A-117 Strategic Memory and Advanced Reasoning Training for Rehabilitation of Warfighters with Mild Traumatic Brain Injury

Background Military personnel require a level of cognitive readiness that ensures they function safely and effectively in high-stress situations. Warfighters who experienced a mild traumatic brain injury (mTBI) often complain of persistent cognitive issues that may impact those abilities. This study presents preliminary data on the efficacy of a 4-week Strategic Memory Advanced Reasoning Training (SMART) for warfighter rehabilitation. SMART improves executive functioning in order to enhance overall cognitive abilities. Methods This is part of a randomized clinical trial (Validation of Cognitive Enhancement Therapy for mTBI). 22 Marines with prior mTBI and current cognitive complaints; 7 of whom completed SMART and were included in the analysis. Cognitive tests of interest included the Delis-Kaplan Executive Function System Color Word (CW) and Trail Making (TM). Results Improvements were observed on TM Number Sequencing (Pre: M = 9.71, SD = 2.06; Post: M = 11.86, SD = 1.35, p = 0.011, d = 1.37) and approached significance on Letter Sequencing (Pre: M = 10.29, SD = 1.81; Post: M = 12.57, SD = 1.13, p = 0.066, d = 1.26). Though non-significant, a large clinically-relevant effect size was found for Number-Letter Switching (Pre: M = 8.14, SD = 1.95; Post: M = 9.57, SD = 2.15, p = 0.106, d = 0.72). CW performance improved on Inhibition (Pre: M = 5.29, SD = 3.86; Post: M = 8.86, SD = 2.34, p = 0.034, d = 1.03) and Inhibition/Switching (Pre: M = 4.86, SD = 4.06; Post: M = 8.43, SD = 4.12, p = 0.015, d = 1.26). Conclusions The SMART program resulted in large improvements in the executive functioning of a small sample of warfighters with persistent cognitive complaints following a mTBI. The results support further examination of the efficacy of SMART for warfighter rehabilitation.

Using Virtual Reality to Assess and Promote Transfer of Memory Training in Older Adults With Memory Complaints: A Randomized Controlled Trial

In this proof-of-concept study, we assessed the potential for immersive virtual reality (VR) to measure transfer following strategic memory training, and whether efficacy and transfer are increased when training is complemented by practice in an immersive virtual environment. Forty older adults with subjective memory complaints were trained with the method of loci. They were randomized to either a condition where they practiced the strategy in VR (n = 20) or a control condition where they were familiarized with VR using a non-memory task (n = 20). Training efficacy was measured with word recall, and transfer of the training benefit was measured with a recall task completed in two VR tasks (primary outcomes) as well as a self-report memory questionnaire (secondary outcomes). Testing was administered before (PRE), midway (POST 3), and after (POST 6) training. Participants improved their scores on word recall. Regarding transfer measures, participants improved their performance in the two VR recall tasks but not on the self-report memory questionnaire. No significant group effect was observed. Improvement was found when comparing PRE to POST 3 with no further improvement at POST 6. Thus, strategic memory training improved the memory of seniors with memory complaints on word recall and a transfer task relying on a VR scenario that resembles real-life. However, no evidence supporting an increase in transfer effects was found when enriching training with VR memory exercises.

A Strategic Memory Advanced Reasoning Training Approach for Enhancing Higher Order Cognitive Functioning Following Sports- and Recreation-Related Mild Traumatic Brain Injury in Youth Using Telepractice

Purpose There is currently a large scope of unmet need in addressing persistent cognitive difficulties after mild traumatic brain injury (mTBI) affecting higher order aspects such as reasoning, strategic learning, and other executive functions (EFs), with potential lasting impacts on academic and everyday life functioning. This study sought to explore the potential for cognitive training delivered via telepractice to enhance cognitive performance after mTBI in adolescence, a critical stage for frontal lobe maturation and EF development. Method This nonrandomized pilot intervention study explored the effects of telepractice delivery of a top-down, strategy-based cognitive training approach, namely, Strategic Memory Advanced Reasoning Training, on higher order strategic learning skills, along with related executive processes and real-life EF behaviors. Twelve adolescents (ages 12–18 years) who were at least 3 months post-mTBI completed 10 individual sessions over 4–6 weeks, delivered using Skype. Results After training, participants exhibited significant improvements in their ability to abstract meanings and recall facts from complex information. They also demonstrated generalized gains in untrained EFs of working memory and cognitive flexibility as well as potential gains in real-life EF behaviors, per parent report. Conclusions Whereas the findings need to be replicated in a larger, randomized study, the preliminary data suggest the clinical utility of training metacognitive strategies to improve top-down cognitive control functions after mTBI that are adaptable and adoptable across academic and real-life domains. Furthermore, leveraging an interactive telepractice communication platform has the potential to maximize the reach of cognitive training/intervention delivery while minimizing costs as well as time and travel demands.

