Clinical trial NCT06130735: Impact of Intensive Computerized Cognitive Training
Official title: Computerized Cognitive Training: Characterization of Factors That Predict Cognitive Enhancement in Acquired Brain Injury
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Acquired Brain Injury
Mild Cognitive Impairment
Mild Neurocognitive Disorder
Keywords: computerized cognitive training
working memory
acquired brain injury
mild neurocognitive impairment
neuropsychological testing
BDNF
event-related potentials
Lead sponsor: Brigham and Women's Hospital
Sponsor class: OTHER
Collaborators: name: Fujifilm
First posted: 2023-11-14
Enrollment: 30
Sex: ALL
Minimum age (years): 25
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: Clinical trials with a single arm.
Primary purpose: TREATMENT

Brief summary: To investigate factors that predict cognitive enhancement following engagement in an intensive Computerized Cognitive Training Protocol.

Detailed description: To investigate factors that predict cognitive enhancement following engagement in an intensive 6-month, 5 days per week training use the ABI Wellness BEARS platform and Brainex Software Symbol Relations Module.

The study will examine the impact of intensive working memory training on neurocognitive markers of brain plasticity (intervention-related changes) in 1) performance on neuropsychological tests, 2) BDNF levels in blood and salivary, 3) ERP measures of working memory, and 4) resting state fMRI and structural MRI.

Eligibility criteria: Inclusion Criteria:

* Patient of the Mass General Brigham Health System with primary attention and executive functioning difficulties and/or a diagnosis of mild cognitive disorder or mild neurocognitive disorder (non-amnestic profile), due to an acquired brain injury (ABI) sustained at least 12 months prior to study contact.
* Ages 25-65 years old
* Proficiency in English
* Willing and able to complete all study-related activities for 12 months, including travel to Brigham and Women's Hospital (Boston) for four in-person assessment visits and two serum and saliva sample collections.
* Access to a computer with webcam and stable internet.
* A reliable study informant who can complete one questionnaire about participant's cognition/daily functioning, at four time points.

Exclusion Criteria:

* History of alcohol or substance abuse, or dependence, within the past 2 years, as per DSM-5 criteria.
* High likelihood of an underlying progressive neurodegenerative disorder.
* Evidence of moderate to severe cognitive disorder, based on a score of 21 or less on the Mini-Mental Status Examination (MMSE) (Tombaugh \& McIntyre, 1992).
* Patient Health Questionnaire (PHQ)-9 (Kroenke et al., 2010) Score ≥ 19, unless deemed by treating provider not to have active depression (e.g., adjustment disorder, grief reaction).
* Active psychotic symptoms.
* Severe sensory losses such that participants would unlikely be able to participate in the study training, even with substantial accommodations (self-report of extreme difficulty reading ordinary newspaper print or a performance-tested corrected vision test score of worse than 20/30).
* Communication difficulties that prevent the participant from effectively participating in this highly interactive study protocol (based on interviewer's rating of a person's ability to be understood and to understand others).
* Current participation in a pharmacological, or other interventional research trial.
* Life expectancy of \< 2 years.

