Objective This study focused on the efficacy of cognitive training for verbal learning and memory deficits in a population of older Veterans with alcohol use disorders. Methods Veterans with alcohol use disorders, who were in outpatient treatment at VA facilities and in early phase recovery (N = 31), were randomized to receive a 3-month trial of daily cognitive training plus work therapy (n = 15) or work therapy alone (n = 16), along with treatment as usual. Participants completed assessments at baseline and at 3- and 6-month follow-ups; the Hopkins Verbal Learning Task (HVLT) was the primary outcome measure. Results Participants were primarily male (97%), in their mid-50’s (M = 55.16, SD = 5.16), and had been sober for 1.64 (SD = 2.81) months. Study retention was excellent (91% at 3-month follow-up) and adherence to treatment in both conditions was very good. On average, participants in the cognitive training condition had more than 41 hours of cognitive training, and both conditions had more than 230 hours of productive activity. HVLT results at 3-month follow-up revealed significant condition effects favoring cognitive training for verbal learning (HVLT Trial-3 T-score, p < .005; Cohen’s d = 1.3) and verbal memory (HVLT Total T-score, p < .01, Cohen’s d = 1.1). Condition effects were sustained at 6-month follow-up. At Baseline, 55.9% of participants showed a significant deficit in verbal memory and 58.8% showed a deficit in verbal learning compared with a premorbid estimate of Verbal IQ. At 3-month follow-up there was a significant reduction in the number of participants in the cognitive training condition with clinically significant verbal memory deficits (p < .01, NNT= 3.0) compared with the work therapy alone condition, and a trend toward significance for verbal learning deficits, which was not sustained at 6-month follow-up. Conclusions This NIDA-funded pilot study demonstrates that cognitive training within the context of another activating intervention (work therapy) may have efficacy in remediating verbal learning and memory deficits in patients with alcohol use disorder. Findings indicate a large effect for cognitive training in this pilot study, which suggests that further research is warranted. This study is is registered on Clinicaltrials.gov (NCT 01410110).
Background: Anxiety, which is very prevalent in multiple sclerosis (MS) but understudied, has been shown to negatively affect cognition in many different populations. Slowed information processing speed underlies most cognitive impairments in MS, including verbal learning. The aim of this study was to look at how anxiety influences cognition—specifically processing speed and verbal learning—in MS. Methods: Eligibility criteria were adults (≥18 years) who had a diagnosis of clinically definite MS and had participated in neuropsychological research projects. A retrospective medical record review was conducted on the neuropsychological testing data. Two hierarchical multiple regressions were conducted to determine the unique contributions of processing speed and anxiety on verbal learning in MS, after adjusting for demographic and disability variables. Two separate mediation analyses were conducted to determine the relationship between processing speed, verbal learning, and anxiety. Results: Participants (N = 141) ranged in age from 18–91 years. Based on the multiple regression analyses, processing speed (β = 0.55, ΔR2 = 0.27, P < .001) and anxiety (β = −0.34, ΔR2 = 0.11, P < .001) were uniquely significant predictors of verbal learning. Based on the mediation analyses, there was a significant indirect effect of anxiety on verbal learning through processing speed (ab = −0.31, 95% CI = −0.60 to −0.09). There was also a significant indirect effect of processing speed on verbal learning through anxiety (ab = −0.05, 95% CI = 0.01 to 0.12). Conclusions: Results suggest a bidirectional relationship of anxiety and processing speed on verbal learning in MS. Anxiety has a significant effect on cognition and should not be overlooked. Interventions targeting anxiety may improve cognition in MS.
Background This study examined visual and verbal learning in the early phase of recovery for 48 Veterans with alcohol use (AUD) and substance use disorders (SUD, primarily cocaine and opiate abusers). Previous studies have demonstrated visual and verbal learning deficits in AUD, however little is known about the differences between AUD and SUD on these domains. Since the DSM-5 specifically identifies problems with learning in AUD and not in SUD, and problems with visual and verbal learning have been more prevalent in the literature for AUD than SUD, we predicted that people with AUD would be more impaired on measures of visual and verbal learning than people with SUD. Methods: Participants were enrolled in a comprehensive rehabilitation program and were assessed within the first 5 weeks of abstinence. Verbal learning was measured using the Hopkins Verbal Learning Test (HVLT) and visual learning was assessed using the Brief Visuospatial Memory Test (BVMT). Results Results indicated significantly greater decline in verbal learning on the HVLT across the three learning trials for AUD participants but not for SUD participants (F=4.653, df =48, p=.036). Visual learning was less impaired than verbal learning across learning trials for both diagnostic groups (F=0.197, df=48, p=.674); there was no significant difference between groups on visual learning (F=0.401, df=14, p=.538). Discussion Older Veterans in the early phase of recovery from AUD may have difficulty learning new verbal information. Deficits in verbal learning may reduce the effectiveness of verbally-based interventions such as psycho-education.
Purpose: The current study attempted to expand the literature on cognition and mood in MS by determining if illness intrusiveness may potentially serve as an intermediary factor in the wellestablished cognition-mood relationship in people with MS. Method: This study employed a retrospective cross-sectional design to answer this question. Baseline neuropsychological test data and mood questionnaires from 199 participants with clinically definite MS were used in this study. The sample was middle-aged (M = 48.4, SD = 11.8), highly educated (M = 14.6, SD = 2.2), majority female (76.9%) and majority White (74.5%). Assumptions for parametric statistics and ordinary least squares regression were met. Conditional process models evaluated whether illness intrusiveness mediated the relationship between cognitive functioning and psychiatric symptoms. Results: In total, 33.2% of the sample met criteria for clinically significant anxiety, 41.7% met criteria for depression, and 27.8% of the sample met criteria for processing speed impairment, consistent with other MS samples. Illness intrusiveness was found to mediate the relationship between processing speed and depression, ab = À.07, 95% CI [À.15, À.002], processing speed and anxiety, ab = À.06, 95% CI [À.12, À.02], and processing speed and more general mood disturbance, ab = À.08, 95% CI [À.13, À.0005]. Conclusions: Illness intrusiveness was found to be a potential important intermediary mechanism by which the primary cognitive impairment in MS, processing speed, impacts mood in this disease population. Conclusions, treatment implications, and directions for future research in light of these findings were discussed. Impact and ImplicationsProcessing speed is related to mood symptoms in people with MS, and illness intrusiveness is a possible pathway by which slowed processing speed influences mood. A potential explanation for these findings is that processing speed is the most common cognitive impairment in MS, and often affects people earlier in life when people's careers and relationships are less well-established. It will be important for clinicians to assess how cognitive impairment is influencing the lives of people with MS including their relationships, goals, and engagement in recreational activities. Cognitive rehabilitation may be an important treatment recommendation, as improving cognition may be able to reduce the perceived burden of the disease and enhance mood. Cognitive behavioral psychotherapy may be another important recommendation for helping MS patients to view their illness from a new perspective.
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