Efficacy and Clinical Relevance of Cognition Enhancers Cognitive improvement after treatment with second-generation antipsychotic medications in first-episode schizophrenia: is it a practice effect? Modafinil combined with cognitive training is associated with improved learning in healthy volunteers – A randomised controlled trial Development of CBT for chemotherapy-related cognitive change: results of a waitlist control trial. Cognitive enhancement therapy for schizophrenia: effects of a 2-year randomized trial on cognition and behavior. Cognitive Functioning During Methadone and Buprenorphine Treatment: Results of a Randomized Clinical Trial Effect of medication review and cognitive behaviour treatment by community pharmacists of patients discharged from the hospital on drug related problems and compliance: design of a randomized controlled trial Early markers of cognitive enhancement: developing an implicit measure of cognitive performance Effect of Pharmacological Enhancement on the Cognitive and Clinical Psychomotor Performance of Sleep-Deprived Doctors: A Randomized Controlled Trial Cognitive impairment, retention and abstinence among cocaine abusers in cognitive-behavioral treatment. Objective and subjective cognitive enhancing effects of mixed amphetamine salts in healthy people Memory enhancement training for older adults with mild cognitive impairment: A preliminary study Cognitive rehabilitation for early post-surgery inpatients affected by primary brain tumor: a randomized, controlled trial Interaction between psychological and pharmacological treatment in cognitive impairment. Effects of Cognitive Enhancement Therapy on Employment Outcomes in Early Schizophrenia: Results From a 2-Year Randomized Trial Computer-assisted delivery of cognitive-behavioral therapy: efficacy and durability of CBT4CBT among cocaine-dependent individuals maintained on methadone. Cognitive-behavioral therapy plus contingency management for cocaine use: findings during treatment and across 12-month follow-up.
Summary : Changes from the end of 4-week placebo ( washout ) baselines to the end of 3-month therapy with three chemically different cognition enhancers ( CEs ) [ i.e. , piracetam , acetyl-L-carnitine , and nimodipine ( NIM ) ] , and parallel changes in placebo controls , were compared to determine the influence of the severity of disease at study entry . Four trials published elsewhere , showing significant treatment differences between active drugs and placebo , were selected according to their ( a ) sharing at least one global measure for treatment outcome and having shown effects on at least one additional scale or test , and ( b ) presenting an obvious rank order in the severity of disease . Each study was a st and ard-controlled clinical phase III trial with>100 psychogeriatric inor out patients . The patients ' symptoms met the criteria for mild to moderate/ severe age-related organic brain syndrome , a core syndrome of senile dementia , either from the primary degenerative , mixed , or multi-infa rct type . The extent of changes on placebo was clearly influenced by the mean pretreatment severity of disease . On the whole , the improvements on active drugs reached or exceeded the baseline variability of psychogeriatric scales and CONTEXT Cognitive impairment in schizophrenia is frequent , involves multiple domains , and is enduring . Numerous recent clinical trials have suggested that second-generation antipsychotic medications significantly enhance cognition in schizophrenia . However , none of these studies included healthy controls undergoing repeated testing to assess the possibility that improvements might reflect simple practice effects . OBJECTIVE To report the results on cognition of a r and omized comparison of 2 widely prescribed second-generation antipsychotic medications , olanzapine and risperidone , in patients with first-episode schizophrenia and a healthy control group . DESIGN R and omized clinical trial . SETTING Hospital-based research units . Patients A total of 104 participants with first-episode schizophrenia and 84 healthy controls . MAIN OUTCOME MEASURES Cognitive assessment of all study participants occurred at baseline , 6 weeks later , and 16 weeks later . Neurocognitive tests included measures of working memory and attention , speed , motor function , episodic memory , and executive function . RESULTS No differential drug effects were observed . Of 16 cognitive measures , 9 demonstrated improvement over time and only 2 demonstrated greater rates of change than those observed in the healthy control group undergoing repeated assessment . The composite effect size for cognitive change was 0.33 in the healthy control group ( attributed to practice ) and 0.36 in the patients with first-episode schizophrenia . Improvements in cognition in the first-episode schizophrenia group could not be accounted for by medication dose , demographic variables , or intellectual level . CONCLUSIONS The cognitive improvements observed in the trial were consistent in magnitude with practice effects observed in healthy controls , suggesting that some of the improvements in cognition in the first-episode schizophrenia group may have been due to practice effects ( ie , exposure , familiarity , and /or procedural