Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Rehabilitation of Attention in Patients With Mild Cognitive Impairment and Brain Subcortical Vascular Changes Using the Attention Process Training-II
Brief Summary: Background: Subcortical Vascular Dementia (VaD), consequent to deep brain small vessel disease (SVD), is the most frequent form of VaD. The term vascular mild cognitive impairment (VMCI) defines a transitional state between normal ageing and VaD. Attentional deficits are a common finding in patients affected by VMCI or subcortical VaD. At present, no drug treatment is available to prevent vascular dementia in patients with VMCI or to improve cognitive performances of this large group of patients. Cognitive rehabilitation is directed to achieve functional changes by reinforcing, strengthening, or reestablishing previously learned patterns of behavior, or establishing new patterns of cognitive activity or compensatory mechanisms.

A hierarchical model of attention has been used to build the Attention Process Training-II (APT-II) programme.

The APT-II programme effectiveness have been demonstrated in traumatic brain injury and post-stroke rehabilitation, but there is an increasing interest in the study of cognitive rehabilitation in pathological processes that evolve over time, such as chronic cerebrovascular diseases (CVD).

Aims: The purpose of this study is to investigate whether the APT-II programme could be a useful tool in the rehabilitation of attention in individuals affected by VMCI with SVD, and if so, whether the improvement in performance is generalized to functionality in daily activities and quality of life.

Main Expected Results and Impact: Considering that the APT-II contains specific exercises to facilitate generalization to daily life, the skills that are learned by each patient during the rehabilitation programme should be generalized to daily activities.

Furthermore, the improvement of cognitive skills should also improve patient's overall quality of life because these learned skills are applicable to real-life situations. The main expected results are: 1) an impact of APT-II on disability, everyday cognition, quality of life, and performance on attention tests at short and long term after rehabilitation programme ending as compared with standard care; 2) a reduction of the risk of transition to dementia at 1 year follow-up as compared with control group.


Options:
A: Inclusion Criteria:

* patient at REHAB Basel
* brain-injury
* willing to participate in animal-assisted therapies
* physical and psychological resilience and ability to go/be transported outside to the "Therapie-Tiergarten"
* ability to get in contact with the animal autonomously

Exclusion Criteria:

* medical contraindications:allergies, phobias, etc.
* no willingness to participate in animal-assisted therapies
* patient might present a danger to the animals (aggressive behaviour)
* patient's medication changes radically during the time of data collection
B: Inclusion Criteria:

* Aged 18 years of age or greater
* Admitted to out-patient rehabilitation post ischemic stroke

Exclusion Criteria:

* more than 6 months post stroke onset
* those not requiring occupational therapy
* hemorrhagic stroke
* neurological diagnoses other than stroke
* major psychiatric illness
* moderate or severe aphasia (NIH Stroke Scale aphasia rating of 2 or more)
* dementia (Mini Mental State Exam scores of 24 or less)
C: Inclusion Criteria:

Patients will be enrolled according to the following criteria:

* MCI defined according to Winblad et al. criteria;
* Evidence of impairment across attention neuropsychological tests;
* Evidence on MRI of subcortical vascular lesions: moderate to severe age-related white matter changes (WMC) according to a modified version of the Fazekas scale.

Exclusion Criteria:

* Age \< 18 years
D: The study will specifically recruit individuals who had an ischemic or hemorrhagic stroke and have probable mild cognitive impairment.

In addition, individuals must meet the following inclusion criteria:

1. Aged 55 years or over;
2. Have a history of a single stroke of at least one year prior to study enrolment;
3. Mini-Mental State Examination (MMSE) (5) score of ≥ 20 at screening, including a perfect score on the 3-step command to ensure intact comprehension and ability to follow instructions;
4. Have subjective cognitive complaints;
5. Community-dwelling;
6. Lives in Metro Vancouver;
7. Able to comply with scheduled visits, treatment plan, and other trial procedures;
8. Must be able to read, write, and speak English in which psychometric tests are provided with acceptable visual and auditory acuity;
9. Stable on a fixed dose of cognitive medications (e.g., donepezil, galantamine, rivastigmine, memantine, etc.) that is not expected to change during the 12-month study period, or, if they are not on any of these medications, they are not expected to start them during the 12-month study period;
10. Able to walk for a minimum of six metres with rest intervals with or without assistive devices;
11. Have an activity tolerance of 60 minutes with rest intervals;
12. Not currently participating in any regular therapy or progressive exercise; and
13. Provide a personally signed and dated informed consent document indicating that the individual (or a legally acceptable representative) has been informed of all pertinent aspects of the trial. In addition, an assent form will be provided at baseline and again at regular intervals.

Exclusion Criteria:

1. Diagnosed with dementia of any type;
2. Diagnosed with another type of neurodegenerative or neurological condition (ie. Parkinson's disease) that affects cognitive function and mobility;
3. At high risk for cardiac complications during exercise and/or unable to self-regulate activity or to understand recommended activity level (i.e., Class C of the American Heart Risk Stratification Criteria);
4. Have clinically significant peripheral neuropathy or severe musculoskeletal or joint disease that impairs mobility, as determined by his/her family physician;
5. Taking medications that may negatively affect cognitive function, such as anticholinergics, including agents with pronounced anticholinergic properties (e.g., amitriptyline), major tranquilizers (typical and atypical antipsychotics), and anticonvulsants (e.g., gabapentin, valproic acid, etc.); or
6. Have aphasia as judged by an inability to communicate by phone.

Answer: C