Executive functioning in alcoholics following an mHealth cognitive stimulation program: randomized controlled trial

Pedro Gamito, Jorge Oliveira, Paulo Lopes, Rodrigo Brito, Diogo Morais, Diana Silva, Ana Silva, Sara Rebelo, Marta Bastos, Alberto Deus, Pedro Gamito, Jorge Oliveira, Paulo Lopes, Rodrigo Brito, Diogo Morais, Diana Silva, Ana Silva, Sara Rebelo, Marta Bastos, Alberto Deus

Abstract

Background: The consequences of alcohol dependence are severe and may range from physical disease to neuropsychological deficits in several cognitive domains. Alcohol abuse has also been related to brain dysfunction specifically in the prefrontal cortex. Conventional neuropsychological interventions (paper-and-pencil cognitive stimulation training) have a positive effect but are time-consuming, costly, and not motivating for patients.

Objective: Our goal was to test the cognitive effects of a novel approach to neuropsychological intervention, using mobile technology and serious games, on patients with alcohol dependence.

Methods: The trial design consisted of a two-arm study assessing the cognitive outcomes of neuropsychological intervention with mobile serious games (mHealth) versus control (treatment-as-usual with no neuropsychological intervention) in patients undergoing treatment for alcohol dependence syndrome. Sixty-eight patients were recruited from an alcohol-rehab clinic and randomly assigned to the mHealth (n=33) or control condition (n=35). The intervention on the experimental group consisted of a therapist-assisted cognitive stimulation therapy for 4 weeks on a 2-3 days/week basis.

Results: Fourteen patients dropped out of the study. The results of the neuropsychological assessments with the remaining 54 patients showed an overall increase (P<.05) of general cognitive abilities, mental flexibility, psychomotor processing speed, and attentional ability in both experimental (n=26) and control groups (n=28). However, there was a more pronounced improvement (P=.01) specifically in frontal lobe functions from baseline (mean 13.89, SE 0.58) to follow-up (mean 15.50, SE 0.46) in the experimental group but not in the control group.

Conclusions: The overall increase in general cognitive function for both experimental and control groups supports the beneficial role of existing alcohol treatment protocols aimed at minimizing withdrawal symptoms, but the differential improvements observed in frontal lobe functioning supports the use of mobile serious games for neuropsychological stimulation to overcome executive dysfunction in patients with alcohol dependence. This trial was negative on two neuropsychological/cognitive tests, and positive on one.

Trial registration: ClinicalTrials.gov NCT01942954; http://www.clinicaltrials.gov/ct2/show/NCT01942954.

Keywords: addiction; alcohol; cognitive stimulation; executive function; mobile health; serious games.

Conflict of interest statement

Conflicts of Interest: The authors have developed and own the majority of the applications, but these are freely available online and no commercial profit is intended from them.

Figures

Figure 1
Figure 1
Flow chart describing the flow of the participants in the treatment group throughout the protocol.
Figure 2
Figure 2
Slot machine (top-left) for attention; visual memory task (bottom-left and bottom-right with increased difficulty) for working memory; and word-object correspondence (top-right) for logical reasoning.
Figure 3
Figure 3
MMSE total scores for the experimental and control conditions at baseline and follow-up.
Figure 4
Figure 4
FAB total scores for the experimental and control conditions at baseline and follow-up.
Figure 5
Figure 5
WCST correct responses (left) perseverative errors (middle) and completed categories (right) for the experimental and control conditions at baseline and follow-up.
Figure 6
Figure 6
CTT1 execution time in seconds (left) and mean errors (right) for the experimental and control conditions at baseline and follow-up.
Figure 7
Figure 7
CTT2 execution time in seconds (left) and mean errors (right) for the experimental and control conditions at baseline and follow-up.

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Source: PubMed

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