learning ) . Our results also indicated that differential medication effects on cognition were small . We believe that these findings have important implication s for drug discovery and the design of registration trials that attempt to demonstrate cognitive enhancement Improving cognition in people with neuropsychiatric disorders remains a major clinical target . By themselves pharmacological and non-pharmacological approaches have shown only modest effects in improving cognition . In the present study we tested a recently-proposed methodology to combine CT with a ' cognitive-enhancing ' drug to improve cognitive test scores and exp and ed on previous approaches by delivering combination drug and CT , over a long intervention of repeated sessions , and used multiple tasks to reveal the cognitive processes being enhanced . We also aim ed to determine whether gains from this combination approach generalised to untrained tests . In this proof of principle r and omised-controlled trial thirty-three healthy volunteers were r and omised to receive either modafinil or placebo combined with daily cognitive training over two weeks . Volunteers were trained on tasks of new- language learning , working memory and verbal learning following 200 mg modafinil or placebo for ten days . Improvements in trained and untrained tasks were measured . Rate of new- language learning was significantly enhanced with modafinil , and effects were greatest over the first five sessions . Modafinil improved within-day learning rather than between-day retention . No enhancement of gains with modafinil was observed in working memory nor rate of verbal learning . Gains in all tasks were retained post drug-administration , but transfer effects to broad cognitive abilities were not seen . This study shows that combining CT with modafinil specifically elevates learning over early training sessions compared to CT with placebo and provides a proof of principle experimental paradigm for pharmacological enhancement of cognitive remediation OBJECTIVE To evaluate the efficacy of a brief cognitive-behavioral therapy ( CBT ) that is being developed for management of cognitive dysfunction following chemotherapy among breast cancer survivors .  Memory and Attention Adaptation Training ( MAAT ) is a brief CBT design ed to improve the quality of life and function among cancer survivors with post-chemotherapy cognitive complaints . METHODS An initial , two-group  ( MAAT versus waitlist , no treatment control ) , r and omized clinical trial ( RCT ) was conducted . Forty stage I and II female breast cancer survivors ( mean age = 50 ; SD = 6.4 ) were r and omized to conditions and assessed at baseline , post-treatment ( 8 weeks ) and 2-month follow-up assessment points on measures of : ( 1 ) self-reported daily cognitive failures ; ( 2 ) quality of life ; and ( 3 ) neuropsychological performance . Participants were also assessed for satisfaction with MAAT . RESULTS With education and IQ as covariates , MAAT participants made significant improvements relative to controls on the spiritual well-being subscale of the quality of life measure and on verbal memory , but statistical significance was not achieved on self-report of daily cognitive complaints . However , moderate-to-large effect sizes were observed on these outcomes . Participants gave MAAT high satisfaction ratings . CONCLUSIONS Although this initial RCT is a small study , MAAT participants appear to improve on one measure of quality of life and verbal memory performance relative to no treatment controls and rate MAAT with high satisfaction . These data are encouraging and support the continued development and evaluation of MAAT efficacy BACKGROUND Deficits in social cognition and neurocognition are believed to underlie schizophrenia disability . Attempts at rehabilitation have had circumscribed effects on cognition , without concurrent improvement in broad aspects of behavior and adjustment . OBJECTIVE To determine the differential effects of cognitive enhancement therapy ( a recovery-phase intervention ) on cognition and behavior compared with state-of-the-art enriched supportive therapy . DESIGN A 2-year , r and omized controlled trial with neuropsychological and behavioral assessment s completed at baseline and at 12 and 24 months . SETTING An outpatient research clinic housed in a medical center 's comprehensive care service for patients with severe mental illness . PATIENTS A total of 121 symptomatically stable , non-substance-abusing but cognitively disabled and chronically ill patients with schizophrenia or schizoaffective disorder . INTERVENTIONS Cognitive enhancement therapy is a multidimensional , developmental approach that integrates computer-assisted training in neurocognition with social cognitive group exercises . Enriched supportive therapy fosters illness management through applied coping strategies and education . MAIN OUTCOME MEASURES Six highly reliable summary measures --Processing Speed , Neurocognition , Cognitive Style , Social Cognition , Social Adjustment and Symptoms -- were tested using analysis of covariance and linear trend analysis . RESULTS At 12 months , robust  cognitive enhancement therapy effects were observed on the Neurocognition and Processing Speed composites ( P<.003 ) , with marginal effects observed on the behavioral composites . By 24 months , differential  cognitive enhancement therapy effects were again observed for the 2 neuropsychological composites and for Cognitive Style ( P=.001 ) , Social Cognition ( P=.001 ) , and Social Adjustment ( P=.01 ) . As expected , no differences were observed on the residual Symptoms composite . Effects were unrelated to the type of antipsychotic medication received . Enriched supportive therapy also demonstrated statistically significant within-group effect sizes , suggesting that supportive psychotherapy can also have positive , although more modest , effects on cognitive deficits . CONCLUSION Many cognitive deficits and related behaviors of patients with stable schizophrenia are improved when sufficient exposure to relevant rehabilitation is provided Cognitive impairment in drug-dependent patients receiving methadone ( MMP ) maintenance treatment has been reported previously . We assessed cognitive functioning after at least 14 days of stable substitution treatment with buprenorphine ( BUP ) or MMP and after 8 to 10 weeks . We performed a r and omized , nonblinded clinical trial in 59 drug-dependent patients receiving either BUP or MMP maintenance treatment and healthy normal controls ( n = 24 ) matched for sex , age , and educational level . Thirteen patients dropped out of the study before the second testing was performed  ( BUP , n = 22 ; MMP , n = 24 ) . A neuropsychological test battery was used to measure selective attention , verbal memory , motor/cognitive speed , and cognitive flexibility . In addition , subjective perceived stress was assessed with a question naire . Patients in both treatment groups performed equally well in all of the cognitive domains tested . Both BUP and MMP patients showed significantly improved concentration and executive functions after 8 to 10 weeks of stable substitution treatment . The control group achieved better results than the BUP and MMP groups in most cognitive domains , indicating cognitive impairment in the patients . Perceived stress did not show any significant change after 8 to 10 weeks of treatment , and no major differences were detected between the 3 groups . No effects of perceived stress on cognitive function were found . Our results indicate a cognitive impairment in patients receiving maintenance treatment with BUP  or  MMP  compared with healthy controls . Selective attention improved in both patient groups during treatment . We propose that the improvement of attention may facilitate rehabilitation of drug-dependent patients Background Drug related problems ( DRPs ) are common among elderly patients who are discharged from the hospital and are using several drugs for their chronic diseases . Examples of drug related problems are contra-indications , interactions , adverse drug reactions and inefficacy of treatment . Causes of these problems include prescription errors and non-compliance with treatment . The aim of this study is to examine the effect of medication review and cognitive behaviour therapy of discharged patients by community pharmacists to minimize the occurrence of drug related problems . Methods / Design A r and omized controlled trial will be performed . Community pharmacists will be r and omized into a control group and an intervention group . 342 Patients , aged over 60 years , discharged from general and academic hospitals , using five or more prescription drugs for their chronic disease will be asked by their pharmacy to participate in the study . Patients r and omized to the control group will receive usual care according to the Dutch Pharmacy St and ard . The medication of patients r and omised to the intervention group will be review ed by the community pharmacist with use of the national guidelines for the treatment of diseases , when patients are discharged from the hospital . The Pharmaceutical Care network Europe Registration form will be used to record drug related problems . Trained pharmacy technicians will counsel patients at home at baseline and at 1,3,6,9 and 12 months , using Cognitive Behaviour Treatment according to the Theory of Planned Behaviour . The patient 's attitude towards medication and patient 's adherence will be subject of the cognitive behaviour treatment . The counselling methods that will be used are motivational interviewing and problem solving treatment . Patients adherence towards drug use will be determined with use of the Medication Adherence Report Scale Question naire . There will be a follow-up of 12 months . The two primary outcome measures are the difference in occurrence of DRPs between intervention and control group and adherence with drug use . Secondary endpoints are attitude towards drug use , incidence of Re-hospitalisations related to medicines , functional status of the patient , quality of life and the cost-effectiveness of this intervention . Discussion Combining both medication review and Cognitive Behaviour Treatment may decrease DRPs and may result in more compliance with drug use among patients discharged from the hospital and using 5 or more chronic drugs . Trial registration Dutch Trial Register There is intense interest in the development of effective cognitive enhancing drugs which would have therapeutic