A controlled clinical effectiveness trial of multimodal cognitive rehabilitation on episodic memory functioning in older adults with traumatic brain injury (TBI)

Abstract ObjectivesThis study aimed to evaluate the impact of a multimodal cognitive intervention, the Cognitive Enrichment Program (CEP), on episodic memory in traumatic brain injured (TBI) older adults, as compared to an active control group that received usual care in the form of holistic rehabilitation. MethodsThe CEP’s Memory module consisted in memory strategies to promote encoding. Effectiveness was evaluated by psychometric tests (Face-name association, Word list recall, Text memory), while generalization was measured through self-reported questionnaires about daily memory functioning (Self-Evaluation Memory Questionnaire) and psychological well-being (Psychological General Well-Being Index). Measures were obtained before and after intervention, and six months later. ResultsBoth groups showed improvement on most measures, but the experimental group showed greater statistically significant improvement. ANCOVA mixed model repeated measures analysis showed a strong group-by-time interaction for the Face-name association test, with a large effect size. A significant group-by-time interaction was obtained on three generalization self-report measures, including increased memorization of the content of Conversations, reduced Slips of attention, and increased memory of Political & social Events, with moderate to large effect sizes. Clinically significant improvements were found for Psychological well-being in the experimental group, where 50% of participants improved to the well-being category and remained stable six months later (9/17; 53%). Also, the number of experimental participants showing severe distress before CEP training (9) was reduced after intervention (5) and remained relatively stable at 6 months. ConclusionsThe CEP is a promising cognitive rehabilitation program that showed high satisfaction in participants and that can not only improve episodic memory in terms of psychometric scores, but also in daily life situations, as well as enhance psychological well-being in older individuals having sustained a TBI.