Alzheimer's disease (AD) is commonly associated with marked memory deficits; however, nonamnestic variants have been consistently described as well. Posterior cortical atrophy (PCA) is a progressive degenerative condition in which posterior regions of the brain are predominantly affected, therefore resulting in a pattern of distinctive and marked visuospatial symptoms, such as apraxia, alexia, and spatial neglect. Despite the growing number of studies on cognitive and neural bases of the visual variant of AD, intervention studies remain relatively sparse. Current pharmacological treatments offer modest efficacy. Also, there is a scarcity of complementary nonpharmacological interventions with only two previous studies of PCA. Here we describe a highly educated 57-year-old patient diagnosed with a visual variant of AD who participated in a cognitive intervention program (comprising reality orientation, cognitive stimulation, and cognitive training exercises). Neuropsychological assessment was performed across moments (baseline, postintervention, follow-up) and consisted mainly of verbal and visual memory. Baseline neuropsychological assessment showed deficits in perceptive and visual-constructive abilities, learning and memory, and temporal orientation. After neuropsychological rehabilitation, we observed small improvements in the patient's cognitive functioning, namely in verbal memory, attention, and psychomotor abilities. This study shows evidence of small beneficial effects of cognitive intervention in PCA and is the first report of this approach with a highly educated patient in a moderate stage of the disease. Controlled studies are needed to assess the potential efficacy of cognition-focused approaches in these patients, and, if relevant, to grant their availability as a complementary therapy to pharmacological treatment and visual aids.
Some variants of Alzheimer's disease (AD) have been previously identified and described in the literature. Despite the existence of a few studies describing the neuropsychological deficits present in atypical presentations, there is still sparse research on cognitive intervention in atypical presentations of AD. In this work we report the case of a 57 years old patient diagnosed with a variant of Alzheimer's disease that presented to our services complaining about temporal disorientation, watching time and reading problems. After a neuropsychological assessment he was submitted to a cognitive intervention program which comprised two blocks of 15 sessions of 2 hours delivered 3 times a week. This cognitive rehabilitation program included exercises like identification of numbers, simple math operations, object naming exercises, clock exercises and providing strategies for orientation. The focus of the intervention was therefore to improve functionality and autonomy through direct retraining and compensation. We conducted neuropsychological assessments at the following moments: baseline, at the end of the first block, after the second block of the program and follow-up. The neuropsychological assessment exhibited deficits in learning and memory (visual and verbal auditory) as well as visual perceptive and visual constructive abilities, and temporal disorientation. After the intervention small improvements in temporal orientation (with some clues), verbal learning and memory and psychomotor abilities were observed. Difficulties in sustained attention and severe deficits in visual constructive abilities were still evident. The patient reported being more confident and some differences in mood were noticed by patient's significant others. 9 months after the intervention the patient was stable on measures of learning and memory. In accordance with the only previous published work on cognitive intervention in AD variants, we observed that this type of intervention can provide small improvements which are clinically relevant. Further studies should be carried out in order to systematically evaluate the potentialities of cognitive intervention in AD variants.
Numerous studies have been conducted discussing the importance and effectiveness of cognitive interventions for stroke-related cognitive impairments. Definite conclusions, however, are yet to be established. An extensive literature and database search was executed to summarize the existing evidence from high-quality randomized clinical trials on the effects of cognitive intervention and feasibility of this approach in stroke patients. Out of 507 identified studies, after thorough inspection, only three randomized clinical trials, with low risk of bias, met the established criteria and were included in the following meta-analysis. No significant effects of cognitive intervention in any of the analyzed outcomes were observed with feasibility analyzes displaying high rates of completion and adherence. The following study suggests a lack of sufficient evidence to support or refute the efficacy of cognitive intervention in stroke patients. However, these results should be interpreted with caution. Additionally, serious efforts must be made to improve the quality of empirical studies in the field. In sum, the quality of methodological techniques in the field were inspected in hopes of contributing to further development of this therapeutic approach.
Although some studies point to cognitive stimulation as a beneficial therapy for older adults with cognitive impairments, this area of research and practice is still lacking dissemination and is underrepresented in many countries. Moreover, the comparative effects of different intervention durations remain to be established and, besides cognitive effects, pragmatic parameters, such as cost-effectiveness and experiential relevance to participants, are seldom explored. In this work, we present a randomized controlled wait-list trial evaluating 2 different intervention durations (standard = 17 vs brief = 11 sessions) of a cognitive stimulation program developed for older adults with cognitive impairments with or without dementia. 20 participants were randomly assigned to the standard duration intervention program (17 sessions, 1.5 months) or to a wait-list group. At postintervention of the standard intervention group, the wait-list group crossed over to receive the brief intervention program (11 sessions, 1 month). Changes in neuropsychological, functionality, quality of life, and caregiver outcomes were evaluated. Experience during intervention and costs and feasibility were also evaluated. The current cognitive stimulation programs (ie, standard and brief) showed high values of experiential relevance for both intervention durations. High adherence, completion rates, and reasonable costs were found for both formats. Further studies are needed to definitively establish the potential efficacy, optimal duration, cost-effectiveness, and experiential relevance for participants of cognitive intervention approaches.
