Transcranial Direct Current Stimulation and Cognitive Rehabilitation: Two Distinct Treatments for Improving Neuropsychological Symptoms in Older Adults with Mild Alzheimer’s Disease

Transcranial Direct Current Stimulation and Cognitive Rehabilitation: Two Distinct Treatments for Improving Neuropsychological Symptoms in Older Adults with Mild Alzheimer’s Disease | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Transcranial Direct Current Stimulation and Cognitive Rehabilitation: Two Distinct Treatments for Improving Neuropsychological Symptoms in Older Adults with Mild Alzheimer’s Disease Arezoo Mojarrad, Esmaeil Sadri Damirchi, Ali sheikholeslami, Ali Rezaeisharif, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7948462/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Objectives: Alzheimer’s disease is one of the most pressing challenges for older adults, often leading to neuropsychological symptoms. This study aimed to compare the effectiveness of transcranial direct current stimulation (tDCS) and a short-term cognitive rehabilitation protocol in improving neuropsychological symptoms in older adults with mild Alzheimer’s disease. Materials and Methods: The research utilized a quasi-experimental design with two experimental groups and one control group, following a pre-test and post-test approach. The study population included all individuals aged 65 and older diagnosed with mild Alzheimer’s disease who visited neurologists in 2022. From this population, 60 individuals were selected through convenience sampling and randomly assigned to two experimental groups and one control group (20 participants per group). In the first experimental group, tDCS was administered in 10 weekly sessions, each lasting 20 minutes. In the second experimental group, a short-term cognitive rehabilitation program, based on Luria's (1963) healthy functional substitution approach, was conducted over 9 weekly sessions, each lasting 90 minutes. The content validity of the rehabilitation program was confirmed by experts. The control group received no intervention. Post-tests were conducted one week after the interventions, followed by a one-month follow-up assessment. The Neuropsychiatric Inventory (NPI) was used to collect data. Repeated measures ANOVA was performed using SPSS version 23 for data analysis. Results: Both interventions significantly improved neuropsychological symptoms at both the post-test and follow-up stages. However, while the short-term cognitive rehabilitation group demonstrated significant differences in symptom scores between the post-test and follow-up phases, the tDCS intervention maintained its effectiveness during the follow-up period. Conclusion: Both tDCS and short-term cognitive rehabilitation can be utilized to improve neuropsychological symptoms in older adults with mild Alzheimer’s disease. However, the sustained effects of tDCS during the follow-up period highlight its potential for longer-term benefits. tDCS short-term cognitive rehabilitation neuropsychological symptoms Alzheimer’s disease older adults Figures Figure 1 Introduction Life expectancy has been increasing globally due to advancements in medical science and improved health standards, leading to a rapid growth in the elderly population worldwide (Cai et al., 2022). Aging is an inevitable phenomenon and a part of the natural life cycle (Chobe et al., 2020 ). According to the World Health Organization (WHO), individuals aged 60 and above are considered elderly (Konda et al., 2019 ). The proportion of people aged 65 and older was 9% in 2019, and it is projected to rise to 12% by 2030, 16% by 2050, and 23% by 2100 globally (World Health Organization, 2011). This creates significant challenges for societies and healthcare systems (Ntanasi et al., 2020 ). Currently, one of the critical challenges in any society is how to prevent and care for the elderly who experience a decline in abilities, particularly cognitive abilities, as they age. Cognitive impairments are among the most common problems faced by the elderly. It is estimated that the prevalence of cognitive impairments among individuals aged 80 and older is 4.4% higher than the general population (Ren et al., 2018 ). Alzheimer’s disease is one of the most common cognitive disorders. Alzheimer's is a progressive and irreversible neurological disease that is increasing rapidly and is considered an epidemic globally. Age is one of the main risk factors for this disease, and with the global growth in aging populations, the number of individuals affected by Alzheimer's is expected to rise in the coming years (Jafarjalal et al., 2017 ). The World Alzheimer Report in 2019 indicated that someone develops dementia every three seconds worldwide, yet most of these individuals remain undiagnosed and unsupported. The annual cost of dementia is $ 1 trillion, projected to double by 2030 (World Alzheimer’s Association, 2019). Globally, 70% of those suffering from dementia have Alzheimer's disease, the most common type of dementia (Sosa-Ortiz et al., 2012 ). Iran also faces this challenge. Statistics suggest that 115 million people worldwide will be affected by this disease by 2050. According to the Iranian Alzheimer’s Association, there are no precise figures for the number of Alzheimer’s patients in the country, but it is estimated that between 300,000 and 450,000 individuals in Iran are affected (Jafarjalal et al., 2017 ). Based on the latest WHO report in 2015, the global prevalence of Alzheimer’s was estimated at approximately 46.8 million people. It is predicted that this number will reach 74.7 million by 2030 and 131.5 million by 2050. The economic burden of this disease in 2015 was about $ 818 billion, with $ 22.9 million in Asia, $ 10.5 million in Europe, $ 9.4 million in America, and $ 4 million in Africa. By 2030, this figure is expected to rise to $ 2 trillion. Additionally, it has been determined that direct and indirect care costs together account for approximately 0.65% of global GDP (World Health Organization, 2015). Individuals with Alzheimer’s disease experience various consequences due to the brain damage associated with this illness (Association, 2017). One of the most common consequences in these patients is the prevalence of neuropsychiatric symptoms, reported to affect 95% of patients (Allegri et al., 2006 ; Aarsland et al., 2007 ). Recent growing evidence suggests that psychiatric symptoms in Alzheimer’s patients primarily reflect pathological changes associated with the disease (Daniel et al., 1998). These symptoms, considered fundamental manifestations of dementia, have significant clinical implications for the quality of life of patients and their caregivers (Aarsland et al., 2001 ). For example, patients with dementia and delusions are more likely to experience violence and aggression compared to those without delusions. Furthermore, caregivers are more likely to exhibit abusive behavior toward patients with aggressive symptoms than toward healthier patients (Jeffrey & Cummings, 1997 ). Thus, the psychiatric symptoms associated with Alzheimer’s, which are considered non-cognitive manifestations of the disease and increasingly recognized as a primary contributor to the burden on patients and caregivers, impose a significant toll on patients and substantially increase the pressure on caregivers (Gauthier et al., 2005 ). Individuals with Alzheimer's disease experience a variety of consequences due to the brain damage associated with the disease (Alzheimer's Association, 2017), with one of the most common outcomes being the prevalence of neuropsychological symptoms, reported to occur in 95% of these patients (Algeri et al., 2006; Arseland et al., 2007). Recent growing evidence indicates that psychological symptoms in Alzheimer's patients predominantly reflect pathological changes associated with the disease (Daniel et al., 1998). These symptoms, which are considered fundamental manifestations of dementia, have significant clinical consequences for the quality of life of both patients and their caregivers (Arseland & Jeffrey, 2001). The presence of these symptoms in Alzheimer's patients leads to various outcomes, such as the simultaneous occurrence of delirium, increased exposure to violence and aggression compared to non-delirious patients, and a higher likelihood of caregiver mistreatment of patients exhibiting "aggressive" symptoms, compared to healthy individuals (Jeffrey & Cumming, 1997). Therefore, the psychological symptoms related to Alzheimer's, which are categorized as non-cognitive manifestations of the disease, have increasingly been recognized as one of the primary factors contributing to the burden on both patients and their caregivers, thereby exacerbating the stress experienced by caregivers (Gassir et al., 2005). Among the treatments that may be effective in improving neuropsychological symptoms is transcranial direct current stimulation (tDCS), which is advantageous due to its simplicity, lack of side effects, short treatment duration, low cost, and the fact that it is a non-pharmacological treatment, free from the side effects of chemical drugs (Westwood et al., 2020). Transcranial brain stimulation is used to control neuronal excitability by passing a small current through an electrode placed on the scalp. Anodal stimulation increases cortical activity by bringing the resting potential closer to the threshold potential, while cathodal stimulation reduces excitability by separating the resting potential from the threshold potential (Nejati, 2019). This non-invasive brain stimulation method, using a weak electrical current applied to the skull, induces temporary changes in cortical excitability (Huynh Lai, 2020). Applying this method to the left dorsolateral prefrontal cortex increases parasympathetic activity and reduces sympathetic activity, leading to improved cognitive function (Ahmadizadeh & Rezaei, 2020). Since brain activity regulation affects cognitive functions, particularly memory, planning, attention, and information processing, clinical applications of the dorsolateral prefrontal cortex for central nervous system disorders and cognitive improvement are under investigation. The most common protocol for transcranial brain stimulation, involving placing the anode on the left dorsolateral prefrontal cortex and the cathode on the right side, has been shown to improve working memory, cognitive performance, and mental state (Huynh Lai, 2020). Another method used for rehabilitation is cognitive rehabilitation protocols. Cognitive rehabilitation is a term used for the treatment and restoration of cognitive disorders, with the primary goal of improving deficits in cognitive functions such as memory, executive function, social cognition, and attention. Cognitive rehabilitation treatment is based on principles of neuroplasticity and involves targeted exercises to enhance various cognitive areas such as memory, attention, language, and executive functions (Burgo et al., 2016). Cognitive rehabilitation programs are designed for patients with cognitive impairments, and they include exercises aimed at improving cognitive processes. Studies have shown that these cognitive training programs are effective in reducing cognitive deficits and even improving cognitive performance in healthy older adults, as well as those with mild cognitive impairment and dementia (Mirzaei et al., 2020 ). Given that the care of Alzheimer's patients requires significant time and resources, creating numerous challenges for both the patient and their family, early diagnosis and treatment can help slow disease progression, delay the decline in individual functional ability, reduce treatment costs, and ease the burden on caregivers (Lambert et al., 2014 ). On the other hand, due to the limited research conducted in Iran on the effectiveness of transcranial brain stimulation in the prefrontal cortex in elderly individuals with Alzheimer's and the fact that most cognitive rehabilitation protocols are long-term and require many sessions, this study seeks to answer the question of whether there is a significant difference in the effectiveness of cognitive rehabilitation programs and transcranial direct current stimulation (tDCS) in addressing neuropsychological symptoms in elderly patients with mild Alzheimer's disease. Method The method of this study is a quasi-experimental design with two experimental groups and one control group, utilizing a pre-test and post-test approach. The target population of this study includes all elderly individuals over 65 years old diagnosed with mild Alzheimer's disease who visited a neurologist's office in 2022. The sample size consisted of 60 participants, selected through convenience sampling and then randomly assigned (via lottery) to two experimental groups and one control group (20 participants in each group), as shown in Flowchart 1. As shown in Fig. 1 , The independent variables in this study include brain electrical stimulation with direct current (tDCS) for 10 sessions, each