application across a number of neurological and psychological disorders including dementia , schizophrenia and depression . However , development in this area has been limited by the absence of sensitive biomarkers which can be used to detect and refine therapeutic-like action in phase 1 clinical studies . The aim of the present study was therefore to develop a measure of cognition relevant to the action of c and i date cognitive enhancers which might be sensitive to pharmacological manipulation in healthy volunteers . Healthy volunteers ( n = 34 ) were r and omised to receive a single dose of modafinil ( 100 mg ) or placebo . Five hours post dose , attentional flexibility in learning was assessed using a novel implicit learning task . Volunteers also completed an auditory digit span task and visual analogue scales ( VAS ) . Modafinil increased alertness as measured by the VAS . In the implicit learning task , modafinil enhanced learning rates in terms of both accuracy and reaction time , suggesting an increase in implicit rule learning . These results suggest that the novel learning task should be explored as a biomarker of early cognitive improvement which could be more sensitive than conventional measures Objectives : To investigate the effect of modafinil 200 mg on the performance of a cohort of healthy male doctors after 1 night of supervised sleep deprivation . Summary Background Data : Sleep-deprived and fatigued doctors pose a safety risk to themselves and their patients . Yet , because of the around-the-clock nature of medical practice , doctors frequently care for patients after periods of extended wakefulness or during circadian troughs . Studies suggest that a group of substances may be capable of safely and effectively reversing the effects of fatigue . However , little work has been done to investigate their role within our profession . Methods : We conducted a parallel , double-blind , r and omized , and placebo-controlled study to investigate the effect of pharmacological enhancement on performance doctors . Thirty-nine healthy male resident doctors received either lactose placebo ( n = 19 ) or modafinil 200 mg ( n = 20 ) after 1 night of sleep deprivation . A selection of CANTAB neuropsychological tests was used to assess higher cognitive function . Clinical psychomotor performance was assessed using the Minimally Invasive Surgical Trainer Virtual Reality . Assessment s were carried out between 6.00 AM and approximately 8.00 AM . Results : Modafinil improved performance on tests of higher cognitive function ; participants in the modafinil group worked more efficiently when solving working memory ( F 1,38 = 5.24 , P = 0.028 ) and planning ( F 1,38 = 4.34 , P = 0.04 ) problems , were less-impulsive decision makers ( F 1,37 = 6.76 , P = 0.01 ) , and were more able to flexibly redirect their attention ( F 1,38 = 4.64 , P = 0.038 ) . In contrast , no improvement was seen in tests of clinical psychomotor performance . Conclusions : Our results suggest that fatigued doctors might benefit from pharmacological enhancement in situations that require efficient information processing , flexible thinking , and decision making under time pressure . However , no improvement is likely to be seen in the performance of basic procedural tasks Cognitive-behavioral therapy ( CBT ) depends on adequate cognitive functioning in patients , but prolonged cocaine use may impair cognitive functioning . Therefore , cognitive impairment may impede the ability of cocaine abusers to benefit from CBT . To begin to address this issue , we investigated the relationship between cognitive impairment and two treatment outcomes , therapy completion and abstention .  Eighteen carefully screened non-depressed cocaine-dependent patients in a psychopharmacological clinical trial were administered the MicroCog computerized battery to assess cognitive performance at treatment entry .  T-tests were used to compare cognitive functioning between completers ( patients remaining in treatment at least 12 weeks ) and dropouts . The results indicated that treatment completers had demonstrated significantly better cognitive performance at baseline than patients who dropped out of treatment . Cognitive domains that significantly distinguished between treatment completers and dropouts were attention , mental reasoning and spatial processing . This study provides preliminary evidence that cognitive impairments may decrease treatment retention and abstinence in CBT of cocaine dependence Psychostimulants such as mixed amphetamine salts ( MAS , br and name Adderall ) are widely used for cognitive enhancement by healthy young people , yet laboratory research on effectiveness has yielded variable results . The present study assessed the effects of MAS in healthy young adults with an adequately powered double-blind cross-over placebo-controlled trial . We examined effects in 13 measures of cognitive ability including episodic memory , working memory , inhibitory control , convergent creativity , intelligence and scholastic achievement  , with the goals of determining ( 1 ) whether the drug is at least moderately enhancing ( Cohen 's d > = .5 ) to some or all cognitive abilities tested , ( 2 ) whether its effects on cognition are moderated by baseline ability