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PubMed1989

Improving aerobic capacity in healthy older adults does not necessarily lead to improved cognitive performance.

The effects of aerobic exercise training in a sample of 85 older adults were investigated. Ss were assigned randomly to either an aerobic exercise group, a nonaerobic exercise (yoga) group, or a waiting-list control group. Following 16 weeks of the group-specific protocol, all of the older Ss received 16 weeks of aerobic exercise training. The older adults demonstrated a significant increase in aerobic capacity (cardiorespiratory fitness). Performance on reaction-time tests of attention and memory retrieval was slower for the older adults than for a comparison group of 24 young adults, and there was no improvement in the older adults' performance on these tests as a function of aerobic exercise training. Results suggest that exercise-related changes in older adults' cognitive performance are due either to extended periods of training or to cohort differences between physically active and sedentary individuals.

Adult↗
PubMed2000

[Cognitive remediation. A new chance in rehabilitation of schizophrenic disorders?].

A critical review of current approaches and principles of cognitive remediation strategies in rehabilitation of schizophrenia is given. Selection of cognitive functions targeted in compensatory training programs could be based on results of neuropsychological predictor research on social and vocational functioning in community and neuropsychological rate limiting factors in rehabilitation. Methodological flaws in data base, missing of task analysis of more complex skills like social perception, social skills and interpersonal problem solving and the lack of evaluation of training generalization on work performance are discussed. Finally the cognitive remediation program developed in the Department of General Psychiatry and Psychotherapy/University of Freiburg, Germany is proposed. The components focused on training in attention, memory, and executive function (decision making, planning). Compensatory strategy building, and computer-mediated automatization are integrated in a group setting.

Cognition Disorders↗
PubMed2007

Stress management at the worksite: reversal of symptoms profile and cardiovascular dysregulation.

Work stress may increase cardiovascular risk either indirectly, by inducing unhealthy life styles, or directly, by affecting the autonomic nervous system and arterial pressure. We hypothesized that, before any apparent sign of disease, work-related stress is already accompanied by alterations of RR variability profile and that a simple onsite stress management program based on cognitive restructuring and relaxation training could reduce the level of stress symptoms, revert stress-related autonomic nervous system dysregulation, and lower arterial pressure. We compared 91 white-collar workers, enrolled at a time of work downsizing (hence, in a stress condition), with 79 healthy control subjects. Psychological profiles were assessed by questionnaires and autonomic nervous system regulation by spectral analysis of RR variability. We also tested a simple onsite stress management program (cognitive restructuring and relaxation training) in a subgroup of workers compared with a sham subgroup (sham program). Workers presented an elevated level of stress-related symptoms and an altered variability profile as compared with control subjects (low-frequency component of RR variability was, respectively, 65.2+/-2 versus 55.3+/-2 normalized units; P<0.001; opposite changes were observed for the high-frequency component). These alterations were largely reverted (low-frequency component of RR variability from 63.6+/-3.9 to 49.3+/-3 normalized units; P<0.001) by the stress management program, which also slightly lowered systolic arterial pressure. No changes were observed in the sham program group. This noninvasive study indicates that work stress is associated with unpleasant symptoms and with an altered autonomic profile and suggests that a stress management program could be implemented at the worksite, with possible preventive advantages for hypertension.

Adult↗
PubMed2006

Assessing cognitive & motor performance in minimally invasive surgery (MIS) for training & tool design.

The objective of this paper is to present the development of a new modelling diagram (MCMD) to represent MIS procedures in terms of both motor and cognitive actions. Through observation and analysis of several laparoscopic cholecystectomy procedures and based on task analysis techniques, we created a diagram language composed of six primary symbols: processes, decisions, interrupt service routines (ISRs), options points and AND and OR gates. We then tested and refined them during 10 new cases until no further changes seemed necessary, we have since applied this approach to 6 laparoscopic colorectal surgeries and have found that no further symbols were necessary though the procedural representation was naturally different. This modelling diagram allowed us to represent both cognitive and motor performance aspects of surgical procedures in a unified framework and will in future allow us to assess motor performance on particular surgical tasks at particular points in the procedure (i.e., the surgical context).

Computer Simulation↗
PubMed2004

[Mild cognitive impairment].