lasting 20 minutes, administered once a week to one experimental group. The second experimental group underwent a short-term cognitive rehabilitation program consisting of 9 sessions (each lasting 90 minutes), designed using the Luria's (1963) functional substitution approach and based on a documentary method, as outlined in Table 1 . After the content validity of the program was confirmed by experts, it was applied weekly to the second experimental group. The third group received no intervention. After the interventions were completed, a post-test was conducted one week later for both experimental groups and the control group. It is worth noting that the study groups were followed up after one month. Inclusion criteria for the study were: no heart disease, no head injuries or cuts, informed willingness to participate, no contagious diseases, no terminal illnesses such as cancer, and no history of epilepsy. The exclusion criteria were: presence of personality disorders, history of substance abuse or addiction, or receiving psychological services at other centers during the study. To ensure ethical research practices, the research objective and confidentiality were explained to the participants, and their informed consent was obtained. Additionally, after the study, both the control group and the experimental groups were provided with the treatment methods (tDCS and the short-term cognitive rehabilitation protocol), as no significant difference in effectiveness was found between the two methods. For data collection, the Neuropsychological Inventory (NPI) questionnaire was used. This tool evaluates non-psychological symptoms of dementia patients and is also applied in vascular dementia and other neurological disorders in the elderly. The NPI includes 12 subscales, and scores above 6 indicate the presence of the respective symptoms )Cummings et al, 1994 ). Compared to other psychological symptom assessment tools, the NPI has several advantages, such as covering a wider range of psychopathological symptoms and assessing common behavioral changes associated with dementia, including irritability, euphoria, and apathy. Additionally, scoring for the 12 items of the NPI is done based on caregiver reports, avoiding issues related to asking questions directly to patients or relying on observed behaviors in a short time frame )Cummings et al, 1994 ). The reliability of this tool is considered good, with high test-retest correlations reported for frequency (0.79) and intensity (0.86) of symptoms. Furthermore, the inter-rater reliability for the aggression subscale was 0.98, for depression was 0.95, for anxiety was 0.97, and for apathy was 1.00, among other subscales. Internal consistency coefficients (Cronbach's alpha) for each of the 12 subscales and the total score ranged from 0.63 to 0.91. The rehabilitation protocol is provided in Table 1 . Table 1 Cognitive Skills Enhancement Rehabilitation Protocol Sessions Objective Content Time (minutes) 1 Introduction to the patient, familiarizing the patient with the treatment environment and therapist, establishing rapport, administering pre-test Mutual introduction of the patient and therapist, familiarizing the patient with the treatment setting, discussing the treatment process, creating readiness in the patient, establishing rapport, administering pre-test 90 2 Memory enhancement Remembering images, remembering names of people, chunking 90 3 Memory training, attention and orientation skills enhancement Remembering events, performing the "count the 'h's" and "'w's" exercise, word search (part 1) 90 4 Attention and orientation skills training, verbal fluency enhancement Word search (part 2), letter cues exercise, category cues exercise 90 5 Verbal fluency training, language and thinking skills enhancement Animal and color categories exercise, word reversal, proverbs, category differentiation (part 1) 90 6 Language and thinking skills training, visual-spatial ability enhancement Category differentiation (part 2), matching logos, remembering patterns, matching traffic signs 90 7 Review of memory, attention, and orientation skills Iranian restaurant exercise, ordering and shopping from a supermarket, finding Persian numbers within words 90 8 Review of verbal fluency, language, and visual-spatial skills Name cues exercise, proverbs and situations, matching animals 90 9 Closing session and administering post-test Final discussion with the patient and closing ceremony, administering post-test 90 Statistical Analysis In the descriptive analysis section, indicators such as frequency, mean, and standard deviation of the scores were reported. For inferential analysis, a repeated measures analysis of variance (ANOVA) was performed using SPSS-23. The significance level of 0.05 was considered for all variables. Findings The demographic information of the participants in the study, such as age, gender, economic status, and marital status, is reported in Table 2 , categorized by groups. Table 2 Demographic Information of Study Participants Categorized by Groups Demographic Information Percentage and Frequency Percentage and Frequency Percentage and Frequency Age 65 to 70 0.15% (3) 0.15% (3) 0.20% (4) 70 to 75 0.70% (14) 0.75% (15) 0.70% (14) 75 and above 0.15% (3) 0.10% (2) 0.10% (2) Gender Female 0.55% (11) 0.50% (10) 0.45% (9) Male 0.45% (9) 0.50% (10) 0.55% (11) Economic Status Low 0.10% (2) 0.10% (2) 0.15% (3) Average 0.85% (17) 0.80% (16) 0.80% (16) High 0.50% (1) 0.10% (2) 0.50% (1) Marital Status Single 0.10% (2) 0.10% (2) 0.15% (3) Married 0.85% (17) 0.80% (16) 0.80% (16) Divorced 0.50% (1) 0.50% (1) 0.50% (1) Widowed 0% (0) 0% (0) 0.50% (1) Descriptive statistics (mean and standard deviation) for the subscales of neuropsychological symptoms, including "Hallucinations," "Delusions," "Aggression," "Depression," "Anxiety," "Euphoria," "Apathy," "Inhibition," "Irritability," "Motor Behavior," "Nocturnal Behavior," and "Appetite," are reported for the three groups (Control, Short-Term Cognitive Rehabilitation Program, and tDCS) at three time points (Pre-Test, Post-Test, and Follow-Up) in Table 3 . Table 3 Descriptive Statistics of Neuropsychological Symptoms by Group and Time (Mean and Standard Deviation) Variable Group Pre-Test Post-Test Follow-Up Hallucination Control (3.27) 2.89 (3.27) 2.99 (3.27) 2.99 Cognitive Rehab (1.00) 1.96 (0.93) 1.87 (0.87) 1.88 tDCS (0.21) 0.58 (0.21) 0.58 (0.21) 0.80 Delusion Control (1.20) 2.34 (1.80) 3.55 (1.80) 3.55 Cognitive Rehab (1.19) 0.53 (0.47) 0.99 (0.60) 1.30 tDCS (0.57) 1.65 (0.64) 1.65 (0.29) 0.73 Aggression Control (8.87) 4.53 (8.33) 4.40 (8.00) 3.82 Cognitive Rehab (9.60) 4.29 (4.53) 2.67 (4.60) 2.95 tDCS (3.21) 3.38 (2.43) 2.85 (2.50) 2.24 Depression Control (5.73) 4.77 (6.20) 4.77 (6.27) 4.80 Cognitive Rehab (8.73) 3.90 (3.20) 1.66 (4.07) 2.05 tDCS (11.64) 2.41 (4.00) 0.96 (4.57) 1.70 Anxiety Control (8.53) 2.75 (8.07) 2.40 (7.93) 2.46 Cognitive Rehab (8.53) 2.75 (3.07) 1.71 (3.60) 1.96 tDCS (9.43) 2.21 (3.57) 1.09 (3.29) 1.44 Euphoria Control (0.00) 0.00 (0.00) 0.00 (3.73) 3.51 Cognitive Rehab (3.60) 3.07 (3.40) 2.87 (3.93) 2.94 tDCS (0.36) 0.93 (0.29) 0.73 (0.43) 1.16 Indifference Control (3.13) 3.14 (3.67) 3.33 (3.73) 3.51 Cognitive Rehab (2.93) 3.08 (2.73) 2.99 (2.73) 3.08 tDCS (10.71) 2.79 (3.93) 2.23 (3.57) 2.62 Inhibition Control (2.81) 2.81 (2.87) 2.59 (2.93) 2.69 Cognitive Rehab (9.33) 2.85 (3.73) 1.79 (4.47) 1.96 tDCS (3.71) 3.58 (2.71) 2.76 (2.71) 2.76 Irritability Control (3.67) 4.65 (3.60) 4.22 (3.47) 3.80 Cognitive Rehab (4.87) 3.78 (4.20) 3.19 (4.07) 3.61 tDCS (8.93) 1.94 (3.57) 1.34 (3.86) 1.41 Motor Symptoms Control (1.73) 2.25 (2.13) 2.77 (2.27) 3.01 Cognitive Rehab (2.33) 3.11 (2.07) 2.84 (2.20) 2.88 tDCS (2.29) 2.92 (2.07) 2.56 (1.86) 2.77 Nocturnal Behavior Control (3.93) 2.63 (4.00) 2.62 (3.93) 2.58 Cognitive Rehab (2.27) 3.37 (2.13) 3.16 (2.00) 3.02 tDCS (2.43) 3.15 (2.29) 3.22 (2.14) 3.08 Appetite Control (3.47) 2.56 (3.33) 2.35 (3.27) 2.34 Cognitive Rehab (8.40) 2.35 (3.40) 1.99 (9.13) 2.23 tDCS (4.93) 3.91 (4.64) 3.73 (4.21) 3.81 Total Symptoms Control (3.76) 0.83 (3.94) 0.81 (3.91) 0.77 Cognitive Rehab (5.18) 1.15 (2.82) 0.68 (3.52) 0.88 tDCS (4.89) 0.70 (2.54) 0.56 (2.49) 0.46 The results of the multivariate Wilks test are reported in Table 4 . Based on the results obtained from Table 4 , at least one linear combination of the 12 sub-indicators "hallucination," "delusion," "aggression," "depression," "anxiety," "euphoria," "indifference," "inhibition," "irritability," "motor," "night behavior," and "appetite" showed a significant difference at the 0.95 confidence level, both between the three groups and across the different time points. Additionally, the interaction effect between group and time was significant, meaning that either there was a significant difference between the means of the three groups at the same time points or, within each group, there was a significant difference between the means across the three time points. Table 4 Results of the Multivariate Wilks Test for Neuropsychological Symptoms Group Time Group*Time Significance of the Multivariate Wilks Test 0.000 0.000 0.000 Table 5 Results of the Mauchly Test and Equality of Means Test for Neuropsychological Symptoms Variable Mauchly's Test Significance Epsilon Test Used Time Significance (Effect Size) Group*Time Significance (Effect Size) Hallucination 0.005 0.883 Huynh-Feldt (0.033) 0.245 (0.120) 0.034 Delusion 0.007 0.894 Huynh-Feldt (0.005) 0.779 (0.010) 0.911 Aggression 0.004 0.873 Huynh-Feldt (0.558) 0.000 (0.535) 0.000 Depression 0 0.64 Greenhouse-Geisser (0.805) 0.000 (0.740) 0.000 Anxiety 0 0.769 Huynh-Feldt (0.809) 0.000 (0.760) 0.000 Euphoria 0 0.613 Greenhouse-Geisser (0.058) 0.107 (0.042) 0.422 Indifference 0.001 0.848 Huynh-Feldt (0.708) 0.000 (0.852) 0.000 Inhibition 0.001 0.843 Huynh-Feldt (0.600) 0.000 (0.648) 0.000 Irritability 0.039 0.95 Huynh-Feldt (0.678) 0.000 (0.727) 0.000 Motor 0.04 0.951 Huynh-Feldt (0.000) 0.980 (0.099) 0.068 Nocturnal Behavior 0.628 1 Assumed Sphericity (0.045) 0.146 (0.026) 0.688 Appetite 0.332 1 Assumed Sphericity (0.556) 0.000 (0.727) 0.000 Based on the results of the Mauchly’s test, the sphericity assumption was only not rejected for the two indicators "Nocturnal Behavior" and "Appetite" at a 95% confidence level, and as a result, the equality of means for these two variables was reported with the assumption of sphericity. For the other indicators, except for "Depression" and "Euphoria", the Hayn-Feldt test was used (Table 5 ). The results of these tests indicated that, except for four indicators—"Delusions", "Euphoria", "Motor", and "Nocturnal Behavior", there was a significant difference between the three test times for the other indicators. The effect size (eta-squared) for the indicators "Aggression", "Depression", "Anxiety", "Euphoria", "Apathy", "Inhibition", "Irritability", and "Appetite" were 0.558, 0.805, 0.809, 0.708, 0.600, 0.678, and 0.556, respectively. Considering the effect size, the greatest differences between times were found for the indicators "Anxiety" and "Depression". The interaction effect between time and the experimental groups for the four indicators "Delusions", "Euphoria", "Motor", and "Nocturnal Behavior" was not significant. This means that there were no significant differences in means either within the groups at the three time points or between the three groups at each time point. In other words, none of the methods studied had an effect on the four indicators "Delusions", "Euphoria", "Motor", and "Nocturnal Behavior" related to neuropsychological symptoms. Furthermore, regardless of the research time, based on the Bonferroni post hoc test, the means of the "Hallucination" indicator in the control group differed significantly from the two methods "Short-Term Cognitive Rehabilitation Program" (P = 0.010) and TDCS method (P = 0.001). The means of the "Aggression" indicator in the control group differed significantly from the two methods "Short-Term Cognitive Rehabilitation Program" (P = 0.015) and TDCS method (P = 0.000). The means of the "Anxiety" indicator in the control group differed significantly from the two methods "Short-Term Cognitive Rehabilitation Program" (P = 0.002) and TDCS method (P = 0.005). The means of the "Euphoria" indicator in the "Short-Term Cognitive Rehabilitation Program" differed significantly from both the TDCS method (P = 0.000) and the control group (P = 0.000). The means of the "Apathy" indicator in the TDCS method differed significantly from the "Short-Term Cognitive Rehabilitation Program" (P = 0.008). The means of the "Inhibition" indicator in the TDCS method differed significantly from the "Short-Term Cognitive Rehabilitation Program" (P = 0.008). The means of the "Appetite" indicator in the "Short-Term Cognitive Rehabilitation Program" differed significantly from the control group (P = 0.002). To examine the interaction effects between time and group for the eight indicators "Hallucination", "Aggression", "Depression", "Anxiety", "Apathy", "Inhibition", "Irritability", and "Appetite", depending on whether the variances between groups were homogeneous or not, the Tukey post hoc test or the Dunnett T3 post hoc test was used to compare pairwise means between the experimental groups at the three different times. The Bonferroni post hoc test was also used for pairwise comparisons of means across three time points for the three groups. The results of these tests are reported in Tables 6 and 7 . Variable Post-hoc Post-test Follow-up Period Test Results (Pairwise Mean Comparisons) Hallucination Dunnett T3 Test Dunnett T3 Test Short-Control (P = 0.049) Short-Control (P = 0.043) TDCS-Control (P = 0.004) TDCS-Control (P = 0.004) Aggression Tukey Test Tukey Test Short-Control (P = 0.010) Short-Control (P = 0.011) TDCS-Control (P = 0.000) TDCS-Control (P = 0.000) Depression Dunnett T3 Test Dunnett T3 Test None were significant None were significant Anxiety Tukey Test Tukey Test Short-Control (P = 0.000) Short-Control (P = 0.010) TDCS-Control (P = 0.000) TDCS-Control (P = 0.000) Apathy Dunnett T3 Test Tukey Test None were significant None were significant Inhibition Dunnett T3 Test Tukey Test None were significant None were significant Irritability Dunnett T3 Test Dunnett T3 Test None were significant None were significant Appetite Dunnett T3 Test Dunnett T3 Test None were significant Short-Control (P = 0.000) Short-TDCS (P = 0.001) Based on the results reported in Table 6, there was no significant difference between the mean scores of the "short-term" and TDCS methods and the control group for any of the "depression," "apathy," "inhibition," and "irritability" variables in both the post-test and follow-up period. Additionally, for the "hallucination," "aggression," and "anxiety" variables, both methods performed similarly in the post-test and follow-up period and showed significant differences compared to the control group. However, for the "appetite" variable, the TDCS method did not show significant results, and only the "short-term" method had a significant effect in the follow-up period. Table 7 Post-hoc Bonferroni Tests Between Three Time Points by Experimental Groups for Neuropsychological Symptoms Variable Control Group Short-term Group TDCS Group Aggression - Pre-Post (P = 0.000) Pre-PP (P = 0.000) Depression - Pre-Post (P = 0.000) Pre-PP (P = 0.000) Pre-PP (P = 0.000) Pre-Post (P = 0.000) Anxiety - Pre-Post (P = 0.000) Pre-PP (P = 0.000) Pre-PP (P = 0.000) Pre-Post (P = 0.000) Indifference - - Pre-Post (P = 0.000) Inhibition - Pre-Post (P = 0.000) Pre-PP (P = 0.000) Irritability - - Pre-Post (P = 0.000) Post-PP (P = 0.000) Appetite - Pre-Post (P = 0.000) Post-PP (P = 0.000) Neuropsychological Symptoms Pre-Post (P = 0.000) Pre-Post (P = 0.000) Pre-PP (P = 0.000) Pre-PP (P = 0.000) Pre-Post (P = 0.000) According to the results reported in Table 7 , both the "short-term" and TDCS methods led to a significant improvement in the "aggression" index during the follow-up period. However, the effect of TDCS on this variable was not significant in the post-test, while the short-term method showed significant improvement. Both methods, "short-term" and TDCS, resulted in a significant reduction in the "depression" index in both post-test and follow-up periods. The only difference between these two methods in this variable is that, unlike the TDCS method, the "short-term" method was not able to maintain its reduction effect from the post-test period in the follow-up. Both the "short-term" and TDCS methods resulted in a significant improvement in the "anxiety" index in both post-test and follow-up periods. Regarding the "indifference" and "irritability" indices, it should be noted that, unlike the "short-term" method, which showed no significant effect, the TDCS method had a significant effect during the post-test period. While the TDCS method also showed a significant effect on "indifference" during the follow-up period, it was unable to replicate the same effect on the "irritability" index during the follow-up. Regarding the "inhibition" and "appetite" indices, it should be mentioned that, unlike the previous two indices, the TDCS method did not show a significant effect in either period, and it was the "short-term" method that showed a significant effect in the post-test. The "short-term" method also had a significant effect on the "inhibition" index during the follow-up period, although it did not have a significant effect on the "appetite" index during the follow-up period. In summary, both the "short-term" and TDCS methods resulted in a significant improvement in "neuropsychological symptoms" in both the post-test and follow-up periods. The difference between these two methods is that, unlike the "short-term cognitive rehabilitation" method, where there was a significant difference between the post-test and follow-up periods in neuropsychological symptoms, the TDCS method was able to maintain its effect on neuropsychological symptoms during the follow-up period. Discussion This study compared the effectiveness of transcranial direct current stimulation (tDCS) and a short-term cognitive rehabilitation protocol on neuropsychological symptoms in older adults with mild Alzheimer’s disease, testing twelve hypotheses related to specific symptom indices. The findings revealed that both interventions had varying degrees of efficacy, with distinct patterns of effectiveness and sustainability, which are analyzed below in a cohesive framework. The first, fourth, fifth, sixth, tenth, and eleventh hypotheses (hallucinations, depression, anxiety, elation, motor behavior, nocturnal behavior) were rejected, as both interventions showed either similar efficacy or no effect. Specifically, tDCS and cognitive rehabilitation equally improved hallucinations, anxiety, and depression at post-test and follow-up (p 0.05). The third, seventh, eighth, ninth, and twelfth hypotheses (aggression, apathy, inhibition, irritability, appetite) were supported due to differential effectiveness. Cognitive rehabilitation was effective for aggression and inhibition at both post-test and follow-up (p < 0.01), and for appetite at post-test (p < 0.05), while tDCS was effective for aggression only at follow-up (p < 0.05), apathy at both time points (p < 0.01), and irritability at post-test (p < 0.05). Notably, tDCS maintained its effects on depression and apathy better at follow-up compared to cognitive rehabilitation. These results align partially with prior research. The efficacy of tDCS on depression and apathy corroborates Rahmatinejad et al. ( 2023 ), Mojarrad et al. (2023), and Benussi et al. ( 2020 ), who linked tDCS’s benefits to prefrontal cortex stimulation. However, the sustained effect of cognitive rehabilitation on inhibition contrasts with Chamil et al. (2024), who reported limited durability, possibly due to the structured protocol used here. The lack of effect on delusions and elation aligns with Montoya-Morillo et al. (2020) and Mofa et al. (2020), who noted these symptoms’ resistance to non-pharmacological interventions due to subcortical dopaminergic deficits (Stein et al., 2020 ). The delayed effect of tDCS on aggression supports Benabi & Hoffen (2018) and Sampaio-Júnior et al. (2018), suggesting gradual neuromodulation of regulatory networks. Cultural factors, such as strong family support systems in Iran, may have enhanced responses to emotional symptoms like depression and anxiety (Mokhtari et al., 2023 ), warranting further investigation. The efficacy of tDCS aligns with the glutamate hypothesis, which attributes neuropsychological symptoms to glutamate dysfunction (Gonzalez-Maiso et al., 2008). tDCS likely modulates mGLUR2 receptor activity, enhancing glutamatergic transmission and reducing symptoms like apathy and depression. Stimulation of the prefrontal cortex increases excitability in cognitive networks, improving motivational and emotional regulation (Benussi et al., 2020 ). Cognitive rehabilitation’s effectiveness, particularly for inhibition and aggression, supports neuroplasticity models, as structured exercises strengthen fronto-striatal circuits critical for executive function (Amini et al., 2013 ). The superior sustainability of tDCS effects may reflect its direct neuromodulatory mechanism, compared to the practice-dependent nature of cognitive rehabilitation, which requires ongoing sessions to maintain gains. The study’s reliance on convenience sampling limited generalizability to broader populations. The short-term cognitive rehabilitation protocol may have contributed to the lack of sustained effects for some symptoms, such as depression and appetite. Self- or caregiver-reported measures introduced potential recall or social desirability biases. Future studies should employ randomized sampling to enhance external validity and explore combined tDCS and cognitive rehabilitation protocols for potential synergistic effects. Longitudinal designs are recommended to assess long-term impacts on disease progression and quality of life. Investigating cultural and socioeconomic moderators, such as family support in Iran, could refine intervention applicability across diverse populations. tDCS and short-term cognitive rehabilitation are effective non-pharmacological interventions for managing specific neuropsychological symptoms in mild Alzheimer’s, including hallucinations, anxiety, depression, aggression, apathy, inhibition, irritability, and appetite. tDCS is particularly suited for sustained management of depression and apathy, while cognitive rehabilitation excels for immediate improvements in inhibition and aggression. Their non-invasive nature and low cost make them viable for resource-limited settings like Iran, enabling integration into personalized, multidisciplinary treatment plans. Conclusion This study aimed to compare the effectiveness of transcranial direct current stimulation (tDCS) and a short-term cognitive rehabilitation protocol on neuropsychological symptoms in older adults with mild Alzheimer’s disease. The findings confirmed that both tDCS and short-term cognitive rehabilitation were equally effective in improving hallucinations, anxiety, and depression at post-test and follow-up, with significant differences compared to the control group. However, neither intervention significantly impacted delusions, elation, motor behavior, or nocturnal behavior. For aggression, short-term cognitive rehabilitation was effective at both post-test and follow-up, while tDCS showed significant effects only at follow-up. For apathy, tDCS was effective at both post-test and follow-up, whereas short-term cognitive rehabilitation showed no significant effect. For inhibition, short-term cognitive rehabilitation was effective at both time points, while tDCS had no effect. For irritability, tDCS was effective only at post-test, and for appetite, short-term cognitive rehabilitation was effective only at post-test. Notably, tDCS better maintained its effectiveness for depression and apathy at follow-up compared to short-term cognitive rehabilitation. However, the use of convenience sampling limited the generalizability of the findings to broader populations. These results underscore the potential of tDCS and short-term cognitive rehabilitation as effective interventions for improving specific neuropsychological symptoms in mild Alzheimer’s disease, highlighting their importance for inclusion in therapeutic and rehabilitative programs. Declarations Translation was performed using Grok and ChatGPT tools. However, no generative artificial intelligence tools were used in the preparation of the manuscript itself, including the discussion section. All content was developed by the research team based on the study findings and relevant literature. Ethics Approval The ethical principles of this study were approved by the Ethics Committee of the University of Mohaghegh Ardabili (Code: IR.UMA.REC.1401.008). Consent to Participate All participants provided written informed consent to participate in this study in accordance with the ethical standards of the University of Mohaghegh Ardabili Ethics Committee. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Clinical Trial Number Clinical trial number: not applicable. Data Availability The data supporting the findings of this study are not publicly available due to ethical considerations and participant privacy. However, upon approval from the Ethics Committee, the relevant data will be made available upon request, subject to ethical and legal requirements. Conflict of Interest The authors declare that they have no financial or professional conflicts of interest regarding the research, authorship, and/or publication of this article. Acknowledgments This research is derived from the first author's doctoral dissertation. The authors wish to express their sincere gratitude to the University of Mohaghegh Ardabili for its support. Special thanks are extended to all the participants in this study for their invaluable contributions. Ethics Approval and Consent to Participate This study was conducted in accordance with the principles of the Declaration of Helsinki, which outlines the ethical guidelines for medical research involving human participants. All participants provided informed and voluntary consent. The study protocol was approved by the Ethics Committee of the University of Mohaghegh Ardabili, and all procedures were designed to ensure the safety, dignity, privacy, and rights of the participants. 