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Okita Y, Kawaguchi Y, Inoue Y, Ohno K, Sawada T, Levack W, Tomori K. Characteristics of goal-setting tools in adult rehabilitation: A scoping review. Clin Rehabil 2024; 38:234-250. [PMID: 37644842 PMCID: PMC10725121 DOI: 10.1177/02692155231197383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES This scoping review aims to map the literature on goal-setting tools in adult rehabilitation, exploring their characteristics, target users and supporting evidence to inform practice and future research in this area. METHODS We completed a comprehensive search of four databases to identify relevant articles on tools for goal setting in rehabilitation. We followed Arkey and O'Malley's scoping review process to guide article selection, data extraction and data analysis. RESULTS We identified a total of 165 studies that reported on 55 different goal-setting tools, including tools for goal selection and goal documentation (n = 31), goal setting and intervention planning (n = 15), and for measuring the quality of the goal-setting process (n = 9). Over half of the tools were primarily designed for use in rehabilitation of physical disabilities (n = 32). Some tools fell under multiple sub-categories based on their characteristics as follows: 22 framework tools, 12 interview tools, 9 outcome measurement tools for goal achievement, 6 outcome measurement tools for goal quality and 25 documentation tools. The majority of goal-setting instruments targeted goals at the level of activity and participation (n = 51) and aimed to facilitate a client-centred or shared decision-making approach to rehabilitation planning (n = 46). CONCLUSIONS This study provides a comprehensive overview of existing goal-setting tools, highlighting their characteristics, target users and identified needs. These findings can enhance practitioners' awareness of the range of goal-setting tools available and can enable more effective utilization of these tools in clinical practice. Further research should investigate how clinicians can combine multiple tools to deliver goal setting.
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Affiliation(s)
- Yuho Okita
- School of Health Science, Swinburne University of Technology, Melbourne, Australia
| | - Yuko Kawaguchi
- Department of Rehabilitation, Kaikoukai Rehabilitation Hospital, Aichi, Japan
| | - Yuki Inoue
- Central Rehabilitation Department, Yokohama Rousai Hospital, Kanagawa, Japan
| | - Kanta Ohno
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Tatsunori Sawada
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - William Levack
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Kounosuke Tomori
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
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Anderson AC, Robinson AH, Lubman DI, Verdejo-Garcia A. Protocol for a cluster randomised crossover pilot trial of Goal Management Training + (GMT +) for methamphetamine use disorder. Contemp Clin Trials Commun 2022; 29:100969. [PMID: 36033363 DOI: 10.1016/j.conctc.2022.100969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methamphetamine use disorder (MUD) is associated with executive dysfunctions, which are linked with poorer treatment outcomes. However, current treatments for MUD do not directly address cognition. We recently modified Goal Management Training (now Goal Management Training+; GMT+), a group-based intervention originally designed to improve executive functions after brain injury, to enhance suitability for MUD. Here, we describe the rationale and design of a trial which aims to determine the acceptability and feasibility of GMT+ during residential rehabilitation for MUD, and its impact on executive functions and clinical outcomes. Methods We used a cluster randomised crossover design: participants are randomised at the cluster level to receive either GMT+ or psychoeducation-control (Brain Health Workshop; BHW). GMT+ is delivered in four 90-min weekly sessions and includes a between-session journal with 10-min daily activities. The program targets attention, impulse control, goal-setting, and decision-making. BHW is a health-oriented intervention that delivers information about the brain and promotes healthy exercise, diet, and sleep. It is matched to GMT+ on program format, length, and time with therapists. We will recruit forty-eight participants with MUD from residential treatment services. Our primary outcomes are acceptability, feasibility, and self-reported executive functioning. Secondary outcomes include craving, quality of life and cognitive performance. Outcome assessments are performed at baseline, post-interventions, 4-week follow-up, and 12-week follow-up. Conclusions This study will provide GMT+ feasibility and acceptability data and will indicate initial efficacy on executive functions and clinical outcomes in residential treatment for MUD. Information from this pilot trial will inform a powered RCT.