It is essential to determine whether memory impairment is accompanied by impairment in other cognitive areas in patients presenting with the complaint of forgetfulness. Furthermore, it should be established whether this impairment is associated with normal aging or dementia. Several terms have been suggested to identify cognitive disorders without dementia. Benign senescent forgetfulness, age-associated memory impairment and aging-associated cognitive decline are considered to fall within the limits of normal aging. A recently proposed term, mild cognitive impairment, as opposed to the terms mentioned above, identifies a transitional state between normal aging and dementia. With the use of criteria proposed for mild cognitive impairment, this disorder converts to Alzheimer's disease at a rate of 10-15 % yearly. However, in longitudinal studies different neuropsychological tests and assessment scales were used for the diagnosis of mild cognitive impairment, resulting in different conversion rates to Alzheimer's disease. Recently, it has been proposed to classify mild cognitive impairment according to memory and non-memory involvement as amnestic, multiple domain and non-memory single domain clinical subtypes. Furthermore, vascular, metabolic, traumatic and various etiologies other than degenerative etiology are mentioned. Besides the medications known to be effective for cognitive dysfunctions, memory enhancement training is suggested for treatment. A consensus on the diagnostic criteria for mild cognitive impairment, determining the subgroups and further studies on treatment are necessary.

Cognition Disorders↗
PubMed2000

The combination of medical treatment plus multicomponent behavioral therapy is superior to medical treatment alone in the therapy of irritable bowel syndrome.

OBJECTIVE: Although the standard treatments for the irritable bowel syndrome (IBS) are medical, growing evidence indicates the substantial therapeutic value of psychological therapy. However, it has not been investigated whether the combination of multicomponent behavioral therapy plus medical treatment is more effective than medical treatment alone. The aim of this study was to investigate this question in patients consulting a tertiary gastrointestinal (GI) referral center. METHODS: Twenty-four IBS outpatients were randomly assigned to the combination of standardized multicomponent behavioral therapy plus standard medical treatment (SMBT) or standard medical treatment alone (SMT). SMBT included IBS information and education, progressive muscle relaxation, training in illness-related cognitive coping strategies, problem-solving, and assertiveness training in 10 sessions over 10 wk. SMT included standardized symptom-oriented medical treatment and regular visits to a gastroenterologist every second week. Posttreatment outcome measures consisted of quantification of GI, vegetative, and psychological symptoms by means of daily symptom diaries and the assessment of changes in rectovisceral perception thresholds, as well as of questionnaire measures on psychological distress, overall well-being, illness-related coping abilities, and quality of life. Follow-ups were conducted at 3- and 6-month intervals. RESULTS: Pre- and posttreatment evaluations showed significantly (p < 0.01) greater IBS symptom reduction as measured by daily symptom diaries for the SMBT group than for the SMT group. Rectovisceral perception remained unchanged by either treatment. Overall well-being significantly improved in the SMBT group but remained unchanged in the SMT group. Subjects in the SMBT group, unlike those in the SMT group, felt significantly more in control of their health, and quality of life was significantly improved in the SMBT group but remained unchanged in the SMT group. CONCLUSIONS: The data provide evidence that the combination of medical treatment plus multicomponent behavioral treatment is superior to medical treatment alone in the therapy of IBS.

Adaptation, Psychological↗
PubMed2000

Treatments for aggressive and antisocial children.

Many different types of treatment have been applied to conduct-disordered youths. Unfortunately, little outcome evidence exists for most of the techniques. Three treatments with the strongest evidence to date were highlighted in this article: PMT, PSST, and MST. Parent management training is directed at altering parent-child interactions in the home, particularly those interactions related to child-rearing practices and coercive interchanges. Cognitive problem-solving skills training focuses on cognitive processes that underlie social behavior. Multisystemic therapy focuses on the individual, family, and extrafamilial systems and their interrelations as a way to reduce symptoms and to promote prosocial behavior. Each of these treatments has multiple controlled studies on its behalf, and some of the techniques (e.g., PMT) have been extraordinarily well evaluated. Significant issues remain to be addressed to accelerate treatment advances. We cannot yet say that one intervention can ameliorate conduct disorder and overcome the poor long-term prognosis. On the other hand, much can be said. Much of what is practiced in clinical settings is based on psychodynamically oriented treatment, general relationship counseling, generic family therapy, and group therapy (with antisocial youths as members). These and other procedures, alone and in various combinations in which they are often used, have not been evaluated carefully in controlled trials. Of course, absence of evidence is not tantamount to ineffectiveness. At the same time, promising treatments have advanced considerably, and a very special argument might be needed to administer treatments that have neither basic research on their conceptual underpinnings in relation to conduct disorder nor outcome evidence from controlled clinical trials on their behalf. Promising treatments, at best, leave important questions unanswered. Further development of treatments clearly is needed. Apart from treatment studies, further progress in understanding the nature of conduct disorder is likely to have very important implications for improving treatment outcome. Improved triage of patients to treatments that are likely to work will require understanding of characteristics of children, parents, and families that will make them more or less amenable to current treatments.