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World Health Organization (WHO). World report on ageing and health. World Health Organization; 2015. World Health Organization. 10 facts on ageing and the life course [Online ]. [cited 2011]. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 12 Dec, 2025 Editor assigned by journal 08 Dec, 2025 Editor invited by journal 17 Nov, 2025 Submission checks completed at journal 17 Nov, 2025 First submitted to journal 10 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7948462","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":560424242,"identity":"2e54ed11-92bb-4b3b-bfd9-615ebd4b4a3f","order_by":0,"name":"Arezoo Mojarrad","email":"","orcid":"","institution":"University of Mohaghegh Ardabili","correspondingAuthor":false,"prefix":"","firstName":"Arezoo","middleName":"","lastName":"Mojarrad","suffix":""},{"id":560424245,"identity":"94276b89-e7d4-4749-ae03-f00b42e7cca5","order_by":1,"name":"Esmaeil Sadri 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09:21:33","extension":"html","order_by":23,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":162583,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7948462/v1/f61ef2c37f4e74edd474e249.html"},{"id":98753354,"identity":"8b624825-9d36-441a-a4ad-824b3cadf39e","added_by":"auto","created_at":"2025-12-22 09:21:33","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":88866,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCONSORT flow diagram\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7948462/v1/69580988d6807ded4a0c83e7.jpg"},{"id":98785990,"identity":"54fb41d7-870e-47ca-adc5-cb0c2498bfda","added_by":"auto","created_at":"2025-12-22 12:43:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1287104,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7948462/v1/0e64805d-edb5-423f-b83a-d8972db5a502.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Transcranial Direct Current Stimulation and Cognitive Rehabilitation: Two Distinct Treatments for Improving Neuropsychological Symptoms in Older Adults with Mild Alzheimer’s Disease","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLife expectancy has been increasing globally due to advancements in medical science and improved health standards, leading to a rapid growth in the elderly population worldwide (Cai et al., 2022). Aging is an inevitable phenomenon and a part of the natural life cycle (Chobe et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). According to the World Health Organization (WHO), individuals aged 60 and above are considered elderly (Konda et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The proportion of people aged 65 and older was 9% in 2019, and it is projected to rise to 12% by 2030, 16% by 2050, and 23% by 2100 globally (World Health Organization, 2011). This creates significant challenges for societies and healthcare systems (Ntanasi et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Currently, one of the critical challenges in any society is how to prevent and care for the elderly who experience a decline in abilities, particularly cognitive abilities, as they age. Cognitive impairments are among the most common problems faced by the elderly. It is estimated that the prevalence of cognitive impairments among individuals aged 80 and older is 4.4% higher than the general population (Ren et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Alzheimer\u0026rsquo;s disease is one of the most common cognitive disorders. Alzheimer's is a progressive and irreversible neurological disease that is increasing rapidly and is considered an epidemic globally. Age is one of the main risk factors for this disease, and with the global growth in aging populations, the number of individuals affected by Alzheimer's is expected to rise in the coming years (Jafarjalal et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The World Alzheimer Report in 2019 indicated that someone develops dementia every three seconds worldwide, yet most of these individuals remain undiagnosed and unsupported. The annual cost of dementia is \u003cspan\u003e$\u003c/span\u003e1 trillion, projected to double by 2030 (World Alzheimer\u0026rsquo;s Association, 2019). Globally, 70% of those suffering from dementia have Alzheimer's disease, the most common type of dementia (Sosa-Ortiz et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Iran also faces this challenge. Statistics suggest that 115\u0026nbsp;million people worldwide will be affected by this disease by 2050. According to the Iranian Alzheimer\u0026rsquo;s Association, there are no precise figures for the number of Alzheimer\u0026rsquo;s patients in the country, but it is estimated that between 300,000 and 450,000 individuals in Iran are affected (Jafarjalal et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Based on the latest WHO report in 2015, the global prevalence of Alzheimer\u0026rsquo;s was estimated at approximately 46.8\u0026nbsp;million people. It is predicted that this number will reach 74.7\u0026nbsp;million by 2030 and 131.5\u0026nbsp;million by 2050. The economic burden of this disease in 2015 was about \u003cspan\u003e$\u003c/span\u003e818\u0026nbsp;billion, with \u003cspan\u003e$\u003c/span\u003e22.9\u0026nbsp;million in Asia, \u003cspan\u003e$\u003c/span\u003e10.5\u0026nbsp;million in Europe, \u003cspan\u003e$\u003c/span\u003e9.4\u0026nbsp;million in America, and \u003cspan\u003e$\u003c/span\u003e4\u0026nbsp;million in Africa. By 2030, this figure is expected to rise to \u003cspan\u003e$\u003c/span\u003e2 trillion. Additionally, it has been determined that direct and indirect care costs together account for approximately 0.65% of global GDP (World Health Organization, 2015).\u003c/p\u003e \u003cp\u003eIndividuals with Alzheimer\u0026rsquo;s disease experience various consequences due to the brain damage associated with this illness (Association, 2017). One of the most common consequences in these patients is the prevalence of neuropsychiatric symptoms, reported to affect 95% of patients (Allegri et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Aarsland et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Recent growing evidence suggests that psychiatric symptoms in Alzheimer\u0026rsquo;s patients primarily reflect pathological changes associated with the disease (Daniel et al., 1998). These symptoms, considered fundamental manifestations of dementia, have significant clinical implications for the quality of life of patients and their caregivers (Aarsland et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). For example, patients with dementia and delusions are more likely to experience violence and aggression compared to those without delusions. Furthermore, caregivers are more likely to exhibit abusive behavior toward patients with aggressive symptoms than toward healthier patients (Jeffrey \u0026amp; Cummings, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1997\u003c/span\u003e). Thus, the psychiatric symptoms associated with Alzheimer\u0026rsquo;s, which are considered non-cognitive manifestations of the disease and increasingly recognized as a primary contributor to the burden on patients and caregivers, impose a significant toll on patients and substantially increase the pressure on caregivers (Gauthier et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2005\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIndividuals with Alzheimer's disease experience a variety of consequences due to the brain damage associated with the disease (Alzheimer's Association, 2017), with one of the most common outcomes being the prevalence of neuropsychological symptoms, reported to occur in 95% of these patients (Algeri et al., 2006; Arseland et al., 2007). Recent growing evidence indicates that psychological symptoms in Alzheimer's patients predominantly reflect pathological changes associated with the disease (Daniel et al., 1998). These symptoms, which are considered fundamental manifestations of dementia, have significant clinical consequences for the quality of life of both patients and their caregivers (Arseland \u0026amp; Jeffrey, 2001). The presence of these symptoms in Alzheimer's patients leads to various outcomes, such as the simultaneous occurrence of delirium, increased exposure to violence and aggression compared to non-delirious patients, and a higher likelihood of caregiver mistreatment of patients exhibiting \"aggressive\" symptoms, compared to healthy individuals (Jeffrey \u0026amp; Cumming, 1997). Therefore, the psychological symptoms related to Alzheimer's, which are categorized as non-cognitive manifestations of the disease, have increasingly been recognized as one of the primary factors contributing to the burden on both patients and their caregivers, thereby exacerbating the stress experienced by caregivers (Gassir et al., 2005).\u003c/p\u003e \u003cp\u003eAmong the treatments that may be effective in improving neuropsychological symptoms is transcranial direct current stimulation (tDCS), which is advantageous due to its simplicity, lack of side effects, short treatment duration, low cost, and the fact that it is a non-pharmacological treatment, free from the side effects of chemical drugs (Westwood et al., 2020). Transcranial brain stimulation is used to control neuronal excitability by passing a small current through an electrode placed on the scalp. Anodal stimulation increases cortical activity by bringing the resting potential closer to the threshold potential, while cathodal stimulation reduces excitability by separating the resting potential from the threshold potential (Nejati, 2019). This non-invasive brain stimulation method, using a weak electrical current applied to the skull, induces temporary changes in cortical excitability (Huynh Lai, 2020). Applying this method to the left dorsolateral prefrontal cortex increases parasympathetic activity and reduces sympathetic activity, leading to improved cognitive function (Ahmadizadeh \u0026amp; Rezaei, 2020). Since brain activity regulation affects cognitive functions, particularly memory, planning, attention, and information processing, clinical applications of the dorsolateral prefrontal cortex for central nervous system disorders and cognitive improvement are under investigation. The most common protocol for transcranial brain stimulation, involving placing the anode on the left dorsolateral prefrontal cortex and the cathode on the right side, has been shown to improve working memory, cognitive performance, and mental state (Huynh Lai, 2020).\u003c/p\u003e \u003cp\u003eAnother method used for rehabilitation is cognitive rehabilitation protocols. Cognitive rehabilitation is a term used for the treatment and restoration of cognitive disorders, with the primary goal of improving deficits in cognitive functions such as memory, executive function, social cognition, and attention. Cognitive rehabilitation treatment is based on principles of neuroplasticity and involves targeted exercises to enhance various cognitive areas such as memory, attention, language, and executive functions (Burgo et al., 2016). Cognitive rehabilitation programs are designed for patients with cognitive impairments, and they include exercises aimed at improving cognitive processes. Studies have shown that these cognitive training programs are effective in reducing cognitive deficits and even improving cognitive performance in healthy older adults, as well as those with mild cognitive impairment and dementia (Mirzaei et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Given that the care of Alzheimer's patients requires significant time and resources, creating numerous challenges for both the patient and their family, early diagnosis and treatment can help slow disease progression, delay the decline in individual functional ability, reduce treatment costs, and ease the burden on caregivers (Lambert et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). On the other hand, due to the limited research conducted in Iran on the effectiveness of transcranial brain stimulation in the prefrontal cortex in elderly individuals with Alzheimer's and the fact that most cognitive rehabilitation protocols are long-term and require many sessions, this study seeks to answer the question of whether there is a significant difference in the effectiveness of cognitive rehabilitation programs and transcranial direct current stimulation (tDCS) in addressing neuropsychological symptoms in elderly patients with mild Alzheimer's disease.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eThe method of this study is a quasi-experimental design with two experimental groups and one control group, utilizing a pre-test and post-test approach. The target population of this study includes all elderly individuals over 65 years old diagnosed with mild Alzheimer's disease who visited a neurologist's office in 2022. The sample size consisted of 60 participants, selected through convenience sampling and then randomly assigned (via lottery) to two experimental groups and one control group (20 participants in each group), as shown in Flowchart 1.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, The independent variables in this study include brain electrical stimulation with direct current (tDCS) for 10 sessions, each lasting 20 minutes, administered once a week to one experimental group. The second experimental group underwent a short-term cognitive rehabilitation program consisting of 9 sessions (each lasting 90 minutes), designed using the Luria's (1963) functional substitution approach and based on a documentary method, as outlined in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. After the content validity of the program was confirmed by experts, it was applied weekly to the second experimental group. The third group received no intervention. After the interventions were completed, a post-test was conducted one week later for both experimental groups and the control group. It is worth noting that the study groups were followed up after one month.\u003c/p\u003e \u003cp\u003eInclusion criteria for the study were: no heart disease, no head injuries or cuts, informed willingness to participate, no contagious diseases, no terminal illnesses such as cancer, and no history of epilepsy. The exclusion criteria were: presence of personality disorders, history of substance abuse or addiction, or receiving psychological services at other centers during the study.\u003c/p\u003e \u003cp\u003eTo ensure ethical research practices, the research objective and confidentiality were explained to the participants, and their informed consent was obtained. Additionally, after the study, both the control group and the experimental groups were provided with the treatment methods (tDCS and the short-term cognitive rehabilitation protocol), as no significant difference in effectiveness was found between the two methods.\u003c/p\u003e \u003cp\u003eFor data collection, the Neuropsychological Inventory (NPI) questionnaire was used. This tool evaluates non-psychological symptoms of dementia patients and is also applied in vascular dementia and other neurological disorders in the elderly. The NPI includes 12 subscales, and scores above 6 indicate the presence of the respective symptoms )Cummings et al, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e1994\u003c/span\u003e). Compared to other psychological symptom assessment tools, the NPI has several advantages, such as covering a wider range of psychopathological symptoms and assessing common behavioral changes associated with dementia, including irritability, euphoria, and apathy. Additionally, scoring for the 12 items of the NPI is done based on caregiver reports, avoiding issues related to asking questions directly to patients or relying on observed behaviors in a short time frame )Cummings et al, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e1994\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe reliability of this tool is considered good, with high test-retest correlations reported for frequency (0.79) and intensity (0.86) of symptoms. Furthermore, the inter-rater reliability for the aggression subscale was 0.98, for depression was 0.95, for anxiety was 0.97, and for apathy was 1.00, among other subscales. Internal consistency coefficients (Cronbach's alpha) for each of the 12 subscales and the total score ranged from 0.63 to 0.91. The rehabilitation protocol is provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCognitive Skills Enhancement Rehabilitation Protocol\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSessions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObjective\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eContent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTime (minutes)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntroduction to the patient, familiarizing the patient with the treatment environment and therapist, establishing rapport, administering pre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMutual introduction of the patient and therapist, familiarizing the patient with the treatment setting, discussing the treatment process, creating readiness in the patient, establishing rapport, administering pre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMemory enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRemembering images, remembering names of people, chunking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMemory training, attention and orientation skills enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRemembering events, performing the \"count the 'h's\" and \"'w's\" exercise, word search (part 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAttention and orientation skills training, verbal fluency enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWord search (part 2), letter cues exercise, category cues exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVerbal fluency training, language and thinking skills enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnimal and color categories exercise, word reversal, proverbs, category differentiation (part 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLanguage and thinking skills training, visual-spatial ability enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCategory differentiation (part 2), matching logos, remembering patterns, matching traffic signs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReview of memory, attention, and orientation skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIranian restaurant exercise, ordering and shopping from a supermarket, finding Persian numbers within words\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReview of verbal fluency, language, and visual-spatial skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eName cues exercise, proverbs and situations, matching animals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClosing session and administering post-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFinal discussion with the patient and closing ceremony, administering post-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eIn the descriptive analysis section, indicators such as frequency, mean, and standard deviation of the scores were reported. For inferential analysis, a repeated measures analysis of variance (ANOVA) was performed using SPSS-23. The significance level of 0.05 was considered for all variables.\u003c/p\u003e \u003c/div\u003e"},{"header":"Findings","content":"\u003cp\u003eThe demographic information of the participants in the study, such as age, gender, economic status, and marital status, is reported in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, categorized by groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Information of Study Participants Categorized by Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDemographic Information\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage and Frequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ePercentage and Frequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePercentage and Frequency\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65 to 70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.15% (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.15% (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.20% (4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70 to 75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.70% (14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.75% (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.70% (14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e75 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.15% (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.10% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.10% (2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.55% (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.50% (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.45% (9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.45% (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.50% (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.55% (11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEconomic Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.10% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.10% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.15% (3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.85% (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.80% (16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.80% (16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.50% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.10% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.50% (1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.10% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.10% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.15% (3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.85% (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.80% (16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.80% (16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.50% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.50% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.50% (1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0% (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0% (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.50% (1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDescriptive statistics (mean and standard deviation) for the subscales of neuropsychological symptoms, including \"Hallucinations,\" \"Delusions,\" \"Aggression,\" \"Depression,\" \"Anxiety,\" \"Euphoria,\" \"Apathy,\" \"Inhibition,\" \"Irritability,\" \"Motor Behavior,\" \"Nocturnal Behavior,\" and \"Appetite,\" are reported for the three groups (Control, Short-Term Cognitive Rehabilitation Program, and tDCS) at three time points (Pre-Test, Post-Test, and Follow-Up) in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive Statistics of Neuropsychological Symptoms by Group and Time (Mean and Standard Deviation)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-Test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-Test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFollow-Up\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eHallucination\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(3.27) 2.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3.27) 2.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3.27) 2.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive Rehab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(1.00) 1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.93) 1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.87) 1.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etDCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.21) 0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.21) 0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.21) 0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eDelusion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(1.20) 2.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(1.80) 3.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(1.80) 3.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive Rehab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(1.19) 0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.47) 0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.60) 1.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etDCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.57) 1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.64) 1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.29) 0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAggression\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(8.87) 4.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(8.33) 4.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(8.00) 3.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive Rehab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(9.60) 4.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(4.53) 2.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(4.60) 2.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etDCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(3.21) 3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2.43) 2.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(2.50) 2.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eDepression\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(5.73) 4.