Cognitive Remediation

Many patients diagnosed and treated with a brain condition or disorder, including tumors, epilepsy, aneurysms, or stroke, experience some degree of emotional difficulties, cognitive changes, or behavioral changes. Cognitive dysfunction is a complication that can be related to both the disorder and its treatment, including surgery, radiation therapy, and chemotherapy. Surgery may cause physical changes to brain tissue and can lead to diffuse cognitive deficits, including problems with attention, memory, executive functioning, and information processing.  A therapy called cognitive remediation — also known as cognitive rehab or cognitive rehabilitation — can help.

Attention and information processing speed can sometimes be affected by treatment. For example, some patients report feeling that their ability to take in information seems to have slowed and their vulnerability to distractions has increased. Those symptoms can be addressed through cognitive remediation.

Executive functioning problems include difficulty with executing “everyday actions,” such as carrying out a sequence of actions, planning a task, beginning a task, knowing when one has completed a task, or even becoming “lost” while in the middle of a task.  Executive functioning problems are highly related to problems carrying out everyday activities.

Cognitive remediation is a valuable therapy to help a patient overcome these difficulties. Cognitive remediation treatment can teach long-lasting skills that help restore everyday functioning.  Research has demonstrated that cognitive remediation interventions that incorporated elements of memory, processing speed, and attention led to significant improvements in a number of cognitive areas.

The good news is that everyone has intact cognitive abilities and strengths. Cognitive remediation therapy teaches a patient to use those existing abilities to compensate for deficits in other areas. Cognitive remediation therapy incorporates all domains of functioning: emotional, behavioral, and cognitive.

Cognitive rehabilitation is based on the principle of neuroplasticity, meaning that the human brain is not a static organ but can be physically changed. These changes can occur within neural pathways and synapses after exposure to enriched environments. Cognitive remediation provides such an enriched environment.

What is cognitive remediation/cognitive rehabilitation?

• Cognitive remediation teaches compensatory strategies, such as using a memory notebook or daily planner, as well as using task analysis (the process of breaking down tasks into logically sequenced steps in order to better carry out important activities of daily living.  The central goal is to apply these strategies to everyday life after brain tumor surgery. 
• Cognitive remediation incorporates attention-enhancing exercises that require internal neurological functions. These attention exercises engage both visual and auditory skills, both of which are essential to many everyday tasks.  Attention and information-processing exercises are designed to enhance information retention and recall, contributing to improvements in memory. 
•  Attention, memory, and executive functions are interdependent, and impairments in these areas profoundly impact daily functioning.  Therefore, exercises that increase capacity for attention, working memory, and short-term memory will increase overall mental capacity.  Such exercises also increase an individual’s awareness of the mental effort required to process information. 
• Cognitive remediation is a collaborative treatment in which the individual and provider set goals and then customize treatment in order to reach these goals.

Psychometric testing after brain tumor treatment can help establish the patient’s abilities and strengths and set the stage for remediation. Individuals will also learn how to self-report their cognitive difficulties to help themselves and their treatment provider develop a rehabilitation plan.

Behavioral, emotional, and cognitive changes can be stressful, but with  quality rehabilitation a patient can achieve excellent results and a good quality of life.

Weill Cornell is pleased to offer several services to assist patients maximize their recovery, including comprehensive Cognitive Remediation Therapy and a Computerized Cognitive Remediation Program that focuses on improving working memory, attention, and focus. The computerized program, which is conducted online over the course of five weeks, also includes personal consultation and telephone sessions designed to improve performance in a wide range of cognitive tasks. Find out more about our Cognitive Remediation Programs.