Therapeutic synergism: How can psychopharmacology improve cognitive rehabilitation?

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.

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Transcranial Electrical Stimulation in Post-Stroke Cognitive Rehabilitation

European Psychologist ◽

10.1027/1016-9040/a000238 ◽

2016 ◽

Vol 21 (1) ◽

pp. 55-64 ◽

Cited By ~ 4

Author(s):

Silvia Convento ◽

Cristina Russo ◽

Luca Zigiotto ◽

Nadia Bolognini

Keyword(s):

Electrical Stimulation ◽

Cognitive Rehabilitation ◽

Cognitive Disorders ◽

Spatial Neglect ◽

Transcranial Electrical Stimulation ◽

Clinical Settings ◽

Post Stroke ◽

Neuropsychological Disorders ◽

Current State ◽

Stimulation Technique

Abstract. Cognitive rehabilitation is an important area of neurological rehabilitation, which aims at the treatment of cognitive disorders due to acquired brain damage of different etiology, including stroke. Although the importance of cognitive rehabilitation for stroke survivors is well recognized, available cognitive treatments for neuropsychological disorders, such as spatial neglect, hemianopia, apraxia, and working memory, are overall still unsatisfactory. The growing body of evidence supporting the potential of the transcranial Electrical Stimulation (tES) as tool for interacting with neuroplasticity in the human brain, in turn for enhancing perceptual and cognitive functions, has obvious implications for the translation of this noninvasive brain stimulation technique into clinical settings, in particular for the development of tES as adjuvant tool for cognitive rehabilitation. The present review aims at presenting the current state of art concerning the use of tES for the improvement of post-stroke visual and cognitive deficits (except for aphasia and memory disorders), showing the therapeutic promises of this technique and offering some suggestions for the design of future clinical trials. Although this line of research is still in infancy, as compared to the progresses made in the last years in other neurorehabilitation domains, current findings appear very encouraging, supporting the development of tES for the treatment of post-stroke cognitive impairments.

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Cognitive rehabilitation effectiveness for severe to moderate traumatic brain injury: case series

Medical Science and Discovery ◽

10.36472/msd.v8i7.573 ◽

2021 ◽

Vol 8 (7) ◽

pp. 437-441

Author(s):

Ahlam Ibrahim Hamami

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Cognitive Rehabilitation ◽

Case Series ◽

Holistic Approach ◽

Rehabilitation Program ◽

Computer Assisted ◽

Neuropsychological Rehabilitation ◽

Case Series Study ◽

Series Study

Objective: This case series study aimed to investigate the effectiveness of a holistic approach of a computer-assisted and traditional neuropsychological rehabilitation program in improving some cognitive functions in patients who sustained a traumatic brain injury (TBI). Methods: The case series study followed a single-case design, with an A-B-A-B design and was conducted in the rehabilitation center at King Fahad Medical City-Saudi Arabia between Aug 2015 and March 2016. Participants comprised 5 males with moderate-to-severe TBI and persistent cognitive impairments. The computerized model included known software programs for cognitive rehabilitation to improve this rehabilitation process. The program period was six weeks for each case, all focusing on executive functions, memory, and attention. Results: three out of the five cases improved remarkably in their attentional, executive, and related memory functions; with one showing moderate improvement and the five-case showing little improvement. Conclusion: The holistic approach of the neuropsychological rehabilitation program is effective for some TBI cases in improving their cognitive and psychosocial functioning, alongside vocational outcomes, as reported in the follow-up interviews of the patients and their families. More research is required to contribute to the current literature and for the study's findings to be further analyzed for these interventions.

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THE AMELIORATION OF BEHAVIORAL DISTURBANCES IN TBI PATIENTS WITH CHRONIC FRONTAL SYNDROME AFTER TREATMENT IN DIFFERENT REHABILITATION PROGRAMS

Acta Neuropsychologica ◽

10.5604/01.3001.0013.3685 ◽

2019 ◽

Vol 17 (3) ◽

pp. 245-260

Author(s):

Maria Pąchalska ◽

Jolanta Góral-Półrola ◽

Andrzej Mirski ◽

Celestyna Grzywniak ◽

Maria Łuckoś ◽

...

Keyword(s):

Social Skills ◽

Behavioral Disorders ◽

Cognitive Deficits ◽

Cognitive Rehabilitation ◽

Rehabilitation Program ◽

Post Injury ◽

Neuropsychological Rehabilitation ◽

Comprehensive Program ◽

Rehabilitation Programs ◽

Group A

We evaluated the effectiveness of three different rehabilitation programs for chronic behavioral disorders in traumatic brain injury (TBI) patients with orbito-frontal damage (OFC), incurred from 13 to 15 years prior to enrollment. From among 547 adult patients with severe TBIs treated neurosurgically from 1999 to 2003, 60 were selected for the study, divided into three groups of 20, matched for age and sex. Each group received one of three different rehabilitation protocols. Group A received a comprehensive program with two components: (1) a 6-month early neuropsychological rehabilitation program targeting cognitive deficits, beginning immediately post-injury, and (2) the “Academy of Life” program, with weekly meetings aimed at reducing behavioral disorders in social transactions. Group B received only cognitive rehabilitation, while Group C received only the “Academy of Life” progam. The Frontal Behavioral Inventory (FBInv) was used to assess behavioral disorders at baseline and again after completion of the study. At baseline, all 60 patients still displayed all or most of the common behavioral symptoms characteristic of frontal syndrome. The improvement achieved by group A (the comprehensive program) was significantly better upon completion of the study than that shown by the patients in groups B (cognitive only) and C (social skills only). A comprehensive program of rehabilitation, which combines early neuropsychological rehabilitation of cognitive deficits with the “Academy of Life” program, aimed at improving social skills, proved to be more effective than either of these two components administered without the other

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Neuropsychological rehabilitation program and behavioral disturbances in early-stage Alzheimer patients

Dementia & Neuropsychologia ◽

10.1590/s1980-57642009dn20200012 ◽

2008 ◽

Vol 2 (2) ◽

pp. 146-150

Author(s):

Vera Lúcia Duarte Vieira ◽

Sônia Maria Dozzi Brucki ◽

Anna Luiza Costa Marques Martins ◽

Fabíola Canali ◽

Luciano Gois ◽

...

Keyword(s):

Pharmacological Treatment ◽

Cognitive Rehabilitation ◽

Cholinesterase Inhibitors ◽

Early Stage ◽

Rehabilitation Program ◽

Disease Assessment ◽

Control Group ◽

Behavioral Alteration ◽

Neuropsychological Rehabilitation ◽

Number Of Patients

Abstract Alzheimer's disease (AD) is the most frequent cause of dementia and cholinesterase inhibitors are the available treatment in the mild stage. However cognitive rehabilitation has shown satisfactory results when combined with pharmacological treatment. Behavioral alteration is common in AD patients, which burdens caregivers and raises the risk of institutionalization. Providing caregivers guidance may enable them to assure better quality of life for patient and caregiver and lower institutionalization rates. Objective: To evaluate the effects of a neuropsychological rehabilitation program (NRP) combined with pharmacological treatment in early stage AD patients. Methods: We studied 12 AD patients (6 women), average age 75.42 (6.22) with 9.58 (5.6) years education in use of stable doses of cholinesterase inhibitors. Cognitive performance was evaluated using Mini-Mental State Examination (MMSE) and Alzheimer´s Disease Assessment Scale-cognitive (ADAS-Cog). Caregivers responded to Neuropsychiatric Inventory (NPI) and Functional Activities Questionnaire (FAQ) at initial evaluation (T1), and after 8 months of rehabilitation program (T2). The program comprised two sessions every week and family guidance every fortnight. Results: MMSE (T1:23.25 (1.82)/T2:23.42 (2.81); ADAS-Cog (T1:17.11 (6.73)/T2:21.2 (8.59); NPI (T1:23.42 (23.38)/T2:19.83 (17.73); FAQ (T1:10.67 (7.24)/T2: 13.92 (6.92). Conclusions: These results show the importance of providing guidance and support for caretakers. Study limitations were the small number of patients and absence of a control group with only drug treatment to compare with combined pharmacological and rehabilitation treatments.

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A Qualitative Study of the Cognitive Rehabilitation Program GRADIOR for People with Cognitive Impairment: Outcomes of the Focus Group Methodology

Journal of Clinical Medicine ◽

10.3390/jcm10040859 ◽

2021 ◽

Vol 10 (4) ◽

pp. 859

Author(s):

Eider Irazoki ◽

Mª Cruz Sánchez-Gómez ◽

Leslie María Contreras-Somoza ◽

José Miguel Toribio-Guzmán ◽

Mª Victoria Martín-Cilleros ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Focus Group ◽

Qualitative Study ◽

Cognitive Rehabilitation ◽

Healthcare Professionals ◽

Rehabilitation Program ◽

Neuropsychological Rehabilitation ◽

People With Dementia ◽

Focus Group Methodology

In recent years, technology has been implemented in the field of interventions for older adults. GRADIOR 4.5 is a cognitive software within the wide variety of available multimedia programs that support healthcare professionals in cognitive assessment and neuropsychological rehabilitation. The study aimed to evaluate the new version of GRADIOR (v4.5) based on the experience of people with mild cognitive impairment (MCI), people with dementia (PWD), and healthcare professionals. A qualitative study using the focus group methodology was carried out involving 13 people with MCI, 13 PWD, and 11 healthcare professionals. An analysis of the content and the level of feedback was performed. The study showed that GRADIOR 4.5 might be sufficiently adapted to PWD and people with MCI. Participants were motivated to use GRADIOR 4.5, showed high acceptability of the software, and a positive attitude towards technology. However, healthcare professionals suggested significant improvements to the software. GRADIOR 4.5 appeared to be a promising intervention that, because of its positive experience and acceptability, could be systematically implemented to complement cognitive rehabilitation interventions for older adults with MCI and dementia. Finally, it is advisable to consider the suggestions gathered in this study for future developments.

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Evaluation of a Web-Based Cognitive Rehabilitation Program in Cancer Survivors Reporting Cognitive Symptoms After Chemotherapy

Journal of Clinical Oncology ◽

10.1200/jco.2016.67.8201 ◽

2017 ◽

Vol 35 (2) ◽

pp. 217-225 ◽

Cited By ~ 60

Author(s):

Victoria J. Bray ◽

Haryana M. Dhillon ◽

Melanie L. Bell ◽

Michael Kabourakis ◽

Mallorie H. Fiero ◽

...

Keyword(s):

Cognitive Function ◽

Cancer Survivors ◽

Cognitive Rehabilitation ◽

Standard Care ◽

Primary Outcome ◽

Intervention Group ◽

Rehabilitation Program ◽

Cognitive Symptoms ◽

Significant Difference

Purpose Cognitive impairment is reported frequently by cancer survivors. There are no proven treatments. We evaluated a cognitive rehabilitation program (Insight) and compared it with standard care in cancer survivors self-reporting cognitive symptoms. Patients and Methods We recruited adult cancer survivors with a primary malignancy (excluding central nervous system malignancies) who had completed three or more cycles of adjuvant chemotherapy in the previous 6 to 60 months and reported persistent cognitive symptoms. All participants received a 30-minute telephone consultation and were then randomly assigned to the 15-week, home-based intervention or to standard care. Primary outcome was self-reported cognitive function (Functional Assessment of Cancer Therapy Cognitive Function [FACT-COG] perceived cognitive impairment [PCI] subscale): difference between groups after intervention (T2) and 6 months later (T3). Results A total of 242 participants were randomly assigned: median age, 53 years; 95% female. The primary outcome of difference in FACT-COG PCI was significant, with less PCI in the intervention group at T2 ( P < .001). This difference was sustained at T3 ( P < .001). At T2, there was a significant difference in all FACT-COG subscales, favoring the intervention. Neuropsychological results were not significantly different between the groups at T2 or T3. There were significantly lower levels of anxiety/depression and fatigue in the intervention group at T2. There were significant improvements in stress in the intervention group at both time points. There was no significant difference in quality of life between the groups at T2, but the intervention group had better quality of life at T3. Conclusion The intervention, Insight, led to improvements in cognitive symptoms compared with standard care. To our knowledge, this is the first large randomized controlled trial showing an improvement in self-reported cognitive function in cancer survivors, indicating that this intervention is a feasible treatment.

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