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(6.20) 4.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(6.27) 4.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive Rehab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(8.73) 3.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3.20) 1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(4.07) 2.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etDCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(11.64) 2.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(4.00) 0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(4.57) 1.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAnxiety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(8.53) 2.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(8.07) 2.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(7.93) 2.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive Rehab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(8.53) 2.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3.07) 1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3.60) 1.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etDCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(9.43) 2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3.57) 1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3.29) 1.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eEuphoria\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.00) 0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.00) 0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3.73) 3.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive Rehab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(3.60) 3.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3.40) 2.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3.93) 2.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etDCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.36) 0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.29) 0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.43) 1.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eIndifference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(3.13) 3.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3.67) 3.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3.73) 3.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive Rehab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2.93) 3.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2.73) 2.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(2.73) 3.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etDCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(10.71) 2.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3.93) 2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3.57) 2.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eInhibition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2.81) 2.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2.87) 2.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(2.93) 2.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive Rehab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(9.33) 2.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3.73) 1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(4.47) 1.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etDCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(3.71) 3.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2.71) 2.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(2.71) 2.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eIrritability\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(3.67) 4.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3.60) 4.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3.47) 3.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive Rehab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(4.87) 3.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(4.20) 3.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(4.07) 3.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etDCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(8.93) 1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3.57) 1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3.86) 1.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eMotor Symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(1.73) 2.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2.13) 2.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(2.27) 3.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive Rehab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2.33) 3.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2.07) 2.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(2.20) 2.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etDCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2.29) 2.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2.07) 2.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(1.86) 2.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eNocturnal Behavior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(3.93) 2.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(4.00) 2.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3.93) 2.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive Rehab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2.27) 3.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2.13) 3.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(2.00) 3.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etDCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2.43) 3.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2.29) 3.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(2.14) 3.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAppetite\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(3.47) 2.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3.33) 2.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3.27) 2.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive Rehab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(8.40) 2.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3.40) 1.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(9.13) 2.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etDCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(4.93) 3.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(4.64) 3.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(4.21) 3.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eTotal Symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(3.76) 0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3.94) 0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3.91) 0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive Rehab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(5.18) 1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2.82) 0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3.52) 0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etDCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(4.89) 0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2.54) 0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(2.49) 0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of the multivariate Wilks test are reported in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Based on the results obtained from Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, at least one linear combination of the 12 sub-indicators \"hallucination,\" \"delusion,\" \"aggression,\" \"depression,\" \"anxiety,\" \"euphoria,\" \"indifference,\" \"inhibition,\" \"irritability,\" \"motor,\" \"night behavior,\" and \"appetite\" showed a significant difference at the 0.95 confidence level, both between the three groups and across the different time points. Additionally, the interaction effect between group and time was significant, meaning that either there was a significant difference between the means of the three groups at the same time points or, within each group, there was a significant difference between the means across the three time points.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of the Multivariate Wilks Test for Neuropsychological Symptoms\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup*Time\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignificance of the Multivariate Wilks Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of the Mauchly Test and Equality of Means Test for Neuropsychological Symptoms\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMauchly's Test Significance\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEpsilon\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTest Used\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTime Significance (Effect Size)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eGroup*Time Significance (Effect Size)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHallucination\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.883\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHuynh-Feldt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.033) 0.245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.120) 0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDelusion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHuynh-Feldt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.005) 0.779\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.010) 0.911\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAggression\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.873\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHuynh-Feldt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.558) 0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.535) 0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDepression\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGreenhouse-Geisser\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.805) 0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.740) 0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnxiety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.769\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHuynh-Feldt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.809) 0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.760) 0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEuphoria\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGreenhouse-Geisser\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.058) 0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.042) 0.422\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndifference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.848\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHuynh-Feldt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.708) 0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.852) 0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInhibition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.843\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHuynh-Feldt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.600) 0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.648) 0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIrritability\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHuynh-Feldt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.678) 0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.727) 0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMotor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.951\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHuynh-Feldt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.000) 0.980\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.099) 0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNocturnal Behavior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssumed Sphericity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.045) 0.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.026) 0.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAppetite\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssumed Sphericity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.556) 0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.727) 0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBased on the results of the Mauchly\u0026rsquo;s test, the sphericity assumption was only not rejected for the two indicators \"Nocturnal Behavior\" and \"Appetite\" at a 95% confidence level, and as a result, the equality of means for these two variables was reported with the assumption of sphericity. For the other indicators, except for \"Depression\" and \"Euphoria\", the Hayn-Feldt test was used (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The results of these tests indicated that, except for four indicators\u0026mdash;\"Delusions\", \"Euphoria\", \"Motor\", and \"Nocturnal Behavior\", there was a significant difference between the three test times for the other indicators. The effect size (eta-squared) for the indicators \"Aggression\", \"Depression\", \"Anxiety\", \"Euphoria\", \"Apathy\", \"Inhibition\", \"Irritability\", and \"Appetite\" were 0.558, 0.805, 0.809, 0.708, 0.600, 0.678, and 0.556, respectively. Considering the effect size, the greatest differences between times were found for the indicators \"Anxiety\" and \"Depression\". The interaction effect between time and the experimental groups for the four indicators \"Delusions\", \"Euphoria\", \"Motor\", and \"Nocturnal Behavior\" was not significant. This means that there were no significant differences in means either within the groups at the three time points or between the three groups at each time point. In other words, none of the methods studied had an effect on the four indicators \"Delusions\", \"Euphoria\", \"Motor\", and \"Nocturnal Behavior\" related to neuropsychological symptoms.