Cognitive Rehabilitation in Multiple Sclerosis in the Period from 2013 and 2021: A Narrative Review

Background: In recent years, several blinded randomized controlled trials (RCT) have been conducted on cognitive rehabilitation (CR) in adults with multiple sclerosis (MS). Objective: To review all blinded RCTs on CR in MS published since 2013. Methods: The National Library of Medicine database (Medline) and PSYCINFO were searched using the keywords MS and CR or cognitive training or NP rehabilitation or memory rehabilitation or attention rehabilitation. Results: After the exclusion of some papers not specifically focused on CR, a final list of 26 studies was established. The papers belong to three main categories: individual specific rehabilitation (8studies), group rehabilitation (4 studies), and computerized training (CT) (14 studies), while one study combined group rehabilitation and CT. Among the individual rehabilitation studies, 5 were devoted to memory, and most of the 19 other selected studies were about several cognitive domains. Most of the studies mainly concerned RRMS patients, except for 2 studies that were carried out exclusively in progressive forms. Despite the methodological limitations of some studies and the great heterogeneity of the protocols, the results are generally in favor of the efficacy of CR in neuropsychological tests. Conclusion: Recent blinded RCTs about CR in MS show promising results.

A meta-analysis on the effect of telemedicine on the management of attention deficit and hyperactivity disorder in children and adolescents

Introduction This study aims to report the effect sizes of telemedicine treatments on the symptom domains of paediatric ADHD. Methods In this systematic review and meta-analysis, electronic databases, i.e. PubMed, Scopus, Web of Science and Embase, were searched for articles published up to December 2020. The inclusion criteria were as follows: children or adolescents diagnosed for ADHD or other hyperkinetic disorders; randomized controlled trials (RCTs); efficacy established with parents and teachers or self-rating scales at least for one of the following domains: inattention, cognitive function, hyperactivity, hyperactivity/impulsivity or oppositional behaviours. The risk of bias was assessed using the Cochrane risk of bias tool for RCTs. Results From 310 records reduced to 228 after removing duplicates, overall 12 studies were fulfilled our inclusion criteria. They consisted of 708 participants (358 with telemedicine intervention and 350 controls). The telemedicine interventions varied from computerized training programmes with phone calls to videoconferencing programmes, virtual reality classrooms or games. The most applicable method consisted of computerized training programmes with phone calls. Pooling results of all studies with available data on each subscale showed a significant effect of telemedicine on inattention/cognitive function (standardized mean difference (SMD) = 0.26, 95% CI: 0.16, 0.36), hyperactivity/impulsivity (SMD = 0.29, 95% CI: 0.06, 0.52), and oppositional behaviours (SMD = 0.72, 95% CI: 0.24, 1.20) subscales in ADHD. Almost all studies had an overall unclear risk of bias. The source of outcome assessment (parents, teachers or self-report questionnaire) was addressed as a potential confounding factor. In almost all symptom domains, the satisfaction from the treatment was higher in parents than in teachers. Conclusions The clinical effects of telemedicine on the treatment of ADHD showed a small effect size for inattention/cognitive function, hyperactivity/impulsivity and oppositional behaviours.

Efficacy of attention bias modification via smartphones in a large population sample

Negative affective biases are a key feature of anxiety and depression that upholdand promote negative mood. Bias modification, which aims to reduce these biases using computerized training, has shown mixed success but has not been tested atscale. Smartphones present an easily-accessible and affordable means of testingthe impact of bias modification on mood in the general population. The aim was todetermine whether bias modification delivered via smartphones can improve mood ina large sample.153,385 self-referring participants were randomly assigned to modification or shambias training on a dot-probe or visual-search task. The primary outcome of interestwas balance of mood, assessed on the Positive and Negative Affect Schedule.22,933 participants who provided at least two sets of mood ratings were included inanalyses.Results supported the prediction that visual-search modification would result inimproved mood (95% CI .10 to .82; p=.01, d=.05 after two mood ratings; 95% CI1.75 to 6.54; p=.001, d=.32 after six mood ratings), which was not seen for the shamversion. Dot-probe modification was not associated with mood improvements(p=.52).Visual-search, but not dot-probe, attention bias modification slightly but significantlyimproved mood in a large sample. Although this effect size is very small;waiting-lists, low responsiveness to available interventions, and, critically, theminimal cost/side-effects, suggest it might be worth considering an adjunct to currenttreatments.

Computerized attention training for visually impaired older adults with dementia: a case study

ABSTRACT. Dementia causes disorders in multiple higher cortical functions. Visual impairment could further impact cognition in those with dementia. This study reports the results of a computerized attention training program in a patient with dementia and visual impairment. The case involves a 98-year-old woman with bilateral maculopathy and moderate dementia. The program consisted of pre- and post-assessments and training sessions. Assessments included the Cantonese version of the Mini-Mental State Examination, the digit span forward test, the Chinese version of the Verbal Learning Test (CVVLT), and the Test of Attentional Performance (TAP). Training sessions were conducted once to twice a week for a total of 8 45-minute sessions. The participant showed a decrease in the CVVLT score and improvements in TAP parameters. The results indicated that, in visually impaired older adults with dementia, attention and processing speed (measured by a sensitive test such as TAP) could potentially be improved with appropriate computerized training.

Computer-based inhibitory control training in children with Attention-Deficit/Hyperactivity Disorder (ADHD): Evidence for behavioral and neural impact

Attention-deficit hyperactivity disorder (ADHD) is the most commonly diagnosed psychological disorder of childhood. Medication and cognitive behavioral therapy are effective treatments for many children; however, adherence to medication and therapy regimens is low. Thus, identifying effective adjunct treatments is imperative. Previous studies exploring computerized training programs as supplementary treatments have targeted working memory or attention. However, many lines of research suggest inhibitory control (IC) plays a central role in ADHD pathophysiology, which makes IC a potential intervention target. In this randomized control trial (NCT03363568), we target IC using a modified stop-signal task (SST) training designed by NeuroScouting, LLC in 40 children with ADHD, aged 8 to 11 years. Children were randomly assigned to adaptive treatment (n = 20) or non-adaptive control (n = 20) with identical stimuli and task goals. Children trained at home for at least 5 days a week (about 15m/day) for 4-weeks. Relative to the control group, the treatment group showed decreased relative theta power in resting EEG and trending improvements in parent ratings of attention (i.e. decreases in inattentive behaviors). Both groups showed improved SST performance. There was not evidence for treatment effects on hyperactivity or teacher ratings of symptoms. Results suggest training IC alone has potential to positively impact symptoms of ADHD and provide evidence for neural underpinnings of this impact (change in theta power; change in N200 latency). This shows promising initial results for the use of computerized training of IC in children with ADHD as a potential adjunct treatment option for children with ADHD.