or COMT genotype , and ( 3 ) whether it induces an illusory perception of cognitive enhancement . The results did not reveal enhancement of any cognitive abilities by MAS for participants in general . There was a suggestion of moderation of enhancement by baseline ability and COMT genotype in a minority of tasks , with MAS enhancing lower ability participants on word recall , embedded figures and Raven 's Progressive Matrices . Despite the lack of enhancement observed for most measures and most participants , participants nevertheless believed their performance was more enhanced by the active capsule than by placebo . We conclude that MAS has no more than small effects on cognition in healthy young adults , although users may perceive the drug as enhancing their cognition . This article is part of a Special Issue entitled ' Cognitive Enhancers ' ' Mild cognitive impairment ' ( MCI ) in older adults refers to a significant decline in memory function but not other cognitive functions . Pharmacological and non-pharmacological treatments for MCI are needed . The present r and omized clinical trial tests the efficacy of a cognitive and behavioral treatment to improve memory performance and participants ' attitudes about their memory .  A multi-faceted intervention that included education about memory loss , relaxation training , memory skills training , and cognitive restructuring for memory-related beliefs was compared to a no-treatment control condition . Outcomes included memory performance and appraisal s of memory function and control . Results indicate that the treated group had significantly better memory appraisal s than controls at the end of treatment and at a six-month follow-up . There were no differences between groups on memory performance at post-test but at follow-up the trained individuals showed a trend toward better word list recall than controls . Findings suggest that individuals with MCI can benefit from multi-component memory enhancement training . Further development of such training programs and tests of their efficacy alone and in combination with medications are needed Cognitive impairment is one of the most common neurological disorders in neuro-oncological patients and exerts a deep negative impact on quality of life interfering with familiar , social and career-related activities . To test the effectiveness of early cognitive rehabilitation treatment for in patients affected by primary brain tumors . Out of 109 consecutive patients enrolled in the study , 58 patients were r and omly assigned to a rehabilitation group or to a control group . The rehabilitation consisted of 16 one-hour individual sessions of therapist-guided cognitive training , spread over 4 weeks , combining computer exercises and metacognitive training . Patients in the control group received usual care without cognitive training . All patients were evaluated by means of a comprehensive neuropsychological battery at the admission ( T0 ) and after 4 weeks ( T1 ) . Patients in the rehabilitation group showed a significant improvement of cognitive functions . In particular , the domains that benefited most from the training were visual attention and verbal memory . The control group exhibited only a slightly , not statistically relevant , enhancement of cognitive performances .  Cognitive rehabilitation for neuro-oncological in patients result ed in a significant enhancement of cognitive performances after the training , also providing a foundation for early administration . Future research should be aim ed to clarify the patients ’ characteristics that predict neuropsychological improvement , to identify the most effective elements in rehabilitative programs and to study the effects of treatment extension to everyday life In contrast to other kinds of psychotropic drugs , nootropics or cognition enhancing drugs may be indicated , not for the direct treatment of the pathology itself , but for improving or restoring the remaining brain functions . Brain functions are normally trained during various kinds of non-medical therapy , such as physiotherapy , speech therapy , occupational therapy , memory training etc ... In research little attention has been paid to the combination of both kinds of therapeutic approaches , probably because of the important method ological difficulties . This combination however , offers various interesting perspectives : L. ISRAEL examined in two placebo-controlled studies the effects of either 160 mg/d of ginkgo biloba extractum ( GBE ) or piracetam 2.4 or 4.8 g/d , combined with a memory training program , in nondemented patients complaining of memory problems . The results of both studies suggest that nootropic drug treatment and memory training have each an effect on different cognitive functions and , hence , are complementary . Some functions , like attention/perception in the GBE study and learning in the piracetam study , seem to benefit from both treatments , suggesting a mutually potentiating effect of drug treatment and training . This potentiation is very clear in the treatment of dyslexic children : in a placebo-controlled study piracetam 3.3 g/d , in combination with normal school teaching and more specific logopedic therapy , allowed a normal progression during the full school year in