Primary outcomes:
measure: Changes in cognitive outcome measures
timeFrame: 6 months
measure: Changes in BDNF Levels in blood and saliva
timeFrame: 6 months
Secondary outcomes:
measure: Self-report exercise and physical activity
timeFrame: 6 months
measure: Intervention-related changes in ERP measures, such as the P3 component (P3a and P3b)
timeFrame: 6 months
measure: Intervention-related changes in resting state fMRI
timeFrame: 6 months
measure: Quality of life self-report
timeFrame: 6 months
measure: Sleep
timeFrame: 6 months
measure: Anxiety
timeFrame: 6 months
measure: Depression
timeFrame: 6 months
measure: Self-report on impact of fatigue
timeFrame: 6 months
measure: Feelings about cognitive/thinking skills
timeFrame: 6 months
Other outcomes:
Locations:
city: Boston
country: United States
facility: Brigham and Women's Hospital
state: Massachusetts
Study officials:
affiliation: Brigham and Women's Hospital
name: Kim C Willment, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Brigham and Women's Hospital
name: Kirk R Daffner, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Norman A, Curro V, Holloway M, Percuklievska N, Ferrario H. Experiences of individuals with acquired brain injury and their families interacting with community services: a systematic scoping review. Disabil Rehabil. 2023 Feb;45(4):739-751. doi: 10.1080/09638288.2022.2043465. Epub 2022 Mar 4.
citation: Amariglio RE, Donohue MC, Marshall GA, Rentz DM, Salmon DP, Ferris SH, Karantzoulis S, Aisen PS, Sperling RA; Alzheimer's Disease Cooperative Study. Tracking early decline in cognitive function in older individuals at risk for Alzheimer disease dementia: the Alzheimer's Disease Cooperative Study Cognitive Function Instrument. JAMA Neurol. 2015 Apr;72(4):446-54. doi: 10.1001/jamaneurol.2014.3375.
citation: Billig AR, Feng NC, Behforuzi H, McFeeley BM, Nicastri CM, Daffner KR. Capacity-limited resources are used for managing sensory degradation and cognitive demands: Implications for age-related cognitive decline and dementia. Cortex. 2020 Dec;133:277-294. doi: 10.1016/j.cortex.2020.09.005. Epub 2020 Sep 24.
citation: Biswal BB. Resting state fMRI: a personal history. Neuroimage. 2012 Aug 15;62(2):938-44. doi: 10.1016/j.neuroimage.2012.01.090. Epub 2012 Jan 24.
citation: Buckner RL, Krienen FM, Yeo BT. Opportunities and limitations of intrinsic functional connectivity MRI. Nat Neurosci. 2013 Jul;16(7):832-7. doi: 10.1038/nn.3423. Epub 2013 Jun 25.
citation: Burckhardt CS, Anderson KL, Archenholtz B, Hagg O. The Flanagan Quality Of Life Scale: evidence of construct validity. Health Qual Life Outcomes. 2003 Oct 23;1:59. doi: 10.1186/1477-7525-1-59.
citation: Chen K, Azeez A, Chen DY, Biswal BB. Resting-State Functional Connectivity: Signal Origins and Analytic Methods. Neuroimaging Clin N Am. 2020 Feb;30(1):15-23. doi: 10.1016/j.nic.2019.09.012.
citation: Coulter CL, Weber JM, Scarvell JM. Group physiotherapy provides similar outcomes for participants after joint replacement surgery as 1-to-1 physiotherapy: a sequential cohort study. Arch Phys Med Rehabil. 2009 Oct;90(10):1727-33. doi: 10.1016/j.apmr.2009.04.019.
citation: Daffner KR, Chong H, Sun X, Tarbi EC, Riis JL, McGinnis SM, Holcomb PJ. Mechanisms underlying age- and performance-related differences in working memory. J Cogn Neurosci. 2011 Jun;23(6):1298-314. doi: 10.1162/jocn.2010.21540. Epub 2010 Jul 9.
citation: Kersel DA, Marsh NV, Havill JH, Sleigh JW. Neuropsychological functioning during the year following severe traumatic brain injury. Brain Inj. 2001 Apr;15(4):283-96. doi: 10.1080/02699050010005887.
citation: Denboer JW, Nicholls C, Corte C, Chestnut K. National Institutes of Health Toolbox Cognition Battery. Archives of Clinical Neuropsychology. 2014; 29(7): 692-694
citation: Hays RD, Stewart AL. Measuring functioning and well-being: The Medical Outcomes Study Approach. Duke University Press. 1992.
citation: Holloway M, Tasker R. The Experiences of Relatives of People with Acquired Brain Injury (ABI) of the Condition and Associated Social and Health Care Services. Journal of Long-term Care. 2019, p.99-110
citation: Ivnik RJ, Malec JF, Smith GE, Tangalos EG, Petersen, RC. Neuropsychological tests' norms above age 55: COWAT, BNT, MAE Token, WRAT-R Reading, AMNART, STROOP, TMT, and JLO. The Clinical Neuropsychologist. 1996; 10(3): 262-278.
citation: Jones JM, Haslam SA, Jetten J, Williams WH, Morris R, Saroyan S. That which doesn't kill us can make us stronger (and more satisfied with life): the contribution of personal and social changes to well-being after acquired brain injury. Psychol Health. 2011 Mar;26(3):353-69. doi: 10.1080/08870440903440699.
citation: Kersel DA, Marsh NV, Havill JH, Sleigh JW. Psychosocial functioning during the year following severe traumatic brain injury. Brain Inj. 2001 Aug;15(8):683-96. doi: 10.1080/02699050010013662.
citation: Kurasik S. Group dynamics in the rehabilitation of hemiplegic patients. J Am Geriatr Soc. 1967 Sep;15(9):852-5. doi: 10.1111/j.1532-5415.1967.tb02443.x. No abstract available.
