Cognitive Interventions with Children with Special Needs - Transfer effects and multidisciplinary perspectives

Our last study with regularly developed children demonstrated a positive effect of working memory training on cognitive abilities. Building upon these findings, the aim of this multidisciplinary study is to investigate the effects of training of core functions with children who are suffering from different learning disabilities, like AD/HD, developmental dyslexia or specific language impairment. In addition to working memory training (BrainTwister), we apply a perceptual training, which concentrates on auditory-visual matching (Audilex), as well as an implicit concept learning task. We expect differential improvements of mental capacities, specifically of executive functions (working memory, attention, auditory and visual processing), scholastic abilities (language and mathematical skills), as well as of problem solving. With that, we hope to find further directions regarding helpful and individually adapted interventions in educational settings. Interested parties are invited to discuss and comment the design, the research question, and the possibilities in recruiting the subjects.

Chronometric features of processing unpleasant stimuli: a functional MRI-based transcranial magnetic stimulation study.

The quick identification of potentially threatening events is a crucial cognitive capacity to survive in a changing environment. Previous functional MRI data revealed the right dorsolateral prefrontal cortex and the region of the left intraparietal sulcus (IPS) to be involved in the perception of emotionally negative stimuli. For assessing chronometric aspects of emotion processing, we applied transcranial magnetic stimulation above these areas at different times after negative and neutral picture presentation. An interference with emotion processing was found with transcranial magnetic stimulation above the dorsolateral prefrontal cortex 200-300 ms and above the left intraparietal sulcus 240/260 ms after negative stimuli. The data suggest a parallel and conjoint involvement of prefrontal and parietal areas for the identification of emotionally negative stimuli.

Cognitive and emotional effects of carotid stenosis

PRINCIPLES Patients with carotid artery stenosis (CAS) are at risk of ipsilateral stroke and chronic compromise of cerebral blood flow. It is under debate whether the hypo-perfusion or embolism in CAS is directly related to cognitive impairment. Alternatively, CAS may be a marker for underlying risk factors, which themselves influence cognition. We aimed to determine cognitive performance level and the emotional state of patients with CAS. We hypothesised that patients with high grade stenosis, bilateral stenosis, symptomatic patients and/or those with relevant risk factors would suffer impairment of their cognitive performance and emotional state. METHODS A total of 68 patients with CAS of ≥70% were included in a prospective exploratory study design. All patients underwent structured assessment of executive functions, language, verbal and visual memory, motor speed, anxiety and depression. RESULTS Significantly more patients with CAS showed cognitive impairments (executive functions, word production, verbal and visual memory, motor speed) and anxiety than expected in a normative sample. Bilateral and symptomatic stenosis was associated with slower processing speed. Cognitive performance and anxiety level were not influenced by the side and the degree of stenosis or the presence of collaterals. Factors associated with less cognitive impairment included higher education level, female gender, ambidexterity and treated hypercholesterolemia. CONCLUSIONS Cognitive impairment and increased level of anxiety are frequent in patients with carotid stenosis. The lack of a correlation between cognitive functioning and degree of stenosis or the presence of collaterals, challenges the view that CAS per se leads to cognitive impairment.

The quiet eye without a target: The primacy of visual information processing

Motor-performance-enhancing effects of long final fixations before movement initiation – a phenomenon called Quiet Eye (QE) – have repeatedly been demonstrated. Drawing on the information-processing framework, it is assumed that the QE supports information processing revealed by the close link between QE duration and task demands concerning, in particular, response selection and movement parameterisation. However, the question remains whether the suggested mechanism also holds for processes referring to stimulus identification. Thus, in a series of two experiments, performance in a targeting task was tested as a function of experimentally manipulated visual processing demands as well as experimentally manipulated QE durations. The results support the suggested link because a performance-enhancing QE effect was found under increased visual processing demands only: Whereas QE duration did not affect performance as long as positional information was preserved (Experiment 1), in the full vs. no target visibility comparison, QE efficiency turned out to depend on information processing time as soon as the interval falls below a certain threshold (Experiment 2). Thus, the results rather contradict alternative, e.g., posture-based explanations of QE effects and support the assumption that the crucial mechanism behind the QE phenomenon is rooted in the cognitive domain.