Aggression↗
PubMed1976

Eye movements and conservation acceleration in mildly retarded children.

Thirty mildly retarded elementary-school children, 15 of whom had received perceptual/attentional training, were tested on four Piagetian conservation tasks (number, length, and continuous quantity solid/liquid) presented on 16 mm movie film with taped instructions. Eye movements were recorded during the response period for each task. Subsequent analyses of eye-movement patterns showed clear differences between the training and control groups. Trained conservers showed more visual exploratory activity and less perceptual centration than control group subjects. Moreover the eye-movement patterns of trained conservers closely approximated those shown by natural (i.e., untrained) retarded conservers in a previous study. The findings were discussed in terms of possible cognitive structural changes resulting from training and possible cognitive structural differences between mildly retarded and nonretarded children.

Child↗
PubMed1996

Influence of training and experience on the perception of multicomponent odor mixtures.

This study examined whether a previously established (D. G. Laing & G. W. Francis, 1989) limited capacity to discriminate and identify the components of olfactory mixtures resulted from the participants' lack of familiarity with the task, training designed to optimize cognitive and perceptual performance, or professional experience in odor discrimination. The participants were a trained panel of 10 women (23-43 years old), and an expert panel of 8 male professional perfumers and flavorists (25-55 years old). The individual chemical stimuli were 7 common dissimilar odorants of equal moderate intensity. An air dilution olfactometer delivered a single odorant or a mixture containing up to 5 odorants. The results indicated that for both panels only 3 or 4 components of a complex mixture could be discriminated and identified and that this capacity could not be increased by training. Therefore, the limit may be imposed physiologically or by processing constraints.

Adult↗
PubMed1995

Social phobia. Longitudinal course and long-term outcome of cognitive-behavioral treatment.

Interest in social phobia has increased dramatically in the past decade, and our knowledge of this previously understudied disorder has increased as well. We now know that social phobia is a chronic condition and that patients with this disorder are unlikely to experience significant improvement without intervention. It is also a highly prevalent condition affecting as many as 13% of the adult population of the Unites States. Although our understanding of the causes of social phobia remains limited, we do know that it is associated with serious impairment and disability in multiple spheres. Thus, the development of treatments with proven long-term efficacy is an important research goal. In this article, we have reviewed studies that examined either exposure, cognitive restructuring, social skills training, or some combination of these treatments. Here, we summarize the major findings of this review. Exposure has fared well as a treatment for social phobia and, in every case, within-group analyses show that patients have improved after treatment. Methodologic problems in some studies, however, limit the conclusions that can be drawn about the comparative efficacy of exposure, social skills training, and relaxation therapy. Conceptual models of social phobia have stressed the importance of cognitive processes in the development and maintenance of social phobia and much attention has been directed at the long-term efficacy of cognitive-behavioral techniques. It has been hypothesized that exposure plus cognitive restructuring would be a particularly effective combination and several methodologically sound studies have examined this combination. These studies have demonstrated consistently clinically significant within-group changes and superiority to control conditions. Heimberg's CBGT is probably the most widely studied of these treatments. CBGT has been shown to be more effective than an equally credible attention-placebo group. Patients receiving CBGT have maintained their advantage over patients in the attention-placebo group, even 5 years after treatment although flaws in that follow-up study limit generalizability of its results. Generalized and nongeneralized social phobic patients respond equivalently to this highly integrated treatment, and it has been applied effectively by researchers outside the center where it was developed. Despite the successes of combined exposure and cognitive restructuring treatments, it remains unclear as to what the effective component(s) of these and similar treatments are and, therefore, whether or not the integration of therapy components is really necessary. A number of the studies reviewed addressed this question with mixed results. Three studies showed that the combination therapy was superior to either treatment alone. There is also evidence that patients treated with exposure only may show some deterioration during follow-up whereas patients treated with cognitive restructuring and exposure may continue to improve. Still, other studies found no differences in long-term outcome among exposure alone, RET, or the combined treatment. Hope et al found that exposure alone was as effective as an integrated treatment combining exposure and cognitive restructuring (CBGT), and Taylor and colleagues (submitted for publication, 1995) reported that exposure was not enhanced by initial treatment with cognitive restructuring. These results are disappointing in light of all that has been written about the likely benefits of combining cognitive and behavioral therapy in the treatment of social phobia. For example, it has been hypothesized that fear of negative evaluation is a key factor in social phobia and that change in this construct should be the goal of treatment. There is some research that supports this claim and other evidence that suggests that exposure alone is not particularly effective in producing those changes. Butler concluded that the treatment of social phobia is made more difficult whe

Cognitive Behavioral Therapy↗
PubMed2001

Mental practice effect on line-tracing accuracy in persons with hemiparetic stroke: a preliminary study.

