Neuroplasticity-Based Cognitive Remediation for Chemotherapy-Related Cognitive Impairment
Condition: Cancer Survivors; Chemotherapy-related Cognitive Impairment
MeSH terms: Chemotherapy-Related Cognitive Impairment; Cognitive Dysfunction
Study type: Interventional

Summary: 
      The investigators propose to apply neuroplasticity-based computerized cognitive remediation
      (nCCR) to treat chemotherapy-related cognitive impairment (CRCI).
    

Detailed description: 
      Advances in cancer treatment are producing a growing number of cancer survivors; therefore,
      issues surrounding quality of life during and following cancer treatment have become
      increasingly important. Chemotherapy-related cognitive impairment (CRCI) is one such quality
      of life issue that is commonly reported following chemotherapy treatment in adults. Although
      studies reporting cognitive impairments associated with chemotherapy have been reported since
      the 1980s, the phenomenon commonly referred to as 'chemo brain' or 'chemo fog' is poorly
      understood, and for some patients becomes the most distressful survivorship issue faced.
      Studies suggest that while up to up to 75% exhibit cognitive decline during treatment, many
      patients will return to their pre-chemo level of functioning 1 year after completing
      treatment. However, for 30-35% of cancer patients, their cognitive issues persist.

      Studies suggest that this persistent chemotherapy-related cognitive impairment (pCRCI) can
      remain for months to years after completing treatment, which may have implications for the
      trajectory of how both normal cognitive aging occurs, but also the risk of cognitive
      disorders such as Alzheimer's disease, for the growing number of long-term cancer survivors.
      These concerns are particularly relevant for older individuals as risk for not only cancer,
      but cognitive impairment (such as dementia) increases with age. As of January 2016, 62% of
      cancer survivors (9.61 million) are currently 65 years or older, and this number is expected
      to increase dramatically over the coming decades. Therefore, as the number of older cancer
      survivors who have will have to cope with pCRCI is likely to increase, it is crucial that The
      investigators understand the cognitive impairments, the impact on survivors' functioning, and
      develop treatments for pCRCI.

      The investigators propose to target cognitive deficit in CRCI using a novel cognitive
      enhancement strategy. Our choice of cognitive focus is informed by clinical, behavioral and
      neurobiological data suggesting a reliable association between cognitive control deficits
      (CCD), damage to the cognitive control network (CCN), and decline in cognitive functioning.
      The CCN is a neural network that supports important cognitive control functions such as
      alerting and orienting attention, response selection, cognitive flexibility, strategy
      generation, and inhibition of prepotent responses. The investigators propose to apply
      neuroplasticity-based computerized cognitive remediation (nCCR) to the treatment of CRCI as
      it has demonstrated training and transfer effects of enhanced CCN function in a similar,
      abnormally aging population. The theory guiding neuroplasticity-based cognitive interventions
      is that network abnormalities associated with negative disease-specific clinical outcomes can
      be altered through the induction of neuroplasticity (even in the aging brain) resulting in
      enhanced functioning of the target network, and symptomatic improvements.
    

Intervention name(s): Neuroplasticity-based Computerized Cognitive Remediation
Intervention type(s): Behavioral
Intervention description(s): The nCCR has two major components: Bottom up and Top down training. "Bottom up" training: The training includes selected tasks from "Brain HQ", a program designed for older adults, that enhances basic processing of sensory stimuli with the goal to improve fidelity of auditory and visual encoding.
"Top down training": We designed programs to target cognitive control functions associated with poor treatment response, i.e., initiation and use of verbal strategy and susceptibility to interference. These "Top Down" Programs include a visual attention program, either Catch the Ball or Neurogrow, and a semantic strategy program, Semantic Organization.
Intervention model: Single Group Assignment
Intervention model description: A single-arm, open label design; All analyses are pre-post, with participants serving as their own controls.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Chemotherapy; Cognitive Impairment; neuroplasticity-based computerized cognitive remediation; nCCR