After a stroke, many patients experience problems with their thinking and memory skills. As you can imagine, it makes common daily activities more difficult. It also increases the risk of other diseases later on. That’s why researchers set out to test what type of training could help patients regain these skills.
Cerebral small vessel disease (CSVD) refers to a group of processes that cause bleeding or blockages in the brain. CSVD can be due to high blood pressure or even normal aging. But, researchers believe that it accounts for up to 20% of strokes. It is also the leading cause of cognitive impairment, a measurable decline in thinking skills, attention, and memory. Patients with SVD and subsequent mild cognitive impairment (MCI) are at higher risk for transitioning to dementia.
Therapeutic approaches to reduce this risk are sparse, and no medications are currently approved to prevent or delay this transition. One area that does have researchers interested, however, is that of cognitive rehabilitation. One form of this is the Attention Process Training-II (APT-II) program. It consists of a group of specific tasks aimed at exercising various aspects of your attention. Researchers hope that using specific exercises will make the training more generalizable to skills required for activities of daily living.
Studying APT-II for attention rehabilitation
A research team from Italy were the first to conduct a clinical trial to assess the effectiveness of the APT-II program on attention rehabilitation in patients with CSVD and MCI. They aimed to observe the effect of the possible improvement on thinking and memory skills. They wanted to see how this affected daily activities and quality of life. In addition, they used resting-state functional MRI (rsfMRI) to evaluate the possible impact of the attention training on brain activity. Researchers recruited a total of 43 patients. There were 21 participants in the experimental APT-II group and 22 in the standard control group. Participants in the experimental group received a total of 40 hours of the APT-II program, split into 2 hours a week for 20 weeks. All patients returned for follow-up visits at six and twelve months.
Can APT-II improve attention, memory, and quality of life?
Researchers observed a moderate benefit on cognitive tests evaluating attention and working memory in the APT-II group. Furthermore, the APT-II program additionally produced an increase in brain activity throughout many circuits known to be involved with sophisticated thinking skills. Despite improved memory, attention, and brain activity, the study found no favorable effect of the APT-II program on functional status or quality of life compared to the participants in the control group. These findings may be due to the relatively short time and intensity of the treatment, age of the patients, or small sample size of participants. While promising, it is too early to say that this type of intensive attention training truly generates a positive impact on CSVD patients’ everyday lives.
The first author of the original article was Leonardo Pantoni, NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy.