{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:21:02Z","timestamp":1787721662356,"version":"build-2784847793"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The Department of Defense is working to establish effective rehabilitative management options for individuals who have experienced Anomalous Health Incidents (AHI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective, observational study conducted at Walter Reed National Military Medical Center describes the clinical presentation of forty patients (21 female and 19 male; mean [SD] age, 43.3 [9.2] years) with reported AHI. It also describes the application of a cognitive training intervention, its utilization, patient satisfaction, and changes in cognitive performance and symptoms over time. At baseline, the overall pattern of objective cognitive efficiency scores was within normal limits, though numerically below healthy norms. However, patients performed below normal limits on measures of processing speed. Patient self-report surveys found slightly elevated psychological symptoms, highly elevated neurobehavioral and headache symptoms, and severe impact on life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients used an at-home cognitive training program and provided generally positive feedback regarding the program. On an internal clinic survey, over 75% of the patients felt that participation helped in areas of memory, visuo-spatial skills, and attention. Some changes in objective cognitive testing were observed over time. Self-reported symptoms, which were not directly targeted in the intervention, did not change over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This study demonstrates that the clinical integration of targeted cognitive training for individuals reporting cognitive symptoms following an AHI is feasible and acceptable, with patients demonstrating good engagement and a positive clinical trajectory in cognitive efficiency over time.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1858023","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:52:00Z","timestamp":1787719920000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical presentation and engagement with a cognitive rehabilitation clinic in individuals reporting anomalous health incidents"],"prefix":"10.3389","volume":"17","author":[{"given":"Kelly","family":"Marshall","sequence":"first","affiliation":[{"name":"National Intrepid Center of Excellence, Walter Reed National Military Medical Center","place":["Bethesda, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Sullivan","sequence":"additional","affiliation":[{"name":"National Intrepid Center of Excellence, Walter Reed National Military Medical Center","place":["Bethesda, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis M.","family":"French","sequence":"additional","affiliation":[{"name":"National Intrepid Center of Excellence, Walter Reed National Military Medical Center","place":["Bethesda, MD, United States"]},{"name":"Uniformed Services University of the Health Sciences","place":["Bethesda, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1001\/jama.2024.2413","article-title":"Clinical, biomarker, and research tests among US government personnel and their family members involved in anomalous health incidents","volume":"331","author":"Chan","year":"2024","journal-title":"JAMA"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.1001\/jama.2018.1742","article-title":"Neurological manifestations among US government personnel reporting directional audible and sensory phenomena in Havana, Cuba","volume":"319","author":"Swanson","year":"2018","journal-title":"JAMA"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1097\/JOM.0000000000002450","article-title":"Clinical and psychological factors associated with return to work among United States diplomats who sustained a work-related injury while on assignment in Havana, Cuba","volume":"64","author":"Green-McKenzie","year":"2022","journal-title":"J Occup Environ Med"},{"key":"ref4","year":"2022"},{"key":"ref5","volume-title":"Assessment and Management of Reported Anomalous Health Incidents: Clinical Recommendation for Primary Care Managers","year":"2025"},{"key":"ref6","volume-title":"Cognitive Rehabilitation for Service Members and Veterans Following Mild to Moderate Traumatic Brain Injury: Clinical Recommendation","year":"2019"},{"key":"ref7","volume-title":"HAVANA SYNDROME Better Patient Communication and Monitoring of Key DOD Tasks Needed to Better Ensure Timely Treatment","year":"2024"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1093\/milmed\/usz218","article-title":"A novel intervention platform for service members with subjective cognitive complaints: implementation, patient participation, and satisfaction","volume":"185","author":"Sullivan","year":"2020","journal-title":"Mil Med"},{"key":"ref9","volume-title":"ANAM4 Military: Administration Manual","year":"2012"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1093\/arclin\/acz021","article-title":"Comparing composite scores for the ANAM4 TBI-MIL for research in mild traumatic brain injury","volume":"35","author":"Iverson","year":"2020","journal-title":"Arch Clin Neuropsychol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1093\/arclin\/act055","article-title":"Initial clinical validation of an embedded performance validity measure within the automated neuropsychological metrics (ANAM)","volume":"28","author":"Roebuck-Spencer","year":"2013","journal-title":"Arch Clin Neuropsychol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/00001199-199510030-00002","article-title":"Persistent postconcussion syndrome: the structure of subjective complaints after mild traumatic brain injury","volume":"10","author":"Cicerone","year":"1995","journal-title":"J. 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