Effectiveness of integrated cognitive remediartion therapy for schizophrenia outpatients: Early versus long-term course of illness – results from an international RCT

Background Nowadays there is extensive evidence available showing the efficacy of cognitive remediation therapies. Integrative approaches seem superior regarding the maintenance of proximal outcome at follow-up as well as generalization to other areas of functioning. To date, only limited evidence about the efficacy of CRT is available concerning elder schizophrenia patients. The Integrated Neurocognitive Therapy (INT) represents a new developed cognitive remediation approach. It is a manualized group therapy approach targeting all 11 NIMH-MATRICS dimensions within one therapy concept. In this study we compared the effects of INT on an early course group (duration of disease<5 years) to a long-term group of schizophrenia outpatients (duration of disease>15 years). Methods An international multicenter study carried out in Germany, Switzerland and Austria with a total of 90 outpatients diagnosed with Schizophrenia (DSM-IV-TR) were randomly assigned either to an INT-Therapy or to Treatment-As-Usual (TAU). 50 of the 90 Patients were an Early-Course (EC) group, suffering from schizophrenia for less than 5 years (Mean age=29 years, Mean duration of illness=3.3 years). The other 40 were a Long-term Course (LC) group, suffering from schizophrenia longer than 15 years (Mean age= 45 years, Mean duration of illness=22 years). Treatment comprised of 15 biweekly sessions. An extensive assessment battery was conducted before and after treatment and at follow up (1 year). Multivariate General Linear Models (GLM) (duration of illness x treatment x time) examined our hypothesis, if an EC group of schizophrenia outpatients differ in proximal and distal outcome from a LC group. Results Irrespective of the duration of illness, both groups (EC & LC) were able to benefit from the INT. INT was superior compared to TAU in most of the assessed domains. Dropout rate of EC group was much higher (21.4%) than LC group (8%) during therapy phase. However, interaction effects show that the LC group revealed significantly higher effects in the neurocognitive domains of speed of processing (F>3.6) and vigilance (F>2.4). In social cognition the EC group showed significantly higher effects in social schema (F>2.5) and social attribution (blame; F>6.0) compared to the LC group. Regarding more distal outcome, patients treated with INT obtained reduced general symptoms unaffected by the duration of illness during therapy phase and at follow-up (F>4.3). Discussion Results suggest that INT is a valid goal-oriented treatment to improve cognitive functions in schizophrenia outpatients. Irrespective of the duration of illness significant treatment, effects were evident. Against common expectations, long-term, more chronic patients showed higher effects in basal cognitive functions compared to younger patients and patients without any active therapy (TAU). Consequently, more integrated therapy offers are also recommended for long-term course schizophrenia patients.

Factors affecting cognitive outcome in early pediatric stroke

OBJECTIVE We examined cognitive performance in children after stroke to study the influence of age at stroke, seizures, lesion characteristics, neurologic impairment (NI), and functional outcome on cognitive outcome. METHODS This was a prospectively designed study conducted in 99 children who sustained an arterial ischemic stroke (AIS) between the age of 1 month and 16 years. All children underwent cognitive and neurologic follow-up examination sessions 2 years after the insult. Cognitive development was assessed with age-appropriate instruments. RESULTS Although mean cognitive performance was in the lower normative range, we found poorer results in subtests measuring visuoconstructive skills, short-term memory, and processing speed. Risk factors for negative cognitive outcome were young age at stroke, seizures, combined lesion location (cortical and subcortical), as well as marked NI. CONCLUSIONS We recommend that all children with a history of AIS undergo regularly scheduled neuropsychological assessment to ensure implementation of appropriate interventions and environmental adjustments as early as possible.

Functional lateralization of the anterior insula during feedback processing

Effective adaptive behavior rests on an appropriate understanding of how much responsibility we have over outcomes in the environment. This attribution of agency to ourselves or to an external event influences our behavioral and affective response to the outcomes. Despite its special importance to understanding human motivation and affect, the neural mechanisms involved in self-attributed rewards and punishments remain unclear. Previous evidence implicates the anterior insula (AI) in evaluating the consequences of our own actions. However, it is unclear if the AI has a general role in feedback evaluation (positive and negative) or plays a specific role during error processing. Using functional magnetic resonance imaging and a motion prediction task, we investigate neural responses to self- and externally attributed monetary gains and losses. We found that attribution effects vary according to the valence of feedback: significant valence × attribution interactions in the right AI, the anterior cingulate cortex (ACC), the midbrain, and the right ventral putamen. Self-attributed losses were associated with increased activity in the midbrain, the ACC and the right AI, and negative BOLD response in the ventral putamen. However, higher BOLD activity to self-attributed feedback (losses and gains) was observed in the left AI, the thalamus, and the cerebellar vermis. These results suggest a functional lateralization of the AI. The right AI, together with the midbrain and the ACC, is mainly involved in processing the salience of the outcome, whereas the left is part of a cerebello-thalamic-cortical pathway involved in cognitive control processes important for subsequent behavioral adaptations.