\u003c/p\u003e \u003cp\u003eFurthermore, regardless of the research time, based on the Bonferroni post hoc test, the means of the \"Hallucination\" indicator in the control group differed significantly from the two methods \"Short-Term Cognitive Rehabilitation Program\" (P\u0026thinsp;=\u0026thinsp;0.010) and TDCS method (P\u0026thinsp;=\u0026thinsp;0.001). The means of the \"Aggression\" indicator in the control group differed significantly from the two methods \"Short-Term Cognitive Rehabilitation Program\" (P\u0026thinsp;=\u0026thinsp;0.015) and TDCS method (P\u0026thinsp;=\u0026thinsp;0.000). The means of the \"Anxiety\" indicator in the control group differed significantly from the two methods \"Short-Term Cognitive Rehabilitation Program\" (P\u0026thinsp;=\u0026thinsp;0.002) and TDCS method (P\u0026thinsp;=\u0026thinsp;0.005). The means of the \"Euphoria\" indicator in the \"Short-Term Cognitive Rehabilitation Program\" differed significantly from both the TDCS method (P\u0026thinsp;=\u0026thinsp;0.000) and the control group (P\u0026thinsp;=\u0026thinsp;0.000). The means of the \"Apathy\" indicator in the TDCS method differed significantly from the \"Short-Term Cognitive Rehabilitation Program\" (P\u0026thinsp;=\u0026thinsp;0.008). The means of the \"Inhibition\" indicator in the TDCS method differed significantly from the \"Short-Term Cognitive Rehabilitation Program\" (P\u0026thinsp;=\u0026thinsp;0.008). The means of the \"Appetite\" indicator in the \"Short-Term Cognitive Rehabilitation Program\" differed significantly from the control group (P\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e \u003cp\u003eTo examine the interaction effects between time and group for the eight indicators \"Hallucination\", \"Aggression\", \"Depression\", \"Anxiety\", \"Apathy\", \"Inhibition\", \"Irritability\", and \"Appetite\", depending on whether the variances between groups were homogeneous or not, the Tukey post hoc test or the Dunnett T3 post hoc test was used to compare pairwise means between the experimental groups at the three different times. The Bonferroni post hoc test was also used for pairwise comparisons of means across three time points for the three groups. The results of these tests are reported in Tables\u0026nbsp;6 and \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e7\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePost-hoc\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFollow-up Period\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eTest Results (Pairwise Mean Comparisons)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHallucination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDunnett T3 Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eDunnett T3 Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShort-Control (P\u0026thinsp;=\u0026thinsp;0.049)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eShort-Control (P\u0026thinsp;=\u0026thinsp;0.043)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTDCS-Control (P\u0026thinsp;=\u0026thinsp;0.004)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eTDCS-Control (P\u0026thinsp;=\u0026thinsp;0.004)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAggression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTukey Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eTukey Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShort-Control (P\u0026thinsp;=\u0026thinsp;0.010)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eShort-Control (P\u0026thinsp;=\u0026thinsp;0.011)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTDCS-Control (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eTDCS-Control (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDunnett T3 Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eDunnett T3 Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone were significant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNone were significant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTukey Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eTukey Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShort-Control (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eShort-Control (P\u0026thinsp;=\u0026thinsp;0.010)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTDCS-Control (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eTDCS-Control (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDunnett T3 Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eTukey Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone were significant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNone were significant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInhibition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDunnett T3 Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eTukey Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone were significant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNone were significant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIrritability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDunnett T3 Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eDunnett T3 Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone were significant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNone were significant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppetite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDunnett T3 Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eDunnett T3 Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone were significant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eShort-Control (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eShort-TDCS (P\u0026thinsp;=\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBased on the results reported in Table\u0026nbsp;6, there was no significant difference between the mean scores of the \"short-term\" and TDCS methods and the control group for any of the \"depression,\" \"apathy,\" \"inhibition,\" and \"irritability\" variables in both the post-test and follow-up period. Additionally, for the \"hallucination,\" \"aggression,\" and \"anxiety\" variables, both methods performed similarly in the post-test and follow-up period and showed significant differences compared to the control group. However, for the \"appetite\" variable, the TDCS method did not show significant results, and only the \"short-term\" method had a significant effect in the follow-up period.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePost-hoc Bonferroni Tests Between Three Time Points by Experimental Groups for Neuropsychological Symptoms\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eShort-term Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTDCS Group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAggression\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-Post (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-PP (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDepression\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-Post (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-PP (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-PP (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-Post (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnxiety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-Post (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-PP (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-PP (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-Post (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndifference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-Post (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInhibition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-Post (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-PP (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIrritability\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-Post (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-PP (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAppetite\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-Post (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-PP (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeuropsychological Symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-Post (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-Post (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-PP (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-PP (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-Post (P\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the results reported in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e7\u003c/span\u003e, both the \"short-term\" and TDCS methods led to a significant improvement in the \"aggression\" index during the follow-up period. However, the effect of TDCS on this variable was not significant in the post-test, while the short-term method showed significant improvement. Both methods, \"short-term\" and TDCS, resulted in a significant reduction in the \"depression\" index in both post-test and follow-up periods. The only difference between these two methods in this variable is that, unlike the TDCS method, the \"short-term\" method was not able to maintain its reduction effect from the post-test period in the follow-up. Both the \"short-term\" and TDCS methods resulted in a significant improvement in the \"anxiety\" index in both post-test and follow-up periods. Regarding the \"indifference\" and \"irritability\" indices, it should be noted that, unlike the \"short-term\" method, which showed no significant effect, the TDCS method had a significant effect during the post-test period. While the TDCS method also showed a significant effect on \"indifference\" during the follow-up period, it was unable to replicate the same effect on the \"irritability\" index during the follow-up. Regarding the \"inhibition\" and \"appetite\" indices, it should be mentioned that, unlike the previous two indices, the TDCS method did not show a significant effect in either period, and it was the \"short-term\" method that showed a significant effect in the post-test. The \"short-term\" method also had a significant effect on the \"inhibition\" index during the follow-up period, although it did not have a significant effect on the \"appetite\" index during the follow-up period. In summary, both the \"short-term\" and TDCS methods resulted in a significant improvement in \"neuropsychological symptoms\" in both the post-test and follow-up periods. The difference between these two methods is that, unlike the \"short-term cognitive rehabilitation\" method, where there was a significant difference between the post-test and follow-up periods in neuropsychological symptoms, the TDCS method was able to maintain its effect on neuropsychological symptoms during the follow-up period.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study compared the effectiveness of transcranial direct current stimulation (tDCS) and a short-term cognitive rehabilitation protocol on neuropsychological symptoms in older adults with mild Alzheimer\u0026rsquo;s disease, testing twelve hypotheses related to specific symptom indices. The findings revealed that both interventions had varying degrees of efficacy, with distinct patterns of effectiveness and sustainability, which are analyzed below in a cohesive framework.\u003c/p\u003e \u003cp\u003eThe first, fourth, fifth, sixth, tenth, and eleventh hypotheses (hallucinations, depression, anxiety, elation, motor behavior, nocturnal behavior) were rejected, as both interventions showed either similar efficacy or no effect. Specifically, tDCS and cognitive rehabilitation equally improved hallucinations, anxiety, and depression at post-test and follow-up (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), with significant differences from the control group, but neither affected delusions, elation, motor behavior, or nocturnal behavior (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The third, seventh, eighth, ninth, and twelfth hypotheses (aggression, apathy, inhibition, irritability, appetite) were supported due to differential effectiveness. Cognitive rehabilitation was effective for aggression and inhibition at both post-test and follow-up (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and for appetite at post-test (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while tDCS was effective for aggression only at follow-up (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), apathy at both time points (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and irritability at post-test (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Notably, tDCS maintained its effects on depression and apathy better at follow-up compared to cognitive rehabilitation.