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3
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Toglia J, Goverover Y. Revisiting the dynamic comprehensive model of self-awareness: a scoping review and thematic analysis of its impact 20 years later. Neuropsychol Rehabil 2022; 32:1676-1725. [PMID: 35583377 DOI: 10.1080/09602011.2022.2075017] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to (1) describe the scope of research related to the Dynamic Comprehensive Model of Awareness (DCMA) (Toglia & Kirk, 2000); (2) identify themes and support for key model postulates; and (3) suggest future research directions related to this model. Using PRISMA scoping guidelines, 366 articles were reviewed, and 54 articles met our inclusion criteria. Selected studies were clustered into three themes: (1) the relationship between general and online self-awareness (50%); (2) interventions based on the model (41%); and (3) factors contributing to self-awareness (9%). Most studies were conducted with participants with acquired brain injury (BI) and traumatic BI (68%), most used a cross-sectional design (50%), and most intervention studies utilized a single-subject design (18%), followed by an experimental design (9%). This review provides evidence for the wide application of the DCMA across varying ages and populations. The need for a multidimensional assessment approach is recognized; however, stronger evidence that supports a uniform assessment of online self-awareness is needed. The intervention studies frequently described the importance of direct experience in developing self-awareness; however, few studies compared how intervention methods to influence general versus online self-awareness, or how cognitive capacity, self-efficacy, psychological factors, and context, influence the development of self-awareness.
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Affiliation(s)
- Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
| | - Yael Goverover
- Department of Occupational Therapy, New York University, New York, NY, United States
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4
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Anderson AC, Robinson AH, Potter E, Kerley B, Flynn D, Lubman DI, Verdejo-García A. Development of Goal Management Training + for Methamphetamine Use Disorder Through Collaborative Design. Front Psychiatry 2022; 13:876018. [PMID: 35546943 PMCID: PMC9082590 DOI: 10.3389/fpsyt.2022.876018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Methamphetamine use disorder (MUD) is associated with executive dysfunctions, which are linked with poorer treatment outcomes including earlier drop out and relapse. However, current treatments for MUD do not address executive functions. Goal Management Training (GMT) is an evidence-based cognitive remediation program for executive dysfunction, although required modifications to enhance its relevance and application within addiction treatment settings. This study aimed to (1) tailor GMT to the key cognitive deficits and typical treatment duration of MUD; (2) explore consumers' (people with MUD) engagement with the revised program; (3) implement a prototype of the program with consumers; and (4) present the manualized standard administration to clinical service providers. METHODS We followed the Medical Research Council Complex Interventions Framework and employed an evidence- and person-based intervention development process. We used a four-phased approach and collaborated with neuropsychology experts, design researchers in healthcare, consumers with MUD, and clinical service providers. Each aim was addressed in a separate study phase; including content refinement and review with neuropsychology experts (phase 1), intervention design and collaboration with consumers (phase 2), prototype development and review with consumers (phase 3), and final program modifications and review with clinical stakeholders (phase 4). RESULTS Findings from phase 1 indicated support for targeting four cognitive processes (attention, impulse control, goal setting, and decision-making). Key feedback included the need to help habitualize cognitive strategies and to guide consumers in applying these strategies in emotionally salient situations. Findings from phases 2 and 3 indicated consumer support for the program strategies and materials but highlighted the need to further enhance the personal relevance of specific content and journal activities. Findings from phase 4 provided clinicians support for the revised program but indicated an opportunity to minimize unintended effects. We present the intervention materials for the final revised program, Goal Management Training+ (GMT+), in line with TIDieR guidelines. CONCLUSIONS GMT+ targets key cognitive processes and is sensitive to the clinical needs of people with MUD. Our intervention development process was important for informing the active ingredients and materials for GMT+, and indicated initial consumer and provider acceptability prior to conducting a clinical trial.
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Affiliation(s)
- Alexandra C Anderson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, VIC, Australia
| | - Alex H Robinson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, VIC, Australia
| | - Eden Potter
- Design Health Collab, Monash Art, Design and Architecture, Monash University, Melbourne, VIC, Australia
| | - Bronte Kerley
- Design Health Collab, Monash Art, Design and Architecture, Monash University, Melbourne, VIC, Australia
| | - Daphne Flynn
- Design Health Collab, Monash Art, Design and Architecture, Monash University, Melbourne, VIC, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre, Monash University, Melbourne, VIC, Australia.,Turning Point, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Antonio Verdejo-García
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, VIC, Australia
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Sliedrecht W, Roozen HG, Witkiewitz K, de Waart R, Dom G. The Association Between Impulsivity and Relapse in Patients With Alcohol Use Disorder: A Literature Review. Alcohol Alcohol 2021; 56:637-650. [PMID: 33382416 DOI: 10.1093/alcalc/agaa132] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/13/2020] [Accepted: 11/07/2020] [Indexed: 01/14/2023] Open
Abstract
AIM Impulsivity has been identified as a key relapse risk factor in patients with alcohol use disorder (AUD); however, the inherent characteristics of this relationship have been largely understudied. The heterogeneity of AUD and variation in impulsivity constructs require careful consideration to inform future work examining the relationship. This study sought to review empirical findings examining facets of impulsivity and AUD relapse. METHODS A systematic search strategy was employed to capture studies on impulsivity measures related to AUD relapse. Impulsivity measures were qualitatively organized in terms of 'trait impulsivity'-typically measured by self-report questionnaires-and 'behavioural impulsivity', i.e. 'motor impulsivity', 'impulsive choice' and 'reflection impulsivity, assessed with cognitive-behavioural tasks. RESULTS Seventeen peer-reviewed papers were identified. Relapse outcomes varied substantially in relation to impulsivity measures. Twelve papers included aspects of 'trait impulsivity', and nine studies included 'behavioural impulsivity' measures, from which five studies dealt with the 'impulsive choice' subcategory. The Barratt Impulsivity Scale was the self-report questionnaire that was most frequently used. CONCLUSIONS All three included facets of impulsivity ('trait-, motor- and impulsive choice impulsivity') were associated with AUD relapse, but none seemed to be superior to another. This study confirmed that research on the relation between impulsivity and AUD relapse is relatively scarce. Future research and treatment options are proposed.
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Affiliation(s)
- Wilco Sliedrecht
- De Hoop GGZ, Provincialeweg 70, 3329 KP Dordrecht, The Netherlands
| | - Hendrik G Roozen
- Center on Alcoholism, Substance Abuse, and Addictions (CASAA), The University of New Mexico (UNM), MSC 11 6280, Albuquerque, NM 87106, USA
| | - Katie Witkiewitz
- The University of New Mexico, MSC 03-2220, Albuquerque, NM 87131, USA
| | - Ranne de Waart
- Mentrum/Arkin, Domselaerstraat 126, 1093 MB Amsterdam, The Netherlands
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Universiteitsplein 1, 2610 Antwerp, Belgium
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Quigley A, Brouillette MJ, Fellows LK, Mayo N. Action for better brain health among people living with HIV: protocol for a randomized controlled trial. BMC Infect Dis 2021; 21:843. [PMID: 34416849 PMCID: PMC8377450 DOI: 10.1186/s12879-021-06540-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lifestyle changes can protect or improve brain health in older adults. However, sustained lifestyle change is difficult for everyone and may be more difficult for those with executive dysfunction, including some people living with HIV. Thus, the key question is how we can improve adherence to the most promising interventions among people living with HIV experiencing cognitive difficulties. Goal management training is a cognitive rehabilitation program that targets executive dysfunction by teaching goal-directed behaviour and self-management. It is a promising means to improve adherence to lifestyle interventions. OBJECTIVE To estimate the extent to which goal management training before a healthy lifestyle program is associated with greater adherence to health recommendations, achievement of health-related goals, and better brain health and health outcomes compared to the healthy lifestyle program alone among people living with HIV. METHODS Brain Health Now cohort participants with cognitive difficulties or are not aging successfully are eligible. All participants will be given health resources, a health coach, a goal-setting digital application, and access to an online goal-setting workshop. The intervention group will participate in nine 2-h goal management training sessions and then will enter the healthy lifestyle program. Control participants will enter the healthy lifestyle program directly. A total sample of 100 participants will participate for 12 months. The main outcome is adherence to the healthy lifestyle program, defined as the number of weeks where physical activity adherence