title: Executive functioning in alcoholics following an mHealth cognitive stimulation program: randomized controlled trial.
abstract: BACKGROUND
  The consequences of alcohol dependence are severe and may range from physical disease to neuropsychological deficits in several cognitive domains. Alcohol abuse has also been related to brain dysfunction specifically in the prefrontal cortex. Conventional neuropsychological interventions (paper-and-pencil cognitive stimulation training) have a positive effect but are time-consuming, costly, and not motivating for patients.
  
  
  OBJECTIVE
  Our goal was to test the cognitive effects of a novel approach to neuropsychological intervention, using mobile technology and serious games, on patients with alcohol dependence.
  
  
  METHODS
  The trial design consisted of a two-arm study assessing the cognitive outcomes of neuropsychological intervention with mobile serious games (mHealth) versus control (treatment-as-usual with no neuropsychological intervention) in patients undergoing treatment for alcohol dependence syndrome. Sixty-eight patients were recruited from an alcohol-rehab clinic and randomly assigned to the mHealth (n=33) or control condition (n=35). The intervention on the experimental group consisted of a therapist-assisted cognitive stimulation therapy for 4 weeks on a 2-3 days/week basis.
  
  
  RESULTS
  Fourteen patients dropped out of the study. The results of the neuropsychological assessments with the remaining 54 patients showed an overall increase (P<.05) of general cognitive abilities, mental flexibility, psychomotor processing speed, and attentional ability in both experimental (n=26) and control groups (n=28). However, there was a more pronounced improvement (P=.01) specifically in frontal lobe functions from baseline (mean 13.89, SE 0.58) to follow-up (mean 15.50, SE 0.46) in the experimental group but not in the control group.
  
  
  CONCLUSIONS
  The overall increase in general cognitive function for both experimental and control groups supports the beneficial role of existing alcohol treatment protocols aimed at minimizing withdrawal symptoms, but the differential improvements observed in frontal lobe functioning supports the use of mobile serious games for neuropsychological stimulation to overcome executive dysfunction in patients with alcohol dependence. This trial was negative on two neuropsychological/cognitive tests, and positive on one.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01942954; http://www.clinicaltrials.gov/ct2/show/NCT01942954.
authors.affiliation: Lusophone University of Humanities and Technologies, Lisbon, Portugal. pedro.gamito@ulusofona.pt.
authors.forename: Pedro
authors.initials: P
authors.lastname: Gamito
authors.forename: Jorge
authors.initials: J
authors.lastname: Oliveira
authors.forename: Paulo
authors.initials: P
authors.lastname: Lopes
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Brito
authors.forename: Diogo
authors.initials: D
authors.lastname: Morais
authors.forename: Diana
authors.initials: D
authors.lastname: Silva
authors.forename: Ana
authors.initials: A
authors.lastname: Silva
authors.forename: Sara
authors.initials: S
authors.lastname: Rebelo
authors.forename: Marta
authors.initials: M
authors.lastname: Bastos
authors.forename: Alberto
authors.initials: A
authors.lastname: Deus
mesh_terms: D000328:Adult; D057229:Alcoholics; D000437:Alcoholism / Q000523:psychology* / Q000628:therapy; D003071:Cognition; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D056344:Executive Function; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests
keywords: addiction; alcohol; cognitive stimulation; executive function; mobile health; serious games
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