Need Intro paragraph from Dr. Amy
Scientific Conference Presentations
Test-Retest, Internal Consistency, and Split-Half Reliabilities of the Gibson Assessment of Cognitive Skills, a Brief Tool for Screening Cognitive Function Across the Lifespan.
Presented at Society for Neuroscience Global Connectome Conference, January 11, 2021.
Authors: Ledbetter, C., and Moore, A.L.
Researchers examined reliability of the Gibson Assessment of Cognitive Skills (GACS), a paper-based, brief cognitive screening tool for children and adults measuring working memory, processing speed, visual processing, fluid reasoning, and three auditory processing constructs: sound blending, sound segmenting, sound deletion along with work attack skills. The sample (n = 103) for the current study consisted of children (n = 73) and adults (n = 30) between the ages of 6 and 80 (M = 20.2, SD = 17.7), 47.6% female, and 52.4% male. Overall coefficient alphas range from .80 to .94. The split-half reliability coefficients ranged from .83 to .96 overall. Across all ages, the test-retest reliability coefficients ranged from .83 to .98. The evidence collected suggests that the GACS is an accessible and reliable brief screening tool for assessing cognitive skill performance across the lifespan.
Cognitive Profiles in Dyslexia: Beyond Phonological Processing Deficits.
Presented at American Psychological Association, Presidential Poster Session, August 6, 2020.
Authors: Moore, A.L., Miller, T., & Ledbetter, C.
Researchers examined the cognitive profiles of a large sample of children with dyslexia or specific learning disability in reading (n = 4,150). Using descriptive statistics, linear regression, and independent samples t tests, we generated overall cognitive profiles and examined differences by age and sex. Overall, long-term memory, working memory, and processing speed were the most deficient cognitive skills, followed by auditory processing (phonological awareness). Age was a significant predictor of 4 of the 7 skills (p < .001) with very small effect sizes: VP, PS, AT, and AP. There was a significant difference between males and females on 4 of the 7 skills (p<.001) with very small effect sizes: VP, PS, AT, and AP. Females scored higher on all constructs except VP. Results revealed marked decline across constructs with age in the absence of an effective intervention, suggesting that interventions for children with dyslexia and specific learning disability in reading should begin early and be aimed at not only the remediation of the typically targeted phonological processing deficits but also at enhancing working memory, long-term memory, and processing speed.
The Promise of Clinician-Delivered Cognitive Training for Mild Cognitive Impairment (MCI).
Presented at Global Virtual Conference on Alzheimer’s and Dementia, June 30, 2020.
Authors: Moore, A.L., James, R., Miller, T., Moore, J.J., & Ledbetter, C.
Cognitive training delivered face to face by a clinician has the potential to slow the progression of cognitive decline in patients with mild cognitive impairment (MCI) and subjective cognitive decline (SCD). We examined this potential in two studies using an intense, metronome-paced multicomponent cognitive training intervention originally created for children designed to remediate multiple cognitive skills including working memory, long-term memory, processing speed, fluid reasoning, visual and auditory processing, and attention. In the first study, we compared two methods of delivering 80 hours of training to 292 participants ranging in age from 51 to 95 with subjective memory or attention complaints. Both delivery methods resulted in significant gains across all cognitive skills, as well as transfer to improvements in mood, memory, cognitive efficiency, life application skills, and attention. In the second study, we examined cognitive training as part of a Functional Medicine intervention with physical exercise, anti-inflammatory diet and nutritional supplements, sleep optimization, and stress management for five cognitively impaired patients over age 50. Following the intervention, three of the five patients were no longer classified as cognitively impaired, a fourth patient improved to only mildly impaired, and the most severely impaired patient remained steady. Patients reported improved memory, mental clarity, and outlook on life. fMRI analyses revealed changes in brain connectivity and efficiency. Both studies support the potential of face-to-face cognitive training for MCI and SCD in patients over age 50 as a standalone intervention or as part of a holistic approach to slowing cognitive decline in this population.
MRI and Neuropsychological Outcomes of Cognitive Rehabilitation Training for Repetitive Sports Concussion.