targets were met (150 min per week, measured with an activity monitor). Weekly social activities will be captured via self-report with confidential photo validation. We will send weekly health state reports to the participants. Downstream outcomes include cognitive ability, health-related quality of life, mobility, vascular risk profile, and social network size. We will analyze the data using a linear regression model. DISCUSSION This project is the first to test whether goal management training can augment adherence to health recommendations among individuals with cognitive difficulties. If successful, behavioural interventions such as goal management training could be implemented as an adjunct to lifestyle interventions in other clinical populations. TRIAL REGISTRATION This trial was registered on clinicaltrials.gov (NCT04345484) on April 14, 2020, https://clinicaltrials.gov/ct2/show/NCT04345484?term=NCT04345484&draw=2&rank=1 .
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Affiliation(s)
- Adria Quigley
- Centre for Outcome Research and Evaluation (CORE), McGill University Health Centre (MUHC), 5252 de Maisonneuve, Montreal, QC, H4A 3S5, Canada.
| | - Marie-Josée Brouillette
- Centre for Outcome Research and Evaluation (CORE), McGill University Health Centre (MUHC), 5252 de Maisonneuve, Montreal, QC, H4A 3S5, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Lesley K Fellows
- Department of Neurology and Neurosurgery, McGill University, 3801 University St, Montreal, QC, H3A 2B4, Canada
| | - Nancy Mayo
- Centre for Outcome Research and Evaluation (CORE), McGill University Health Centre (MUHC), 5252 de Maisonneuve, Montreal, QC, H4A 3S5, Canada
- Department of Medicine, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
- School of Physical and Occupational Therapy, McGill University, 3654 prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada
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7
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Woods SP, Morgan EE, Loft S, Matchanova A, Verduzco M, Cushman C. Enhancing cue salience improves aspects of naturalistic time-based prospective memory in older adults with HIV disease. Neuropsychology 2021; 35:111-122. [PMID: 33393805 DOI: 10.1037/neu0000644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Older persons living with HIV (PLWH) disease commonly experience failures of time-based prospective memory (PM) in their daily lives. This study examined the benefits of providing strategic supports at encoding, monitoring, and cue detection for naturalistic time-based PM among older PLWH. METHOD Participants included 116 older PLWH and 48 seronegatives who completed a baseline neuropsychological evaluation (see Woods et al., 2020), including a laboratory PM experiment that paralleled the design of the current naturalistic study. The naturalistic time-based PM task required participants to press a button on a portable PM response box 4 times per day for 1 month. PLWH were randomly assigned to an unsupported control condition or to an experimental group in which strategic processing was supported at encoding (implementation intentions and visualization), monitoring (content-free cuing), and/or cue detection (auditory alarm). The seronegative participants were all assigned to the unsupported control group. RESULTS In a model adjusting for age and affective disorders, PLWH who received all three supports in combination demonstrated moderately better naturalistic time-based PM accuracy as compared with PLWH controls. Both the cue detection and combination conditions were associated with markedly more precise response timing on the naturalistic time-based PM task. Supported PM accuracy as measured in the laboratory was positively associated with naturalistic PM accuracy among PLWH in the experimental groups. CONCLUSIONS Providing strategic supports to enhance the cue salience of naturalistic time-based PM tasks may improve both the accuracy and timing with which older PLWH remember to perform time-based intentions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Erin E Morgan
- Department of Psychiatry, University of California, San Diego
| | - Shayne Loft
- School of Psychological Science, University of Western Australia
| | | | | | - Clint Cushman
- Department of Psychiatry, University of California, San Diego
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Abstract
PURPOSE OF REVIEW Cognitive impairment leading to disability is increasingly seen in people living with human immunodeficiency virus (PLWH). Rehabilitation can alleviate the effects of cognitive impairment upon function. The aim of this paper is to discuss the strategies that have been used in cognitive and neurologic rehabilitation in PLWH. RECENT FINDINGS Studies examining pharmacological and non-pharmacological strategies were analysed. Medical management of HIV and co-morbidities should be optimised. Non-pharmacological strategies, including nerve stimulation techniques, exercise-based interventions, and paper and computer-based cognitive rehabilitation, have some evidence supporting their use in PLWH either as stand-alone interventions or as part of a multidisciplinary approach. Both pharmacological and non-pharmacological rehabilitation strategies have been used with PLWH. More intervention trials are needed to assess cognitive and neurological rehabilitation strategies and further evaluate their potential benefit in PLWH.
