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Nauta IM, van Dam M, Bertens D, Kessels RPC, Fasotti L, Uitdehaag BMJ, Speckens AEM, de Jong BA. Improved quality of life and psychological symptoms following mindfulness and cognitive rehabilitation in multiple sclerosis and their mediating role for cognition: a randomized controlled trial. J Neurol 2024:10.1007/s00415-024-12327-y. [PMID: 38653820 DOI: 10.1007/s00415-024-12327-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) frequently gives rise to depressive and anxiety symptoms, but these are often undertreated. This study investigated the effect of mindfulness-based cognitive therapy (MBCT) and cognitive rehabilitation therapy (CRT) on psychological outcomes and quality of life (QoL), and whether they mediate treatment effects on MS-related cognitive problems. METHODS This randomized controlled trial included MS patients with cognitive complaints (n = 99) and compared MBCT (n = 32) and CRT (n = 32) to enhanced treatment as usual (n = 35). Baseline, post-treatment and 6-months follow-up assessments included patient-reported outcome measures (PROMS) and cognitive outcomes (self-reported and neuropsychological assessment). PROMS concerned psychological symptoms, well-being, QoL, and daily life function. Linear mixed models indicated intervention effects on PROMS and mediation effects of PROMS on cognitive outcomes. RESULTS MBCT positively affected depressive symptoms (Cohen's d (d) = -0.46), fatigue (d = -0.39), brooding (d = -0.34), mindfulness skills (d = 0.49), and mental QoL (d = -0.73) at post-treatment. Effects on mindfulness skills remained significant 6 months later (d = 0.42). CRT positively affected depressive symptoms (d = -0.46), mindfulness skills (d = 0.37), and mental QoL (d = -0.45) at post-treatment, but not at 6-month follow-up. No effects on anxiety, well-being, self-compassion, physical QoL, and daily life function were found. Treatment effects on self-reported, but not objective, cognition were mediated by psychological symptoms and mindfulness skills. CONCLUSIONS MBCT and CRT reduced a wide array of psychological symptoms and improved mental QoL. These improvements seemed to impact self-reported cognitive problems after both treatments, whereas objective cognitive improvements after MBCT seemed independent of improvement in psychological symptoms. Future studies should investigate long-term sustainability of these beneficial effects. TRIAL REGISTRATION The trial was prospectively registered in the Dutch Trial registry on 31 May 2017 (NL6285; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6459 ).
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Affiliation(s)
- Ilse M Nauta
- Department of Neurology, MS Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Maureen van Dam
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, Leiden, The Netherlands.
| | - Dirk Bertens
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Klimmendaal Rehabilitation Center, Arnhem, The Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Klimmendaal Rehabilitation Center, Arnhem, The Netherlands
- Vincent Van Gogh Institute for Psychiatry, Venray, The Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luciano Fasotti
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Klimmendaal Rehabilitation Center, Arnhem, The Netherlands
| | - Bernard M J Uitdehaag
- Department of Neurology, MS Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Anne E M Speckens
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Brigit A de Jong
- Department of Neurology, MS Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
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Nauta IM, Kessels RPC, Bertens D, Stam CJ, Strijbis EEM, Hillebrand A, Fasotti L, Uitdehaag BMJ, Hulst HE, Speckens AEM, Schoonheim MM, de Jong BA. Neurophysiological brain function predicts response to cognitive rehabilitation and mindfulness in multiple sclerosis: a randomized trial. J Neurol 2024; 271:1649-1662. [PMID: 38278979 DOI: 10.1007/s00415-024-12183-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/07/2023] [Accepted: 12/30/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Cognitive treatment response varies highly in people with multiple sclerosis (PwMS). Identification of mechanisms is essential for predicting response. OBJECTIVES This study aimed to investigate whether brain network function predicts response to cognitive rehabilitation therapy (CRT) and mindfulness-based cognitive therapy (MBCT). METHODS PwMS with cognitive complaints completed CRT, MBCT, or enhanced treatment as usual (ETAU) and performed three measurements (baseline, post-treatment, 6-month follow-up). Baseline magnetoencephalography (MEG) measures were used to predict treatment effects on cognitive complaints, personalized cognitive goals, and information processing speed (IPS) using mixed models (secondary analysis REMIND-MS study). RESULTS We included 105 PwMS (96 included in prediction analyses; 32 CRT, 31 MBCT, 33 ETAU), and 56 healthy controls with baseline MEG. MEG did not predict reductions in complaints. Higher connectivity predicted better goal achievement after MBCT (p = 0.010) and CRT (p = 0.018). Lower gamma power (p = 0.006) and higher connectivity (p = 0.020) predicted larger IPS benefits after MBCT. These MEG predictors indicated worse brain function compared to healthy controls (p < 0.05). CONCLUSIONS Brain network function predicted better cognitive goal achievement after MBCT and CRT, and IPS improvements after MBCT. PwMS with neuronal slowing and hyperconnectivity were most prone to show treatment response, making network function a promising tool for personalized treatment recommendations. TRIAL REGISTRATION The REMIND-MS study was prospectively registered in the Dutch Trial registry (NL6285; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6459 ).
