Immediate and Sustained Effects of Neurofeedback and Working Memory Training on Cognitive Functions in Children and Adolescents with ADHD: A Multi-Arm Pragmatic Randomized Controlled Trial

Objective: To evaluate the effects of neurocognitive training methods on targeted cognitive functions in children and adolescent with ADHD. Method: A pragmatic four-arm randomized controlled trial compared two types of neurofeedback (Slow Cortical Potential and Live Z-score) and Working-memory training (WMT) with treatment as usual. N = 202 participants with ADHD aged 9 to 17 years were included. A battery of cognitive function tests was completed pretreatment, posttreatment, and after 6-months. Results: The effects of WMT on spatial and verbal working-memory were superior to neurofeedback and treatment as usual at posttreatment, but only partially sustained at follow-up. No other consistent effects were observed. We found no clear indications that effects were moderated by ADHD presentation, ongoing medication, age, or sex. Conclusion: The sustained effects of neurocognitive training on cognitive functioning in children and adolescents with ADHD may be limited. Future research should focus on more personalized forms of neurocognitive training.

Hospital-Based Modified Cogmed Working Memory Training for Youth With ADHD

Objective: This study evaluated a modified working memory training program, Cogmed, for ADHD youth. Method: Forty youth were randomized to modified Cogmed training (MCT) or treatment as usual (CON). MCT was delivered in an outpatient mental health clinic in 3 weekly 35-minute sessions with a dedicated coach for 10 weeks. Participants completed assessments at baseline, after the intervention, and again 3 months later. Results: After controlling for baseline, groups were comparable on working memory, academics, and ADHD symptoms. The MCT group was rated by parents and teachers as having fewer executive function challenges and youth endorsed better self-concept compared with the CON group. Conclusions: MCT was associated with some improvement, which could not be attributed to increased working memory capacity and may reflect other facets of the program. Results question the usefulness of Cogmed but highlight considerations for optimizing adherence, engagement, and the therapeutic alliance in interventions for ADHD youth.

The Mindset of Intelligence Is Not a Contributor of Placebo Effects in Working Memory Training

Whether working memory training is effective in enhancing fluid intelligence remains in dispute. Several researchers, who doubt the training benefits, consider that placebo effects may be the reason for positive training gains. One of the vital variables that may induce the placebo effect is the mindset of intelligence. In this article, we provide a test of whether the mindset of intelligence leads to placebo effects in working memory training. Participants were overtly recruited and allocated to the growth mindset group or the fixed mindset group by Theories of Intelligence Scale scores. A single, 1 h session working memory training is the cue to introduce the placebo effects. During pre/post-testing, all participants completed tasks measuring working memory capacity (near transfer) and fluid intelligence (far transfer). Our findings show no significant difference between the two groups in both tasks. Therefore, these results suggest that the placebo effect does not exist in this study, which means individuals' mindset of intelligence may not be a contributor to the placebo effect in 1 h working memory training. This research will further help to clarify the mechanism of the placebo effect in working memory training.

QOLP-11. WORKING MEMORY TRAINING FOR ADULTS WITH GLIOMA

BACKGROUND CogMed Working Memory Training (CWMT) is a computer-based program shown to improve working memory (WM) among those with cognitive impairment. No study to date has investigated its feasibility, acceptability, and satisfaction in adult patients with glioma, despite the well-documented incidence of WM impairment in this population. METHODS Twenty patients with glioma and objective and/or perceived WM deficits enrolled in the study: 52% high-grade, 57% female, Mage=47 (range=21-72 years). Adverse events were monitored to determine safety. Feasibility and acceptability were assessed based on established metrics. Satisfaction was explored by exit-interviews. Neurocognitive tests and measures of psychological distress were administered pre-/post-CWMT to assess preliminary efficacy. RESULTS Of 20 enrolled patients, 16 completed the study protocol (80% retention rate). Reasons for withdrawal included time burden (n=2); tumor-related fatigue (n=1) or lost to follow-up (n=1). No adverse events were determined to be study-related. Adherence was 69%. The perceived degree of benefit was only moderate. Pre- to post-CWMT assessments showed medium to large effects on near-transfer tasks (h p 2 =.35, p=.01 and h p 2 =.25, p=.04) and far-transfer tasks (h p 2 =.20, p=.07 and h p 2 =.16, p=.12) but small to no effects on perceived WM (h p 2 =.01, p=.79) and psychological distress (h p 2 =.01-.06, p=.35-.79). CONCLUSION CWMT was found to be safe and acceptable in adult patients with glioma. Enrollment, retention rates, and treatment adherence were all adequate, yet only moderate perceived benefit was reported. Given that objective measures of WM improved but psychological distress did not, it may be worth considering a less burdensome CWMT protocol, perhaps investigating a less time intensive intervention with respect to both frequency and length of training sessions.

Working memory training efficacy in COPD: the randomised double-blind placebo-controlled Cogtrain trial

BackgroundCognitive impairment (CI) is highly prevalent in chronic obstructive pulmonary disease (COPD) and is associated with a sedentary lifestyle, unhealthy diet and increased cognitive stress susceptibility. Enhancement of cognitive performance by working memory training (WMT) may reverse these effects. Therefore, this study aimed to investigate the efficacy of WMT in COPD on cognitive performance, healthy lifestyle behaviours and cognitive stress susceptibility.MethodsThe double-blind randomised, placebo-controlled Cogtrain trial consisted of a 12-week training phase comprising 30 active or sham WMT sessions, followed by a second 12-week maintenance phase with 12 sessions. Measurements took place at baseline and after the first and second phases. The primary outcome was cognitive performance. Secondary outcomes were the recall of prespecified healthy lifestyle goals, physical capacity and activity, dietary quality, and cognitive stress susceptibility. Motivation towards exercising and healthy eating and psychological wellbeing were exploratory outcomes.ResultsSixty-four patients with moderate COPD (45% male, aged 66.2±7.2 years, median FEV1 60.6% predicted) were randomised. WMT significantly increased patients’ performance on the trained tasks in the first phase, which remained stable in the second phase. Of the 17 cognitive outcome measures only one measure of memory improved after the first phase and one measure of reaction time after the second phase. This intervention did not influence physical capacity and activity, recall of prespecified healthy lifestyle goals, psychological wellbeing, or cognitive stress susceptibility.ConclusionWMT improved performance on the trained tasks but not overall cognitive performance, healthy lifestyle behaviours or cognitive stress susceptibility in patients with COPD.