OBJECTIVE: To investigate the effect of mental practice on line-tracing accuracy of persons with hemiparetic stroke. DESIGN: A single-case, experimental, multiple baseline design. SETTING: Electromyography laboratory of a rehabilitation medicine department of a university hospital. PARTICIPANTS: Three persons with right hemiparesis from stroke. INTERVENTION: Mental practice for line-tracing training. MAIN OUTCOMES MEASURES: Two tracing tasks were used to evaluate the effect of mental practice: (1) tracing a 5.9-inch long horizontal line (task 1); and (2) tracing a 6-inch long curved line (task 2) as a generalization probe. Participants were first trained to master the cognitive rehearsal skill by checking the reduction level of tension in their upper trapezius while listening to a relaxation cassette tape. Second, participants were trained to trace task 1 immediately after listening to a cognitive rehearsal tape that contained the command to trace over a horizontal line as accurately as possible. Then, without the cognitive rehearsal process, participants traced over a curved line as a generalization probe. The dependent variable, called the line length error, was the total distance that the traced line deviated from the printed lines (both horizontal and curved). RESULTS: Mean-line length errors of participants 1, 2, and 3 were: horizontal line tracing, 3.33, 7.38, and.30 inches, respectively, in the baseline and 1.41, 2.70, and.24 inches, respectively, after mental practice training. With the curved line tracing, mean length errors were 3.15, 6.56, and.52 inches in the baseline and 1.85, 4.36, and.80 inches postintervention, respectively. CONCLUSIONS: Mental practice can be an effective method to improve line tracing by persons with hemiparetic stroke. Training in horizontal line tracing showed a modest level of generalization to curved line tracing.

Activities of Daily Living↗
PubMed1991

Subspecialty training: is it financially worthwhile?

OBJECTIVE: To determine the financial return of additional training in a cognitive-oriented medical subspecialty (rheumatology) and in a procedure-oriented medical subspecialty (gastroenterology) relative to general internal medicine. DESIGN: Analysis of existing data to compare lifetime discounted earnings of physicians in different medical specialties. PARTICIPANTS: General internists, gastroenterologists, and rheumatologists were surveyed. MAIN OUTCOME MEASURES: Using data from surveys conducted by Medical Economics and the American College of Rheumatology, we constructed lifetime earnings streams that allowed the calculation of the net present values of discounted lifetime earnings in general internal medicine, gastroenterology, and rheumatology. Net present values of lifetime earnings were calculated for each group at two discount rates. Sensitivity analyses were done to estimate how changes in relative income would affect calculations of the net present values. MAIN RESULTS: The average net incomes before taxes for general internists, gastroenterologists, and rheumatologists in 1988 were $115,825, $201,875, and $118,056, respectively. At 5% and 10% discount rates, the net present values of the estimated career earnings stream for additional training in gastroenterology relative to general internal medicine were + $1,101,863 and + $512,952, respectively; for additional training in rheumatology relative to general internal medicine, the respective values were - $84,748 and - $92,467. If the incomes of general internists were decreased by 3% and the incomes of gastroenterologists were decreased by 25% to reflect the effect of potential changes due to the resource-based relative value scale (RBRVS), or if gastroenterology training were increased to 3 years and rheumatology fellowship stipends were increased by 30%, large differences would still exist between the groups. CONCLUSION: Gastroenterologists have an extremely large return on their additional investment in training, but rheumatologists have a negative return. When considered exclusively as a financial decision, fellowship training in a cognitive-oriented medical subspecialty such as rheumatology is a poor investment. Even major changes in reimbursement policies will not affect the relative pecuniary attractiveness of procedure-oriented medical subspecialties.

Economics, Medical↗
PubMed2004

Neuropsychological rehabilitation of memory deficits and activities of daily living in patients with Alzheimer's disease: a pilot study.

Patients with Alzheimer's disease (AD) gradually lose their cognitive competence, particularly memory, and the ability to perform daily life tasks. Neuropsychological rehabilitation is used to improve cognitive functions by facilitating memory performance through the use of external aids and internal strategies. The effect of neuropsychological rehabilitation through memory training - motor movements, verbal association, and categorization - and activities of daily living (ADL) training was tested in a sample of 5 elderly out-patients (mean age: 77.4 +/- 2.88 years), with mild AD (Mini-Mental State Examination score: 22.20 +/- 2.17) and their caregivers. All patients had been taking rivastigmine (6-12 mg/day) for at least 3 months before being assigned to the rehabilitation sessions, and they continued to take the medication during the whole program. Just before and after the 14-week neuropsychological rehabilitation program all patients were assessed by interviewers that did not participate in the cognitive training, using the Mini-Mental State Examination, Montgomery-Alsberg Depression Rating Scale, Hamilton Anxiety Scale, Interview to Determine Deterioration in Functioning in Dementia, Functional Test, Memory Questionnaire of Daily Living for patient and caregiver, Quality of Life Questionnaire for patient and caregiver, and a neuropsychological battery. The results showed a statistically significant improvement in ADL measured by Functional Test (P = 0.04), and only a small improvement in memory and psychiatric symptoms. Our results support the view that weekly stimulation of memory and training of ADL is believed to be of great value in AD treatment, not only delaying the progress of the disease, but also improving some cognitive functions and ADL, even though AD is a progressively degenerative disease.

Activities of Daily Living↗
PubMed2006

[Effects of a cognitive-behavioral intervention on blood pressure of hypertensive elderly subjects].

BACKGROUND: Cognitive and behavior therapy can be used as an adjunct to medications to reduce blood pressure in hypertensive patients. AIM: To design a brief psychological intervention for hypertensive patients and assess its effects on blood pressure. MATERIAL AND METHODS: Thirty eight hypertensive subjects (35 women, age range 63-77 years) were studied. They were randomly divided in a control and experimental group. The latter group attended eight sessions of a cognitive-behavioral intervention, lasting two hours each, during one month. In each session, subjects were trained in relaxation techniques, cognitive modeling and psycho education. The main outcome assessed was a change in blood pressure levels. RESULTS: In the experimental group, there was a significant reduction from baseline to the second post test assessment, in systolic and diastolic blood pressure levels from 134+/-9 to 123+/-8 mmHg and from 87+/-5 to 73+/-6 mmHg, respectively. CONCLUSIONS: The psychological intervention used in the present study achieved significant reductions in blood pressure levels in this group of hypertensive subjects.

Age Factors↗
PubMed1997

Reduction in risk behavior among adults with severe mental illness who learned to advocate for HIV prevention.

OBJECTIVES: The study evaluated the relative impact of HIV risk reduction interventions for adults with severe mental illness living in the inner city. METHODS: A total of 104 chronically mentally ill men and women were interviewed to determine sexual risk behavior over the past month and to assess HIV risk-related psychological characteristics, including their knowledge about risk behavior, their belief in their ability to change their behavior, their perceptions of peer and social norms about safer sex, their expectancies about the outcomes of these changes, and their perceived barriers to condom use. Participants were then randomly assigned to one of three conditions: a single AIDS education session, a seven-session cognitive-behavioral HIV risk reduction group intervention, or a seven-session group intervention that combined the cognitive-behavioral intervention with training to act as a risk reduction advocate to friends (advocacy training). Individuals were reinterviewed three months after completion of the intervention. RESULTS: Although all participants exhibited change at follow-up in some risk-related psychological characteristics and sexual risk behaviors, participants who received the cognitive-behavioral intervention that included the advocacy training reported greater reductions in rates of unprotected sex and had fewer sexual partners at follow-up. CONCLUSIONS: HIV prevention interventions that teach risk reduction skills and then encourage participants to advocate behavior change to others appear to strengthen participants' capacity to change their behavior to reduce HIV risk, even those from a disenfranchised group such as severely mentally ill adults.

Adult↗
PubMed2004

Brief emotion training improves recognition of facial emotions in chronic schizophrenia. A pilot study.

Impaired emotional communication may be an important contributing factor to poor social function in schizophrenia. This pilot study examined the effect of emotion training exercises on the perception of facial emotional expression. Twenty male chronic schizophrenia patients underwent three training sessions using a computerized Emotion Training program, developed for teaching autistic children, which was adapted to the clinical setting. Patients were assessed before and after training with validated tests of identification of facial emotions (PEAT, ER40), differentiation of facial emotions (EmDiff) and working memory. In comparison to baseline, patients performed significantly better on the PEAT and ER40 tests after training. No change was observed in EmDiff or in cognitive test performance. Brief Emotion Training can improve recognition of facial emotional expressions in chronic schizophrenia patients. This may be due to increased patient awareness of emotional aspects of stimuli and/or improvement in specific emotional perceptual skills. Further studies of Emotion Training as a potential treatment modality are warranted.

Adult↗