Abstract Background Baricitinib has shown efficacy in hospitalized patients with COVID-19, but no placebo-controlled trials have focused specifically on severe/critical COVID, including vaccinated participants. Methods Bari-SolidAct is a phase-3, multicentre, randomised, double-blind, placebo-controlled trial, enrolling participants from June 3, 2021 to March 7, 2022, stopped prematurely for external evidence. Patients with severe/critical COVID-19 were randomised to Baricitinib 4 mg once daily or placebo, added to standard of care. The primary endpoint was all-cause mortality within 60 days. Participants were remotely followed to day 90 for safety and patient related outcome measures. Results Two hundred ninety-nine patients were screened, 284 randomised, and 275 received study drug or placebo and were included in the modified intent-to-treat analyses (139 receiving baricitinib and 136 placebo). Median age was 60 (IQR 49–69) years, 77% were male and 35% had received at least one dose of SARS-CoV2 vaccine. There were 21 deaths at day 60 in each group, 15.1% in the baricitinib group and 15.4% in the placebo group (adjusted absolute difference and 95% CI − 0.1% [− 8·3 to 8·0]). In sensitivity analysis censoring observations after drug discontinuation or rescue therapy (tocilizumab/increased steroid dose), proportions of death were 5.8% versus 8.8% (− 3.2% [− 9.0 to 2.7]), respectively. There were 148 serious adverse events in 46 participants (33.1%) receiving baricitinib and 155 in 51 participants (37.5%) receiving placebo. In subgroup analyses, there was a potential interaction between vaccination status and treatment allocation on 60-day mortality. In a subsequent post hoc analysis there was a significant interaction between vaccination status and treatment allocation on the occurrence of serious adverse events, with more respiratory complications and severe infections in vaccinated participants treated with baricitinib. Vaccinated participants were on average 11 years older, with more comorbidities. Conclusion This clinical trial was prematurely stopped for external evidence and therefore underpowered to conclude on a potential survival benefit of baricitinib in severe/critical COVID-19. We observed a possible safety signal in vaccinated participants, who were older with more comorbidities. Although based on a post-hoc analysis, these findings warrant further investigation in other trials and real-world studies. Trial registration Bari-SolidAct is registered at NCT04891133 (registered May 18, 2021) and EUClinicalTrials.eu ( 2022-500385-99-00 ).
Assessment of therapies for the key consequences of mild traumatic brain injury (mTBI)/concussion is required.Identify all RCTs of mTBI/concussion therapy, risks of bias, and therapies with significant positive results.17 electronic, 9 grey-literature databases searched without language/date restrictions; independent assessment of 1450 Abstracts/titles, 141 fulltext articles, 14 included RCTs.Four RCTs used American Congress of Rehabilitation TBI definition, others used unique definitions. Risk of bias: 43% low risk randomization; 14% concealed assignments; 21% blinded participants/personnel; 57% blinded assessors; 64% low risk attrition; 100% no selective reporting. Eleven RCTs included only mTBI. Ten significant positive results: six cognitive behavioral therapy (CBT), three videotape, pagers or personal digital assistants, and one physical therapy. One of referrals to health professionals no significant positive results. Three RCTs included both mTBI and moderate TBI. We wished to assess if authors proved using same interventions with both groups is appropriate. Two used CBT, one used pagers. All three RCTs significant positive results but results for their mild and moderate TBI patients were not separated. Two RCTs assessed return to work and no differences between intervention.Of 14 RCTs, six CBT, four digital assistants or videotape feedback and one physical therapy all had significant positive results. One referred patients to consultants and no significant positive results. Two assessed return to employment and no differences between interventions. Limitations are: (1) only four RCTs used the same concussion definition; (2) average age 38 (except for one study of adolescents, (3) all studies used unique interventions; (4) most authors used multiple interventions and effects could not be separated; (5) substantial attrition from eligibles to randomization, (4) only 64% at low risk from randomization, (5) 80 different outcome measures and meta-analysis was not possible, (6) only two studies assessed return to work.
Several studies have shown that cognitive intervention may be beneficial for people with Alzheimer disease (AD), but literature reviews conducted so far, have yielded mixed and inconclusive results. In this work, through an extensive bibliographic search, we aim: (1) to analyze the efficacy of cognitive intervention in patients diagnosed with AD; (2) to provide an estimate of the feasibility of cognitive intervention; and (3) to review available cost-effectiveness data of this approach. Four randomized controlled trials of cognitive intervention, for patients diagnosed with AD that incorporated cognitive intervention and mock intervention control conditions, were included in the analysis. Only the domain of global cognitive functioning, as measured by Mini-Mental State Examination, showed significant intervention effects. No effects were observed in the remaining domains. Concerning feasibility, high rates of completion and adherence were found. A single randomized controlled trial, with unspecified dementia, suggested cognitive intervention to be cost-effective. Given the currently available dearth of well-controlled and focused trials in AD, these results should be carefully interpreted and remain to be confirmed in the future. There is a clear need for more high-quality research.
Purpose: Fifty percent of patients with Multiple Sclerosis (MS) are estimated to have cognitive impairments leading to considerable decline in productivity and quality of life.Cognitive intervention has been considered to complement pharmacological treatments.However, a lack of agreement concerning the efficacy of cognitive interventions in MS still exists.A systematic review and meta-analysis was conducted to assess the effects of cognitive interventions in MS.Methods: To overcome limitations of previous meta-analyses, several databases were searched only for Randomized Clinical Trials (RCTs) with low risk of bias.Results: Five studies (total of 139 participants) met our eligibility criteria.Although good completion and adherence rates were evident, we found no evidence of intervention effects on cognition or mood in post-intervention or follow-up assessments.Conclusions: This is the first meta-analysis assessing the effects of cognitive intervention in MS including only RCTs with comparable conditions.Research regarding efficacy, cost-effectiveness and feasibility is still in its infancy.Caution is advised when interpreting these results due to the small number of RCTs meeting the inclusion criteria.Considering the costs of disease, good completion and adherence rates of this approach, further research is warranted.Recommendations concerning improved research practices in the field are presented as well.
