ABSTRACT NUMBER: ESOC2026A2325 EFFICACY OF INFRA-LOW VERSUS ALPHA FREQUENCY NEUROFEEDBACK FOR COGNITIVE AND PSYCHO-EMOTIONAL DEFICITS IN EARLY CEREBRAL MICROANGIOPATHY: A RANDOMIZED CONTROLLED TRIAL

Abstract Background and aims Early Cerebral Microangiopathy (CMA) is a major contributor to cognitive and psycho-emotional deficits. Given the emerging role of psychosocial stress in CMA pathogenesis, non-pharmacological neuromodulation techniques like neurofeedback present a promising therapeutic avenue. This study aimed to conduct a placebo-controlled trial comparing the efficacy of infra-low-frequency (ILF) and alpha-frequency neurofeedback for addressing these deficits in early CMA. Methods This prospective, randomized, double-blind, placebo-controlled trial included 66 patients with early CMA (mean age 51.2±5.1 years). Participants were randomized into three arms: ILF neurofeedback (n=23), alpha-frequency neurofeedback (n=21), or a sham (placebo) intervention (n=22). Each patient received 14 sessions of their assigned training. Cognitive, psycho-emotional, and quantitative electroencephalography (qEEG) parameters were assessed at baseline, immediately post-intervention, and at a 1 month follow-up. Results The ILF neurofeedback group demonstrated statistically significant and sustained improvements (p<0.05) in executive functions, including verbal fluency and cognitive flexibility (Stroop test), alongside reductions in personal anxiety, depression, and health-related anxiety. In contrast, alpha-frequency neurofeedback significantly improved anxiety and verbal memory (p<0.02), but not depression; its effect on executive function was limited to a delayed improvement in cognitive flexibility. A key neurophysiological finding was a significant increase in occipital alpha-rhythm power exclusively in the ILF group (p<0.014), which correlated with improved executive function and reduced depression. The placebo group showed no significant improvements. Conclusions ILF neurofeedback is an effective non-pharmacological treatment for early CMA's executive dysfunction and anxiety-depressive symptoms. ILF is preferable for combined deficits; alpha-frequency may suit isolated anxiety. Increased occipital alpha power is a potential biomarker for ILF response. Conflict of interest Kostiantyn Stepanchenko and Alla Zhidkova nothing to disclose