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Stress Relief and Memory Training Center

N-back Task as a Paradigm for Working Memory Testing and Training in Dementia: Case Studies

An integrative rehabilitation program with working memory training helped two patients with dementia/depression to stabilize and improve their brain speed and arrest cognitive decline for 24 months.

Valentin Bragin(1), Gary Shereshevsky(1, 2), Ilya Bragin(1, 3), Ayzik Vaysman(1), Elina Slobod(1), Anastasiya Tsoy(1).

  1. Stress Relief and Memory Training Center, Brooklyn, NY, USA
  2. Staten Island University Hospital, Department of Rehabilitation Medicine, Staten Island, NY, USA
  3. Upstate Medical University, Syracuse, NY, USA

Poster Presented at the Alzheimer’s Association International Conference. Washington D.C., United States, July 18-23, 2015

Background: The N-back task is increasingly used for working memory (WM) assessment and training in different clinical settings. We developed and implemented computer-based WM testing and training protocol along with other treatment modalities to investigate the possibility of delaying cognitive decline in dementia. Here we present two cases of individuals in outpatient treatment for 24 months (mo).

Methods:В  Data of 2 female patients with dementia and depression were collected from their charts. On initial visit, their age was 70 (patient 1) and 69 (patient 2), education 16 and 12 years respectively. Both patients had hypertension, coronary artery disease, high cholesterol, diabetes. Patient 2 had prior stroke. They took medication for medical problems and escitalopram with rivastigmine (patient 1) or escitalopram with memantine (patient 2). Cognitive assessment included Mini Mental Status Exam (MMSE), clock drawing task (CDT), verbal fluency task (animals – VFA, letters – VFL) and computerized assessment and training of motor speed (MS), simple reaction time (SRT), go/no-go reaction time (GNGRT) and N-2 back task with registration of reaction time (RT), accuracy and errors. Information load for the N-back task consisted of 40 trials separately for words, numbers, shapes, pictures, or textures with inter-stimulus intervals of 400 milliseconds (ms).

Results: Both patients demonstrated stability on most of cognitive tasks (MMSE, CDT, VFA, MS, SRT, GNGRT) by 24 months of combined treatment. Working memory profile was unique for each patient. Patient 1 had shorter RT for words (1157ms initially, 820 ms  in 24 mo), and longer RT for textures (2309 ms initially, 1050 ms  in 24 mo). Patient 2 had shorter RT for texture (1098 ms initially, 980 ms in 24 mo) and longer RT for numbers (1460 ms initially and in 24 mo). Patient 1 performance did not change on words, numbers, shapes, improved on textures and decreased on people. Patient 2 performance did not change on words and decreased on numbers, shapes, people and textures.

Conclusion: Cognitive training together with other components of an integrative rehabilitation program might help stabilize or improve brain speed and arrest cognitive decline in select patients with dementia and depression for 24 months.

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