Clinical presentation and engagement with a cognitive rehabilitation clinic in individuals reporting anomalous health incidents.

Introduction: The Department of Defense is working to establish effective rehabilitative management options for individuals who have experienced Anomalous Health Incidents (AHI). Methods: This retrospective, observational study conducted at Walter Reed National Military Medical Center describes the clinical presentation of forty patients (21 female and 19 male; mean [SD] age, 43.3 [9.2] years) with reported AHI. It also describes the application of a cognitive training intervention, its utilization, patient satisfaction, and changes in cognitive performance and symptoms over time. At baseline, the overall pattern of objective cognitive efficiency scores was within normal limits, though numerically below healthy norms. However, patients performed below normal limits on measures of processing speed. Patient self-report surveys found slightly elevated psychological symptoms, highly elevated neurobehavioral and headache symptoms, and severe impact on life. Results: Patients used an at-home cognitive training program and provided generally positive feedback regarding the program. On an internal clinic survey, over 75% of the patients felt that participation helped in areas of memory, visuo-spatial skills, and attention. Some changes in objective cognitive testing were observed over time. Self-reported symptoms, which were not directly targeted in the intervention, did not change over time. Discussion: This study demonstrates that the clinical integration of targeted cognitive training for individuals reporting cognitive symptoms following an AHI is feasible and acceptable, with patients demonstrating good engagement and a positive clinical trajectory in cognitive efficiency over time.