reading accuracy and reading comprehension , while the placebo treated children getting a similar training progressed only with 50 % . Recently promising results were obtained in the treatment of dysphasic patients with a combination of speech therapy and piracetam 4.8 g/d , especially when given during the first months after the stroke , or otherwise in combination with an intensive speech training . In both double-blind studies the piracetam treated group improved about 60 % more than the group who only got speech therapy and placebo . All these data may be explained by the restorative or enhancing influence of nootropic drugs on neurotransmitter systems closely related to learning and memory functions . E.g. piracetam restores the availability and function of muscarinic and NMDA receptors in aging animals , most probably through a modulation of the psychico-chemical properties of the neuronal membrane such as the membrane fluidity Objective : To examine the effects of psychosocial cognitive rehabilitation on employment outcomes in a r and omized controlled trial for individuals with early course schizophrenia . Method : Early course schizophrenia out patients ( N = 58 ) were r and omly assigned to cognitive enhancement therapy ( CET ) or an enriched supportive therapy ( EST ) control and treated for 2 years . Comprehensive data on cognition and employment were collected annually . Results : Individuals treated with CET were significantly more likely to be competitively employed , had greater earnings from employment , and were more satisfied with their employment status by the end of treatment compared to EST recipients . Mediator analyses revealed that improvements in both social and nonsocial cognition mediated CET effects on employment . Conclusion : CET can help facilitate employment in early schizophrenia by addressing the cognitive impairments that limit functioning in the disorder . Inclusion of cognitive rehabilitation in social work practice can support more optimal functional recovery from schizophrenia OBJECTIVE A previous pilot trial evaluating computer-based training for cognitive-behavioral therapy ( CBT4CBT ) in 77 heterogeneous substance users ( alcohol , marijuana , cocaine , and opioids ) demonstrated preliminary support for its efficacy in the context of a community-based outpatient clinic . The authors conducted a more definitive trial in a larger , more homogeneous sample . METHOD In this r and omized clinical trial , 101 cocaine-dependent individuals maintained on methadone were r and omly assigned to st and ard methadone maintenance or methadone maintenance with weekly access to CBT4CBT , with seven modules delivered within an 8-week trial . RESULTS Treatment retention and data availability were high and comparable across the treatment conditions . Participants assigned to the CBT4CBT condition were significantly more likely to attain 3 or more consecutive weeks of abstinence from cocaine ( 36 % compared with 17 % ; p<0.05 , odds ratio=0.36 ) . The group assigned to CBT4CBT also had better outcomes on most dimensions , including urine specimens negative for all drugs , but these reached statistical significance only for individuals completing the 8-week trial ( N=69 ) . Follow-up data collected 6 months after treatment termination were available for 93 % of the r and omized sample ; these data indicate continued improvement for those assigned to the CBT4CBT group , replicating previous findings regarding its durability . CONCLUSIONS This trial replicates earlier findings indicating that CBT4CBT is an effective adjunct to addiction treatment with durable effects .  CBT4CBT is an easily disseminable strategy for broadening the availability of CBT , even in challenging population s such as cocaine-dependent individuals enrolled in methadone maintenance programs Contingency management ( CM ) rapidly reduces cocaine use , but its effects subside after treatment . Cognitive-behavioral therapy ( CBT ) produces reductions months after treatment . Combined , the 2 might be complementary . One hundred ninety-three cocaine-using methadone-maintained out patients were r and omly assigned to 12 weeks of group therapy ( CBT or a control condition ) and voucher availability ( CM contingent on cocaine-negative urine or noncontingent ) . Follow-ups occurred 3 , 6 , and 12 months posttreatment . Primary outcome was cocaine-negative urine ( urinalysis 3 times/week during treatment and once at each follow-up ) . During treatment , initial effects of CM were dampened by CBT . Posttreatment , there were signs of additive benefits , significant in 3- versus 12-month contrasts . Former CBT participants were also more likely to acknowledge cocaine use and its effects and to report employment
In conclusion , a number of new active drugs were found to improve some cognitive functions , in particular verbal episodic memory .
Pharmacological cognitive enhancement refers to improvement in cognitive functions after drug use in healthy individuals .
This popular topic attracts attention both from the general public and the scientific community .
The objective was to explore innovative mechanisms of psychostimulant 's action , whose potential effectiveness was assessed in r and omized placebo-controlled trials ( RCTs ) .