cognitive processing speed and attentional problems. Cognitive rehabilitation of attention and processing speed can lead to an improvement in postural stability in patients with Parkinson's. Methods: We present a parallel and controlled randomized clinical trial (RCT) to assess the impact on balance of a protocol based on cognitive rehabilitation focused on sustained attention through the NeuronUP platform (Neuronup SI, La Rioja, Spain) in patients with PD. For 4 weeks, patients in the experimental group will receive cognitive therapy three days a week while the control group will not receive any therapy. The protocol has been registered at trials.gov NCT04730466. Conclusions: Cognitive therapy efficacy on balance improvement may open the possibility of new rehabilitation strategies for prevention of falls in PD, reducing morbidity, and saving costs to the health care system.

Herramientas TIC e intervención cognitiva en la enfermedad de Alzheimer: estado actual y recomendaciones / ITC tools and cognitive therapy in Alzheimer’s disease: state of the art and recommendations

La enfermedad de Alzheimer (EA) es la enfermedad neurodegenerativa que mayor impacto personal y social genera en el mundo, con unas previsiones que cuadruplican el número de afectados en menos de 40 años. Este reto social y global requiere una inversión de recursos económicos y humanos considerables. Las nuevas tecnologías aplicadas a la intervención terapéutica representan en este contexto una solución económica, accesible y flexible. El artículo identifica los principales problemas asociados a la intervención cognitiva con nuevas tecnologías en la EA en tres áreas: investigación, desarrollo y diseño. Se proponen alternativas para el abordaje de esta realidad que mejoren las propuestas clínicas existentes (AU)

Alzheimer’s disease (AD) is the neurodegenerative disease with the most prominent personal and global impact in the world,with predictions that increase fourfold the number of persons affected in less than forty years. This societal and global challenge demands a considerable investment in economical and human resources. Information and communications technologies applied in therapeutic areas mean in this context a budget, accessible and flexible solution. This article points out the main problems related to cognitive intervention with communications technologies on AD in three areas: research, development and design. Looking for the improvement of already existing clinical proposals, alternatives to address this issues are proposed (AU)