Neurofeedback in the treatment of cognitive impairment in patients with early cerebral small vessel disease

Objective. To compare the effectiveness of neurofeedback (NFB) at infra-low and alpha frequencies in the treatment of cognitive impairment in patients with early cerebral small vessel disease (cSVD). Material and methods. The study included 71 patients (average age 52.8±6.3 years, men 15%, women 85%) with early cSVD and 21 healthy volunteers (average age 53.2±4.8 years, men 29%, women 71%). All participants were assessed for clinical manifestations and cognitive functions, brain MRI, and EEG. cSVD patients were randomized by an envelope method with double-blind placebo control. Three groups of neurofeedback were formed: infra-low waves (n=25), alpha waves (n=22), simulated neurofeedback using EEG (placebo) (n=24). Fifteen sessions of 30 minutes were conducted 2—5 times a week. The cognitive profile and EEG were assessed immediately and 6—8 weeks after completion of the neurofeedback course. Results. Patients with early cSVD had subjective (65%) and moderate (35%) cognitive impairment with predominant deviations in the components of executive brain functions (EBF). Neurofeedback using infra-low waves significantly improved EBF in the components of productivity, switching and inhibition, non-verbal delayed memory immediately after the course, maintaining the effect for at least 6—8 weeks, which was accompanied by an increase in the power (μB2) of the alpha rhythm in the occipital regions. Neurofeedback using alpha waves showed improvement in the Stroop test (interference index) in the delayed period. Conclusion. In patients with early cSVD and deterioration of EBF, it is preferable to conduct biofeedback neurotraining at infra-low frequencies to treat cognitive impairment and create a cognitive reserve. An increase in the power of the alpha rhythm in the occipital regions during the course can be considered a prognostic marker of its effectiveness.