working memory training in huntington's disease

Conditions: Huntington's Disease

Summary: there is a paucity of investigation into effective interventions to enhance cognitive function and/or mitigate cognitive decline in individuals with huntington disease (hd). this study targeted working memory (wm), which is the ability to actively hold information in the mind in order to perform complex mental tasks, given reports of wm dysfunction in patients with hd. the investigators examined the feasibility of conducting a 5-week wm training program (cogmed). patient adherence and treatment tolerance were assessed. in addition, preliminary evidence for the efficacy of this training program on targeted cognitive abilities was examined. nine patients with pre-manifest or early stage hd underwent training. patients were assessed before the intervention and one week after completion.

huntington disease (hd) is associated with a variety of cognitive deficits, with prominent difficulties in working memory (wm). wm deficits are notably compromised in early-onset and prodromal hd patients. this study aimed to determine the feasibility of a computer-ized wm training program (cogmed qm), novel to the hd population. nine patients, aged 26-62, with early stage hd underwent a 25-session (5 days/week for 5 weeks) wm training program (cogmed qm). training exercises involved the manipulation and storage of verbal and visuospatial information, with difficulty adapted as a function of individual performance. neuropsychological testing was conducted before and after training, and performance on criterion wm measures (digit span and spatial span) and near-transfer wm measures (symbol span and auditory wm) were evaluated. post-training inter-views about patient experience were thematically analyzed using nvivo software. seven of nine patients demonstrated adherence to the training and completed all sessions within the recommended timeframe of 5 weeks. all adherent patients reported that they found training helpful (n=7), and almost all felt that their memory improved (n=6). compared to baseline scores, patients showed significant improvement on the neuropsychological measures of verbal wm, including digit span (p = .047) and auditory wm (p = .041). this pilot study provides support for feasibility of computerized wm training in early-stage patients with hd. results suggest that hd patients can improve wm with intensive training, though a full-scale intervention project is needed to understand the reliability of changes over time.

Eligibility criteria:
inclusion criteria: 1. laboratory-confirmed gene expansion of at least 36 cag repeats 2. reported working memory difficulties on the patient-reported outcomes in cognitive impairment (procog) questionnaire 3. total functional capacity (tfc) score of at least 3, taken from the uhdrs 4. montreal cognitive assessment (moca) score of 19 or greater exclusion criteria: 1. history of head trauma/neurological event such as stroke 2. untreated psychiatric symptoms or substance abuse 3. visual or motor symptoms that would impede ability to complete the program and/or neuropsychological testing 4. nonfluency in english

Keywords: huntington disease cognitive rehabilitation cognitive dysfunction