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Evaluation of a Cognitive Rehabilitation Protocol in HIV Patients with Associated Neurocognitive Disorders: Efficacy and Stability Over Time.

Livelli A, Orofino GC, Calcagno A, Farenga M, Penoncelli D, Guastavigna M, Carosella S, Caramello P, Pia L - Front Behav Neurosci (2015)

Bottom Line: Our results show that the two groups did not differ at the pre-assessment, but differed at post-assessment.Specifically, the experimental group showed a significant improvement in five domains (Learning and memory, Abstraction/executive functioning, Verbal fluency, Attention/working memory, and Functional), whereas the control group significantly worsened in the same domains.The improvement of the experimental group did not change in the follow up-assessment in two domains (Abstraction/executive functioning, Attention/working memory, and Functional).

View Article: PubMed Central - PubMed

Affiliation: Division A of Infectious Diseases, Amedeo of Savoia Hospital Torino, Italy ; SpAtial, Motor and Bodily Awareness Research Group, Department of Psychology, University of Torino Torino, Italy.

ABSTRACT
The primary aim of the present study was to evaluate the efficacy and stability over time of a cognitive rehabilitation protocol (restorative and compensatory approach) in HIV/AIDS patients with HIV-associated Neurocognitive Disorder (HAND). At baseline, 32 HIV/AIDS patients (16 with and 16 without HAND) were assessed with a neuropsychological battery (i.e., pre-assessment) consisting of 22 tests covering eight cognitive domains. Then, the experimental group was administered over 4 months a cognitive rehabilitation protocol aimed at improving four cognitive domains by means of eight paper and pencil/computer-based exercises. The control group received guideline-adherent clinical care (i.e., standard of care). At the end of the cognitive treatment, both groups were re-administered the neuropsychological battery (i.e., post-assessment). Additionally, 6 months after post-assessment, the experimental group was given the same neuropsychological battery (i.e., follow up-assessment). In order to test the efficacy of the cognitive rehabilitation protocol, we compared between groups the results of the neuropsychological battery at the pre- and post-assessments. In order to evaluate the stability over time, the effects of the cognitive rehabilitation protocol was examined comparing within the experimental group the results of the neuropsychological battery at post- and follow up-assessments. Our results show that the two groups did not differ at the pre-assessment, but differed at post-assessment. Specifically, the experimental group showed a significant improvement in five domains (Learning and memory, Abstraction/executive functioning, Verbal fluency, Attention/working memory, and Functional), whereas the control group significantly worsened in the same domains. The improvement of the experimental group did not change in the follow up-assessment in two domains (Abstraction/executive functioning, Attention/working memory, and Functional). Overall, these findings support the efficacy and, to some extent, the stability over time of our cognitive rehabilitation protocol.

No MeSH data available.


Related in: MedlinePlus

Between-groups comparisons (domains) along time (pre- vs. post-assessment). Error bars represent standard errors. Asterisks indicate significant comparisons, n.s. indicate non-significant comparisons.
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Figure 1: Between-groups comparisons (domains) along time (pre- vs. post-assessment). Error bars represent standard errors. Asterisks indicate significant comparisons, n.s. indicate non-significant comparisons.