Archives of Physical Medicine and Rehabilitation, 100(10), e100. doi.org/10.1016/j.apmr.2019.08.288
Authors: Ledbetter, C., Moore, A.L., Miller, T.M., & Taylor, M. (2019).
Using an interventional single case study pre-post trial design, cognitive and neuroimaging changes following 60 hours of ThinkRx training were evaluated in a student-athlete with repetitive concussions and post-concussion syndrome. After training, fMRI showed a dramatic normalization of the Default Mode Network with increased connectivity between the right parietal node and the medial prefrontal cortex. Full scale IQ score improved along with gains in all individual skills, including large jumps in logic and reasoning, working memory, and long-term memory. Overall executive function score improved by 30 points. After training, the patient returned to school, was able to actively participate in conversations again, reported that ‘brain fog’ had lifted, and had a hopeful outlook for his future.
Key Ingredients of Effective Cognitive Rehabilitation Training. Proceedings of the 5th Neurological Disorders.
Summit in Journal of Neurology & Experimental Neuroscience.
doi: 10.17756/jnen.2019-suppl1
Authors: Moore, A.L., & Ledbetter, C. (2019).
Much more than brain games, effective clinician-delivered cognitive rehabilitation training can remediate learning struggles, recover cognitive functioning following traumatic brain injury, increase self-esteem and confidence, and improve quality of life across the lifespan. The human interaction in effective cognitive training is grounded in Feuerstein’s theory of structural cognitive modifiability, or the potential of an individual’s cognition AND synaptic strength to be changed by mediated experience. This interactionist approach to a cognitive intervention aligns with the therapeutic perspective. In this workshop, we present seven elements to make cognitive rehabilitation training more effective: repetitively practiced, delivered by a clinician (not a computer), intense, targeted, sequenced, progressively loaded, and with dynamic feedback. These elements have been critical components of the cognitive rehabilitation intervention the presenters use and in the studies they have published and presented on the efficacy of the intervention.
Neuropsychological Assessment Outcomes Following Cognitive Rehabilitation Training for Children and Adults with Traumatic Brain Injury.
Presented at Society for Neuroscience, November 2018, San Diego, CA.
Authors: Moore, A.L., Ledbetter, C., & Carpenter, D. (2018).
Using a quasi-experimental design, this study examined differences between children and adults in neuropsychological and functional outcomes following 95 hours of LearningRx training with 329 clients post-TBI. Clients attended three 90-minute training sessions per week for an average of 95 hours over 6-9 months. MANOVA revealed no significant differences between children and adults on any variable. All changes from pretest to post-test within groups were significant. Transfer to real life benefits was achievement for both age groups, including improved work or academic performance, greater self-discipline, increase confidence, improved social skills, better driving, and improved focus, memory, and processing speed.
MRI and Neuropsychological Outcomes Following a Functional Medicine Intervention with Cognitive Training in Mild Cognitive Impairment (MCI): A Multiple Case Study.
Presentation at American Psychological Association Annual Convention, August 2018, San Francisco, CA.
Authors: Moore, A.L., James, R., Carpenter, D., Miller, T., & Ledbetter, C. (2018).
Using a multiple case study design, we examined neural connectivity with fMRI, executive function, memory, attention, reasoning, everyday functioning, and overall IQ score for 5 clients with varying levels of Mild Cognitive Impairment (MCI) before the intervention, after 12 weeks on functional medicine (FM) protocols (grain-free/sugar-free diet, nutritional supplements, aerobic activity, optimized sleep & stress reduction) without cognitive training, and again following the addition and completion of 72 hours of cognitive training. In all five cases, improvement in both cognitive and life skills was achieved with a functional medicine protocol that included cognitive training. Normalization of the Default Mode Network (DMN) was evident along with the appearance of anti-correlations and decreased hyperconnectivity. A multidisciplinary approach to slowing or reversing cognitive decline appears to be promising.
MRI, qEEG, and Neuropsychological Outcomes Following Cognitive Rehabilitation Training for Severe Traumatic Brain Injury: A Clinical Case Study.
Presentation at Brain Injury Summit, Jan 2018, Vail, CO.
Authors: Moore, A.L., & Ledbetter, C. (2018).