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Affiliation(s)
- Terrence Chan
- Mildmay Hospital, 19 Tabernacle Gardens, London, E2 7DZ, UK
| | - Monica Marta
- Grahame Hayton Unit, I&I and Neurology Department, Barts Health NHS Trust, London, UK
- Neurosciences, Blizard Institute, Queen Mary University of London, London, UK
| | | | - Simon Rackstraw
- Mildmay Hospital, 19 Tabernacle Gardens, London, E2 7DZ, UK.
- Grahame Hayton Unit, I&I and Neurology Department, Barts Health NHS Trust, London, UK.
- Neurosciences, Blizard Institute, Queen Mary University of London, London, UK.
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9
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Abstract
People living with HIV (PLWH) experience greater everyday functioning impairment. We examined frequency and correlates of successful functional aging (SFA) in PLWH. Using gold-standard questionnaires, SFA was defined in 174 HIV+ and 71 HIV- adults as absence of significant everyday cognitive symptoms and declines in instrumental activities of daily living. More HIV- (45%) than HIV+ (18%) adults met SFA criteria (p < 0.01). Depression, cognitive functioning, socioeconomic status, and HIV status were independent correlates of SFA (p values < 0.05). Motor ability, learning, and verbal fluency were associated with SFA. SFA was associated with health-related quality of life (HRQoL). PLWH are three times less likely to achieve SFA than HIV- adults, a phenotype that translates to HRQoL. While SFA is multifactorial, driven by clinico-demographic factors, HIV may pose additional risk to achieving SFA. Further work should examine other mechanisms whereby HIV hinders SFA (e.g., biomarkers, stress, mental health) and ultimately inform interventions to facilitate SFA.
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10
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Abstract
In this targeted review, we summarize current knowledge on substance-use disorder
(SUD)-related cognitive deficits, the link between these deficits and clinical outcomes,
and the cognitive training, remediation, and pharmacological approaches that have the
potential to rescue cognition. We conclude that: (i) people with SUDs have moderate
deficits in memory, attention, executive functions, and decision-making (including
reward expectancy, valuation, and learning); (ii) deficits in higher-order executive
functions and decision-making are significant predictors of relapse; (iii) cognitive
training programs targeting reward-related appetitive biases, cognitive remediation
strategies targeting goal-based decision-making, and pharmacotherapies targeting memory,
attention, and impulsivity have potential to rescue SUD-related cognitive deficits. We
suggest avenues for future research, including developing brief, clinically oriented
harmonized cognitive testing suites to improve individualized prediction of treatment
outcomes; computational modeling that can achieve deep phenotyping of cognitive subtypes
likely to respond to different interventions; and phenotype-targeted cognitive,
pharmacological, and combined interventions. We conclude with a tentative model of
neuroscience-informed precision medicine.