Towards a biomarker model for cognitive improvement: No change in memory-related prefrontal engagement following a negative cognitive remediation trial in bipolar disorder

Background: Cognitive deficits are prevalent in bipolar disorder during remission but effective cognition treatments are lacking due to insufficient insight into the neurobiological targets of cognitive improvement. Emerging data suggest that dorsal prefrontal cortex target engagement is a key neurocircuitry biomarker of pro-cognitive treatment effects. Aims: In this randomized controlled functional magnetic resonance imaging study, we test this hypothesis by investigating the effects of an ineffective cognitive remediation intervention on dorsal prefrontal response during strategic memory encoding and working memory engagement. Methods: Bipolar disorder patients in partial remission with subjective cognitive difficulties were randomized to receive 12-week group-based cognitive remediation ( n = 13) or to continue their standard treatment ( n = 14). The patients performed a strategic episodic picture encoding task and a spatial n-back working memory task under functional magnetic resonance imaging at baseline and following cognitive remediation or standard treatment. Results: The right dorsolateral prefrontal cortex was commonly activated by both strategic memory tasks across all patients. The task-related prefrontal engagement was not altered by cognitive remediation relative to standard treatment. The dorsolateral prefrontal cortex response was not significantly associated with recall accuracy or working memory performance. Conclusions: As hypothesized, no task-related change in prefrontal activity was observed in a negative cognitive remediation trial in remitted bipolar disorder patients. By complementing previous findings linking cognitive improvement with increased dorsolateral prefrontal cortex engagement, our negative findings provide additional validity evidence to the dorsal prefrontal target engagement biomarker model of cognitive improvement by strengthening the proposed causality between modulation of dorsolateral prefrontal cortex engagement and pro-cognitive effects.

The effect of strategic memory training in older adults: who benefits most?

ABSTRACTBackground:Previous research has suggested that there is a degree of variability among older adults’ response to memory training, such that some individuals benefit more than others. The aim of the present study was to identify the profile of older adults who were likely to benefit most from a strategic memory training program that has previously proved to be effective in improving memory in healthy older adults.Method:In total, 44 older adults (60–83 years) participated in a strategic memory training. We examined memory training benefits by measuring changes in memory practiced (word list learning) and non-practiced tasks (grocery list and associative learning). In addition, a battery of cognitive measures was administered in order to assess crystallized and fluid abilities, short-term memory, working memory, and processing speed.Results:Results confirmed the efficacy of the training in improving performance in both practiced and non-practiced memory tasks. For the practiced memory tasks, results showed that memory baseline performance and crystallized ability predicted training gains. For the non-practiced memory tasks, analyses showed that memory baseline performance was a significant predictor of gain in the grocery list learning task. For the associative learning task, the significant predictors were memory baseline performance, processing speed, and marginally the age.Conclusions:Our results indicate that older adults with a higher baseline memory capacity and with more efficient cognitive resources were those who tended to benefit most from the training. The present study provides new avenues in designing personalized intervention according to the older adults’ cognitive profile.

Evidence of an Intelligent Tutoring System as a Mindtool to Promote Strategic Memory of Expository Texts and Comprehension With Children in Grades 4 and 5

Reading and comprehending content area texts require learners to effectively select and encode with hierarchically strategic memory structures in order to combine new information with prior knowledge. Unfortunately, evidence from state and national tests shows that children fail to successfully navigate the reading comprehension challenges they face. Schools have struggled to find approaches that can help children succeed in this important task. Typical instruction in classrooms across the country has focused on procedural application of strategies or content-focused approaches that encourage rich discussions. Both approaches have achieved success but have limitations-related transparency and specificity of scaffolds and guidance for the teacher and learner in today’s diverse and complex classroom settings. The text structure strategy combines content and strategy to provide pragmatic, transparent, and scaffolded instruction addressing these challenges. A web-based intelligent tutoring system for the text structure strategy, named ITSS, was designed and developed to provide consistent and high-quality instruction to learners in Grades 4 and 5 about how to read, select main ideas, encode strategic memory structures, make inferences, and monitor comprehension during reading. In this article, we synthesize results from two recent large-scale randomized controlled studies to showcase how the ITSS supports selection and encoding of students’ strategic memory structures and how prior knowledge affects the memory structures. We provide greater depth of information about such processing than examined and reported in extant literature about overall increases in reading comprehension resulting from students using ITSS.