\u003c/p\u003e \u003cp\u003eThese results align partially with prior research. The efficacy of tDCS on depression and apathy corroborates Rahmatinejad et al. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), Mojarrad et al. (2023), and Benussi et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), who linked tDCS\u0026rsquo;s benefits to prefrontal cortex stimulation. However, the sustained effect of cognitive rehabilitation on inhibition contrasts with Chamil et al. (2024), who reported limited durability, possibly due to the structured protocol used here. The lack of effect on delusions and elation aligns with Montoya-Morillo et al. (2020) and Mofa et al. (2020), who noted these symptoms\u0026rsquo; resistance to non-pharmacological interventions due to subcortical dopaminergic deficits (Stein et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The delayed effect of tDCS on aggression supports Benabi \u0026amp; Hoffen (2018) and Sampaio-J\u0026uacute;nior et al. (2018), suggesting gradual neuromodulation of regulatory networks. Cultural factors, such as strong family support systems in Iran, may have enhanced responses to emotional symptoms like depression and anxiety (Mokhtari et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), warranting further investigation.\u003c/p\u003e \u003cp\u003eThe efficacy of tDCS aligns with the glutamate hypothesis, which attributes neuropsychological symptoms to glutamate dysfunction (Gonzalez-Maiso et al., 2008). tDCS likely modulates mGLUR2 receptor activity, enhancing glutamatergic transmission and reducing symptoms like apathy and depression. Stimulation of the prefrontal cortex increases excitability in cognitive networks, improving motivational and emotional regulation (Benussi et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Cognitive rehabilitation\u0026rsquo;s effectiveness, particularly for inhibition and aggression, supports neuroplasticity models, as structured exercises strengthen fronto-striatal circuits critical for executive function (Amini et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). The superior sustainability of tDCS effects may reflect its direct neuromodulatory mechanism, compared to the practice-dependent nature of cognitive rehabilitation, which requires ongoing sessions to maintain gains.\u003c/p\u003e \u003cp\u003eThe study\u0026rsquo;s reliance on convenience sampling limited generalizability to broader populations. The short-term cognitive rehabilitation protocol may have contributed to the lack of sustained effects for some symptoms, such as depression and appetite. Self- or caregiver-reported measures introduced potential recall or social desirability biases.\u003c/p\u003e \u003cp\u003eFuture studies should employ randomized sampling to enhance external validity and explore combined tDCS and cognitive rehabilitation protocols for potential synergistic effects. Longitudinal designs are recommended to assess long-term impacts on disease progression and quality of life. Investigating cultural and socioeconomic moderators, such as family support in Iran, could refine intervention applicability across diverse populations.\u003c/p\u003e \u003cp\u003etDCS and short-term cognitive rehabilitation are effective non-pharmacological interventions for managing specific neuropsychological symptoms in mild Alzheimer\u0026rsquo;s, including hallucinations, anxiety, depression, aggression, apathy, inhibition, irritability, and appetite. tDCS is particularly suited for sustained management of depression and apathy, while cognitive rehabilitation excels for immediate improvements in inhibition and aggression. Their non-invasive nature and low cost make them viable for resource-limited settings like Iran, enabling integration into personalized, multidisciplinary treatment plans.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study aimed to compare the effectiveness of transcranial direct current stimulation (tDCS) and a short-term cognitive rehabilitation protocol on neuropsychological symptoms in older adults with mild Alzheimer\u0026rsquo;s disease. The findings confirmed that both tDCS and short-term cognitive rehabilitation were equally effective in improving hallucinations, anxiety, and depression at post-test and follow-up, with significant differences compared to the control group. However, neither intervention significantly impacted delusions, elation, motor behavior, or nocturnal behavior. For aggression, short-term cognitive rehabilitation was effective at both post-test and follow-up, while tDCS showed significant effects only at follow-up. For apathy, tDCS was effective at both post-test and follow-up, whereas short-term cognitive rehabilitation showed no significant effect. For inhibition, short-term cognitive rehabilitation was effective at both time points, while tDCS had no effect. For irritability, tDCS was effective only at post-test, and for appetite, short-term cognitive rehabilitation was effective only at post-test. Notably, tDCS better maintained its effectiveness for depression and apathy at follow-up compared to short-term cognitive rehabilitation. However, the use of convenience sampling limited the generalizability of the findings to broader populations. These results underscore the potential of tDCS and short-term cognitive rehabilitation as effective interventions for improving specific neuropsychological symptoms in mild Alzheimer\u0026rsquo;s disease, highlighting their importance for inclusion in therapeutic and rehabilitative programs.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eTranslation was performed using Grok and ChatGPT tools. However, no generative artificial intelligence tools were used in the preparation of the manuscript itself, including the discussion section. All content was developed by the research team based on the study findings and relevant literature.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u003cbr\u003e\u003c/strong\u003eThe ethical principles of this study were approved by the Ethics Committee of the University of Mohaghegh Ardabili (Code: IR.UMA.REC.1401.008).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003cbr\u003e\u003c/strong\u003eAll participants provided written informed consent to participate in this study in accordance with the ethical standards of the University of Mohaghegh Ardabili Ethics Committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003cbr\u003e\u003c/strong\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003cbr\u003e\u003c/strong\u003eClinical trial number: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003cbr\u003e\u003c/strong\u003eThe data supporting the findings of this study are not publicly available due to ethical considerations and participant privacy. However, upon approval from the Ethics Committee, the relevant data will be made available upon request, subject to ethical and legal requirements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003cbr\u003e\u003c/strong\u003eThe authors declare that they have no financial or professional conflicts of interest regarding the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003cbr\u003e\u003c/strong\u003eThis research is derived from the first author's doctoral dissertation. The authors wish to express their sincere gratitude to the University of Mohaghegh Ardabili for its support. Special thanks are extended to all the participants in this study for their invaluable contributions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the principles of the Declaration of Helsinki, which outlines the ethical guidelines for medical research involving human participants. All participants provided informed and voluntary consent. The study protocol was approved by the Ethics Committee of the University of Mohaghegh Ardabili, and all procedures were designed to ensure the safety, dignity, privacy, and rights of the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAarsland D, Br\u0026oslash;nnick K, Ehrt U, De Deyn PP, Tekin S, Emre M, Cummings JL. 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Neuropsychiatr Dis Treat. 2020;16:161.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWestwood, S. J., Criaud, M., Lam, S. L., Lukito, S., Wallace-Hanlon, S., Kowalczyk,O. S., \u0026hellip; Rubia, K. 2020. Transcranial direct current stimulation (tDCS) combined with cognitive training in adolescent boys with ADHD: a double-blind, randomised, sham-controlled trial. medRxiv.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). World report on ageing and health. World Health Organization; 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. 10 facts on ageing and the life course [Online ]. [cited 2011].\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"tDCS, short-term cognitive rehabilitation, neuropsychological symptoms, Alzheimer’s disease, older adults","lastPublishedDoi":"10.21203/rs.3.rs-7948462/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7948462/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003eAlzheimer’s disease is one of the most pressing challenges for older adults, often leading to neuropsychological symptoms. This study aimed to compare the effectiveness of transcranial direct current stimulation (tDCS) and a short-term cognitive rehabilitation protocol in improving neuropsychological symptoms in older adults with mild Alzheimer’s disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e The research utilized a quasi-experimental design with two experimental groups and one control group, following a pre-test and post-test approach. The study population included all individuals aged 65 and older diagnosed with mild Alzheimer’s disease who visited neurologists in 2022. From this population, 60 individuals were selected through convenience sampling and randomly assigned to two experimental groups and one control group (20 participants per group).\u003c/p\u003e\n\u003cp\u003eIn the first experimental group, tDCS was administered in 10 weekly sessions, each lasting 20 minutes. In the second experimental group, a short-term cognitive rehabilitation program, based on Luria's (1963) healthy functional substitution approach, was conducted over 9 weekly sessions, each lasting 90 minutes. The content validity of the rehabilitation program was confirmed by experts. The control group received no intervention. Post-tests were conducted one week after the interventions, followed by a one-month follow-up assessment. The Neuropsychiatric Inventory (NPI) was used to collect data. Repeated measures ANOVA was performed using SPSS version 23 for data analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eBoth interventions significantly improved neuropsychological symptoms at both the post-test and follow-up stages. However, while the short-term cognitive rehabilitation group demonstrated significant differences in symptom scores between the post-test and follow-up phases, the tDCS intervention maintained its effectiveness during the follow-up period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eBoth tDCS and short-term cognitive rehabilitation can be utilized to improve neuropsychological symptoms in older adults with mild Alzheimer’s disease. However, the sustained effects of tDCS during the follow-up period highlight its potential for longer-term benefits.\u003c/p\u003e","manuscriptTitle":"Transcranial Direct Current Stimulation and Cognitive Rehabilitation: Two Distinct Treatments for Improving Neuropsychological Symptoms in Older Adults with Mild Alzheimer’s Disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 09:21:28","doi":"10.21203/rs.3.rs-7948462/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-12-12T17:45:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-08T15:08:03+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-17T12:25:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-17T11:43:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-11-10T15:35:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"271b7e24-809b-4639-a707-e5f305aa260e","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T09:21:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 09:21:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7948462","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7948462","identity":"rs-7948462","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}