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Affiliation(s)
| | - Gloria Garcia-Fernandez
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia; Department of Psychology, University of Oviedo, Spain
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerp, Belgium
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11
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Woods SP, Morgan EE, Loft S, Matchanova A, Verduzco M, Cushman C. Supporting strategic processes can improve time-based prospective memory in the laboratory among older adults with HIV disease. Neuropsychology 2019; 34:249-263. [PMID: 31789564 DOI: 10.1037/neu0000602] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Older adults with HIV disease demonstrate moderate deficits in time-based prospective memory (PM), which is the strategically demanding ability of remembering to perform a task at a specific time. Using theories from the PM literature, we hypothesized that supporting strategic processes would improve time-based PM in the laboratory among HIV+ older adults. METHOD One hundred forty-five HIV+ participants were randomly assigned to a control condition or an experimental group in which strategic processing was supported at encoding (i.e., implementation intentions and visualization), monitoring (i.e., content-free cuing), and/or cue detection (i.e., auditory alarm). The HIV+ control group and 58 seronegative participants completed two ongoing language tasks with a time-based PM requirement. The HIV+ experimental groups underwent counterbalanced time-based PM trials under both control and strategically supported conditions. RESULTS The HIV+ cue-detection group showed a large within-subjects improvement, which was strongly related to lower scores on separate clinical time-based PM measure and was accompanied by a large reduction in clock-checking behavior. Results also revealed a small within-subjects improvement in time-based PM in the encoding condition. CONCLUSIONS Supporting strategic encoding and cue-detection processes in the laboratory can improve time-based PM deficits in older HIV+ adults, which may inform the development of more naturalistic PM-based interventions to enhance health behaviors. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Erin E Morgan
- Department of Psychiatry, University of California, San Diego
| | - Shayne Loft
- School of Psychological Science, University of Western Australia
| | | | | | - Clint Cushman
- Department of Psychiatry, University of California, San Diego
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12
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Verdejo-garcía A, Alcázar-córcoles MA, Albein-urios N. Neuropsychological Interventions for Decision-Making in Addiction: a Systematic Review. Neuropsychol Rev 2019; 29:79-92. [DOI: 10.1007/s11065-018-9384-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 08/17/2018] [Indexed: 11/25/2022]
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13
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Fazeli PL, Casaletto KB, Woods SP, Umlauf A, Scott JC, Moore DJ. Everyday Multitasking Abilities in Older HIV+ Adults: Neurobehavioral Correlates and the Mediating Role of Metacognition. Arch Clin Neuropsychol 2018; 32:917-928. [PMID: 28575231 DOI: 10.1093/arclin/acx047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Indexed: 11/14/2022] Open
Abstract
Objective The prevalence of older adults living with HIV is rising, as is their risk for everyday functioning problems associated with neurocognitive dysfunction. Multitasking, the ability to maintain and carry out subgoals in support of a larger goal, is a multidimensional skill ubiquitous during most real-life tasks and associated with prefrontal networks that are vulnerable in HIV. Understanding factors associated with multitasking will improve characterization of HIV-associated neurocognitive disorders. Metacognition is also associated with frontal systems, is impaired among individuals with HIV, and may contribute to multitasking. Method Ninety-nine older (≥50 years) adults with HIV completed: the Everyday Multitasking Test (MT), a performance-based measure during which participants concurrently attempt four everyday tasks (e.g., medication management) within a time limit; a comprehensive neuropsychological battery; measures of metacognition regarding their MT performance (e.g., metacognitive knowledge and online awareness). Results Better global neuropsychological performance (i.e., average T-score across all domains) was associated with better Everyday MT total scores (rho = 0.34; p < .001), as was global metacognition (rho = 0.37, p < .01). Bootstrapping mediation analysis revealed global metacognition was a significant partial mediator between neurocognition and Everyday MT (b = 0.09, 95% confidence interval [CI] = 0.01, 0.25). Specifically, metacognitive knowledge (but not online awareness) drove this mediation (b = 0.13, 95% CI = 0.03, 0.27). Conclusions Consistent with findings among younger persons with HIV, neuropsychological performance is strongly associated with a complex, laboratory-based test of everyday multitasking, and metacognition of task performance was a pathway through which successful multitasking occurred. Interventions aimed at modifying metacognition to improve daily functioning may be warranted among older adults with HIV.
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Affiliation(s)
- P L Fazeli
- Department of Family, Community and Health Systems, School of Nursing, Birmingham, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - S P Woods
- Department of Psychiatry, University of San Diego, San Diego, CA, USA.,Department of Psychology, University of Houston, TX, USA
| | - A Umlauf
- Department of Psychiatry, University of San Diego, San Diego, CA, USA
| | - J C Scott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,VISN4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - D J Moore
- Department of Psychiatry, University of San Diego, San Diego, CA, USA
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Rubenis AJ, Fitzpatrick RE, Lubman DI, Verdejo-Garcia A. Impulsivity predicts poorer improvement in quality of life during early treatment for people with methamphetamine dependence. Addiction 2018; 113:668-676. [PMID: 28987070 DOI: 10.1111/add.14058] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/13/2017] [Accepted: 10/04/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIMS Methamphetamine dependence is associated with heightened impulsivity and diminished quality of life, but the link between impulsivity and changes in quality of life during treatment has not been examined. We aimed to investigate how different elements of impulsivity predict change in quality of life in the 6 weeks after engaging in treatment. DESIGN Longitudinal, observational cohort study. SETTING Public and private detoxification and rehabilitation facilities in metropolitan Melbourne, Australia. PARTICIPANTS One hundred and eight individuals with methamphetamine dependence (81 male) tested within 3 weeks of commencing treatment; 80 (74%) were followed-up at 6 weeks. MEASUREMENTS The Continuous Performance Test-2 measured impulsive action (cognitive and motor impulsivity); the Delay Discounting Task measured impulsive choice. Quality of life was measured with the World Health Organization Quality of Life Scale-Brief, which includes social, psychological, physical and environment domains. Control variables included age, gender, estimated IQ, depression severity score, methamphetamine dependence severity score, cannabis dependence severity score and treatment modality. FINDINGS We found that all three forms of impulsivity were significant predictors of change in the social domain: motor impulsivity (β = -0.54, P = 0.013), cognitive impulsivity (β = -0.46, P = 0.029) and impulsive choice (β = -0.26, P = 0.019). Change in the psychological domain was predicted significantly by motor impulsivity (β = -0.45, P = 0.046). Control variables of age and depression were associated significantly with changes in the physical domain. CONCLUSIONS In Australian methamphetamine-dependent individuals, elevated impulsivity predicts lower improvement of social and psychological quality of life in the first 6-9 weeks of treatment.
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Affiliation(s)
- Adam J Rubenis
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC, Australia
| | - Rebecca E Fitzpatrick
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Fitzroy, VIC, Australia.,Eastern Health Clinical School, Monash University, Fitzroy, VIC, Australia
| | - Antonio Verdejo-Garcia
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC, Australia
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15
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Abstract
Our objective was to review the literature and quantitatively summarise the effectiveness of Goal Management Training® (GMT) (alone or in combination with other training approaches) in improving executive functions in adult populations. Ovid, Scopus, Web of Science, and ProQuest Dissertations & Theses Global were searched for articles citing "goal management training". Any group trials (n > 3) in adults that used multiple-session GMT programmes were included in the analyses. Outcome variables were extracted and classified into one of nine cognitive measures domains: executive functioning tasks, everyday executive functioning tasks, subjective executive tasks rated by the patient, subjective executive tasks rated by proxy, working memory, speed of processing, long-term memory, instrumental activities of daily living and general mental health status questionnaires. A total of 21 publications, containing 19 separate treatment group samples were included in the final analyses. Significantly positive small to moderate effect sizes were observed in all cognitive measure domains (except speed of processing) with effects maintained at follow-up assessments for all followed-up outcome measures, except for subjective ratings by patients and proxy. The analysis suggests that GMT is an effective intervention, leading to moderate improvements in executive functions that are usually maintained at follow-up.
