Upper Alpha Based Neurofeedback Training in Chronic Stroke: Brain Plasticity Processes and Cognitive Effects

Whatever the fuck upper alpha is?
http://link.springer.com/article/10.1007/s10484-017-9353-5

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• Silvia Erika KoberEmail author
• Daniela Schweiger
• Johanna Louise Reichert
• Christa Neuper
• Guilherme Wood

• Silvia Erika Kober
  • 1
  • 2
  Email author
• Daniela Schweiger
  • 1
• Johanna Louise Reichert
  • 1
• Christa Neuper
  • 1
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• Guilherme Wood
  • 1
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1. 1.Department of PsychologyUniversity of GrazGrazAustria
2. 2.BioTechMed-GrazGrazAustria
3. 3.Institute of Neural Engineering, Laboratory of Brain-Computer InterfacesGraz University of TechnologyGrazAustria

Open AccessArticle

First Online:

14 February 2017

DOI: 10.1007/s10484-017-9353-5

Cite this article as:

Kober, S.E., Schweiger, D., Reichert, J.L. et al. Appl Psychophysiol Biofeedback (2017). doi:10.1007/s10484-017-9353-5

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Abstract

In the present study, we investigated the effects of upper alpha based neurofeedback (NF) training on electrical brain activity and cognitive functions in stroke survivors. Therefore, two single chronic stroke patients with memory deficits (subject A with a bilateral subarachnoid hemorrhage; subject B with an ischemic stroke in the left arteria cerebri media) and a healthy elderly control group (N  = 24) received up to ten NF training sessions. To evaluate NF training effects, all participants performed multichannel electroencephalogram (EEG) resting measurements and a neuropsychological test battery assessing different cognitive functions before and after NF training. Stroke patients showed improvements in memory functions after successful NF training compared to the pre-assessment. Subject B had a pathological delta (0.5–4 Hz) and upper alpha (10–12 Hz) power maximum over the unaffected hemisphere before NF training. After NF training, he showed a more bilateral and “normalized” topographical distribution of these EEG frequencies. Healthy participants as well as subject A did not show any abnormalities in EEG topography before the start of NF training. Consequently, no changes in the topographical distribution of EEG activity were observed in these participants when comparing the pre- and post-assessment. Hence, our results show that upper alpha based NF training had on the one hand positive effects on memory functions, and on the other hand led to cortical “normalization” in a stroke patient with pathological brain activation patterns, which underlines the potential usefulness of NF as neurological rehabilitation tool.

Keywords

Cortical reorganizationNeurofeedbackMemoryStroke recovery

Background

Following stroke, changes in electrical brain activity as well as cognitive impairment are often evident (Melkas et al. 2014; Jordan 2004; Kaplan and Rossetti 2011; Finnigan and van Putten 2013; Niedermeyer 2005). In this context, EEG based neurofeedback (NF) might be a useful rehabilitation tool. There is evidence that NF training can lead to changes in electrical brain activity which goes along with cognitive improvements (Kober et al. 2015a, b; Reichert et al. 2016; Kropotov 2009; Gruzelier 2014). Using NF, participants can learn to voluntarily modulate their electrical brain activity. Specific parameters of the EEG, such as power values in specific frequency bands, can be extracted and analyzed in real-time and fed back to the participants via auditory and/or visual feedback. Hence, with the method of NF, the electrical activity of the brain is modulated directly and, therefore, the cortical substrates of cognitive functions. This direct access to neural activity by means of NF may alter or accelerate functional reorganization in the brain following stroke. NF might speed up functional recovery or even enable functional recovery that otherwise would not have occurred (Nelson 2007). Therefore, the aim of the present study was to evaluate the effects of EEG based NF training on brain plasticity processes and cognitive functions in stroke survivors.

It has been demonstrated that the electroencephalogram (EEG) is a highly sensitive measure to detect cerebral ischemic or hemorrhagic stroke. Stroke patients show EEG abnormalities compared to healthy people, which change over the course of the disease. The quantitative EEG during the acute and sub-acute state has a high prognostic value concerning the outcome from stroke (Finnigan et al. 2007; Finnigan and van Putten 2013; Tecchio et al. 2007; Sheorajpanday et al. 2011). In this context, slow wave EEG activity in the delta range (0.5–4 Hz) as well as faster oscillatory activity in the alpha range (8–12 Hz) turned out to play an essential role (Niedermeyer 2005). Delta power was found to be negatively correlated with regional cerebral blood flow (rCBF) while alpha power showed a relatively strong positive correlation with rCBF (Tolonen and Sulg 1981; Finnigan and van Putten 2013). In stroke patients with unilateral cerebral infarction delta activity is typically most pronounced over the affected hemisphere in the acute state (Finnigan and van Putten 2013; Jordan 2004; Tecchio et al. 2006). Across a few hours during the acute stroke period, the scalp topography of delta activity shifts from a maximum over the affected hemisphere to a maximum over the healthy, unaffected hemisphere. This interhemispheric shift of scalp delta power maxima is associated with worsening of cerebral pathophysiology and clinical state in stroke patients (Finnigan et al. 2008; Tecchio et al. 2007; Zappasodi et al. 2007; Niedermeyer 2005; Rossini et al. 2003). There is evidence that pathological asymmetry in EEG delta power decreases after thrombolytic therapy, which in turn leads to improvements in clinical symptoms (Finnigan et al. 2006; de Vos et al. 2008). Alpha amplitude attenuation is also generally indicative for cortical injury (Finnigan and van Putten 2013; Finnigan et al. 2007; Klimesch 1999). Alpha power in the acute state is negatively related to the severity of stroke symptoms in patients with unilateral lesions in the arteria cerebri media (ACM) (Finnigan et al. 2007). In stroke patients with acute subarachnoid hemorrhage (SAH), EEG delta activity is increased and alpha activity is reduced, too (Vespa et al. 1997; Claassen et al. 2004; Niedermeyer 2005; Labar et al. 1991). Some EEG studies also investigated changes in EEG activity in the post-acute and chronic stage (Mattia et al. 2003). These studies showed that the greatest improvement in EEG activity occurred during the first 3 months after stroke (Giaquinto et al. 1994; de Weerd et al. 1988; Jonkman et al. 1984). Stroke patients with a unilateral insult in the ACM showed decreases in delta power and increases in alpha power levels over the injured hemisphere during this time period. Alpha power levels also increased over the healthy hemisphere. An overall increase in alpha power was also partially associated with improvements in motor functions and activities in daily living (Giaquinto et al. 1994). Furthermore, delta and alpha power became more symmetrically distributed over both hemispheres with clinical recovery, which might be an indicator of “normalization” of electrical brain activity (Giaquinto et al. 1994; Tecchio et al. 2006).