Implicit threat, self-regulatory resources, and cognitive performance

The color red has been considered to indicate threat in achievement contexts. Recent studies have used brief confrontations with red — either as the color or as the word red — to prime for implicit threat, and have found a related impairment of cognitive performance. In another line of research, it has been shown that initial self-regulatory efforts cause diminished investment of self-regulatory resources afterwards, leading to a relative shift from a controlled to an automatic mode of information processing. We assume that activation of implicit threat via the color or the word red impairs cognitive performance more strongly during automatic compared to controlled processing of information. To test this hypothesis, we manipulated undergraduates’ (n = 78) momentary processing mode (automatic vs. controlled) by an initial task that required either high or low self-regulatory effort. Afterwards, participants were briefly confronted with red or gray stimuli and were then asked to complete a standardized intelligence measure. As expected, confrontation with red, as opposed to gray, impaired intellectual performance when participants were in an automatic processing mode. In contrast, no color effect emerged when participants were in a relatively controlled processing mode. In a second study, we replicated this finding in a sample of secondary school students (n = 130), using the black-printed word red or gray to experimentally manipulate implicit threat. Among others, the present findings may help to explain occasional difficulties in replicating findings of priming research.

Cognitive dysfunction in children with brain tumors at diagnosis

Background: Survivors of brain tumors have a high risk for a wide range of cognitive problems. These dysfunctions are caused by the lesion itself and its surgical removal, as well as subsequent treatments (chemo- and/or radiation therapy). Multiple recent studies have indicated that children with brain tumors (BT) might already exhibit cognitive problems at diagnosis, i.e., before the start of any medical treatment. The aim of the present study was to investigate the baseline neuropsychological profile in children with BT compared to children with an oncological diagnosis not involving the central nervous system (CNS). Methods: Twenty children with BT and 27 children with an oncological disease without involvement of the CNS (age range: 6.1 to 16.9 years) were evaluated with an extensive battery of neuropsychological tests tailored to the patient’s age. Furthermore, the child and his/her parent(s) completed self-report questionnaires about emotional functioning and quality of life. In both groups, tests were administered before any therapeutic intervention such as surgery, chemotherapy or irradiation. Groups were comparable with regard to age, gender and socioeconomic status. Results: Compared to the control group, patients with BTs performed significantly worse in tests of working memory, verbal memory and attention (effect sizes between 0.28 and 0.47). In contrast, the areas of perceptual reasoning, processing speed and verbal comprehension were preserved at the time of measurement. Conclusion: Our results highlight the need for cognitive interventions early in the treatment process in order to minimize or prevent academic difficulties as patients return to school.

Granular computing as a tool of human data interaction - a cognitive cities use case

The article proposes granular computing as a theoretical, formal and methodological basis for the newly emerging research field of human–data interaction (HDI). We argue that the ability to represent and reason with information granules is a prerequisite for data legibility. As such, it allows for extending the research agenda of HDI to encompass the topic of collective intelligence amplification, which is seen as an opportunity of today’s increasingly pervasive computing environments. As an example of collective intelligence amplification in HDI, we introduce a collaborative urban planning use case in a cognitive city environment and show how an iterative process of user input and human-oriented automated data processing can support collective decision making. As a basis for automated human-oriented data processing, we use the spatial granular calculus of granular geometry.

Facilitating Emotional Processing: An Experimental Induction of Psychotherapeutically Relevant Affective States

Psychotherapy research has shown that cognitive-affective meaning making is related to beneficial therapy outcomes. This study explores the underlying micro-processes by inducing specific cognitive-affective states and studying their immediate effects on emotional activation, the resolution of interpersonal grievances, and factors related to therapeutic progress, e.g., mastery experiences, clarification of meaning. Participants suffering from interpersonal grievances were randomly assigned to two conditions. A sentence completion task was employed to induce either the expression of emotional distress or cognitive-affective meaning making. Expressive writing was used to deepen processing. Findings of those participants adhering to the induction procedure (n = 85) showed no differences between conditions at baseline. During writing, participants in both conditions were equally emotionally activated. Directly after the writing task, participants in the meaning making condition (n = 50) reported less unresolved interpersonal grievances, and more mastery experiences, but, e.g., not more clarification, compared to those in the emotional expression condition (n = 35). Results suggest that engagement in specific states that promote meaning making of emotional experience facilitates emotional processing and is related to therapeutic benefit.

