The influence of computer-based cognitive flexibility training on subjective cognitive well-being after stroke: A multi-center randomized controlled trial

Abstract

BackgroundStroke can result in cognitive complaints that can have a large impact on quality of life long after its occurrence. A number of computer-based training programs have been developed with the aim to improve cognitive functioning. Most studies investigating their efficacy used only objective outcome measures, whereas a reduction of subjective cognitive complaints may be equally important for improving quality of life. A few studies used subjective outcome measures but were inconclusive, partly due to methodological shortcomings such as lack of proper active and passive control groups.ObjectiveThe aim of the current study was to investigate whether computer-based cognitive flexibility training can improve subjective cognitive functioning and quality of life after stroke.MethodsWe performed a randomized controlled double blind trial (RCT). Adults (30–80 years old) who had a stroke 3 months to 5 years ago, were randomly assigned to either an intervention group (n = 38), an active control group (i.e., mock training; n = 35), or a waiting list control group (n = 24). The intervention and mock training consisted of 58 half-hour sessions within 12 weeks. The primary subjective outcome measures were cognitive functioning (Cognitive Failure Questionnaire), executive functioning (Dysexecutive Functioning Questionnaire), quality of life (Short Form Health Survey), instrumental activities of daily living (IADL; Lawton & Brody IADL scale), and participation in society (Utrecht Scale for Evaluation of Rehabilitation-Participation). Secondary subjective outcome measures were recovery after stroke, depressive symptoms (Hospital Anxiety Depression Scale—depression subscale), fatigue (Checklist Individual Strength—Fatigue subscale), and subjective cognitive improvement (exit list). Finally, a proxy of the participant rated the training effects in subjective cognitive functioning, subjective executive functioning, and IADL.Results and conclusionsAll groups improved on the two measures of subjective cognitive functioning and subjective executive functioning, but not on the other measures. These cognitive and executive improvements remained stable 4 weeks after training completion. However, the intervention group did not improve more than the two control groups. This suggests that improvement was due to training-unspecific effects. The proxies did not report any improvements. We, therefore, conclude that the computer-based cognitive flexibility training did not improve subjective cognitive functioning or quality of life after stroke.

Impacts of stroke and cognitive impairment on activities of daily living in the Taiwan longitudinal study on aging

“…Items included bathing, dressing, eating, transferring, indoor walking, and toileting. On the other hand, the Lawton-Brody Instrumental Activities of Daily Living Scale 8 is a popular assessment of IADLs, which has been validated in a previous study 47 , and multiple studies involving this measurement have been published in older adults 48 , patients with stroke 49 , and those with cognitive impairment 50 . The current study used a nine-item modified version of the original eight items, with housework subdivided into light and heavy housework, and additionally including transport, managing finances, shopping, laundry, medication, food preparation, and using the telephone.…”

Change of cognitive functions after stroke with rehabilitation systems

“…Researchers indicated the need for an appropriate practise duration for the training to be more effective, since a short-termed cognitive training usually renders only a brief and temporary effect [10, 12]. However, van de Ven et al indicated that the connection between the duration of training and the effectiveness of the impact remained unclear [30]. The interactive experience should be perceived by the OT specialist as well as by the patient as a very positive factor allowing continued treatment without fatigue or boredom [31, 32].…”

Depressed mood and cognitive deficits as distinct mechanisms of subjective memory and executive complaints

“…Moreover, various types of complaints may have different meaning for the development of predictive subtypes of MCI or dementia (Gu, Fischer, Saposnik, & Schweizer, 2013). Regarding the importance of data in clinical practice, it has been shown that cognitive function training reduces the severity of SCD in healthy older adults (Kwok, Bai, Li, Ho, & Lee, 2013), especially in adults with SCD (López-Higes et al, 2018) and after stroke (van de Ven et al, 2017).…”

“…Referring to the discussions outlined in the introduction, whether the SCD can be considered as an indicator of actual cognitive difficulties or depressive mood, we have reason to indicate two mechanisms of SCD -emotional and/or cognitive. Stimulation of cognitive functions and/or prevention of depression (treatment) are effective in reducing complaints in people without dementia (Kwok et al, 2013;López-Higes et al, 2018;van de Ven et al, 2017). However, these techniques may not be effective when complaints are part of developing dementia.…”