In the present investigation, we evaluated whether EEG based NF training can be used as therapeutic tool to evoke changes in electrical brain activation patterns in chronic stroke patients, which may be accompanied by cognitive improvements. In NF training paradigms, participants can learn to voluntarily increase or decrease the amplitude of specific EEG frequencies. There is some empirical evidence that voluntary modulation of EEG amplitudes determines other aspects of electrical brain activity in healthy people, which are responsible for improved cognitive performance (Egner et al. 2004; Egner and Gruzelier 2004; Kropotov et al. 2005; Kober et al. 2015a; Reichert et al. 2016). A few single-case studies in stroke patients reported heterogeneous results. Some found positive effects of NF training on cognitive functions as well as a EEG normalization after NF training (Rozelle and Budzynski 1995; Bearden et al. 2003; Laibow et al. 2002; Putman 2002; Hofer et al. 2014), others could not find any significant effects (Doppelmayr et al. 2007). However, the generalizability of these prior findings is limited due to the incomplete description of training-specific EEG signal changes as well as the absence of control groups. The majority of NF training studies examined the effects of NF only on the behavioral level (see Gruzelier 2014 for a review). Generally, successful modulation of EEG band power is associated with cognitive and behavioral improvements (Kropotov 2009; Gruzelier 2014; Kober et al. 2015a, b; Hofer et al. 2014; Reichert et al. 2016). For instance, voluntary up-regulation of the upper alpha frequency band (UA, about 10–12 Hz) generally leads to improvements in working memory (WM) and short-term memory performance (Escolano et al. 2011, 2012, 2013, 2014; Angelakis et al. 2007; Nan et al. 2012). It is assumed that alpha activity inhibits unnecessary or conflicting processes to the task being performed, thus facilitating attention and memory by actively suppressing distracting stimuli (Klimesch et al. 2007). Beside voluntary modulation of the magnitude of EEG amplitudes, NF can be also used to change the topographical distribution of EEG activity. For instance, NF is used to tread depressive symptoms by changing hemispheric asymmetry in alpha band power (8–12 Hz) in prefrontal brain areas (Kropotov 2009).

Summing up, we aimed at investigated the effects of NF training on (i) electrical brain activity, such as power in different EEG frequencies and the topographical distribution of EEG activity, and (ii) cognitive functions in chronic stroke patients. Therefore, we present two cases, a stroke patient with a unilateral middle cerebral artery (ACM) stroke and a stroke patient with a bilateral subarachnoid hemorrhage (SAH). We used an UA based NF training, since the two chronic stroke patients showed deficits in memory functions prior to the NF training. Based on the literature, UA based NF training should have specific positive effects on memory functions (Escolano et al. 2011, 2012, 2013, 2014; Angelakis et al. 2007; Nan et al. 2012). We compared the results of the two stroke patients to the results of a healthy, elderly control group. We expected that pathological EEG patterns in stroke patients would change due to UA based NF training, which should be associated with cognitive recovery.

Moderate wine consumption is associated with better cognitive test results: a 7 year follow up of 5033 subjects in the Tromsø Study

I'm sure your hospital will never start serving red wine to increase your cognition. Don't ask your friends to bring in bottles either. Wine parties in the hospital would be great, excellent for balance therapy and urination control. No need to worry about driving afterward.
http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0404.2010.01371.x/abstract;jsessionid=743C17EECC240A6E6F24BC46540BE5A0.f02t02

1. K. A. Arntzen^1,2,
2. H. Schirmer^1,3,
3. T. Wilsgaard¹ and
4. E. B. Mathiesen^2,4

Article first published online: 2 JUN 2010

DOI: 10.1111/j.1600-0404.2010.01371.x

© 2010 John Wiley & Sons A/S

Issue

Acta Neurologica Scandinavica

Special Issue: Selected Articles from the Annual Meeting of the Norwegian Neurological Association, Oslo, November 2009

Volume 122, Issue Supplement s190, pages 23–29, July 2010

Additional Information(Show All)

How to CiteAuthor InformationPublication History

1. Conflicts of interest: none.

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Keywords:

• alcohol;
• cognitive function;
• epidemiology;
• wine

Arntzen KA, Schirmer H, Wilsgaard T, Mathiesen EB. Moderate wine consumption is associated with better cognitive test results: a 7 year follow up of 5033 subjects in the Tromsø Study. Acta Neurol Scand: 2010: 122 (Suppl. 190): 23–29. © 2010 John Wiley & Sons A/S.

Background –  The impact of moderate alcohol consumption on cognitive function and dementia is unclear. We examined the relationship between consumption of different alcoholic beverages and cognitive function in a large population-based study.

