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Neurofeedback For Dementia Improves Executive Functioning and Memory In A Small Pilot Study

Berman_Figure5_smallThe results of an ongoing unpublished clinical trial* provides initial evidence that neurofeedback may significantly improve some components of memory and executive functioning in persons with dementia. The investigators want to expand this pilot study into a large clinical trial and seek additional participants (contact information is provided below). Berman et al.’s review of prior research found that persons with dementia exhibited common quantitative EEG (QEEG) abnormalities that included excessive slow wave activity (delta or 1-3.5Hz; theta or 4-7Hz), deceased power in alpha (8-12Hz) and beta (13-30Hz), and a lower dominant alpha frequency. The investigators hypothesized that QEEG-guided neurofeedback might be able to normalize some or all of these EEG abnormalities. Check the end of this review to download a poster presentation of this research.

Participants (n=27) received random assignment to a neurofeedback (n=16) or wait-list control group (n=11). Individualized neurotherapy protocols (i.e., based on the QEEG) were utilized for the 30-40 half-hour EEG biofeedback sessions received by those in the treatment group. Typically, participants were rewarded when they decreased 0-8Hz (slow wave activity) and 22-35Hz (fast activity associated with anxiety and rumination) and increased 10-18Hz (Alpha and cognitive Beta).

A wide variety of psychological and neuropsychological assessments were administered pre/post-treatment to determine changes in executive functioning, memory, and EEG. The researchers did not specify the exact components of executive functioning they sought to assess though their choice of tests gave some indication.The specific assessment measures were:

  1. QEEG
  2. Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A; self and informant report)
  3. Symptom Checklist 90-R
  4. Williams’ Memory Assessment Scale
  5. Rey-Osterreith Complex Figure Task
  6. Wisconsin Card Sort Test
  7. Integrated Visual and Auditory Continuous Performance Test (IVA)
  8. Delis-Kaplan Executive Function Battery (omitted Proverbs, second Card Sort set, and Tower test)
  9. Mini Mental Status Exam
(click to enlarge) Figure 5. Compared to controls, improvement in treated subjects showed a significantly greater correlation with reduction in slow wave activity.

(click to enlarge) Figure 5. Compared to controls, improvement in treated subjects showed a significantly greater correlation with reduction in slow wave activity.

Participants in the QEEG-guided neurofeedback group realized statistically significant improvements in verbal memory, verbal fluency, visual memory, executive function, and behavioral inhibition at post-testing. The researchers noted “trends” toward improvement on the Mini-Mental Status Exam (p=.072) and Symptom Checklist 90-R (p= .085). No changes were found on the IVA Attention, Wisconsin Card Sort, and Delis-Kaplan Executive Function System. Statistically meaningful changes in the QEEG for persons in the treatment group included greater power in all frequencies higher than 10 Hz, as well as reduced 1-4 Hz amplitudes during eyes-closed assessment at F4 and C4. See Figure 5 for an example of changes in the QEEG. For comparison, 10 of 12 persons in the control group remained the same or declined in their overall functioning.

The researchers noted that despite the positive findings for the neurofeedback group as a whole, 6 of 16 participants with dementia evidenced little change or even declined. They then set out to identify the best candidates for neurofeedback and their initial assessment revealed that the Williams’ Memory Assessment Scale Global Memory Index pretest score significantly correlated (r= .71, p< .01) with the standardized mean treatment effect on variables that improved (p< .10) in the neurofeedback group and not in the control group. This suggested that those who entered the study with better memory functioning benefited most from neurotherapy.

The researchers concluded that:

“This study showed that neurofeedback training resulted in significant improvement in memory and some aspects of executive function, compared to a waiting list control, suggesting that neurofeedback is a “possibly efficacious” [Level 3] treatment for dementia. The finding that the efficacy of neurofeedback is greater in persons with more intact memory function suggests that this intervention is more strongly indicated for earlier stage cases. It also suggests that learning and memory are involved in neurofeedback’s mechanism of action.”

Please review the BMED Report article, “Evidenced-Based Biofeedback/Neurofeedback” for a quick overview of the 5 levels of efficacy accepted by ISNR and AAPB.

Keep in mind that small sample sizes typically limit or nullify research findings due to poor statistical power; however, in the present study, neurofeedback proved to be effective despite a small number of participants. Obviously, a much larger sample size is required to better estimate the efficacy of neurofeedback for dementia, to determine its side effects, if any, to refine criteria for ideal candidates for EEG biofeedback, and to identify the most effective protocols.

Important Note: The researchers are actively recruiting additional participants. Please contact Marvin H. Berman, Ph.D., Principal Investigator for additional information at (610) 940-0488 or online.

Download a poster presentation of “Efficacy of neurofeedback for executive and memory function in dementia” here.

Reference:
*Berman, M., & Frederick, J. (unpublished manuscript). Efficacy of neurofeedback for executive and memory function in dementia.

Editorial Note: While The Behavioral Medicine Report believes that Marvin H. Berman, Ph.D. will conduct safe and quality research, we cannot guarantee your safety or satisfaction with the results. We encourage all participants to discuss the research with the primary investigator and to review the informed consent documents before deciding to participate.

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