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 (p0.05) 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 (p0.02), 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 (p0.014), 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