Methods –  Subjects were 5033 stroke-free men and women who participated in a longitudinal population-based study in Tromsø, Norway. Alcohol consumption and other cardiovascular risk factors were measured at baseline and cognitive function was assessed after 7 years follow up with verbal memory test, digit–symbol coding test and tapping test.

Results –  Moderate wine consumption was independently associated with better performance on all cognitive tests in both men and women. There was no consistent association between consumption of beer and spirits and cognitive test results. Alcohol abstention was associated with lower cognitive performance in women.

Conclusions –  Light-to-moderate wine consumption was associated with better performance on cognitive tests after 7 years follow up.

VO2 peak a better predictor of cognitive benefits than exercise dose (total duration of exercise). So your doctor and therapists will need to calculate the type and duration of exercise that produces the best VO2 max for cognitive benefits. Don't let them get away with not doing this, you are paying them. 

Dose-Response of Aerobic Exercise on Cognition: A Community-Based, Pilot Randomized Controlled Trial

• Eric D. Vidoni ,
• David K. Johnson ,
• Jill K. Morris,
• Angela Van Sciver,
• Colby S. Greer,
• Sandra A. Billinger,
• Joseph E. Donnelly,
• Jeffrey M. Burns

Dose-Response of Aerobic Exercise on Cognition: A Community-Based, Pilot Randomized Controlled Trial

• Eric D. Vidoni, 
• David K. Johnson, 
• Jill K. Morris, 
• Angela Van Sciver, 
• Colby S. Greer, 
• Sandra A. Billinger, 
• Joseph E. Donnelly, 
• Jeffrey M. Burns

x

• Published: July 9, 2015
• DOI: 10.1371/journal.pone.0131647

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Abstract

Epidemiological studies suggest a dose-response relationship exists between physical activity and cognitive outcomes. However, no direct data from randomized trials exists to support these indirect observations. The purpose of this study was to explore the possible relationship of aerobic exercise dose on cognition. Underactive or sedentary participants without cognitive impairment were randomized to one of four groups: no-change control, 75, 150, and 225 minutes per week of moderate-intensity semi-supervised aerobic exercise for 26-weeks in a community setting. Cognitive outcomes were latent residual scores derived from a battery of 16 cognitive tests: Verbal Memory, Visuospatial Processing, Simple Attention, Set Maintenance and Shifting, and Reasoning. Other outcome measures were cardiorespiratory fitness (peak oxygen consumption) and measures of function functional health. In intent-to-treat (ITT) analyses (n = 101), cardiorespiratory fitness increased and perceived disability decreased in a dose-dependent manner across the 4 groups. No other exercise-related effects were observed in ITT analyses. Analyses restricted to individuals who exercised per-protocol (n = 77) demonstrated that Simple Attention improved equivalently across all exercise groups compared to controls and a dose-response relationship was present for Visuospatial Processing. A clear dose-response relationship exists between exercise and cardiorespiratory fitness. Cognitive benefits were apparent at low doses with possible increased benefits in visuospatial function at higher doses but only in those who adhered to the exercise protocol. An individual’s cardiorespiratory fitness response was a better predictor of cognitive gains than exercise dose (i.e., duration) and thus maximizing an individual’s cardiorespiratory fitness may be an important therapeutic target for achieving cognitive benefits.

Trial Registration

ClinicalTrials.gov NCT01129115

Systematic review shows ‘smart drug’ modafinil does enhance cognition

Do survivors need something like this? To make up for the cognitive decline associated with lots of survivors? I could have used this immediately post-stroke because I could have then questioned my doctor why he knew absolutely nothing about how to facilitate stroke recovery.

Traumatic brain injury patients with more education recover faster: Study

http://www.alphagalileo.org/ViewItem.aspx?ItemId=155535&CultureCode=en
A new systematic review, published online in the peer-reviewed journal European Neuropsychopharmacology shows that modafinil does indeed confer significant cognitive benefits in in certain groups. This raises ethical questions over e.g. it's use in exams.
The drug modafinil was developed to treat narcolepsy (excessive sleeping), but it is widely used off-licence as a ‘smart drug’ to promote cognitive enhancement, where qualities such as alertness and concentration are desired to assist someone with, for example, exam preparation.  Past studies on sleep-deprived individuals have shown a strong positive effect of modafinil on these functions, but there has been less attention and scientific consensus on the drug’s overall effectiveness as a cognitive enhancer in people that are not sleep-deprived – presumably the majority of people taking it. Now, a new systematic review, published online in the peer-reviewed journal European Neuropsychopharmacology* shows that modafinil does indeed confer significant cognitive benefits in this group, at least on a particular subset of tasks.
Dr Ruairidh Battleday and Dr Anna-Katharine Brem from the University of Oxford and Harvard Medical School evaluated all research papers on cognitive enhancement with modafinil from January 1990 to December 2014. They found 24 studies dealing with different benefits associated with taking modafinil, including planning and decision making, flexibility, learning and memory, and creativity.
 Unsurprisingly, they found that the performance-enhancing capacity of modafinil varied according to the task. What emerged was that the longer and more complex the task tested, the more consistently modafinil conferred cognitive benefits.
Modafinil made no difference to working memory, or flexibility of thought, but did improve decision-making and planning. Very encouragingly, the 70% of studies that looked at the effects of modafinil on mood and side effects showed very little overall effect, although a couple reported insomnia, headache, stomach ache or nausea (which were also reported in the placebo group).
According to Ruairidh McLennan Battleday (University of Oxford):
“This is the first overview of modafinil’s actions in non-sleep-deprived individuals since 2008, and so we were able to include a lot of recent data. Interestingly, we found that the type of test used to assess modafinil’s cognitive benefits has changed over the last few decades. In the past, people were using very basic tests of cognition, developed for neurologically-impaired individuals. In contrast, more recent studies have, in general, used more complex tests: when these are used, it appears that modafinil more reliably enhances cognition: in particular ‘higher’ brain functions that rely on contribution from multiple simple cognitive processes.”
According to Anna-Katharine Brem (University of Oxford and Harvard Medical School):
“So, we ended up having two main conclusions: first, that, in the face of vanishingly few side effects in these controlled environments,  modafinil can be considered a cognitive enhancer; and, second that we need to figure out better ways of testing normal or even supra-normal cognition in a reliable manner. However, we would like to stress the point that with any method used to enhance cognition, ethical considerations always have to be taken into account: this is an important avenue for future work to explore.”
Professor Guy Goodwin, President of the European College of Neuropsychopharmacology (ECNP) commented :
“This overview suggests that, on current evidence, modafinil enhances cognition independent of its known effects in sleep disordered populations. Thus, the authors say that “modafinil may well deserve the title of the first well-validated pharmaceutical nootropic agent”. In other words, it’s the first real example of a ‘smart drug’, which can genuinely help, for example, with exam preparation. Previous ethical discussion of such agents has tended to assume extravagant effects before it was clear that there were any. If correct, the present update means the ethical debate is real: how should we classify, condone or condemn a drug that improves human performance in the absence of pre-existing cognitive impairment?
As the authors point out, modafinil is not licenced for this use, and it will not be because it would be outside the current terms of reference of regulatory bodies. The non-medical use of mind altering drugs has hitherto broadly conflicted with the work ethic of many societies, has been very popular but leads to a range of demonstrable harms. Regulation has been and remains problematic. We cannot know either if demand for modafinil in the same societies will actually be significant, whether society will be more accepting and how regulation will then be framed.”

