The Effect of Combined Brain Stimulation and Yoga for Improving Cognitive Function in Psychosis

The Logical Memory test is a standardized test used to evaluate narrative verbal memory, immediate free recall, and delayed free recall. The examiner reads one short, structured stories aloud to the participant. The test consists of two main parts: Logical Memory I (Immediate Recall), where the participant is asked to retell the story from memory immediately after hearing it, and Logical Memory II (Delayed Recall), where the participant is asked to retell the story again after a 30-minute delay. Scoring is based on the total number of predefined story elements or ideas correctly recalled. For each story, the raw score ranges from 0 to 23 story units. Higher scores indicate better verbal memory and auditory narrative recall capabilities.

The Digit Span Test is a standardized cognitive subtest used to evaluate short-term verbal memory, attention, and working memory. The examiner reads a sequence of random numbers aloud at a rate of one digit per second, and the participant is asked to repeat them. The test consists of two primary components: Digit Span Forward (where digits are repeated in the exact order heard to assess attention and short-term memory) and Digit Span Backward (where digits are repeated in the reverse order to assess working memory and mental manipulation). Scoring is based on the total number of trials correctly recalled. Higher scores indicate better auditory attention, short-term memory capacity, and working memory functioning.

The Positive and Negative Syndrome Scale (PANSS) is a 30-item rating scale used to measure the symptom severity of patients with schizophrenia. It consists of three subscales: the Positive Scale (7 items), the Negative Scale (7 items), and the General Psychopathology Scale (16 items). Each item is rated on a 7-point symptom-severity scale from 1 (absent) to 7 (extreme). The total score ranges from a minimum of 30 to a maximum of 210. Higher scores indicate greater severity of psychiatric symptoms.

The Calgary Depression Scale is a 9-item structured interview scale specifically designed to assess the severity of depression in patients with schizophrenia. Each of the 9 items is scored on a 4-point scale from 0 (absent) to 3 (severe). The total score ranges from a minimum of 0 to a maximum of 27. Higher scores indicate more severe depressive symptoms.

The Social and Occupational Functioning Assessment Scale (SOFAS) is a clinician-rated numeric scale used to assess an individual's level of social and occupational functioning, distinct from the severity of their psychological or psychiatric symptoms. The scale ratings range from 1 to 100, divided into 10-point intervals. A score of 100 represents superior functioning in a wide range of activities, while a score of 1 indicates a persistent inability to maintain minimal personal hygiene or gross impairment in social and occupational functioning. Higher scores indicate a higher level of social and occupational functioning and greater independence.

The Role Functioning Scale (RFS) is a 4-item instrument designed to assess the level of functioning of individuals with severe mental illness in four areas: Working Productivity, Immediate Past Social Network, Extended Social Network, and Independent Living / Self-Care. Each of the 4 domains is rated on a 7-point behavioral index scale ranging from 1 (severely impaired) to 7 (optimal functioning). The total score ranges from a minimum of 4 to a maximum of 28. Higher scores indicate a higher level of role functioning and greater independence.

The 36-Item Short Form Health Survey (SF-36) is a patient-reported questionnaire used to assess health-related quality of life. It measures eight health domains: Physical Functioning, Role Limitations due to Physical Health, Role Limitations due to Emotional Problems, Energy/Fatigue, Emotional Well-Being, Social Functioning, Pain, and General Health. Responses are multi-choice, and individual domain scores are transformed onto a scale from 0 to 100. For each domain and summary score, the scale range is 0 to 100, where higher scores indicate better health status and higher quality of life.

Body Mass Index (BMI) is a standardized anthropometric measure used to estimate body fat and classify weight status. It is calculated by dividing an individual's body weight in kilograms by the square of their height in meters (kg/m²). Higher BMI values indicate greater body mass relative to height, which can correspond to higher body fat levels.

A common measure of flexibility, specifically assessing the lower back and hamstring muscles. The subject is seated against the wall, arms outstretched towards the box. A sliding ruler is used to measure the position of the fingertips. Higher scores (greater distance reached) indicate greater hamstring and lower back flexibility.

Give the subject a minute to practice their balancing before starting the test. Then ask the person to stand on one foot for as long as possible. The total length of time a person can stay in the balance position will be recorded. The timing stops when the elevated foot touches the ground or the person hops or otherwise loses their balance position. The test will be conducted with the person having their arms on their waist. Repeat the test on the other leg. Higher scores (longer durations) indicate better static balance and postural control.

The Digit Symbol Coding Test is a standardized paper-and-pencil neurocognitive task used to assess processing speed, attention, psychomotor performance, and visual-motor coordination. Participants are presented with a key pairing single digits (1 through 9) with unique geometric symbols. Below the key, rows of digits are displayed with empty spaces beneath them. Participants are instructed to write the correct corresponding symbol for each digit as quickly and accurately as possible within 120 seconds. The outcome score is calculated as the total number of correct digit-symbol pairs completed within the time frame. Higher scores indicate superior processing speed and enhanced cognitive efficiency.

The Letter Cancellation Test is a standardized paper-and-pencil psychomotor task used to assess visual attention, sustained attention, psychomotor speed, and visual neglect. Participants are presented with a sheet of paper containing rows of random letters and are instructed to cross out (cancel) a specific target letters as quickly and accurately as possible. The outcome score is reported as the total number of correct targets identified (hits). Higher scores indicate superior visual attention and faster processing speed.

The Trail Making Test (TMT) is a standard neurocognitive task used to assess visual search, scanning, processing speed, and executive function. It consists of two distinct parts: Part A and Part B. In Part A (TMT-A), participants are instructed to connect a series of encircled numbers in chronological order (1-2-3, etc.) as quickly and accurately as possible. In Part B (TMT-B), participants must connect a alternating series of encircled numbers and letters in sequential order (1-A-2-B-3-C, etc.). The outcome score for each part is recorded as the total time in seconds required to complete the trail. Lower scores (shorter durations to complete the task) indicate superior processing speed, enhanced cognitive flexibility, and better executive functioning.

Functional Near-Infrared Spectroscopy (fNIRS) is a non-invasive optical imaging technique used to monitor hemodynamic responses in the cerebral cortex. This outcome measure evaluates the relative concentration changes of oxygenated hemoglobin (HbO) and deoxygenated hemoglobin (HbR) within defined regions of interest in the prefrontal cortex (PFC). Measurements are continuously recorded during two distinct states: a resting-state baseline condition and a target cognitive task condition. Increased HbO concentration accompanied by a concurrent decrease in HbR concentration relative to baseline indicates localized cortical activation in the prefrontal region during the cognitive task.

Functional connectivity within the prefrontal cortex (PFC) is evaluated by measuring the temporal correlation of hemodynamic signal fluctuations. Continuous fNIRS data for both oxygenated hemoglobin (HbO) and deoxygenated hemoglobin (HbR) are recorded during resting-state and the cognitive task. After preprocessing to remove systemic noise and motion artifacts, the functional connectivity is quantified by calculating the Pearson correlation coefficient (r) and its Fisher z-transformed equivalent between the time courses of different prefrontal regions. The resulting correlation values range from -1.0 to +1.0 . Higher positive values indicate stronger functional connectivity and greater synchronized neural activity between those specific prefrontal cortical regions.

Number of class attended during the 6-week intervention.

Participants report the frequency and duration of doing the home-based practice.