Cognitive Training for Visuospatial Processing in Children Aged 5½ to 6 Years Born Very Preterm With Working Memory Dysfunction
Authors: Gire Catherine , Beltran Anzola Any , Marret Stéphane , Foix L’Hélias Laurence , Roze Jean-Christophe , Granier Michèle , Patural Hugues , Lecomte Bénédicte , Guillois Bernard , Souksi Medioni Isabelle , Bednarek Weirauch Nathalie , Claris Olivier , Hascoët Jean-Michel , Kuhn Pierre , Zahed Meriem , Boucekine Mohamed , Ancel Pierre-Yves , Arnaud Catherine , Cambonie Gilles , Dorriere Datin Valérie ,   EPIREMED Study Group, TOSELLO Barthélémy , BREVAUT Veronique , GARCIA Patricia , DESILES Tristan , MENARD Gwenaëlle , PACHE Mélodie , ZAHED Ludovic-Mohamed , MITANCHEZ Delphine , COUDRONNIERE Charlotte , DENAVEAUT BOULAY Mireille , FALQUE Elodie , REBATTEL Magali , VOIRIN Karine , BASSON Eliane , RUBIO GURUNG Sophie , RODRIGUEZ Mélanie , DEFORGE Hélène , LEMARCHAND Marie , DUBOIS Emeline , IANNUZZI Stéphanie , OERTEL Julie , DE SAINT MARTIN Anne , ZORES KOENIG Claire , MUSMEAUX Hélène , SCHNEIDER Lucille , LERAT Claire , PANNETIER Angélique , PIN Isabelle , DEBILLON Thierry , GUICHARDET Karine , ZANDER Patrick , SALIBA Elie , BENHAMMOU Valérie , KAMINSKI Monique , MARCHAND-MARTIN Laetitia , MEDJAHED Samira , PIRRELLO Johanne , BERBIS Julie , AUQUIER Pascal , BAUMSTARCK Karine 
Published: September 2023

Importance

Compared with term-born peers, children born very preterm generally perform poorly in executive functions, particularly in working memory and inhibition. By taking advantage of neuroplasticity, computerized cognitive training of working memory in those children could improve visuospatial processing by boosting visual inhibition via working memory.

Objective

To evaluate the long-term effect of cognitive working memory training on visuospatial processing in children aged 5½ to 6 years born very preterm who have working memory impairment.

Design, Setting, and Participants

This multicenter (18 French university hospitals), open-label randomized clinical trial with 2 parallel groups (EPIREMED) was conducted from November 2016 to April 2018, with the last follow-up during August 2019. Eligible children from the EPIPAGE 2 cohort were aged 5½ to 6 years, were born between 24 and 34 weeks’ gestation, and had a global intelligence quotient greater than 70 and a working memory index less than 85. Data were analyzed from February to December 2020.

Intervention

Children were randomized 1:1 to standard care management and a working memory cognitive training program (Cogmed software) for 8 weeks (25 sessions) (intervention) or to standard management (control).

Main Outcomes and Measures

The primary outcome was the visuospatial index score from the Wechsler Preschool and Primary Scale of Intelligence, 4th Edition. Secondary outcomes were working memory, intellectual functioning, executive and attention processes, language skills, behavior, quality of life, and schooling. Neurobehavioral assessments were performed at inclusion and after finishing training at 6 months (intermeditate assessment; secondary outcomes) and at 16 months (final assessment; primary outcome).

Results

There were 169 children randomized, with a mean (SD) age of 5 years 11 months (2 months); 91 (54%) were female. Of the participants, 84 were in the intervention group (57 of whom [68%] completed at least 15 cognitive training sessions) and 85 were in the control group. The posttraining visuospatial index score was not different between groups at a mean (SD) of 3.0 (1.8) months (difference, −0.6 points; 95% CI, −4.7 to 3.5 points) or 12.9 (2.6) months (difference, 0.1 points; 95% CI, −5.4 to 5.1 points). The working memory index score in the intervention group significantly improved from baseline at the intermediate time point (difference, 4.7 points; 95% CI, 1.2-8.1 points), but this improvement was not maintained at the final assessment.

Conclusions and Relevance

This randomized clinical trial found no lasting effect of a cognitive training program on visuospatial processing in children aged 5½ to 6 years with working memory disorders who were born very preterm. The findings suggest that this training has limited long-term benefits for improving executive function. Transient benefits seemed to be associated with the developmental state of executive functions.

Trial Registration

ClinicalTrials.gov Identifier: NCT02757794