• Full bibliographic informationModafinil for cognitive neuroenhancement in healthy non-sleep-deprived subjects: a systematic review, R.M. Battleday and A.-K. Brem, European Neuropsychopharmacology doi: 10.1016/j.euroneuro.2015.07.028

Study cautions against statins as general preventive medicine

You'll find out how up-to-date and informed your doctor is if s/he brings this up before you start asking about it. You do expect your doctor to know more about medical stuff than you do, don't you?
http://medicalxpress.com/news/2015-08-cautions-statins-medicine.html
Statins' success in reducing atherosclerosis-related events has elevated the medications to wonder-drug status, with some researchers advocating for their wider use as a preemptive therapy for cardiovascular disease. Using statins, however, can have side effects, including memory loss, muscle problems and increased diabetes risk. A new study in the American Journal of Physiology—Cell Physiology explains why statins are more beneficial in some cases than others and highlights the importance of weighing individual risk when considering statins as a preventive measure. 
More at link.

Even this one is not up-to-date because the idea that statins cause memory problems has supposedly been refuted.

No link between statins and cognition

Because no one seems to know anything definitive about stroke, prevention or anything useful at all for survivors, you are completely on your own and will have to become your own medical advisor. Hopefully you won't get charged with practicing medicine without a license, as compared to your doctors practicing medicine with no knowledge at all.

Historic gift to launch Woodcock Institute for Advancement of Neurocognitive Research and Applied Practice

Our stroke associations IF ANY GOOD AT ALL would be working with this institute to see what collaborations could be accomplished in solving all the problems in stroke. But I would be willing to bet that the stroke associations will continue to sit on their damned asses doing nothing but press releases.
http://www.twu.edu/twunews/press_releases/15-woodcock-gift.asp
A gift of nearly $10 million from a foundation created by world-renowned psychologist and psychometrician Richard W. Woodcock will put Texas Woman’s University at the center of interdisciplinary research into cognitive and achievement assessments and advancing effective clinical practice for two-year-olds to octogenarians.
The gift from the Woodcock-Muñoz Foundation in Nashville, Tenn. is the largest single donation in TWU history.
“Improving the tools by which cognitive abilities are measured has been my life’s work,” Woodcock said. “Texas Woman’s University, with its multidisciplinary approach to education, research and clinical practice, is ideally suited to continue advancing this field and making a profound difference in the lives of others.”
Woodcock, the senior author of the Woodcock-Johnson Tests of Cognitive Abilities and Achievement, is dissolving the Tennessee-based foundation to create an endowment that will fund the new Woodcock Institute for the Advancement of Neurocognitive Research and Applied Practice at TWU. Annual interest generated from this endowment fund, along with about $1 million in annual royalties from his newly updated tests measuring cognitive ability, oral language skills and achievement, will support the growth of this new institute on TWU’s Denton campus.
The Woodcock-Johnson assessments are one of the leading cognitive and achievement evaluations instruments for preschoolers, children, adolescents and adults. They are used by schools and clinics to assist in diagnosing and supporting children with special needs.
Millions of children across the United States have taken the Woodcock-Johnson assessments, which are becoming globally popular as well, from Canada and Spanish-speaking countries, to Jordan, following their translation into Farsi.
“The Woodcock-Johnson suite of assessments has had an extraordinary impact on the educational landscape and serves a valuable function for educators and researchers around the world. They remain the leading individually administered achievement assessment program in the United States,” said Tracey Barrett, vice president for product management and assessments at Houghton Mifflin Harcourt. “Dr. Woodcock’s work in the area of intellectual assessments speaks for itself, and the new Woodcock Institute will continue his profound legacy in this field.”
TWU Chancellor and President Carine M. Feyten credited the renowned psychologist’s decision to locate the institute at the university to Daniel C. Miller, professor emeritus and former chair of the university’s psychology and philosophy department.