Using a single case design, we examined neural connectivity changes with fMRI, qEEG, and changes in IQ score, working memory, long-term memory, visual & auditory processing, processing speed, attention, reasoning, and everyday functioning following 60 hours of cognitive training 8 years after a severe Traumatic Brain Injury. Neuropsychological testing results showed a 21-point increase in IQ score and significant gains in working memory, processing speed, logic and reasoning, and visual processing; as well as gains in long-term memory and auditory processing. FMRI showed normalization of the Default Mode Network (DMN) with the reappearance of anti-correlations and decreased hyperconnectivity was evident post-training. Post qEEG showed normalization of activity in the left frontal region which was previously abnormal. Functional outcomes included improved motivation for life, better focus and problem-solving, improved mood, no deficits in daily living tasks, and a return to former high-level career field.
MRI and Neuropsychological Outcomes Following Cognitive Rehabilitation Training in Traumatic Brain Injury: A Multiple Case Study.
Presented at Society for Neuroscience, November 2017, Washington, DC.
Authors: Moore, A.L., Ledbetter, C., & Carpenter, D. (2017).
Using a multiple case study design, we examined neural connectivity changes with fMRI and changes in IQ score, working memory, long-term memory, visual and auditory processing, processing speed, attention, reasoning, and everyday functioning following 60 hours of cognitive training for 5 clients with Traumatic Brain Injury. Results from the Woodcock-Johnson IV -Tests of Cognitive Abilities showed increases in IQ score for all cases (n = 5), with a mean increase of 21 points. All cases achieved gains in long-term memory, processing speed, logic and reasoning, and auditory processing; and four of five cases gained on visual processing and working memory. mTBI participants exhibited significant training-induced changes in neural connectivity. Normalization of the Default Mode Network (DMN) was evident in the severe TBI case along with the appearance of anti-correlations and decreased hyperconnectivity.
Beyond Attention: Memory and Processing Speed Deficits Dominate Cognitive Profiles in ADHD Across the Lifespan.
Presented at American Psychological Association Annual Convention, August 2017, Washington, DC.
Authors: Moore, A.L., & Ledbetter, C. (2017).
The objective of this study was to examine the cognitive profiles of a large sample of children and adults with Attention Deficit Hyperactivity Disorder (n = 5,417). We collected scores on the Woodcock-Johnson III – Tests of Cognitive Abilities administered to children and adults with ADHD at 79 cognitive therapy centers between 2010 and 2015. Deficits were identified in comparison to the standardization sample as standard scores under the 38th percentile. Results indicated that although deficits in broad attention were present, there were even larger deficits in working memory, long-term memory, and processing speed. The results suggest that interventions for children and adults with ADHD should be aimed at not only the remediation of attentional difficulties but also at enhancing memory and processing speed.
Correlation of Cognitive Training Gains and Resting State Functional Connectivity.
Presented at Society for Neuroscience, November 2016, San Diego, CA.
Authors: Ledbetter, C., Faison, M.O., & Patterson, J. (2016).
In a randomized controlled trial, 30 high school students were randomly assigned to ThinkRx cognitive training (n = 11), Brainskills digital training (n = 12), or a control group (n = 7). Resting state MRI results showed training-induced gains in global efficiency associated with visual processing, auditory processing, contextual associations, the default mode network, and the cerebellum. For all seven cognitive skills measured, changes in resting-state functional connections correlated with changes in performance on the test.
Intensive, Metronome-Based, 1-On-1 Cognitive Training Improves Cognitive Skills in Children.
Presented at Society for Neuroscience, November 2016, San Diego, CA.
Authors: Moore, A.L., Ledbetter, C., & Carpenter, D.M. (2016).
In a 2-phase randomized controlled trial, we examined the efficacy of ThinkRx cognitive training on IQ score, working memory, long-term memory, visual & auditory processing, processing speed, and reasoning for children ages 8-14 in a clinic setting. Then, we examined the differences between two methods of delivering ThinkRx. Phase 1 training effects included significant pretest to post-test gains on all measures and a mean gain of 21 points in IQ scores for the trained group. Phase 2 training effects included significant pretest to post-test gains on all measures and a mean gain of 22 points in IQ score for the second trained group. Pairwise comparisons only indicated a significant difference between the two delivery methods on long-term memory.