Cognitive Remediation Therapy for Brain Tumor Patients: Improving Working Memory

Study Overview
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Brief Summary
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To investigate a computer-based Cognitive Remediation Therapy (CRT) for brain tumor patients at the Massey Cancer Center on measures of cognitive functioning (e.g., working memory, attention, processing speed, language, visuospatial functioning, immediate and delayed memory, or executive functioning) over time.

Detailed Description
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Participants will be recruited by their neuropsychologist in the VCU Massey Cancer Center following standard neuropsychological evaluation (their neuro-oncologist may refer them to this study). If meeting inclusion criteria (described in later sections on participants), participants will be recruited and enrolled in the study. Two groups will be formed: High grade gliomas (WHO grade III or IV; n=15) and Low grade gliomas (WHO grade II; n=15). Participants will be followed over 11 months. The two groups will follow identical study timelines.

Official Title
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Cognitive Remediation Therapy for Brain Tumor Patients: Improving Working Memory

Conditions
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Glioma, Brain Tumor, Primary

Intervention / Treatment
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* Behavioral: CogMed®


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Confirmed primary brain tumor diagnosis via MRI and their neuro-oncologist A minimum of 2 months post-surgical resection or biopsy(if applicable) and/or a minimum 1 month post radiation treatment (if applicable) Karnofsky performance status more than 60 Estimated intelligence at least 80 (standard score) Demonstrated attention difficulties (T-score of at least 65 on attention questionnaire or 1 or more standard deviations below mean on direct attention measures) No history of cognitive disorder No history of mood disorder Predicted life expectancy of at least 12 months Computer capability at home or provided a departmental iPad Mini to borrow for study purposes Primarily English speaking Aged 18+ (for which there is available age-adjusted neuropsychological testing standardization / normative data) Exclusion Criteria: If they are not patients of Massey Cancer Center or do not meet the inclusion criteria listed above

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: High grade gliomas(WHO grade III or IV; n=15)<br>The two groups will follow identical study timelines. Participants will receive a 1 hour training session on CogMed® (PI or trained graduate student). Participants will complete 5 weeks of CogMed® training within their own home. It consists of 25 training sessions. Each session lasts 30-45 minutes.The study team will check in with participants once a week via phone or email. Brief neuropsychological evaluations will be conducted at 4 time points. Each assessment will take approximately 30-60 minutes. Each participant will receive a $25 gift card to the VCU medical center gift shop at two time points. | Behavioral: CogMed®<br>* It consists of 25 training sessions which can all be completed online and at home. Each session lasts 30-45 minutes. They must have a computer at home compatible with the CogMed® program. Brief neuropsychological evaluations will be conducted at 4 time points (these assessments are standard of care): Baseline before the participant is introduced to the CogMed® training program Within 2 weeks of completion of the CogMed® program At 3 months of completion of the CogMed® program to establish maintenance of gains At 6 months of completion of the CogMed® program to establish longer-term maintenance of gains<br>|
| Experimental: Low grade gliomas(WHO grade II; n=15)<br>The two groups will follow identical study timelines. Participants will receive a 1 hour training session on CogMed® (PI or trained graduate student). Participants will complete 5 weeks of CogMed® training within their own home. It consists of 25 training sessions. Each session lasts 30-45 minutes.The study team will check in with participants once a week via phone or email. Brief neuropsychological evaluations will be conducted at 4 time points. Each assessment will take approximately 30-60 minutes. Each participant will receive a $25 gift card to the VCU medical center gift shop at two time points. | Behavioral: CogMed®<br>* It consists of 25 training sessions which can all be completed online and at home. Each session lasts 30-45 minutes. They must have a computer at home compatible with the CogMed® program. Brief neuropsychological evaluations will be conducted at 4 time points (these assessments are standard of care): Baseline before the participant is introduced to the CogMed® training program Within 2 weeks of completion of the CogMed® program At 3 months of completion of the CogMed® program to establish maintenance of gains At 6 months of completion of the CogMed® program to establish longer-term maintenance of gains<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Treatment enrollment rates | Determine feasibility and acceptability of the CogMed training program by assessing treatment enrollment | 6 months | 
| Attrition rates | Determine feasibility and acceptability of the CogMed training program by assessing attrition rates. | 6 months | 
| Change in scores on Behavior Rating Inventory of Executive Function-Adult (BRIEF-A) over time | Brief neuropsychological evaluations will be conducted at 4 time points (these assessments are standard of care). Baseline before the participant is introduced to the CogMed® training program, within 2 weeks of completion of the CogMed® program, at 3 months of completion of the CogMed® program to establish maintenance of gains, and at 6 months of completion of the CogMed® program to establish longer-term maintenance of gains. During these time points, the scores are measured on Behavior Rating Inventory of Executive Function-Adult (BRIEF-A). | Baseline to 6 months | 
| Change in scores on Conners' Continuous Performance Test - Third Edition (CPT-3) over time | Brief neuropsychological evaluations will be conducted at 4 time points (these assessments are standard of care). Baseline before the participant is introduced to the CogMed® training program, within 2 weeks of completion of the CogMed® program, at 3 months of completion of the CogMed® program to establish maintenance of gains, and at 6 months of completion of the CogMed® program to establish longer-term maintenance of gains. During these time points, the scores are measured on Conners' Continuous Performance Test - Third Edition (CPT-3). | Baseline to 6 months | 
| Change in scores on Delis-Kaplan Executive Function System (D-KEFS) over time | Brief neuropsychological evaluations will be conducted at 4 time points (these assessments are standard of care). Baseline before the participant is introduced to the CogMed® training program, within 2 weeks of completion of the CogMed® program, at 3 months of completion of the CogMed® program to establish maintenance of gains, and at 6 months of completion of the CogMed® program to establish longer-term maintenance of gains. During these time points, the scores are measured on Delis-Kaplan Executive Function System (D-KEFS). | Baseline to 6 months | 
| Change in scores on Repeatable Battery for the Assessment of Neuropsychological Status (RBANS-Update A, B, C, or D) over time | Brief neuropsychological evaluations will be conducted at 4 time points (these assessments are standard of care). Baseline before the participant is introduced to the CogMed® training program, within 2 weeks of completion of the CogMed® program, at 3 months of completion of the CogMed® program to establish maintenance of gains, and at 6 months of completion of the CogMed® program to establish longer-term maintenance of gains. During these time points, the scores are measured on Repeatable Battery for the Assessment of Neuropsychological Status (RBANS-Update A, B, C, or D). | Baseline to 6 months | 
| Scores on Test of Premorbid Functioning (TOPF) at baseline | Brief neuropsychological evaluations will be conducted at baseline before the participant is introduced to the CogMed® training program. During this time point, the scores are measured and compared on Test of Premorbid Functioning (TOPF) with other psychological measures. | Baseline | 
| Change in scores on Trial Making Test (TMT) over time | Brief neuropsychological evaluations will be conducted at 4 time points (these assessments are standard of care). Baseline before the participant is introduced to the CogMed® training program, within 2 weeks of completion of the CogMed® program, at 3 months of completion of the CogMed® program to establish maintenance of gains, and at 6 months of completion of the CogMed® program to establish longer-term maintenance of gains. During these time points, the scores are measured on Trial Making Test (TMT). | Baseline to 6 months | 
| Change in scores on Wechsler Memory Scale - Fourth Edition (WMS-IV) over time | Brief neuropsychological evaluations will be conducted at 4 time points (these assessments are standard of care). Baseline before the participant is introduced to the CogMed® training program, within 2 weeks of completion of the CogMed® program, at 3 months of completion of the CogMed® program to establish maintenance of gains, and at 6 months of completion of the CogMed® program to establish longer-term maintenance of gains. During these time points, the scores are measured on Wechsler Memory Scale - Fourth Edition (WMS-IV). | Baseline to 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in scores on Beck Anxiety Inventory (BAI) over time | Brief neuropsychological evaluations will be conducted at 4 time points (these assessments are standard of care). Baseline before the participant is introduced to the CogMed® training program, within 2 weeks of completion of the CogMed® program, at 3 months of completion of the CogMed® program to establish maintenance of gains, and at 6 months of completion of the CogMed® program to establish longer-term maintenance of gains. During these time points, the scores are measured on Beck Anxiety Inventory (BAI). | Baseline to 6 months | 
| Change in scores on Beck Depression Inventory-II (BDI-II) over time | Brief neuropsychological evaluations will be conducted at 4 time points (these assessments are standard of care). Baseline before the participant is introduced to the CogMed® training program, within 2 weeks of completion of the CogMed® program, at 3 months of completion of the CogMed® program to establish maintenance of gains, and at 6 months of completion of the CogMed® program to establish longer-term maintenance of gains. During these time points, the scores are measured on Beck Depression Inventory-II (BDI-II). | Baseline to 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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High grade gliomas (WHO grade III or IV), Low grade gliomas (WHO Grade II)