Investigation of the effects of solid lipid curcumin on cognition and mood in a healthy older population

Curcumin has been touted for its wonderful properties. What does this research tell your doctor about updating your stroke diet protocol?  I've only written 12 posts on curcumin.
YOU DO HAVE A STROKE DIET PROTOCOL? DON'T YOU?
http://jop.sagepub.com/content/29/5/642.abstract?&

1. Katherine HM Cox
2. Andrew Pipingas
3. Andrew B Scholey

1. Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia

1. Andrew B Scholey, Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, 3122, Australia. Email: andrew@scholeylab.com

Abstract

Curcumin possesses many properties which may prevent or ameliorate pathological processes underlying age-related cognitive decline, dementia or mood disorders. These benefits in preclinical studies have not been established in humans. This randomized, double-blind, placebo-controlled trial examined the acute (1 and 3 h after a single dose), chronic (4 weeks) and acute-on-chronic (1 and 3 h after single dose following chronic treatment) effects of solid lipid curcumin formulation (400 mg as Longvida®) on cognitive function, mood and blood biomarkers in 60 healthy adults aged 60–85. One hour after administration curcumin significantly improved performance on sustained attention and working memory tasks, compared with placebo. Working memory and mood (general fatigue and change in state calmness, contentedness and fatigue induced by psychological stress) were significantly better following chronic treatment. A significant acute-on-chronic treatment effect on alertness and contentedness was also observed. Curcumin was associated with significantly reduced total and LDL cholesterol and had no effect on hematological safety measures. To our knowledge this is the first study to examine the effects of curcumin on cognition and mood in a healthy older population or to examine any acute behavioral effects in humans. Results highlight the need for further investigation of the potential psychological and cognitive benefits of curcumin in an older population.

Common electric brain stimulation has significant detrimental effect on IQ scores -tDCS

So maybe you don't want to do this for increasing your cognition. I've written 24 posts on the subject 
that might now be invalid.
http://www.news-medical.net/news/20150506/Common-electric-brain-stimulation-has-significant-detrimental-effect-on-IQ-scores.aspx

Using a weak electric current in an attempt to boost brainpower or treat conditions has become popular among scientists and do-it-yourselfers, but a new University of North Carolina School of Medicine study shows that using the most common form of electric brain stimulation had a statistically significant detrimental effect on IQ scores.
Published in the journal Behavioural Brain Research, the study adds to the increasing amount of literature showing that transcranial direct current stimulation - tDCS - has mixed results when it comes to cognitive enhancement.
"It would be wonderful if we could use tDCS to enhance cognition because then we could potentially use it to treat cognitive impairment in psychiatric illnesses," said Flavio Frohlich, PhD, study senior author and assistant professor of psychiatry, cell biology and physiology, biomedical engineering, and neurology. "So, this study is bad news. Yet, the finding makes sense. It means that some of the most sophisticated things the brain can do, in terms of cognition, can't necessarily be altered with just a constant electric current."
Frohlich, though, said that using less common alternating current stimulation - so-called tACS - could be a better approach, one that he has been investigating. Earlier this year, Frohlich's lab found that tACS significantly boosted creativity, likely because he used it to target the brain's natural electrical alpha oscillations, which have been implicated in creative thought.
With tDCS, scientists don't target these brain waves, which represent neuronal patterns of communication throughout regions of the brain. Instead, they use tDCS to target brain structures, such particular regions of the cortex.
The tDCS boom started in 2000, when German scientists published a paper showing that tDCS could change the excitability of neurons in the motor cortex - the brain region that controls voluntary body movement. Since then, there's been an explosion of tDCS studies to try to make neurons more active or less active and therefore change outcomes for a variety of brain functions, such as working memory and cognitive acuity, and for illnesses, such as depression and schizophrenia.
But Frohlich said that some of the studies that have made waves were poorly designed. Some studies were not properly double-blinded or properly placebo controlled. Other studies were very small - less than 10 people.
A recent meta-analysis of a large number of tDCS papers showed that tDCS is far from a magic pill for cognitive enhancement or brain-related health conditions.
"Aside from stimulating the motor cortex, which has very exciting implications for stroke rehabilitation, I think the jury is still out on tDCS," said Frohlich, who is a member of the UNC Neuroscience Center.
In the Behavioural Brain Research study, Frohlich's team - including graduate student Kristin Sellers, the paper's first author - recruited 40 healthy adults, each of whom took the standard WAIS-IV intelligence test, which is the most common and well-validated test of IQ. It includes tests for verbal comprehension, perceptional reasoning, working memory, and processing speed.

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A week later, Frohlich's team divided the participants into two groups. Electrodes were placed on each side of each participant's scalp, under which sat the frontal cortex. Duke University collaborator and co-author Angel Peterchev, PhD, created imaging simulations to ensure Frohlich's team targeted the same parts of the cortex that previous tDCS studies had targeted.
Then the placebo group received sham stimulation - a brief electrical current, which led participants to think they had been receiving the full tDCS. The other participants received the standard tDCS for twenty minutes - a weak electrical current of 2 millioamperes.
All participants then retook the IQ tests. Frohlich expected that most, if not all, IQ scores would improve because of the practice effect, but that tDCS would not markedly improve scores.
Frohlich's team did find that all scores improved. Surprisingly, though, the participants who did not receive tDCS saw their IQ scores increase by ten points, whereas participants who received tDCS saw their IQ scores increase by just shy of six points, on average.
When Frohlich and colleagues analyzed the test scores, they saw that the scores for three of the four main kinds of cognitive tests were very similar between the two groups of participants. But the scores for perceptual reasoning were much lower among people who underwent tDCS.
Perceptual reasoning tests fluid intelligence, which is defined as the ability to think logically and apply innovative problem solving to new problems.
Within the category of perceptual reasoning, the researchers saw the biggest differences in the subcategory of matrix reasoning - when participants viewed two groups of symbols and had to find the one symbol missing from the other group.
Frohlich emphasized, "Our findings do not preclude the possibility that other tDCS paradigms may be less harmful or even beneficial. However, it is time to make sure that everybody uses gold standard, placebo-controlled, double-blind study designs. Also, our study demonstrates the importance of more research on how stimulation interacts with brain activity."
Frohlich stressed that the scientific community should be careful not to create simplistic storylines about tDCS being a 'magic pill' for many brain-related conditions. "There could be dangerous consequences, especially if tDCS is used daily," he said. "Ours was an acute study. We don't know what the long-term effects are. There is so much more we need to understand before tDCS is ready for home use without medical supervision"
Frohlich added, "I think our study demonstrates that we need to think of smarter ways to engage the brain to really target the specific brain dynamics involved in what we want to improve, such as cognition for people with depression or schizophrenia. I think tACS is an option, as well as more sophisticated modalities we've yet to develop."

