UNSW Fatigue Clinic, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia; University of Sydney, School of Public Health, Camperdown, NSW 2006, Australia.
Psychiatry Res. 2017 Nov;257:400-405. doi: 10.1016/j.psychres.2017.08.035. Epub 2017 Aug 18.
Neurocognitive disturbance with subjectively-impaired concentration and memory is a common, disabling symptom reported by patients with chronic fatigue syndrome (CFS). We recently reported preliminary evidence for benefits of cognitive remediation as part of an integrated cognitive-behavioral therapy (CBT)/ graded exercise therapy (GET) program. Here, we describe a contemporaneous, case-control trial evaluating the effectiveness of an online cognitive remediation training program (cognitive exercise therapy; CET) in addition to CBT/GET (n=36), compared to CBT/GET alone (n=36). The study was conducted in an academic, tertiary referral outpatient setting over 12 weeks (11 visits) with structured, home-based activities between visits. Participants self-reported standardized measures of symptom severity and functional status before and after the intervention. Those in the CET arm also completed standardized neurocognitive assessment before, and following, treatment. The addition of formal CET led to significantly greater improvements in self-reported neurocognitive symptoms compared to CBT/GET alone. Subjective improvement was predicted by CET group and lower baseline mood disturbance. In the CET group, significant improvements in objectively-measured executive function, processing speed, and working memory were observed. These subjective and objective performance improvements suggest that a computerized, home-based cognitive training program may be an effective intervention for patients with CFS, warranting randomized controlled trials.
神经认知障碍伴有主观注意力和记忆力受损，是慢性疲劳综合征（CFS）患者常报告的一种致残症状。我们最近报道了认知矫正作为综合认知行为疗法（CBT）/分级运动疗法（GET）的一部分的初步益处。在这里，我们描述了一项同期的病例对照试验，评估了在线认知矫正训练计划（认知运动疗法；CET）在 CBT/GET 之外（n=36）的有效性，与 CBT/GET 单独（n=36）相比。该研究在学术性三级转诊门诊环境中进行，为期 12 周（11 次就诊），就诊之间有结构化的家庭活动。参与者在干预前后自行报告症状严重程度和功能状态的标准化测量。CET 组的参与者还在治疗前后完成了标准化的神经认知评估。与 CBT/GET 单独治疗相比，正式 CET 的加入导致自我报告的神经认知症状显著改善。主观改善由 CET 组和较低的基线情绪障碍预测。在 CET 组中，观察到客观测量的执行功能、处理速度和工作记忆有显著改善。这些主观和客观的表现改善表明，基于计算机的家庭认知训练计划可能是 CFS 患者的有效干预措施，值得进行随机对照试验。