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Affiliation(s)
- Vessela Stamenova
- Women's College Hospital Institute for Health System Solutions and Virtual Care , Toronto , ON , Canada
| | - Brian Levine
- Rotman Research Institute at Baycrest, University of Toronto , Toronto , ON , Canada
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16
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Christensen B, Qin Z, Byrd DA, Yu F, Morgello S, Gelman BB, Moore DJ, Grant I, Singer EJ, Fox HS, Baccaglini L. Measures of Physical and Mental Independence Among HIV-Positive Individuals: Impact of Substance Use Disorder. AIDS Res Hum Retroviruses 2017; 33:1048-1055. [PMID: 28288515 DOI: 10.1089/aid.2016.0269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
With the transition of HIV infection from an acute to a chronic disease after the introduction of antiretroviral medications, there has been an increased focus on long-term neurocognitive and other functional outcomes of HIV patients. Thus, we assessed factors, particularly history of a substance use disorder, associated with time to loss of measures of physical or mental independence among HIV-positive individuals. Data were obtained from the National NeuroAIDS Tissue Consortium. Kaplan-Meier and Cox proportional hazards regression analyses were used to estimate the time since HIV diagnosis to loss of independence, and to identify associated risk factors. HIV-positive participants who self-identified as physically (n = 698) or mentally (n = 616) independent on selected activities of daily living at baseline were eligible for analyses. A history of substance use disorder was associated with a higher hazard of loss of both physical and mental independence [adjusted hazard ratio (HR) = 1.71, 95% confidence interval (95% CI): 1.07-2.78; adjusted HR = 1.67, 95% CI: 1.11-2.52, respectively]. After adjusting for substance use disorder and other covariates, older age at diagnosis and female gender were associated with higher hazards of loss of both physical and mental independence, non-white participants had higher hazards of loss of physical independence, whereas participants with an abnormal neurocognitive diagnosis and fewer years of education had higher hazards of loss of mental independence. In summary, history of substance use disorder was associated with loss of measures of both physical and mental independence. The nature of this link and the means to prevent such loss of independence need further investigation.
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Affiliation(s)
- Bianca Christensen
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Zijian Qin
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Desiree A. Byrd
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Fang Yu
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Benjamin B. Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas
- Department of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, Texas
| | - David J. Moore
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California
| | - Igor Grant
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California
| | - Elyse J. Singer
- Department of Neurology, School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Howard S. Fox
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Lorena Baccaglini
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
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17
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Bender AC, Austin AM, Grodstein F, Bynum JPW. Executive function, episodic memory, and Medicare expenditures. Alzheimers Dement 2017; 13:792-800. [PMID: 28174070 DOI: 10.1016/j.jalz.2016.12.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/08/2016] [Accepted: 12/28/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION We examined the relationship between health care expenditures and cognition, focusing on differences across cognitive systems defined by global cognition, executive function, or episodic memory. METHODS We used linear regression models to compare annual health expenditures by cognitive status in 8125 Nurses' Health Study participants who completed a cognitive battery and were enrolled in Medicare parts A and B. RESULTS Adjusting for demographics and comorbidity, executive impairment was associated with higher total annual expenditures of $1488 per person (P < .01) compared with those without impairment. No association for episodic memory impairment was found. Expenditures exhibited a linear relationship with executive function, but not episodic memory ($584 higher for every 1 standard deviation decrement in executive function; P < .01). DISCUSSION Impairment in executive function is specifically and linearly associated with higher health care expenditures. Focusing on management strategies that address early losses in executive function may be effective in reducing costly services.
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Affiliation(s)
- Alex C Bender
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Andrea M Austin
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Francine Grodstein
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Julie P W Bynum
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
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