citation: Ledreux A, Hakansson K, Carlsson R, Kidane M, Columbo L, Terjestam Y, Ryan E, Tusch E, Winblad B, Daffner K, Granholm AC, Mohammed AKH. Differential Effects of Physical Exercise, Cognitive Training, and Mindfulness Practice on Serum BDNF Levels in Healthy Older Adults: A Randomized Controlled Intervention Study. J Alzheimers Dis. 2019;71(4):1245-1261. doi: 10.3233/JAD-190756.
citation: Levin C, Chisholm D.
citation: Lezak MD, Howieson DB, Bigler ED, & Tranel D. Neuropsychological assessment, 5th ed. APA PsychNet. 2012.
citation: Nicastri CM, McFeeley BM, Simon SS, Ledreux A, Hakansson K, Granholm AC, Mohammed AH, Daffner KR. BDNF mediates improvement in cognitive performance after computerized cognitive training in healthy older adults. Alzheimers Dement (N Y). 2022 Aug 30;8(1):e12337. doi: 10.1002/trc2.12337. eCollection 2022.
citation: Kroenke K, Spitzer RL, Williams JB, Lowe B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010 Jul-Aug;32(4):345-59. doi: 10.1016/j.genhosppsych.2010.03.006. Epub 2010 May 7.
citation: Porter S, Torres IJ, Panenka W, Rajwani Z, Fawcett D, Hyder A, Virji-Babul N. Changes in brain-behavior relationships following a 3-month pilot cognitive intervention program for adults with traumatic brain injury. Heliyon. 2017 Aug 4;3(8):e00373. doi: 10.1016/j.heliyon.2017.e00373. eCollection 2017 Aug.
citation: Retan R, Wolfson D. The Halstead-Reitan neuropsychological test battery: Theory and clinical interpretation. Neuropsychology Press. 1985.
citation: Rosazza C, Minati L. Resting-state brain networks: literature review and clinical applications. Neurol Sci. 2011 Oct;32(5):773-85. doi: 10.1007/s10072-011-0636-y. Epub 2011 Jun 11.
citation: Schulenberg SE, Yutrzenka BA, Gohm CL. The Computer Aversion, Attitudes, and Familiarity Index (CAAFI): A Measure for the Study of Computer-Related Constructs. Journal of Educational Computing Research. 2006; 34(2): 129-146.
citation: Sevick et al. Alterations in Resting State Functional Connectivity in Patients with Traumatic Brain Injury Following a 3-month Pilot Cognitive Intervention Program. Poster Presented at: UBC Department of Psychiatry 2020 Virtual Research Day. 2020.
citation: Simon SS, Tusch ES, Feng NC, Hakansson K, Mohammed AH, Daffner KR. Is Computerized Working Memory Training Effective in Healthy Older Adults? Evidence from a Multi-Site, Randomized Controlled Trial. J Alzheimers Dis. 2018;65(3):931-949. doi: 10.3233/JAD-180455.
citation: Smets EM, Garssen B, Bonke B, De Haes JC. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 1995 Apr;39(3):315-25. doi: 10.1016/0022-3999(94)00125-o.
citation: Tennstedt SL, Unverzagt FW. The ACTIVE study: study overview and major findings. J Aging Health. 2013 Dec;25(8 Suppl):3S-20S. doi: 10.1177/0898264313518133. No abstract available.
citation: Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992 Sep;40(9):922-35. doi: 10.1111/j.1532-5415.1992.tb01992.x.
citation: Trahey PJ. A comparison of the cost-effectiveness of two types of occupational therapy services. Am J Occup Ther. 1991 May;45(5):397-400. doi: 10.5014/ajot.45.5.397.
citation: Troyer AK, Leach L, Vandermorris S, Rich JB. The measurement of participant-reported memory across diverse populations and settings: a systematic review and meta-analysis of the Multifactorial Memory Questionnaire. Memory. 2019 Aug;27(7):931-942. doi: 10.1080/09658211.2019.1608255. Epub 2019 Apr 25.
citation: Tulsky DS, Kisala PA. Overview of the Spinal Cord Injury-Functional Index (SCI-FI): Structure and Recent Advances. Arch Phys Med Rehabil. 2022 Feb;103(2):185-190. doi: 10.1016/j.apmr.2021.10.006. Epub 2021 Oct 28.
citation: Tusch ES, Alperin BR, Ryan E, Holcomb PJ, Mohammed AH, Daffner KR. Changes in Neural Activity Underlying Working Memory after Computerized Cognitive Training in Older Adults. Front Aging Neurosci. 2016 Nov 8;8:255. doi: 10.3389/fnagi.2016.00255. eCollection 2016.
citation: Vakil E, Blachstein H. Rey Auditory-Verbal Learning Test: structure analysis. J Clin Psychol. 1993 Nov;49(6):883-90. doi: 10.1002/1097-4679(199311)49:63.0.co;2-6.
citation: Vos T, Corry J, Haby MM, Carter R, Andrews G. Cost-effectiveness of cognitive-behavioural therapy and drug interventions for major depression. Aust N Z J Psychiatry. 2005 Aug;39(8):683-92. doi: 10.1080/j.1440-1614.2005.01652.x.
citation: Walsh RS, Fortune DG, Gallagher S, Muldoon OT. Acquired brain injury: combining social psychological and neuropsychological perspectives. Health Psychol Rev. 2014;8(4):458-72. doi: 10.1080/17437199.2012.733914. Epub 2012 Oct 22.
citation: Washburn RA, Smith KW, Jette AM, Janney CA. The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol. 1993 Feb;46(2):153-62. doi: 10.1016/0895-4356(93)90053-4.
citation: Wechsler D. Manual for the Wechsler Adult Intelligence Scale. Psychological Corporation. 1955.
citation: Zanca JM, Dijkers MP, Hsieh CH, Heinemann AW, Horn SD, Smout RJ, Backus D. Group therapy utilization in inpatient spinal cord injury rehabilitation. Arch Phys Med Rehabil. 2013 Apr;94(4 Suppl):S145-53. doi: 10.1016/j.apmr.2012.11.049.