GAME Veterans With PTSD Using Computer-Based Cognitive Training
Condition: Cognitive Impairment
MeSH terms: Cognitive Dysfunction
Study type: Interventional

Summary: 
      The investigators hypothesis are as follows:

      H1a: OEF/OIF veterans with PTSD who perform cognitive training (CT) will demonstrate greater
      objective improvements on standard (untrained) neurocognitive measures, with the largest
      gains in verbal memory, learning and sustained attention.

      H1b: Objective cognitive improvements in CT participants will be sustained at three months
      post-intervention, suggesting persistence of neuroplasticity-based cognitive training
      benefits.

      H2a: OEF/OIF veterans with PTSD who perform CT will report greater improvements in cognitive
      function.

      H2b: OEF/OIF veterans with PTSD who perform CT will demonstrate improved social and
      occupational functioning and quality of life.

      H2c: OEF/OIF veterans with PTSD who perform CT will demonstrate greater improvements in
      community reintegration.
    

Detailed description: 
      Posttraumatic Stress Disorder (PTSD)-related cognitive dysfunction is well-described and has
      been associated with specific impairments in verbal memory, learning, attention and emotional
      regulation, deficits which have been correlated with abnormalities in specific brain regions.
      Both PTSD and cognitive dysfunction have been associated with impairments in social and
      occupational functioning and may contribute to operational or battlefield errors, soldiers'
      safety and threaten the success of military operations. In addition, following military
      service separation, PTSD-related cognitive impairment adversely impacts quality of life,
      readjustment, and community reintegration. A computerized neuroplasticity-based auditory
      cognitive training program (Plasticity-Based Adaptive Cognitive Remediation, Posit Science,
      San Francisco, CA) has been shown in several randomized controlled trials to improve verbal
      memory, attention, cognitive control, quality of life and daily function in
      community-dwelling elders and individuals with schizophrenia. To our knowledge however, there
      have been no studies of cognitive remediation training in individuals with PTSD. Therefore,
      the overall aim of this proposal was to investigate the efficacy of neuroplasticity-based
      auditory cognitive training in Veterans with PTSD and cognitive dysfunction. The primary
      specific aim of this pilot study was to examine change in objective cognitive function in
      Veterans with PTSD and cognitive dysfunction who participated in an open-label trial of an
      auditory cognitive training program. Our secondary aim was to examine change in self-reported
      cognitive function, social and occupational functioning, quality of life and community
      reintegration in Veterans with PTSD who participate in auditory CT. Finally, we evaluated the
      feasibility and usability of home-based computerized auditory cognitive training in Veterans
      with PTSD and cognitive dysfunction. We enrolled subjects in a program of 3 months of
      auditory cognitive training (CT) followed by 3 months of no contact. We assessed
      participants' change scores on neuropsychological outcome measures from pre- to
      post-treatment using reliable change indicators. We utilized qualitative thematic analysis to
      identify themes from participants about the feasibility, acceptability, and usability of the
      treatment. Information derived from this pilot study may be used to inform future cognitive
      training interventions for Veterans.
    

Intervention name(s): Cognitive Training
Intervention type(s): Behavioral
Intervention description(s): Plasticity Based Adaptive Cognitive Remediation (PACR)
Other intervention name(s): Plasticity Based Adaptive Cognitive Remediation (PACR)
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment