Web-Based Cognitive Training: Patient Adherence and Intensity of Treatment in an Outpatient Memory Clinic

Background Cognitive training has been playing an increasing role in the treatment of patients with cognitive deficits. This type of intervention, namely its intensity, can be optimized by incorporating information technology-based systems. Objective The intent of the study was to determine the treatment intensity and patient adherence to home-based cognitive training strategies (Web-based cognitive training). Methods A cohort of 45 patients with neurologic and psychiatric diseases attending an outpatient memory clinic (average age 50.7 years, SD 17.0; average education 7.8 years, SD 4.9) was followed over 18 months. Participants were challenged to use a Web-based cognitive training system, “COGWEB”, on a daily basis, and fulfilled at least four weeks of training supervised remotely. Additionally, 11 patients attended face-to-face sessions. Results The average duration of continuous cognitive training was 18.8 weeks (SD 18.9). Each patient performed on average 363.5 minutes/week (SD 136.6). At 6-month follow-up, 82.8% complied with their treatment plan. The average proportion of complete weeks was 0.75 (SD 0.22). Patients with dementia trained more intensively (444.6 minutes/week), followed by patients with static brain lesion (414.5 minutes/week; P=.01). The group that held face-to-face sessions performed more training overall (481.4 vs 366.9 minutes/week), achieving a stronger expression and statistical significance in the last week of training (652.6 versus 354.9 minutes/week, P=.027). Conclusions Overall, the weekly training intensity was high. Patients with dementia and static lesions performed more cognitive training. Face-to-face sessions were associated with higher intensities. The combination of classical methods with information technology systems seems to ensure greater training intensity.

[1]  A. Raz,et al.  Training the brain: Fact and fad in cognitive and behavioral remediation , 2012, Brain and Cognition.

[2]  Joanne Azulay,et al.  Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008. , 2011, Archives of physical medicine and rehabilitation.

[3]  Cameron S. Carter,et al.  Developing treatments for impaired cognition in schizophrenia , 2012, Trends in Cognitive Sciences.

[4]  P. Whitehouse,et al.  Marketplace of memory: what the brain fitness technology industry says about us and how we can do better. , 2011, The Gerontologist.

[5]  P. Langhorne,et al.  Stroke rehabilitation , 2011, The Lancet.

[6]  C. S. Green,et al.  Brains on video games , 2011, Nature Reviews Neuroscience.

[7]  B. Rockstroh,et al.  Extending the Constraint-Induced Movement Therapy (CIMT) approach to cognitive functions: Constraint-Induced Aphasia Therapy (CIAT) of chronic aphasia. , 2007, NeuroRehabilitation.

[8]  Yu-Jin Cha,et al.  Effect of computer-based cognitive rehabilitation (CBCR) for people with stroke: a systematic review and meta-analysis. , 2013, NeuroRehabilitation (Reading, MA).

[9]  C. Chronaki,et al.  eHealth Trends in Europe 2005-2007: A Population-Based Survey , 2008, Journal of medical Internet research.

[10]  A. Pollock,et al.  Cognitive Rehabilitation for Executive Dysfunction in Adults With Stroke or Other Adult Nonprogressive Acquired Brain Damage , 2013, The Cochrane database of systematic reviews.

[11]  V. Cruz,et al.  Prevalence and pattern of cognitive impairment in rural and urban populations from Northern Portugal , 2010, BMC Neurology.

[12]  Peter J. Snyder,et al.  Immediate and delayed effects of cognitive interventions in healthy elderly: A review of current literature and future directions , 2009, Alzheimer's & Dementia.

[13]  L. Pantoni,et al.  The VAS-COG clinic: an out-patient service for patients with cognitive and behavioral consequences of cerebrovascular diseases , 2012, Neurological Sciences.

[14]  Jeanine M. Parisi,et al.  Computerized Cognitive Training with Older Adults: A Systematic Review , 2012, PloS one.

[15]  R. Rhodes,et al.  Adult sedentary behavior: a systematic review. , 2012, American journal of preventive medicine.

[16]  N. Lincoln,et al.  Memory rehabilitation for people with multiple sclerosis. , 2016, The Cochrane database of systematic reviews.

[17]  J. Giacino,et al.  Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002. , 2005, Archives of physical medicine and rehabilitation.

[18]  T. Sanger,et al.  Harnessing neuroplasticity for clinical applications , 2011, Brain : a journal of neurology.

[19]  Virgílio F. Bento,et al.  A Rehabilitation Tool Designed for Intensive Web-Based Cognitive Training: Description and Usability Study , 2013, JMIR research protocols.

[20]  Michael Valenzuela,et al.  Cognitive and memory training in adults at risk of dementia: A Systematic Review , 2011, BMC geriatrics.

[21]  T. Ashman,et al.  An evidence-based review of cognitive rehabilitation in medical conditions affecting cognitive function. , 2013, Archives of physical medicine and rehabilitation.

[22]  Abbas Ali Mahdi,et al.  Therapeutics of Alzheimer's disease: Past, present and future , 2014, Neuropharmacology.

[23]  R. Omar,et al.  Study protocol: cluster randomised controlled trial to assess the clinical and cost effectiveness of a staff training intervention in inpatient mental health rehabilitation units in increasing service users’ engagement in activities , 2013, BMC Psychiatry.

[24]  R. Araya,et al.  Scale up of services for mental health in low-income and middle-income countries , 2011, The Lancet.

[25]  Susanne M. Jaeggi,et al.  Improving fluid intelligence with training on working memory: a meta-analysis , 2008, Psychonomic Bulletin & Review.

[26]  A. Mackey,et al.  Differential effects of reasoning and speed training in children. , 2011, Developmental science.

[27]  Jerri D. Edwards,et al.  Randomized trial of cognitive speed of processing training in Parkinson disease , 2013, Neurology.

[28]  Martin Orrell,et al.  Cognitive stimulation for dementia: A systematic review of the evidence of effectiveness from randomised controlled trials , 2013, Ageing Research Reviews.

[29]  P. Hämäläinen,et al.  Neuropsychological rehabilitation for multiple sclerosis. , 2014, The Cochrane database of systematic reviews.

[30]  T. Münte,et al.  Constraint-induced aphasia therapy following sub-acute stroke: a single-blind, randomised clinical trial of a modified therapy schedule , 2013, Journal of Neurology, Neurosurgery & Psychiatry.

[31]  A. Diamond,et al.  Interventions Shown to Aid Executive Function Development in Children 4 to 12 Years Old , 2011, Science.

[32]  David Coghill,et al.  Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. , 2013, The American journal of psychiatry.

[33]  Richard J. Davidson,et al.  Brain training: Games to do you good , 2013, Nature.

[34]  R. Cohen Kadosh,et al.  The Mental Cost of Cognitive Enhancement , 2013, The Journal of Neuroscience.

[35]  Y. Dhansay,et al.  Specific Mental Health Disorders: Child and Adolescent Mental Disorders , 2008 .

[36]  Vikram Patel,et al.  Mental health of young people: a global public-health challenge , 2007, The Lancet.

[37]  E. Taub.  The behavior-analytic origins of constraint-induced movement therapy: An example of behavioral neurorehabilitation , 2012, The Behavior analyst.

[38]  George W Rebok,et al.  Ten‐Year Effects of the Advanced Cognitive Training for Independent and Vital Elderly Cognitive Training Trial on Cognition and Everyday Functioning in Older Adults , 2014, Journal of the American Geriatrics Society.

[39]  Bob Woods,et al.  Cognitive training and cognitive rehabilitation for persons with mild to moderate dementia of the Alzheimer's or vascular type: a review , 2013, Alzheimer's Research & Therapy.

[40]  Susanne M. Jaeggi,et al.  The Relationship between N-Back Performance and Matrix Reasoning--Implications for Training and Transfer. , 2010 .

[41]  M. Rafii.  Update on Alzheimer's disease therapeutics. , 2013, Reviews on recent clinical trials.

[42]  S. Vinogradov,et al.  Cognitive Training for Impaired Neural Systems in Neuropsychiatric Illness , 2012, Neuropsychopharmacology.

[43]  C. Bottino,et al.  Cognitive intervention in amnestic Mild Cognitive Impairment: A systematic review , 2012, Neuroscience & Biobehavioral Reviews.

[44]  Julie A Fiez,et al.  Play, attention, and learning: How do play and timing shape the development of attention and influence classroom learning? , 2013, Annals of the New York Academy of Sciences.

[45]  John Bond,et al.  The worldwide economic impact of dementia 2010 , 2013, Alzheimer's & Dementia.

[46]  Christopher M Callahan,et al.  Systematic review of non-pharmacologic interventions to delay functional decline in community-dwelling patients with dementia , 2013, Aging & mental health.

[47]  J. Morgenlander,et al.  Update on Alzheimer's disease: Promising advances in detection and treatment , 1999 .