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Affiliation(s)
- Ilse M Nauta
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands.
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Klimmendaal Rehabilitation Center, Arnhem, The Netherlands
- Vincent Van Gogh Institute for Psychiatry, Venray, The Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dirk Bertens
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Klimmendaal Rehabilitation Center, Arnhem, The Netherlands
| | - Cornelis J Stam
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- MEG Center, Clinical Neurophysiology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Eva E M Strijbis
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Arjan Hillebrand
- MEG Center, Clinical Neurophysiology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Luciano Fasotti
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Klimmendaal Rehabilitation Center, Arnhem, The Netherlands
| | - Bernard M J Uitdehaag
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Hanneke E Hulst
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Anne E M Speckens
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Menno M Schoonheim
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Brigit A de Jong
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
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Scheper I, Brazil IA, Claassen JAHR, Bertens D, Geurts S, Kessels RPC. Learning capacity in early-stage Alzheimer's disease: The role of feedback during learning on memory performance. J Neuropsychol 2024; 18:100-119. [PMID: 37319104 DOI: 10.1111/jnp.12330] [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: 01/14/2023] [Revised: 04/21/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023]
Abstract
Alzheimer's disease is characterized by a decline in episodic memory and executive functioning, hampering learning ability. Insight into outcome-based learning capacity may be relevant for optimizing the learning potential of these patients. To date, mixed results have been found in studies in which cognitively impaired participants have to learn based on positive and negative outcomes. In this study, we investigated the role of negative and positive feedback on memory performance and participants' ability to adjust their behaviour accordingly in a sample of 23 early-stage AD patients and 23 matched healthy controls. We administered a novel computerized object-location memory task, in which participants were instructed to learn and memorize the locations of different everyday objects following errorless learning (EL) and trial-and-error learning (TEL). A separate probabilistic TEL task was employed in which participants had to learn how to adjust their behaviour based on positive and negative feedback. EL had a beneficial general effect on memory performance for object locations. However, this effect was not larger in early-stage AD patients compared to controls and error frequency during acquisition of object locations was unrelated to later recall performance. No group differences were found on the probabilistic learning task with respect to learning performance over time and based on positive and negative feedback. Although the error monitoring system seems intact in patients with early-stage AD, errors during learning are likely acting as a source of interference causing difficulty in storage or retrieval of object locations.
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Affiliation(s)
- Inge Scheper
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
- Center for Psychiatry, GGZ Centraal, Amersfoort, The Netherlands
| | - Inti A Brazil
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Division Diagnostics, Research, & Education, Forensic Psychiatric Centre Pompestichting, Nijmegen, The Netherlands
| | - Jurgen A H R Claassen
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Dirk Bertens
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Klimmendaal Rehabilitation Specialists, Arnhem, The Netherlands
| | - Sofie Geurts
- Department of Medical Psychology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
- Klimmendaal Rehabilitation Specialists, Arnhem, The Netherlands
- Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
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Abelmann AC, Kessels RPC, Brazil IA, Fasotti L, Bertens D. Game-supported cognitive strategy training for slowed information processing speed after acquired brain injury: study protocol for a randomised controlled trial. BMJ Open 2023; 13:e067108. [PMID: 37734890 PMCID: PMC10514599 DOI: 10.1136/bmjopen-2022-067108] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 08/24/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION Many individuals with acquired brain injury tend to experience problems with slowed information processing speed (IPS). A potentially beneficial and cost-effective supplement for cognitive rehabilitation of impaired IPS may be the implementation of serious gaming that focuses on compensatory learning as part of cognitive training. However, most digital platforms used during cognitive rehabilitation focus on restoring cognitive function and evidence for skill transfer from digital practice to everyday life is lacking. This study aims to investigate the efficacy of a game-supported cognitive strategy training. The training combines a well-validated time pressure management cognitive strategy training, targeting slowed IPS, with a novel game and a mobile application. The game-supported training focuses on the generalisation of strategy-use to untrained tasks in everyday life. METHODS AND ANALYSIS The study is designed as a randomised controlled trial in which the experimental group (Karman Line - Tempo module: an 8-week game-supported cognitive strategy training) will be compared with an active control group (CogniPlus training: an 8-week computerised cognitive function training). Data from 60 individuals with acquired brain injury (30 per group, ages between 16 and 75) will be collected at baseline (T0), post-treatment (T1) and at 3-month follow-up (T2). The primary outcome measure is an objective assessment of compensatory strategy use in an untrained experimental task. The secondary outcome is the attainment of trained and untrained treatment goals assessed by goal attainment scaling. Pre-training and post-training data will be analysed using a 2×2 repeated measure analysis of variance. ETHICS AND DISSEMINATION This study has been approved by the medical review ethics committee CMO Region Arnhem and Nijmegen (NL74818.091.20) and is registered in the Netherlands Trial Register. Research findings will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER NL9437; The Netherlands Trial Register.