The impact of absolute importance and processing overlaps on prospective memory performance

Prospective memory is the ability to remember an intention at an appropriate moment in the future. Prospective memory tasks can be more or less important. Previously, importance was manipulated by emphasizing the importance of the prospective memory task relative to the ongoing task it was embedded in. This resulted in better prospective memory performance but also ongoing task costs. In the present study, we simply instructed one group of participants that the prospective memory task was important (i.e., absolute importance instruction) and compared them to a group with relative importance instructions and a control group. The results showed that absolute importance lead to an increase in prospective memory performance without enhancing ongoing task costs, whereas relative importance resulted in both increased prospective memory performance and ongoing task costs. Thus, prospective memory can be enhanced without ongoing task costs, which is particularly crucial for safety-work contexts.

Differential effectiveness of integrated cognitive remediation therapy for schizophrenbia outpatients: The impact oft he duration of illness

Background Nowadays there is extensive evidence available showing the efficacy of cognitive remediation (CR). To date, only limited evidence is available about the impact of the duration of illness on CR effects. The Integrated Neurocognitive Therapy (INT) represents a new developed CR approach. It is a manualized group therapy targeting all 11 NIMH-MATRICS domains. Methods In an international multicenter study, 166 schizophrenia outpatients (DSM-IV-TR) were randomly assigned either to INT or to Treatment-As-Usual (TAU). 60 patients were defined as Early Course group (EC) characterized by less than 5 years of illness, 40 patients were in the Long-Term group (LT) characterized by more than 15 years of illness, and 76 patients were in the Medium-Long-Term group (MLT) characterized by an illness of 5-15 years. Treatment comprised of 15 biweekly sessions. Assessments were conducted before and after treatment and at follow up (1 year). Multivariate General Linear Models (GLM) examined our hypothesis, whether EC, LT, and MLT groups differ under INT and TAU from each other in outcome. Results First of all, the attendance rate of 65% was significantly lower and the drop out rate of 18.5% during therapy was higher in the EC group compared to the other groups. Interaction effects regarding proximal outcome showed that the duration of illness has a strong impact on neurocognitive functioning in speed of processing (F>2.4) and attention (F>2.8). But INT intervention compared to TAU only had a significant effect in more chronically ill patients of MLT and LT, but not in younger patients in EC. In social cognitive domains, only the EC group showed a significant change in attribution (hostility; F>2.5), LT and MLT groups did not. However, no differences between the 3 groups were evident in memory, problem solving, and emotion perception. Regarding more distal outcome, LT patients had more symptoms compared to EC (F>4.4). Finally, EC patients showed higher improvements in psychosocial functioning compared to LT and MLT (F=1.8). Conclusions Against common expectations, long-term, more chronically ill patients showed higher effects in basal cognitive functions compared to younger patients and patients without any active therapy (TAU). On the other hand, early-course patients had a greater potential to change in attribution, symptoms and psychosocial functioning. Consequently, more integrated therapy offers are also recommended for long-term course schizophrenia patients.

What do brain network interactions tell about cognitive processes? How to seek causality?

Optimal adjustment of brain networks allows the biased processing of information in response to the demand of environments and is therefore prerequisite for adaptive behaviour. It is widely shown that a biased state of networks is associated with a particular cognitive process. However, those associations were identified by backward categorization of trials and cannot provide a causal association with cognitive processes. This problem still remains a big obstacle to advance the state of our field in particular human cognitive neuroscience. In my talk, I will present two approaches to address the causal relationships between brain network interactions and behaviour. Firstly, we combined connectivity analysis of fMRI data and a machine leaning method to predict inter-individual differences of behaviour and responsiveness to environmental demands. The connectivity-based classification approach outperforms local activation-based classification analysis, suggesting that interactions in brain networks carry information of instantaneous cognitive processes. Secondly, we have recently established a brand new method combining transcranial alternating current stimulation (tACS), transcranial magnetic stimulation (TMS), and EEG. We use the method to measure signal transmission between brain areas while introducing extrinsic oscillatory brain activity and to study causal association between oscillatory activity and behaviour. We show that phase-matched oscillatory activity creates the phase-dependent modulation of signal transmission between brain areas, while phase-shifted oscillatory activity blunts the phase-dependent modulation. The results suggest that phase coherence between brain areas plays a cardinal role in signal transmission in the brain networks. In sum, I argue that causal approaches will provide more concreate backbones to cognitive neuroscience.