title: Web-based cognitive training: patient adherence and intensity of treatment in an outpatient memory clinic.
abstract: BACKGROUND
  Cognitive training has been playing an increasing role in the treatment of patients with cognitive deficits. This type of intervention, namely its intensity, can be optimized by incorporating information technology-based systems.
  
  
  OBJECTIVE
  The intent of the study was to determine the treatment intensity and patient adherence to home-based cognitive training strategies (Web-based cognitive training).
  
  
  METHODS
  A cohort of 45 patients with neurologic and psychiatric diseases attending an outpatient memory clinic (average age 50.7 years, SD 17.0; average education 7.8 years, SD 4.9) was followed over 18 months. Participants were challenged to use a Web-based cognitive training system, "COGWEB", on a daily basis, and fulfilled at least four weeks of training supervised remotely. Additionally, 11 patients attended face-to-face sessions.
  
  
  RESULTS
  The average duration of continuous cognitive training was 18.8 weeks (SD 18.9). Each patient performed on average 363.5 minutes/week (SD 136.6). At 6-month follow-up, 82.8% complied with their treatment plan. The average proportion of complete weeks was 0.75 (SD 0.22). Patients with dementia trained more intensively (444.6 minutes/week), followed by patients with static brain lesion (414.5 minutes/week; P=.01). The group that held face-to-face sessions performed more training overall (481.4 vs 366.9 minutes/week), achieving a stronger expression and statistical significance in the last week of training (652.6 versus 354.9 minutes/week, P=.027).
  
  
  CONCLUSIONS
  Overall, the weekly training intensity was high. Patients with dementia and static lesions performed more cognitive training. Face-to-face sessions were associated with higher intensities. The combination of classical methods with information technology systems seems to ensure greater training intensity.
authors.affiliation: Hospital São Sebastião, Neurology Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal. vitor.cruz@chedv.min-saude.pt.
authors.forename: Vítor
authors.initials: V
authors.lastname: Tedim Cruz
authors.forename: Joana
authors.initials: J
authors.lastname: Pais
authors.forename: Ivânia
authors.initials: I
authors.lastname: Alves
authors.forename: Luís
authors.initials: L
authors.lastname: Ruano
authors.forename: Cátia
authors.initials: C
authors.lastname: Mateus
authors.forename: Rui
authors.initials: R
authors.lastname: Barreto
authors.forename: Virgílio
authors.initials: V
authors.lastname: Bento
authors.forename: Márcio
authors.initials: M
authors.lastname: Colunas
authors.forename: Nelson
authors.initials: N
authors.lastname: Rocha
authors.forename: Paula
authors.initials: P
authors.lastname: Coutinho
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D003071:Cognition; D003072:Cognition Disorders / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D053208:Kaplan-Meier Estimate; D008297:Male; D008569:Memory Disorders / Q000628:therapy*; D008875:Middle Aged; D010349:Patient Compliance
keywords: Web-based training; adherence; cognitive training; eHealth systems; memory clinic; neurorehabilitation; training intensity