Mentions: Respect to “Screening,” the TIME x group interaction resulted to be significant [F(1, 30) = 7.05, p = 0.013]. Post-hoc comparisons (Duncan) revealed that the two groups did not differ at pre-assessment (experimental group: mean = 50.23, SE = 1.32; control group: mean = 49.77, SE = 1.31), but differed (p = 0.007) at post-assessment (experimental group: mean = 53.3, SE = 1.74; control group: mean = 46.7, SE = 1.74); see Figure 1. The analysis on “Speed information processing” was not significant. As regards “Learning and memory,” the TIME × GROUP interaction was significant [F(1, 30) = 31.58, p < 0.0001]. Post-hoc comparisons (Duncan) revealed that the two groups did not differ at pre-assessment (experimental group: mean = 51.11, SE = 1.96; control group: mean = 48.89, SE = 1.95), but differed (p = 0.0002) at post-assessment (experimental group: mean = 55.75, SE = 1.54; control group: mean = 44.24, SE = 1.54) because the mean score of the experimental group significantly (p = 0.0005) increased and the mean score of the control group significantly (p = 0.0001) decreased (see Figure 1). The TIME × GROUP interaction was significant [F(1, 30) = 21.42, p < 0.0001 also for “Abstraction/Executive Functioning.” Duncan post-hoc showed that the groups did not differ at pre-assessment (experimental group: mean = 50.41, SE = 1.9; control group: mean = 49.6, SE = 1.38), but differed (p < 0.001) at post-assessment (experimental group: mean = 54.51, SE = 1.27; control group: mean = 47.48, SE = 1.27) because the mean score of the experimental group significantly (p = 0.003) increased, and the mean score of the control group significantly (p = 0.003) decreased (see Figure 1). The same was true for the “verbal fluency” in which the TIME × GROUP interaction was significant [F(1, 30) = 11.45, p = 0.002]. Duncan post-hoc analysis revealed that groups did not differ at pre-assessment (experimental group: mean = 51.95, SE = 1.91; control group: mean = 48.05, SE = 1.91), but differed (p < 0.0001) at post-assessment (experimental group: mean = 56.66, SE = 1.34; control group: mean = 43.34, SE = 1.34) because the mean score of the experimental group significantly (p = 0.02) increased and the mean score of the control group significantly (p = 0.02) decreased (see Figure 1). The TIME × GROUP interaction was significant [F(1, 30) = 13.8, p = 0.001] also for “Attention/Working memory.” Duncan post-hoc analysis revealed that groups did not differ at pre-assessment (experimental group: mean = 50.62, SE = 1.49; control group: mean = 49.38, SE = 1.49), but differed (p = 0.0001) at post-assessment (experimental group: mean = 54.42, SE = 1.22; control group: mean = 45.58, SE = 1.22) because the mean score of the experimental group significantly (p = 0.016) increased and the mean score of the control group significantly (p = 0.016) decreased. The same was true for “Functional” in which the TIME × GROUP interaction was significant [F(1, 30) = 12.91, p = 0.001]. Duncan post-hoc revealed that groups did not differ at pre-assessment (experimental group: mean = 49.64, SE = 2.54; control group: mean = 50.36, SE = 2.53), but differed (p = 0.042) at post-assessment (experimental group: mean = 53.92, SE = 2.31; control group: mean = 46.08, SE = 2.33) because the mean score of the experimental group significantly (p = 0.021) increased and the mean score of the control group significantly (p = 0.021) decreased. The analysis on “Mental Health” was not significant.


Evaluation of a Cognitive Rehabilitation Protocol in HIV Patients with Associated Neurocognitive Disorders: Efficacy and Stability Over Time.

Livelli A, Orofino GC, Calcagno A, Farenga M, Penoncelli D, Guastavigna M, Carosella S, Caramello P, Pia L - Front Behav Neurosci (2015)

Between-groups comparisons (domains) along time (pre- vs. post-assessment). Error bars represent standard errors. Asterisks indicate significant comparisons, n.s. indicate non-significant comparisons.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4644912&req=5

Figure 1: Between-groups comparisons (domains) along time (pre- vs. post-assessment). Error bars represent standard errors. Asterisks indicate significant comparisons, n.s. indicate non-significant comparisons.
Mentions: Respect to “Screening,” the TIME x group interaction resulted to be significant [F(1, 30) = 7.05, p = 0.013]. Post-hoc comparisons (Duncan) revealed that the two groups did not differ at pre-assessment (experimental group: mean = 50.23, SE = 1.32; control group: mean = 49.77, SE = 1.31), but differed (p = 0.007) at post-assessment (experimental group: mean = 53.3, SE = 1.74; control group: mean = 46.7, SE = 1.74); see Figure 1. The analysis on “Speed information processing” was not significant. As regards “Learning and memory,” the TIME × GROUP interaction was significant [F(1, 30) = 31.58, p < 0.0001]. Post-hoc comparisons (Duncan) revealed that the two groups did not differ at pre-assessment (experimental group: mean = 51.11, SE = 1.96; control group: mean = 48.89, SE = 1.95), but differed (p = 0.0002) at post-assessment (experimental group: mean = 55.75, SE = 1.54; control group: mean = 44.24, SE = 1.54) because the mean score of the experimental group significantly (p = 0.0005) increased and the mean score of the control group significantly (p = 0.0001) decreased (see Figure 1). The TIME × GROUP interaction was significant [F(1, 30) = 21.42, p < 0.0001 also for “Abstraction/Executive Functioning.” Duncan post-hoc showed that the groups did not differ at pre-assessment (experimental group: mean = 50.41, SE = 1.9; control group: mean = 49.6, SE = 1.38), but differed (p < 0.001) at post-assessment (experimental group: mean = 54.51, SE = 1.27; control group: mean = 47.48, SE = 1.27) because the mean score of the experimental group significantly (p = 0.003) increased, and the mean score of the control group significantly (p = 0.003) decreased (see Figure 1). The same was true for the “verbal fluency” in which the TIME × GROUP interaction was significant [F(1, 30) = 11.45, p = 0.002]. Duncan post-hoc analysis revealed that groups did not differ at pre-assessment (experimental group: mean = 51.95, SE = 1.91; control group: mean = 48.05, SE = 1.91), but differed (p < 0.0001) at post-assessment (experimental group: mean = 56.66, SE = 1.34; control group: mean = 43.34, SE = 1.34) because the mean score of the experimental group significantly (p = 0.02) increased and the mean score of the control group significantly (p = 0.02) decreased (see Figure 1). The TIME × GROUP interaction was significant [F(1, 30) = 13.8, p = 0.001] also for “Attention/Working memory.” Duncan post-hoc analysis revealed that groups did not differ at pre-assessment (experimental group: mean = 50.62, SE = 1.49; control group: mean = 49.38, SE = 1.49), but differed (p = 0.0001) at post-assessment (experimental group: mean = 54.42, SE = 1.22; control group: mean = 45.58, SE = 1.22) because the mean score of the experimental group significantly (p = 0.016) increased and the mean score of the control group significantly (p = 0.016) decreased. The same was true for “Functional” in which the TIME × GROUP interaction was significant [F(1, 30) = 12.91, p = 0.001]. Duncan post-hoc revealed that groups did not differ at pre-assessment (experimental group: mean = 49.64, SE = 2.54; control group: mean = 50.36, SE = 2.53), but differed (p = 0.042) at post-assessment (experimental group: mean = 53.92, SE = 2.31; control group: mean = 46.08, SE = 2.33) because the mean score of the experimental group significantly (p = 0.021) increased and the mean score of the control group significantly (p = 0.021) decreased. The analysis on “Mental Health” was not significant.

Bottom Line: Our results show that the two groups did not differ at the pre-assessment, but differed at post-assessment.Specifically, the experimental group showed a significant improvement in five domains (Learning and memory, Abstraction/executive functioning, Verbal fluency, Attention/working memory, and Functional), whereas the control group significantly worsened in the same domains.The improvement of the experimental group did not change in the follow up-assessment in two domains (Abstraction/executive functioning, Attention/working memory, and Functional).

View Article: PubMed Central - PubMed

Affiliation: Division A of Infectious Diseases, Amedeo of Savoia Hospital Torino, Italy ; SpAtial, Motor and Bodily Awareness Research Group, Department of Psychology, University of Torino Torino, Italy.

ABSTRACT
The primary aim of the present study was to evaluate the efficacy and stability over time of a cognitive rehabilitation protocol (restorative and compensatory approach) in HIV/AIDS patients with HIV-associated Neurocognitive Disorder (HAND). At baseline, 32 HIV/AIDS patients (16 with and 16 without HAND) were assessed with a neuropsychological battery (i.e., pre-assessment) consisting of 22 tests covering eight cognitive domains. Then, the experimental group was administered over 4 months a cognitive rehabilitation protocol aimed at improving four cognitive domains by means of eight paper and pencil/computer-based exercises. The control group received guideline-adherent clinical care (i.e., standard of care). At the end of the cognitive treatment, both groups were re-administered the neuropsychological battery (i.e., post-assessment). Additionally, 6 months after post-assessment, the experimental group was given the same neuropsychological battery (i.e., follow up-assessment). In order to test the efficacy of the cognitive rehabilitation protocol, we compared between groups the results of the neuropsychological battery at the pre- and post-assessments. In order to evaluate the stability over time, the effects of the cognitive rehabilitation protocol was examined comparing within the experimental group the results of the neuropsychological battery at post- and follow up-assessments. Our results show that the two groups did not differ at the pre-assessment, but differed at post-assessment. Specifically, the experimental group showed a significant improvement in five domains (Learning and memory, Abstraction/executive functioning, Verbal fluency, Attention/working memory, and Functional), whereas the control group significantly worsened in the same domains. The improvement of the experimental group did not change in the follow up-assessment in two domains (Abstraction/executive functioning, Attention/working memory, and Functional). Overall, these findings support the efficacy and, to some extent, the stability over time of our cognitive rehabilitation protocol.

No MeSH data available.


Related in: MedlinePlus