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Affiliation(s)
- Amy C Abelmann
- Neuropsychology and Rehabilitation Psychology, Radboud University Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
- Research and Innovation, Klimmendaal, Arnhem, The Netherlands
| | - Roy P C Kessels
- Neuropsychology and Rehabilitation Psychology, Radboud University Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
- Research and Innovation, Klimmendaal, Arnhem, The Netherlands
| | - Inti A Brazil
- Neuropsychology and Rehabilitation Psychology, Radboud University Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
- Division Diagnostics, Pompestichting Langdurige Forensisch Psychiatrische Zorg, Nijmegen, The Netherlands
| | - Luciano Fasotti
- Neuropsychology and Rehabilitation Psychology, Radboud University Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
- Research and Innovation, Klimmendaal, Arnhem, The Netherlands
| | - Dirk Bertens
- Neuropsychology and Rehabilitation Psychology, Radboud University Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
- Research and Innovation, Klimmendaal, Arnhem, The Netherlands
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de Vries FS, van Dongen RTM, Bertens D. Pain education and pain management skills in virtual reality in the treatment of chronic low back pain: A multiple baseline single-case experimental design. Behav Res Ther 2023; 162:104257. [PMID: 36731183 DOI: 10.1016/j.brat.2023.104257] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/19/2023]
Abstract
Chronic lower back pain is a major health problem and current treatments do not always lead to adequate pain control. Virtual reality (VR) is an upcoming technology that has shown to be effective in reducing acute pain. However, the value of VR in reducing chronic pain is still unknown. Therefore, the current study focuses on the effects of a recently developed VR application 'Reducept' using a multiple baseline single-case experimental design in 8 patients (N = 8). Reducept is a VR-training program aiming to improve pain management skills and providing pain education in patients with (chronic lower) back pain. Results based on visual and statistical analyses indicated that Reducept has the potential to reduce chronic lower back pain, although its clinical relevance was small. This study is one of the first that focuses on the possible effects of Reducept using sophisticated visual and statistical analyses. Our study shows a detailed overview of individual changes in pain intensity over time. Further research is necessary to investigate the working mechanism of Reducept and its impact on chronic pain conditions.
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Affiliation(s)
- Froukje S de Vries
- Canisius-Wilhelmina Medical Center, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands.
| | - Robert T M van Dongen
- Canisius-Wilhelmina Medical Center, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands; Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525GA, Nijmegen, the Netherlands
| | - Dirk Bertens
- Klimmendaal Rehabilitation Specialists, Heijenoordseweg 5, 6813 GG, Arnhem, the Netherlands; Radboud University, Donders Institute for Brain, Cognition and Behaviour, Thomas van Aquinostraat 4, 6525 GD, Nijmegen, the Netherlands
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Pilon L, Frankenmolen NF, van der Zijp J, Kessels RP, Bertens D. A short add-on sleep intervention in the rehabilitation of individuals with acquired brain injury: A randomized controlled trial. NeuroRehabilitation 2023; 53:323-334. [PMID: 37694314 PMCID: PMC10657700 DOI: 10.3233/nre-230139] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Sleep disturbances are common after acquired brain injury (ABI) and have a negative impact on functioning. OBJECTIVE This study examines whether a short add-on therapy for sleep disturbances in individuals with ABI is effective in addition to rehabilitation treatment as usual. METHODS In the randomized-controlled study, 54 adults with ABI and self-reported sleep disturbances receiving outpatient rehabilitation services were randomized in two groups: one receiving a sleep intervention (based on cognitive behavioural therapy for insomnia (CBT-I)) in addition to their rehabilitation treatment (CBT-I + TAU group) and one receiving treatment as usual (TAU). The primary outcome was sleep quality, measured with the Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes included measures of anxiety, depression, fatigue and dysfunctional beliefs and attitudes about sleep. RESULTS The short add-on sleep therapy resulted in improvements in sleep quality in the CBT-I + TAU group as compared to the TAU group (ES = 0.924). Furthermore, the CBT-I + TAU group reported less dysfunctional beliefs and attitudes about sleep and were better able to cope with fatigue compared to the TAU group. CONCLUSIONS The application of this short add-on sleep intervention could be implemented in neuropsychological rehabilitation settings.