Source:

University of North Carolina Health Care

20 Everyday Activities That Keep Memory and Thinking Sharp

Does your doctor have a stroke protocol for these activities to keep your memory and cognition sharp? If not does your doctor want you dumb and forgetful so you don't remember how little help they provided in your recovery?
http://www.spring.org.uk/2015/04/20-everyday-activities-that-keep-memory-and-thinking-sharp.php?
A couple selected paragraphs;
However, those who had participated regularly in arts, crafts, socialising or computer use were less likely to develop MCI.
The activities which appeared to have the strongest protective effect were artistic.
People who engaged in artistic activities in middle and old age were 73% less likely to develop memory and thinking problems.
For crafts the reduction in the chance was 45%, for socialising it was 55% and for computer use it was 53%.

£1.1m study to reduce cognitive problems in people with MS

I can easily see being able to reuse this for stroke survivors. What is your doctor doing to follow this and create a cognitive stroke protocol for you? ANYTHING AT ALL?
http://www.alphagalileo.org/ViewItem.aspx?ItemId=151130&CultureCode=en
Experts in Nottingham are leading a major new study into how people with multiple sclerosis (MS) could overcome problems with attention and memory associated to their condition.
The Cognitive Rehabilitation for Attention and Memory in people with Multiple Sclerosis (CRAMMS) trial will evaluate the effectiveness of new strategies to improve and compensate for these difficulties and aims to improve the quality of life for the patient.
The trial is being led by Nadina Lincoln, Professor of Clinical Psychology in the Division of Rehabilitation and Ageing at The University of Nottingham and Dr Roshan das Nair, consultant clinical psychologist at Nottingham University Hospitals NHS Trust and honorary Associate Professor in the University’s Division of Rehabilitation and Ageing.
Funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme, the trial will begin recruiting participants later this month.
Professor Lincoln said: “The purpose of our research is to help people with multiple sclerosis boost their everyday memory so they can get on with their lives and do the things that people take for granted, for example remembering to pick their children up from school, turning the stove off, or knowing where they have put things.
“It will also provide them with strategies to enable them to concentrate on information without getting distracted.”
Memory and attention problems are common complaints for those who have multiple sclerosis. More than 100,000 people in the UK have multiple sclerosis and of these, 50,000 will have problems with attention and memory at some stage in the progression of their condition.
Very few people with multiple sclerosis get treatment for cognitive problems in usual clinical practice, despite some evidence that cognitive rehabilitation may help reduce problems in attention and everyday forgetting. However, cognitive rehabilitation for people with multiple sclerosis has not been demonstrated to be effective or cost-effective in large-scale randomised controlled trials.
The study will be exploring the benefits of using internal memory aids, such as mnemonics — using patterns, words and images to remember details — and external aids, such as diaries, mobile phones and cameras. The researchers will also be looking for other imaginative ways to help improve memory and reduce forgetting.
The study is being conducted in collaboration with Swansea University, Nottingham University Hospitals NHS Trust, Sheffield Teaching Hospitals NHS Trust, The Walton Centre NHS Trust, and University Hospitals Birmingham NHS Trust.
They will recruit 400 volunteers, aged 16 to 69 years, from NHS hospitals, rehabilitation centres, multiple sclerosis charities, and web forums. About half the volunteers will then receive a 10-week group intervention at one of the study centres in Nottingham, Sheffield, Liverpool and Birmingham. The groups will focus on strategies to improve attention and to reduce memory problems in daily life. The remaining volunteers will continue to receive their existing level of care.
If this study confirms the benefits of cognitive rehabilitation it could lead to a change in clinical practice in the NHS and abroad. The researchers will also use questionnaires to determine the cost-effectiveness of this intervention, and to get feedback from those taking part in the trial to establish if intervention improved their quality of life.
http://www.nottingham.ac.uk/news/pressreleases/2015/march/11m-study-to-reduce-cognitive-problems-in-people-with-ms.aspx

A bidirectional relationship between physical activity and executive function in older adults

This sounds extremely important for survivors. What stroke protocol does your doctor have for this?
http://journal.frontiersin.org/article/10.3389/fnhum.2014.01044/full?
Michael Daly^1*, David McMinn² and Julia L. Allan³

• ¹Behavioural Science Centre, Stirling Management School, University of Stirling, Stirling, UK
• ²School of Medicine and Dentistry, Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, UK
• ³Health Psychology, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK

Physically active lifestyles contribute to better executive function. However, it is unclear whether high levels of executive function lead people to be more active. This study uses a large sample and multi-wave data to identify whether a reciprocal association exists between physical activity and executive function. Participants were 4555 older adults tracked across four waves of the English Longitudinal Study of Aging. In each wave executive function was assessed using a verbal fluency test and a letter cancelation task and participants reported their physical activity levels. Fixed effects regressions showed that changes in executive function corresponded with changes in physical activity. In longitudinal multilevel models low levels of physical activity led to subsequent declines in executive function. Importantly, poor executive function predicted reductions in physical activity over time. This association was found to be over 50% larger in magnitude than the contribution of physical activity to changes in executive function. This is the first study to identify evidence for a robust bidirectional link between executive function and physical activity in a large sample of older adults tracked over time.

Introduction

Advancements in medical science in the past century have markedly increased life expectancy but have also heralded a broad set of challenges that accompany an aging population (United Nations, 2011). Age-related cognitive decline is one such challenge, producing wide ranging psychological, social, and economic consequences at both the individual and population level (Frank et al., 2006; Olesen et al., 2012). Emerging evidence suggests that age-related neurocognitive-decline should not be seen as fixed or immutable (Hamer and Chida, 2009). Rather, cognitive function seems to benefit from a healthy lifestyle, most notably from regular physical activity (Hertzog et al., 2009; Ku et al., 2012; Gow, 2013).

This study examines whether engaging in physical activity attenuates declines in higher level cognitive function (executive functioning) over a period of 6 years in older English adults. In addition, the current study investigates the more novel prediction that the relationship between physical activity and cognitive performance is bidirectional, and that executive function will also play a predictive role in shaping activity levels over time (Batty et al., 2007; Sabia et al., 2010). The executive functions, in particular, may enable people to consistently engage in effortful behaviors like physical activity in order to achieve long-term health benefits (Hall and Fong, 2007). As the contribution of executive functioning to physical activity has not yet been established in large scale prospective studies, this study also aimed to test this pathway in a sample of more than four thousand older English adults.

‘Smart’ drugs won’t make smart people smarter

Our doctors need to answer the question. Would this drug help the cognitive performance of stroke survivors? Immediately post-stroke there was no way I considered myself smart anymore.
http://www.psypost.org/2014/11/smart-drugs-wont-make-smart-people-smarter-29406
One paragraph.
He said: “Our study backs up previous research that suggests psychostimulants improve people at the lower end of the spectrum in cognition whereas they impair people who are at the optimum level of cognitive function — healthy people for example. It looks like Modafinil is not helpful for healthy individuals and it might even impair their ability to respond and might stifle their lateral thinking, while people who have some sort of deficiency in creativity are helped by the drug.”

Nostalgia Activates Parts Of The Brain For Better Mental Performance

Does your doctor have a stroke protocol to cover this to boost your cognitive abilities?

Nostalgia Activates Parts Of The Brain For Better Mental Performance

Cornell University researchers just reversed the idea nostalgia doesn’t activate the parts of your brain responsible for better mental performance; it 100 percent does.
"The prevailing view is that activating brain regions referred to as the default network impairs performance on attention-demanding tasks because this network is associated with behaviors such as mind-wandering," Nathan Spreng, lead study author, said in a press release. "Our study is the first to demonstrate the opposite — that engaging the default network can also improve performance." To arrive at this conclusion, Spreng and his team recruited 36 young adults to undergo a brain scan.

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While being scanned, researchers asked participants to take a look at sets of famous and anonymous faces in a specific order.  As they were going through the photos, researchers also asked participants to identify — or reminisce — whether the current faced matched the face in two previous photos. Participants answered both faster and more accurate when matching famous faces compared to anonymous faces, all the while experiencing spikes in their default network.
This goes to show that accessing long-term memory (famous faces) does work to strengthen short-term memory performance. "Outside the laboratory, pursuing goals involves processing information filled with personal meaning — knowledge about past experiences, motivations, future plans, and social context," Spreng said. "Our study suggests that the default network and executive control networks dynamically interact to facilitate an ongoing dialogue between the pursuit of external goals and internal meaning."
It's easy to see why mind-wandering was believed to negatively impact mental peformance. I mean, there's actual evidence. A study published in the Canadian Journal of Experimental Psychology found mind-wandering hinders reading comprehension and performance on working memory- and intelligence-related tests. Interestingly enough, this same study found mind-wandering also played a crucial role when it came to creative problem solving.

Cognitive control in the self-regulation of physical activity and sedentary behavior

Your doctor should be an expert at motivating you to get off your butt and exercise. Because unless YOU do the work you won't recover very well.
This might help your doctor create a stroke protocol on motivation. You can always hope your doctor is trainable.

Cognitive control in the self-regulation of physical activity and sedentary behavior

Jude Buckley¹, Jason D. Cohen², Arthur F. Kramer^2,3, Edward McAuley^2,3 and Sean P. Mullen^2,3*

• ¹School of Psychology, University of Auckland, Auckland, New Zealand
• ²Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
• ³Beckman Institute for Advanced Science and Technology, Urbana, IL, USA

Cognitive control of physical activity and sedentary behavior is receiving increased attention in the neuroscientific and behavioral medicine literature as a means of better understanding and improving the self-regulation of physical activity. Enhancing individuals’ cognitive control capacities may provide a means to increase physical activity and reduce sedentary behavior. First, this paper reviews emerging evidence of the antecedence of cognitive control abilities in successful self-regulation of physical activity, and in precipitating self-regulation failure that predisposes to sedentary behavior. We then highlight the brain networks that may underpin the cognitive control and self-regulation of physical activity, including the default mode network, prefrontal cortical networks and brain regions and pathways associated with reward. We then discuss research on cognitive training interventions that document improved cognitive control and that suggest promise of influencing physical activity regulation. Key cognitive training components likely to be the most effective at improving self-regulation are also highlighted. The review concludes with suggestions for future research.

For nearly half of a century, researchers have been trying to uncover how to motivate people to become more physically active (Trost et al., 2002; Schutzer and Graves, 2004; Buckworth et al., 2013) and, recently, more effort has been made to understand how to motivate people to be less sedentary (Hamilton et al., 2008). Despite resources devoted to these efforts, more than 30% of the world’s population remains physically inactive (Hallal et al., 2012) and, on average, people are sitting for more than 300 min/day (Bauman et al., 2011). Our understanding of the regulation of these behaviors has advanced, but these prevalence rates suggest that our knowledge of physical activity and sedentary behavior remains incomplete. Research supports theoretical proposals that health behavior is dependent, in part, on self-regulation capacities (Bandura, 1986; De Ridder and de Wit, 2006), but only recently has research attention been directed toward the preceding factors of self-regulation that influence physical activity and sedentary behavior.

Recent theory (e.g., Temporal Self-Regulation Theory; Hall and Fong, 2007, 2010, 2013) and evidence suggest that the relation between physical activity and cognitive control is reciprocal (Daly et al., 2013). Most research has focused on the beneficial effects of regular physical activity on executive functions-the set of neural processes that define cognitive control. Considerable evidence shows that regular physical activity is associated with enhanced cognitive functions, including attention, processing speed, task switching, inhibition of prepotent responses and declarative memory (for reviews see Colcombe and Kramer, 2003; Smith et al., 2010; Guiney and Machado, 2013; McAuley et al., 2013). Recent research demonstrates a dose-response relationship between fitness and spatial memory (Erickson et al., 2011), however the long-term effects of physical activity on working memory have been less consistent (Smith et al., 2010).

Positive physical activity effects on executive function have been found in children for both acute and regular activity (Chang et al., 2012; Hillman et al., in press). For example, findings from a 9-month randomized controlled trial in 221 prepubertal children attending an afterschool physical activity program (vs. a wait-list control group), showed improvements in fitness (VO_2peak), cognitive control, and neuroelectrical activity (P3-ERP) during tasks that required significantly more cognitive control (Hillman et al., in press). In addition, a modest dose-response effect of program attendance on cognitive control measures was also found. Improvements in cognitive function are not always observed in older adults (Angevaren et al., 2008) or in children (Janssen et al., 2014) involved in physical activity programs. These findings suggest that the effects of physical activity on cognitive function may depend on the particular cognitive function being assessed. Taken together, this research suggests that physical activity training can enhance cognitive control abilities. The effects of physical activity on cognitive control appear to be underpinned by a variety of brain processes including: increased hippocampal volume, increased gray matter density in the prefrontal cortex (PFC), upregulation of neurotrophins and greater microvascular density (for a review see Voss et al., 2013). Much less is understood about the influence of cognitive control on physical activity but emerging evidence suggests that executive functions play an antecedent role in effective self-regulation of physical activity (Hall et al., 2008; Riggs et al., 2010; McAuley et al., 2011; Daly et al., 2013; Pentz and Riggs, 2013; Best et al., 2014).

The goals of this paper are (1) to review emerging evidence of the antecedence of cognitive control abilities in enabling successful self-regulation for physical activity, and in precipitating self-regulation failures that predispose individuals to remain sedentary; (2) to highlight neural networks that may underlie the cognitive control of physical activity and sedentary behavior; and (3) to review emerging research on training effects on cognitive and physical functioning and summarize components of training that may produce positive cognitive outcomes associated with increased physical activity engagement.

More at link.

Western Diet Leads to Diminished Cognitive Performance

How precisely do they tell? This would then lead immediately to hospitals changing their food availability for all stroke survivors. Not doing so would mean that hospitals have no concern for their patients cognitive abilities.
http://www.biosciencetechnology.com/news/2014/09/western-diet-leads-diminished-cognitive-performance
I'm going to demand that my hospital at least consider these:

What would a post-stroke diet look like?

The Cognitive Benefits of Interacting With Nature

Is your doctor going to have a stroke protocol to increase your cognition by making sure you get a daily walk or wheelchair ride thru a natural area? Or is that too much to ask to get done in the next year?

Do you prefer your doctor incompetence NOT KNOWING? OR NOT DOING?

The Cognitive Benefits of Interacting With Nature

1. Marc G. Berman1,2,
2. John Jonides1 and
3. Stephen Kaplan1,3

+ Author Affiliations

1. ¹Department of Psychology
2. ²Department of Industrial and Operations Engineering
3. ³Department of Electrical Engineering and Computer Science, University of Michigan

1. Marc G. Berman, Department of Psychology, University of Michigan, 530 Church St., Ann Arbor, MI 48109–1043, e-mail: bermanm@umich.edu.

Abstract

We compare the restorative effects on cognitive functioning of interactions with natural versus urban environments. Attention restoration theory (ART) provides an analysis of the kinds of environments that lead to improvements in directed-attention abilities. Nature, which is filled with intriguing stimuli, modestly grabs attention in a bottom-up fashion, allowing top-down directed-attention abilities a chance to replenish. Unlike natural environments, urban environments are filled with stimulation that captures attention dramatically and additionally requires directed attention (e.g., to avoid being hit by a car), making them less restorative. We present two experiments that show that walking in nature or viewing pictures of nature can improve directed-attention abilities as measured with a backwards digit-span task and the Attention Network Task, thus validating attention restoration theory. 

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The results showed that people’s performance on the test improved by almost 20% after wandering amongst the trees. By comparison those subjected to a busy street did not reliably improve on the test.

In the second study participants weren’t even allowed to leave the lab but instead some stared at pictures of natural scenes while others looked at urban environments. The improvements weren’t quite as impressive as the first study, but, once again, the trees and fields beat the roads and lampposts.