Introduction: Cognitive impairments occur frequently in stoke survivors, yet current conventional post-stroke care focuses mainly on motor function. Transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) are noninvasive brain stimulation techniques (NIBS) that are used in neurological rehabilitation. Its efficacy is well-established in motor recovery post-stroke, but research on its effects on the associated cognitive decline after stroke is fairly new. The aim of this review is to evaluate recent studies and provide a summary on the effects of NIBS on post-stroke cognitive decline. Methods: PubMed and CINAHL were searched using the keywords: “cerebrovascular accident”, “stroke”, “NIBS” or “noninvasive brain stimulation”, “tDCS” or “transcranial direct current stimulation”, and “TMS” or “transcranial magnetic stimulation”. PEDro system was used to assess the quality of the studies that passed the inclusion and exclusion criteria. Results: The initial search returned 1081 citations, among which 12 were included in this review. The mean PEDro score of the studies was 7.5 out of 10. The trials had a total of 176 participants with stroke. Lesion site was heterogeneous. Six trials investigated tDCS, and the other 6 investigated rTMS. The main outcome measures were grouped into 3 domains: memory, visuospatial, and attention. Both tDCS and rTMS resulted in significant changes in the visuospatial domain in terms of improving spatial neglect. The results on memory and attention are mixed, but tDCS shows more consistent results. Conclusion: NIBS is a safe and low-cost treatment that can improve cognitive decline post-stroke. However, the evidence is still lacking due to the small number of trials and sample sizes. More studies need to be conducted in order to establish a proper guideline for usage. Long term effects also need to be investigated. / published_or_final_version / Public Health / Master / Master of Public Health

The hippocampus is a brain structure involved in memory as well as anxiety and depression-related behavior. One unique property of the hippocampus is that adult neurogenesis occurs in this region. Rodent studies in which adult hippocampal neurogenesis is ablated have shown a role for this process in the cognitive domain, specifically in pattern separation tasks, as well as in mediating the behavioral effects of antidepressants. These studies have furnished the intriguing hypothesis that increasing adult hippocampal neurogenesis may improve these functions and therefore serve as a target for novel treatments for cognitive impairments as well as depression and anxiety disorders. Here, we use both genetic and pharmacological models to increase adult neurogenesis in mice. Under baseline conditions, we find that increasing adult hippocampal neurogenesis is sufficient to improve performance in a fear-based pattern separation task, but has no effect on exploratory, anxiety or depression-related behavior. In mice exposed to voluntary exercise, increasing adult hippocampal neurogenesis increases exploration, without affecting anxiety or depression-related behavior. Finally, in mice treated with chronic corticosterone, a model of anxiety and depression, increasing adult hippocampal neurogenesis is sufficient to prevent the behavioral effect of CORT on anxiety and depression-related behavior. Here, we therefore describe dissociations between the effects of increasing adult hippocampal neurogenesis under baseline, voluntary exercise and chronic stress conditions. Together, our results suggest that increasing adult hippocampal neurogenesis has therapeutic potential for both cognitive, and anxiety and depression-related disorders.

This qualitative case study investigated the impact of sand tray on individuals diagnosed with Alzheimer’s and other forms of dementia. Four participants successfully completed the creation of sand trays while the researcher observed, interviewed, and documented the individual sand trays. The intervention established that sand tray allows the dementia patient to kinesthetically connect to their inner cognitions through the intentional symbolic expression offered by this unique therapeutic medium. Using a series of eight sand trays of varying thematic concepts, the participants were offered a modality to facilitate a synthesization of their continued individuation, presenting a possible neural pathway to connect and express thoughts, feelings, emotions, concerns, challenges, and fears. The findings of this study include the fact that all trays were classified as “empty” and that the majority of the participants placed objects almost exclusively on the right side of the tray, which is commonly associated with the concreteor conscious side. The use of sand tray allowed each individual the opportunity to create autobiographies in the sand and literally navigate through time – past, present, and future, confronting fears, expressing hope and possibilities. The results of the research study offer insight into the psychotherapeutic effects of using sand tray with dementia patients, as well as a better understanding of the cognitive and expressive abilities and limitations of an individual with impaired memory. The results also offer insight into the difficulties with short-term memory in this population and possibly indicate a potential means for monitoring cognitive decline. Keywords: Neurocognitive disorder, Alzheimer’s, dementia, sand tray, play therapy / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2013.

The purpose of this project is to offer a functionally comprehensive application, Cognitive Rehab Solutions (CRS), that is designed for neuropsychologists to deliver restorative cognitive training in areas of attention and memory of persons with brain impairment.