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Affiliation(s)
- Louise Pilon
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
- Rehabilitation Medical Centre Klimmendaal, Arnhem, The Netherlands
| | - Nikita F. Frankenmolen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Rehabilitation Medical Centre Klimmendaal, Arnhem, The Netherlands
| | | | - Roy P.C. Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
- Rehabilitation Medical Centre Klimmendaal, Arnhem, The Netherlands
| | - Dirk Bertens
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Rehabilitation Medical Centre Klimmendaal, Arnhem, The Netherlands
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Van Heugten CM, Bertens D, Fasotti L. Can We Successfully Improve Attentional Impairments After Brain Injury With Computer-Based Interventions? Letter to the Editor on "Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014". Arch Phys Med Rehabil 2022; 103:2065. [PMID: 35777469 DOI: 10.1016/j.apmr.2022.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Caroline M Van Heugten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands
| | - Dirk Bertens
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Klimmendaal Rehabilitation Center, Arnhem, the Netherlands
| | - Luciano Fasotti
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Klimmendaal Rehabilitation Center, Arnhem, the Netherlands
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Scheper I, Kessels RPC, Brazil IA, Bertens D. Errorless and trial-and-error learning of object locations in patients with executive deficits after brain injury. Neuropsychol Rehabil 2021; 33:226-238. [PMID: 34753415 DOI: 10.1080/09602011.2021.1997765] [Citation(s) in RCA: 3] [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] [Indexed: 10/19/2022]
Abstract
Studies investigating the efficacy of errorless learning (EL), a rehabilitation method in which the occurrence of errors during learning are eliminated, have predominantly involved patients with memory impairment. However, the most recent perspective on the underlying mechanism of EL explicitly takes executive processes into account. The aim of this study was to investigate whether EL of object locations is beneficial for memory performance compared to trial-and-error learning (TEL) in patients with acquired brain injury (ABI) experiencing executive deficits (N = 15) and matched healthy controls (N = 15). Participants completed an EL and TEL condition of a computerized spatial learning task, in which the location of everyday objects had to be memorized. The number of errors made during learning was predetermined, varying from 0 (EL condition) to 1, 2, 3, 4 or 5 errors (TEL condition). Results showed a beneficial effect of EL on memory performance in both ABI patients and controls (p < .001), but this advantage was not larger in ABI patients compared to controls and was not moderated by the amount of errors made during learning.
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Affiliation(s)
- Inge Scheper
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Roy P C Kessels
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.,Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands.,Klimmendaal Rehabilitation Specialists, Arnhem, The Netherlands
| | - Inti A Brazil
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.,Division Diagnostics, Research, & Education, Forensic Psychiatric Centre Pompestichting, Nijmegen, The Netherlands
| | - Dirk Bertens
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.,Klimmendaal Rehabilitation Specialists, Arnhem, The Netherlands
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Nauta IM, Bertens D, van Dam M, Huiskamp M, Driessen S, Geurts J, Uitdehaag B, Fasotti L, Hulst HE, de Jong BA, Klein M. Performance validity in outpatients with multiple sclerosis and cognitive complaints. Mult Scler 2021; 28:642-653. [PMID: 34212754 PMCID: PMC8961248 DOI: 10.1177/13524585211025780] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Suboptimal performance during neuropsychological assessment renders cognitive test results invalid. However, suboptimal performance has rarely been investigated in multiple sclerosis (MS). OBJECTIVES To investigate potential underlying mechanisms of suboptimal performance in MS. METHODS Performance validity testing, neuropsychological assessments, neuroimaging, and questionnaires were analyzed in 99 MS outpatients with cognitive complaints. Based on performance validity testing patients were classified as valid or invalid performers, and based on neuropsychological test results as cognitively impaired or preserved. Group comparisons and correlational analyses were performed on demographics, patient-reported, and disease-related outcomes. RESULTS Twenty percent displayed invalid performance. Invalid and valid performers did not differ regarding demographic, patient-reported, and disease-related outcomes. Disease severity of invalid and valid performers with cognitive impairment was comparable, but worse than cognitively preserved valid performers. Lower performance validity scores related to lower cognitive functioning, lower education, being male, and higher disability levels (p < 0.05). CONCLUSION Suboptimal performance frequently occurs in patients with MS and cognitive complaints. In both clinical practice and in cognitive research, suboptimal performance should be considered in the interpretation of cognitive outcomes. Identification of factors that differentiate between suboptimal and optimal performers with cognitive impairment needs further exploration.
