CogniFit - Personalized Cognitive Training in Unipolar and Bipolar Disorder: A Study of Cognitive Functioning

Original Name: Personalized Cognitive Training in Unipolar and Bipolar Disorder: A Study of Cognitive Functioning.

Authors: Marek Preiss1,2, Evelyn Shatil3,4, Radka Čermáková2, Dominika Cimermanová5 e Ilana Ram4.

• 1. Department of Psychology, University of New York in Prague, Prague, Czech Republic.
• 2. Department of Psychology, Prague Psychiatric Center, Prague, Czech Republic.
• 3. Department of Psychology, Centre for Psychobiological Research, Max Stern Acadmic College of Emek Yezreel, Emek Yezreel, Israel
• 4. CogniFit Ltd, Yokneam Ilit, Israel.
• 5. Filozofická Fakulta Univerzity Karlovy v Praze, Prague, Czech Republic.

Journal: Frontiers in Human Neuroscience (2013), vol. 7: 1-10.

References to this article (APA style):

• Preiss, M., Shatil, E., Čermáková, R., Cimermanová, D. and Ram, I. (2013). Personalized Cognitive Training in Unipolar and Bipolar Disorder: A Study of Cognitive Functioning. Frontiers in Human Neuroscience, 7, pp.1-10.

Study Conclusion

CogniFit personalized cognitive training has been successful in reducing depression and improving cognitive function in people with depression and bipolar disorder through an 8-week intervention, 3 non-consecutive days a week, with 20 minutes of training each day. Depression Index: BDI of 14.27±12.43 to 8.33±9.44 (t=2.806, Sig.=.014), CFQ of 60.87±15.26 to 53.33±13.58 (t=3.697, Sig.=.002), DEX of 39.53±11.21 to 34.20±9.94 (t=2.411, Sig.=.03), EMQ of 66.00±27.74 to 50.20±20.10 (t=2.639, Sig.=.019). Cognitive Skills: Executive Functions of -.46±1.06 to .17±.43 (t=-3.43, Sig.=.004).

Study summary

Both people suffering from depression, as well as people with bipolar disorder in the depressive phase, usually show psychological distress and cognitive deficits, especially affecting executive functions. These symptoms have a negative impact on patients' quality of life. Through customized cognitive training they aim to reduce the extent of psychological alterations, improve performance in daily activities and improve the state of cognitive functions.

The participants were divided into two groups: those who underwent personalized cognitive training with CogniFit for 8 weeks, 3 days a week, for 20 minutes each day (experimental group) and those who simply received ordinary treatment (control group). Participants were given a series of questionnaires and neurocognitive tests before (pre) and after training (post).

After comparing the difference in the results between pre-evaluation and the "post" evaluation in both groups ("inter-group comparison"), it was observed that the level of depression in the experimental group had decreased significantly. In addition, this same group also improved some of their cognitive capacities, such as shifting, divided attention or cognitive control. Based on data from each group ("intra-group comparison"), it was seen that experimental group participants complained of fewer cognitive failures, fewer problems related to executive functions and fewer errors in day-to-day tasks. In contrast, the control group participants only improved their cognitive complaints in working memory.

Context

People with depressive disorders tend to present difficulties mainly in three cognitive areas: attention, memoria and executive functions People with depression (unipolar depressive disorder or unipolar depression) or bipolar disorder usually have these deficits. These deficits are beginning to be considered nuclear symptoms of depression and both symptoms and cognitive impairment can have a very negative impact on the daily lives of people with these mood disorders.

More and more studies are advocating the use of neurocognitive training in patients with various disorders, such as depression or schizophrenia. The therapies proposed by these studies are an extension of Cognitive-Behavioral Therapy or depression therapies that include executive functions and attention training. The ability to generalize these improvements to new tasks is not yet clear, but studies indicate that improvements in cognitive status may be useful in new tasks. For this cognitive training, CogniFit cognitive assessment and training tool was used, since it has a series of characteristics that make it ideal for this type of studies and treatments:

• Employs a prior cognitive evaluation to direct the training automatically fitted to the individual's initial needs.
• Adapts the difficulty level constantly during cognitive training by an interactive system.
• Provides visual and written feedback after each training session, so you can track their progress.
• It is scientifically accurate for its effectiveness, specificity, reliability and validity.

Methodology

Recruitment and design

To conduct the study, outpatients who had been attending the Psychiatric Center of the Prague Clinic for a long time were chosen. They all complied with criteria for ICD-10 of unipolar depressive disorder (depression) or bipolar depressive disorder, they spoke Czech, were able to use their personal computer and showed interest in the study. People with any neurological disorder or alcohol or drug dependence were excluded from the study.

A group (experimental or control) was assigned to each participant by balancing the proportion of patients according to their diagnosis (depression or bipolar disorder) and following a gender and age equivalence. The control group received the usual treatment, while the experimental group was given cognitive training in addition to the usual treatment.

First, each participant's functioning in daily life and neurocognitive status was assessed before starting treatment. After 8 weeks of intervention, these variables were re-evaluated. The study was conducted at the Prague Psychiatric Center and the protocol was approved by the ethics committee.

Conventional intervention

The conventional intervention was applied in both the experimental and control groups. Therefore, this was the only treatment received by the control group. Therapy consisted of regular visits to the psychiatrist, prescription medication, individual or group therapy and access to social workers.

Main outcomes measured

To reliably measure CogniFit cognitive training outcomes, different questionnaires on emotional and cognitive status were administered.

• Cognitive Failures Questionnaire (CFQ).
• Dysexecutive Questionnaire (DEX).
• Everyday memory Questionnaire (EMQ).
• Schwartz Outcomes Scale-10 (SOS).
• Subjective quality of life questionnaire.
• Beck Depression Inventory-II (BDI-II).

Other measurements

Six different executive control measures were taken into account from the CogniFit evaluations: Working memory, cognitive flexibility, inhibition, visual motor monitoring, divided attention and auditory memory.

Statistical analysis

Through SPSS 17, general linear models for repeated measures were developed to evaluate the differences between groups in the eight variables of self-report and the seven variables of executive control. Separate models were used for each variable. The independent variables were the groups (experimental and control) and the time of the evaluation (pre or post). On the other hand, the dependent variables were the self-report or executive control variables. T-tests of paired samples, Pearson correlation coefficient, hierarchical regression analysis and t-tests for independent samples were applied to evaluate all changes.

Results and Conclusions

The study results indicated that participants who had undergone cognitive training (experimental group) showed a significant reduction of subjective depression symptoms and dysexecutive symptoms (to the point where patients' loved ones also noticed the change). We have to take into account that these patients were highly motivated and without a deep depression, which can help obtain these results.

In summary, we can say that CogniFit cognitive training can improve depression symptoms and dysexecutive symptoms in people with depression or bipolar disorder. This has important implications for treating these and other mood disorders. CogniFit cognitive training as a complementary therapy could help reduce various symptoms of these disorders, which could help improve quality of life.