An Evidence-Based Review of Cognitive Rehabilitation in Medical Conditions Affecting Cognitive Function

Archives of Physical Medicine and Rehabilitation

Langenbahn, D. M., Ashman, T., et al. (2013).

Archives of Physical Medicine and Rehabilitation, 94(2), 271-286.

This systematic review examines the effects of cognitive rehabilitation on cognitive processes in individuals diagnosed with medical conditions that are known to affect cognitive function (e.g., Parkinson's disease, neoplasms, anoxia, Huntington's disease).

American Congress of Rehabilitation Medicine

Through December 2008

Peer-reviewed, English-language studies (excluding review articles or case reports without empirical data)

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<div>Cognitive interventions improved memory and executive functioning in individuals with Parkinson's disease (PD) across 4 studies (Class II-Class IV Evidence). However, given the the limited number of studies, "there is insufficient evidence to make recommendations for [cognitive rehabilitation] for individuals with PD" (p. 282).</div>

<div>One Class IV study shows that a multidisciplinary, inpatient training program involving cognitive rehabilitation (e.g., external memory aids, metacognitive treatment) led to maintained cognitive functioning in individuals with Huntington's disease. Treatment was delivered for three weeks, three times a year over the course of three years. Cognitive skills were maintained throughout this entire treatment duration.&nbsp;</div>

<div>Evidence was found addressing cognitive rehabilitation in a range of acquired brain injury diagnosis categories, with results summarized below:</div> <ul> <li><strong>Brain Neoplasms:</strong> Two Class II studies suggested "process-based [cognitive rehabilitation] interventions (eg, APT, strategy acquisition and internalization, self-monitoring, and corrective feedback) as probably effective in treating attention and memory deficits in children and adolescents who undergo resection, radiation or both" (p. 274). Evidence was mixed for adults with brain neoplasm.&nbsp;</li> <li><strong>Anoxia or Hypoxia:</strong>&nbsp;Two Class IV studies found benefit in a combination of medical treatment (physostigmine), operant conditioning, and memory and orientation training. A randomized controlled trial (RCT) found no additional benefits, compared to standard care, for cognitive rehabilitation for individuals with hypoxemia related to [chronic obstructive pulmonary disease (COPD)]. Evidence was insufficient to recommend for or against cognitive rehabilitation for individuals with anoxia or hypoxia.</li> <li><strong>Encephalitis:</strong> Eight Class IV studies suggested, overall, that external aids or other memory strategies may be helpful for adults with encephalitis. Insufficient evidence precludes any treatment recommendations.&nbsp;</li> <li><strong>Toxic Encephalopathy:</strong> One Class II randomized controlled trial (RCT) suggested a treatment program involving memory aids and internal memory strategies was more beneficial than control on memory scores and memory complaints for adults with toxic encephalopathy. However, more health related complaints were reported, "perhaps because of increased awareness" (p. 283) of impairments, and evidence was limited on maintenance of effects.</li> </ul>

<div>In one randomized controlled trial (RCT), rated Class II, individuals with toxic encephalopathy who received a treatment program involving memory aids and internal memory strategies reported high satisfaction with treatment overall.</div>