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Affiliation(s)
- I M Nauta
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - D Bertens
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands/Klimmendaal Rehabilitation Center, Arnhem, The Netherlands
| | - M van Dam
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - M Huiskamp
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - S Driessen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Psychology, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Jjg Geurts
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Bmj Uitdehaag
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - L Fasotti
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands/Klimmendaal Rehabilitation Center, Arnhem, The Netherlands
| | - H E Hulst
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - B A de Jong
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - M Klein
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Psychology, Amsterdam Neuroscience, Amsterdam, The Netherlands
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Abstract
OBJECTIVE To systematically review the evidence on the treatments of sleep disturbances in individuals with acquired brain injury. DATA SOURCES PubMed, Embase, Web of Science, and PsycINFO were searched from inception to January 2021. REVIEW METHOD Eligibility criteria were (1) participants with mild to severe acquired brain injury from traumatic brain injury and stroke (⩾three months post-injury), (2) individuals aged 16 years and older, (3) participants with self-reported sleep disturbances, (4) controlled group studies and single case (experimental) studies, and (5) interventions aimed at treatment of sleep disturbances. Two researchers independently identified relevant studies and assessed their study quality using the revised Cochrane assessment of bias tool (RoB 2.0) and the risk-of-bias in N-of-1 trials (RoBiNT) scale. RESULTS The search yielded 655 records; 11 studies met the inclusion criteria and were included, with a total of 227 participants (207 individuals with traumatic brain injury, 20 stroke patients). Two studies included pharmacological therapy, six studies examined the effects of cognitive behavioral therapy and three studies investigated alternative interventions such as acupuncture. CONCLUSION Although there was heterogeneity in the study quality of the included studies, their outcomes suggest that cognitive behavioral therapy is recommended as treatment of choice for improving sleep in individuals with acquired brain injury, especially for patients with mild to severe traumatic brain injury. Future research should examine the effects of cognitive behavioral therapy in more high-quality randomized controlled designs.
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Affiliation(s)
- Louise Pilon
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Nikita Frankenmolen
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Dirk Bertens
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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11
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Nauta IM, Kulik SD, Breedt LC, Eijlers AJ, Strijbis EM, Bertens D, Tewarie P, Hillebrand A, Stam CJ, Uitdehaag BM, Geurts JJ, Douw L, de Jong BA, Schoonheim MM. Functional brain network organization measured with magnetoencephalography predicts cognitive decline in multiple sclerosis. Mult Scler 2020; 27:1727-1737. [PMID: 33295249 PMCID: PMC8474326 DOI: 10.1177/1352458520977160] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cognitive decline remains difficult to predict as structural brain damage cannot fully explain the extensive heterogeneity found between MS patients. OBJECTIVE To investigate whether functional brain network organization measured with magnetoencephalography (MEG) predicts cognitive decline in MS patients after 5 years and to explore its value beyond structural pathology. METHODS Resting-state MEG recordings, structural MRI, and neuropsychological assessments were analyzed of 146 MS patients, and 100 patients had a 5-year follow-up neuropsychological assessment. Network properties of the minimum spanning tree (i.e. backbone of the functional brain network) indicating network integration and overload were related to baseline and longitudinal cognition, correcting for structural damage. RESULTS A more integrated beta band network (i.e. smaller diameter) and a less integrated delta band network (i.e. lower leaf fraction) predicted cognitive decline after 5 years (Radj2=15%), independent of structural damage. Cross-sectional analyses showed that a less integrated network (e.g. lower tree hierarchy) related to worse cognition, independent of frequency band. CONCLUSIONS The level of functional brain network integration was an independent predictive marker of cognitive decline, in addition to the severity of structural damage. This work thereby indicates the promise of MEG-derived network measures in predicting disease progression in MS.
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Affiliation(s)
- Ilse M Nauta
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Shanna D Kulik
- Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Lucas C Breedt
- Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Anand Jc Eijlers
- Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Eva Mm Strijbis
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands/Department of Clinical Neurophysiology and MEG Center, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Dirk Bertens
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands; Klimmendaal Rehabilitation Center, Arnhem, The Netherlands
| | - Prejaas Tewarie
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Arjan Hillebrand
- Department of Clinical Neurophysiology and MEG Center, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Cornelis J Stam
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands/Department of Clinical Neurophysiology and MEG Center, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Bernard Mj Uitdehaag
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Jeroen Jg Geurts
- Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Linda Douw
- Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Brigit A de Jong
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Menno M Schoonheim
- Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
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12
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Palmisano S, Fasotti L, Bertens D. Neurobehavioral Initiation and Motivation Problems After Acquired Brain Injury. Front Neurol 2020; 11:23. [PMID: 32153486 PMCID: PMC7049782 DOI: 10.3389/fneur.2020.00023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 01/08/2020] [Indexed: 12/11/2022] Open
Abstract
Motivation is a primary and permanent source of human behavior and adaptation. Motivational deficits, along with deficiencies in initiation, frequently occur in individuals with acquired brain injury (ABI). These neurobehavioral problems are associated with consequences at the participation level: patients are reluctant to engage in rehabilitation, and their subsequent social reintegration is often at risk. The same problems may also become a heavy burden for the families of individuals with ABI. In the present paper, we will critically review both the current definitions and the instruments used to measure motivational disorders following ABI. We will also describe the neural system underlying motivation and its impairments. What emerges is the need to develop specific rehabilitative treatments, still absent at the moment, with the ultimate aim of ensuring a better quality of life for both the patients and their proxies.
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Affiliation(s)
- Simona Palmisano
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.,Rehabilitation Center Klimmendaal, Arnhem, Netherlands
| | - Luciano Fasotti
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.,Rehabilitation Center Klimmendaal, Arnhem, Netherlands
| | - Dirk Bertens
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.,Rehabilitation Center Klimmendaal, Arnhem, Netherlands
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13
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Scheper I, de Bruijn ERA, Bertens D, Kessels RPC, Brazil IA. The impact of error frequency on errorless and errorful learning of object locations using a novel paradigm. Memory 2019; 27:1371-1380. [DOI: 10.1080/09658211.2019.1661493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Inge Scheper
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Ellen R. A. de Bruijn
- Department of Clinical Psychology, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden, Netherlands
| | - Dirk Bertens
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Klimmendaal Rehabilitation Specialists, Arnhem, Netherlands
| | - Roy P. C. Kessels
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Vincent van Gogh Institute for Psychiatry, Venray, Netherlands
| | - Inti A. Brazil
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Division Diagnostics, Research, & Education, Forensic Psychiatric Centre Pompestichting, Nijmegen, Netherlands
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
- Brain, Belief and Behaviour Lab, Coventry University, Coventry, UK
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14
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Bertens D, Kessels RP, Boelen DH, Fasotti L. Transfer effects of errorless Goal Management Training on cognitive function and quality of life in brain-injured persons. NeuroRehabilitation 2016; 38:79-84. [DOI: 10.3233/nre-151298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Dirk Bertens
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Outpatient Neuropsychiatry Center Thalamus, Institution for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
| | - Roy P.C. Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Radboud University Medical Center, Department of Medical Psychology, Nijmegen, The Netherlands
- Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
| | - Danielle H.E. Boelen
- Outpatient Neuropsychiatry Center Thalamus, Institution for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
- Rehabilitation Medical Centre Groot Klimmendaal, Arnhem, The Netherlands
| | - Luciano Fasotti
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Rehabilitation Medical Centre Groot Klimmendaal, Arnhem, The Netherlands
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15
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Bertens D, Fasotti L, Boelen DH, Kessels RP. Moderators, Mediators, and Nonspecific Predictors of Treatment Outcome in an Intervention for Everyday Task Improvement in Persons With Executive Deficits After Brain Injury. Arch Phys Med Rehabil 2016; 97:97-103. [DOI: 10.1016/j.apmr.2015.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/20/2015] [Accepted: 07/27/2015] [Indexed: 12/21/2022]
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16
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Bertens D, Fasotti L, Egger JIM, Boelen DHE, Kessels RPC. Reliability of an Adapted Version of the Modified Six Elements Test as a Measure of Executive Function. Appl Neuropsychol Adult 2015; 23:35-42. [PMID: 26111243 DOI: 10.1080/23279095.2015.1012258] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The Modified Six Elements Test (MSET) is used to examine executive deficits-more specifically, planning deficits. This study investigates the reliability of an adapted version of the MSET and proposes a novel scoring method. Two parallel versions of the adapted MSET were administered in 60 healthy participants in a counterbalanced order. Test-retest and parallel-form reliability were examined using intraclass correlation coefficients, Bland-Altman analyses, standard errors of measurement, and smallest real differences, representing clinically relevant changes over time. Moreover, the ecological validity of the adapted MSET was evaluated using the Executive Function Index, a self-rating questionnaire measuring everyday executive performance. No systematic differences between the test occasions were present, and the adapted MSET including the proposed scoring method was capable of detecting real clinical changes. Intraclass correlations for the test-retest and parallel-form reliability were modest, and the variability between the test scores was high. The nonsignificant correlations with the Executive Function Index did not confirm the previously established ecological validity of the MSET. We show that both parallel versions of the test are clinically equivalent and can be used to measure executive function over the course of time without task-specific learning effects.
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Affiliation(s)
- Dirk Bertens
- a Donders Institute for Brain, Cognition and Behaviour , Radboud University , Nijmegen , The Netherlands
| | - Luciano Fasotti
- a Donders Institute for Brain, Cognition and Behaviour , Radboud University , Nijmegen , The Netherlands.,b Rehabilitation Medical Centre Groot Klimmendaal , Arnhem , The Netherlands
| | - Jos I M Egger
- a Donders Institute for Brain, Cognition and Behaviour , Radboud University , Nijmegen , The Netherlands.,c Centre of Excellence for Neuropsychiatry , Vincent van Gogh Institute for Psychiatry , Venray , The Netherlands.,d Behavioural Science Institute , Radboud University , Nijmegen , The Netherlands.,e Pompe Institute for Forensic Psychiatry , Pro Persona , Nijmegen , The Netherlands
| | - Danielle H E Boelen
- b Rehabilitation Medical Centre Groot Klimmendaal , Arnhem , The Netherlands.,f Department of Medical Psychology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Roy P C Kessels
- a Donders Institute for Brain, Cognition and Behaviour , Radboud University , Nijmegen , The Netherlands.,f Department of Medical Psychology , Radboud University Medical Center , Nijmegen , The Netherlands.,g Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders , Vincent van Gogh Institute for Psychiatry , Venray , The Netherlands
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17
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Bertens D, Frankenmolen N, Boelen DHE, Kessels RPC, Fasotti L. Validity of an Adapted Scoring Method for a Modified Six Elements Test in Individuals with Brain Injury. Arch Clin Neuropsychol 2014; 30:122-9. [DOI: 10.1093/arclin/acu093] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Mulder SF, Bertens D, Desar IME, Vissers KCP, Mulders PFA, Punt CJA, van Spronsen DJ, Langenhuijsen JF, Kessels RPC, van Herpen CML. Impairment of cognitive functioning during Sunitinib or Sorafenib treatment in cancer patients: a cross sectional study. BMC Cancer 2014; 14:219. [PMID: 24661373 PMCID: PMC3987809 DOI: 10.1186/1471-2407-14-219] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 03/13/2014] [Indexed: 01/14/2023] Open
Abstract
Background Impairment of cognitive functioning has been reported in several studies in patients treated with chemotherapy. So far, no studies have been published on the effects of the vascular endothelial growth factor receptor (VEGFR) inhibitors on cognitive functioning. We investigated the objective and subjective cognitive function of patients during treatment with VEGFR tyrosine kinase inhibitors (VEGFR TKI). Methods Three groups of participants, matched on age, sex and education, were enrolled; 1. metastatic renal cell cancer (mRCC) or GIST patients treated with sunitinib or sorafenib (VEGFR TKI patients n = 30); 2. patients with mRCC not receiving systemic treatment (patient controls n = 20); 3. healthy controls (n = 30). Sixteen neuropsychological tests examining the main cognitive domains (intelligence, memory, attention and concentration, executive functions and abstract reasoning) were administered by a neuropsychologist. Four questionnaires were used to assess subjective cognitive complaints, mood, fatigue and psychological wellbeing. Results No significant differences in mean age, sex distribution, education level or IQ were found between the three groups. Both patient groups performed significantly worse on the cognitive domains Learning & Memory and Executive Functions (Response Generation and Problem Solving) compared to healthy controls. However only the VEGFR TKI patients showed impairments on the Executive subdomain Response Generation. Effect sizes of cognitive dysfunction in patients using VEGFR TKI were larger on the domains Learning & Memory and Executive Functions, compared to patient controls. Both patients groups performed on the domain Attention & Concentration the same as the healthy controls. Longer duration of treatment on VEGFR TKI was associated with a worse score on Working Memory tasks. Conclusions Our data suggest that treatment with VEGFR TKI has a negative impact on cognitive functioning, specifically on Learning & Memory, and Executive Functioning. We propose that patients who are treated with VEGFR TKI are monitored and informed for possible signs or symptoms associated with cognitive impairment. Trial registration ClinicalTrials.gov Identifier: NCT01246843.
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Affiliation(s)
- Sasja F Mulder
- Department of Medical Oncology, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Bertens D, Fasotti L, Boelen DHE, Kessels RPC. A randomized controlled trial on errorless learning in goal management training: study rationale and protocol. BMC Neurol 2013; 13:64. [PMID: 23786651 PMCID: PMC3693893 DOI: 10.1186/1471-2377-13-64] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 06/19/2013] [Indexed: 11/24/2022] Open
Abstract
Background Many brain-injured patients referred for outpatient rehabilitation have executive deficits, notably difficulties with planning, problem-solving and goal directed behaviour. Goal Management Training (GMT) has proven to be an efficacious cognitive treatment for these problems. GMT entails learning and applying an algorithm, in which daily tasks are subdivided into multiple steps. Main aim of the present study is to examine whether using an errorless learning approach (preventing the occurrence of errors during the acquisition phase of learning) contributes to the efficacy of Goal Management Training in the performance of complex daily tasks. Methods/Design The study is a double blind randomized controlled trial, in which the efficacy of Goal Management Training with an errorless learning approach will be compared with conventional Goal Management Training, based on trial and error learning. In both conditions 32 patients with acquired brain injury of mixed etiology will be examined. Main outcome measure will be the performance on two individually chosen everyday-tasks before and after treatment, using a standardized observation scale and goal attainment scaling. Discussion This is the first study that introduces errorless learning in Goal Management Training. It is expected that the GMT-errorless learning approach will improve the execution of complex daily tasks in brain-injured patients with executive deficits. The study can contribute to a better treatment of executive deficits in cognitive rehabilitation. Trial registration (Dutch Trial Register):
http://NTR3567
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Affiliation(s)
- Dirk Bertens
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands.
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Janssen MAM, Bertens D, Kessels L, Kessels RPC, Koopmans PP. A case-control pilot study on cognitive functioning, symptom validity and psychological wellbeing in HIV-1-infected patients in the Netherlands. Int J STD AIDS 2013; 24:387-91. [PMID: 23970707 DOI: 10.1177/0956462412472802] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 11/16/2022]
Abstract
The objective of this study was to examine and relate both cognitive functioning and psychological wellbeing in Dutch HIV-1-infected patients (n = 30) in comparison with a matched healthy control group (n = 30), taking symptom validity into account. Significant differences in performance between patients and controls were found in the domain Working memory (P = 0.036), but not in the other cognitive domains. There was a significant difference in all dimensions of the psychological wellbeing scale, measured with the SCL-90-R (P values between 0.002 and 0.023), except for agoraphobia, cognitive performance difficulty and sleep disturbances. No correlations were found between the performance on the Working memory domain and wellbeing. Future research should focus on unravelling the underlying mechanisms of neurocognitive dysfunction further using neuropsychological tests, including a symptom validity test in combination with neuroimaging techniques in larger samples.
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Affiliation(s)
- M A M Janssen
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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21
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Mulder S, Bertens D, Vissers K, Punt C, Mulders P, van Spronsen D, Kessels R, Herpen C. 7132 POSTER Impairment of Cognitive Functioning During Sunitinib or Sorafenib Treatment – a Cross Sectional Study. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72047-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dorhout Mees SM, Bertens D, van der Worp HB, Rinkel GJE, van den Bergh WM. Magnesium and headache after aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 2010; 81:490-3. [PMID: 19828484 DOI: 10.1136/jnnp.2009.181404] [Citation(s) in RCA: 18] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND In patients with aneurysmal subarachnoid haemorrhage (SAH), headache typically is severe and often requires treatment with opioids. Magnesium has analgesic effects in several conditions, but whether it reduces headache after SAH is unknown. METHODS In a cohort of 108 SAH patients included in the randomised controlled trial Magnesium in Aneurysmal Subarachnoid Haemorrhage-II (MASH-II), severity of headache was regularly assessed on an 11-point scale until day 10 after SAH. Headache was treated according to a standardised protocol with acetaminophen, codeine, tramadol or piritramide. Serum magnesium levels were assessed every other day. Differences in mean headache scores between patients with mean high (>1.0 mmol/l) and normal (< or =1.0 mmol/l) magnesium levels were analysed with a Student t test. Crude and adjusted ORs for the use of codeine, tramadol and piritramide for patients with high versus normal magnesium levels were calculated with logistic regression. RESULTS The 61 patients with high magnesium levels had lower mean headache scores (4.1) than the 47 patients with normal magnesium levels (4.9; mean difference, 0.8; 95% CI 0.1 to 1.6) and required less tramadol (adjusted OR, 0.3; 95% CI 0.1 to 0.7) or piritramide (adjusted OR 0.2; 95% CI 0.1 to 0.5). There were no differences in the use of acetaminophen or codeine. CONCLUSION In SAH patients, elevated serum magnesium levels are associated with slightly less severe headache and less frequent use of opioids. These data imply that intravenous magnesium therapy, besides a supposed beneficial effect on outcome, also provides pain relief for SAH patients, for whom it might also improve functional outcome.
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Affiliation(s)
- S M Dorhout Mees
- Department of Neurology, Room G03.228, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
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