Are cognitive interventions for multiple sclerosis effective and feasible?

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.R.M. and J.A. are supported by doctoral Grants from Fundac¸ao para a Ci ˜ encia e Tecnologia (FCT) ˆ (SFRH/BD/65213/2009, SFRH/BD/64457/2009 and co-funded by FSE/POPH). A.S. is funded for the project PIC/IC/83290/2007, supported by FEDER (POFC–COMPETE) and FCT to develop and assess the effectiveness of a cognitive stimulation tool for Portuguese clinicians

Importance of web-based intervention in minimizing depressive symptoms and associated stigma in depressed medical students

[Excerpt] There is a considerable prevalence of depression in medical students, and those who are depressed more frequently endorse feeling stigmatized than non-depressed students.1 Because concerns about confidentiality are often cited by depressed medical students as a major barrier in seeking help, there is a significant need to develop an innovative way to provide medical students with safe and confidential access to services to improve prevention, detection, and intervention in depression and its associated stigma.1 A web-based approach could be potentially useful for addressing this issue and has already been used for delivering intervention in various health conditions, with benefits such as low cost, user convenience, timely information, privacy and confidentiality, reduced levels of stigmatization, and increased user and supplier control.2 Moreover, although current evidence is limited, a recent meta-review3 points to the efficacy of web-based cognitive behavioral interventions in treating/improving depression symptoms in adults. In relation to depression stigma, there is evidence that web-based interventions (e.g., MoodGYM) can reduce personal stigmatizing attitudes toward depression. The web-based approach assumes even greater importance when we consider that stigmatization increases with either the use of prescription medication or mental health counseling, and that only a small percentage of depressed medical students seek mental health counseling services, due to lack of time, confidentiality, stigma, and fear of documentation in academic records.4 However, unintended negative effects could easily arise with web-based approaches as well (e.g. decline in seeking support from family and friends, avoidance of in-person mental health services, inadequate assessment and diagnosis). [...]- (undefined

A psicologia como neurociência cognitiva : implicações para a compreensão dos processos básicos e suas aplicações

O presente artigo procura ilustrar o modo como os desenvolvimentos das neurociências cognitivas poderão ajudar a compreender alguns dos processos psicológicos básicos e, simultaneamente, ser traduzidos para importantes domínios da psicologia aplicada, particularmente no domínio clínico. Exemplificaremos a partir de algumas linhas de investigação programática em curso nas diferentes subsecções do Laboratório de Neuropsicofisiologia da Escola de Psicologia da Universidade do Minho. As potencialidades metodológicas proporcionadas pela neurofisiologia, neuroimagiologia, neuromodelação, psicofisiologia, neurobioquímica e neurogenética serão exemplificadas nas suas aplicações à linguagem (e suas implicações para a compreensão da esquizofrenia), funcionamento sócio-cognitivo (e implicações para a compreensão das perturbações do neurodesenvolvimento), funcionamento executivo (com implicações para a compreensão das perturbações do espectro obsessivo), empatia (e implicações para a compreensão da psicoterapia), mecanismos de stress (com implicações para a compreensão das perturbações de ansiedade), e, finalmente, comportamento animal (com implicações para o conhecimento dos sistemas sensoriais e perceptuais).(undefined

Observer weighting of interaural cues in positive and negative envelope slopes of amplitude-modulated waveforms

The auditory system can encode interaural delays in highpass-filtered complex sounds by phase locking to their slowly modulating envelopes. Spectrotemporal analysis of interaurally time-delayed highpass waveforms reveals the presence of a concomitant interaural level cue. The current study systematically investigated the contribution of time and concomitant level cues carried by positive and negative envelope slopes of a modified sinusoidally amplitude-modulated (SAM) high-frequency carrier. The waveforms were generated from concatenation of individual modulation cycles whose envelope peaks were extended by the desired interaural delay, allowing independent control of delays in the positive and negative modulation slopes. In experiment 1, thresholds were measured using a 2-interval forced-choice adaptive task for interaural delays in either the positive or negative modulation slopes. In a control condition, thresholds were measured for a standard SAM tone. In experiment 2, decision weights were estimated using a multiple-observation correlational method in a single-interval forced-choice task for interaural delays carried simultaneously by the positive, and independently, negative slopes of the modulation envelope. In experiment 3, decision weights were measured for groups of 3 modulation cycles at the start, middle, and end of the waveform to determine the influence of onset dominance or recency effects. Results were consistent across experiments: thresholds were equal for the positive and negative modulation slopes. Decision weights were positive and equal for the time cue in the positive and negative envelope slopes. Weights were also larger for modulations cycles near the waveform onset. Weights estimated for the concomitant interaural level cue were positive for the positive envelope slope and negative for the negative slope, consistent with exclusive use of time cues.We thank Virginia M. Richards and Bruce G. Berg for helpful discussions. We also thank Brian C. J. Moore and an anonymous reviewer for their insightful comments on an earlier draft of the manuscript. Work supported by grants from the National Science Council, Taiwan NSC 98-2410-H-008-081-MY3 and NIH R01DC009659

Enhanced tethered-flight duration and locomotor activity by overexpression of the human gene SOD1 in Drosophila motorneurons

Mutation of the human gene superoxide dismutase (hSOD1) is associated with the fatal neurodegenerative disease familial amyotrophic lateral sclerosis (Lou Gehrig’s disease). Selective overexpression of hSOD1 in Drosophila motorneurons increases lifespan to 140% of normal. The current study was designed to determine resistance to lifespan decline and failure of sensorimotor functions by overexpressing hSOD1 in Drosophila‘s motorneurons. First, we measured the ability to maintain continuous flight and wingbeat frequency (WBF) as a function of age (5 to 50 days). Flies overexpressing hSOD1 under the D42-GAL4 activator were able to sustain flight significantly longer than controls, with the largest effect observed in the middle stages of life. The hSOD1-expressed line also had, on average, slower wingbeat frequencies in late, but not early life relative to age-matched controls. Second, we examined locomotor (exploratory walking) behavior in late life when flies had lost the ability to fly (age ≥ 60 d). hSOD1-expressed flies showed significantly more robust walking activity relative to controls. Findings show patterns of functional decline dissimilar to those reported for other life-extended lines, and suggest that the hSOD1 gene not only delays death but enhances sensorimotor abilities critical to survival even in late life

Is there evidence for cognitive intervention in Alzheimer disease? A systematic review of efficacy, feasibility, and cost-effectiveness

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.J.A. and R. M. are supported by doctoral Grants from the Portuguese Foundation for Science and Technology (Fundacao para a Ciencia e Tecnologia, FCT) (SFRH/BD/64457/2009 and SFRH/BD/65213/2009, co-funded by FSE/POPH). A. S. is funded by the project PIC/IC/83290/2007, supported by FEDER (POFC-COMPETE) and FCT, to develop and assess the effectiveness of a cognitive stimulation tool for Portuguese clinicians