Computerized cognitive training in people with depression: a protocol for a systematic review and meta-analysis

Background People with depression often present with concurrent cognitive impairment. Computerized cognitive training (CCT) is a safe and efficacious strategy to maintain or enhance cognitive performance in a range of clinical populations. However, its efficacy in people with depression and how it varies across populations and design factors are currently unclear. Methods We searched MEDLINE, EMBASE, and PsycINFO from inception to 13 July 2021 for randomised controlled trials examining the efficacy of CCT vs any control condition on cognitive, mood, psychiatric symptoms, psychosocial, and daily functioning in adults with depression. Eligible samples include studies specifically targeting people with major depressive disorder as well as those with other diagnoses where at least 50% of the sample meets the clinical criteria for depression, with the exception of major psychiatric disorders or dementia. The primary outcome is change in the overall cognitive performance. Multivariate analyses will be used to examine the effect sizes on each outcome category as well as possible effect modifiers and correlations between categories. The risk of bias will be assessed using the Cochrane risk of bias tool version 2. Discussion To the best of our knowledge, this will be the first systematic review and meta-analysis of narrowly defined CCT across clinical populations with depression. We aim to investigate not only whether CCT is efficacious for cognition, but also how such effects vary across design factors, what other clinically relevant outcomes might respond to CCT, and the extent to which they differ across populations. Systematic review registration PROSPERO CRD42020204209

Exploring Factors Contribute to Adhering in Computerized Cognitive Training Among Healthy Older Adults in China

Computerized cognitive intervention has the potential to enhance cognition among healthy older adults. However, little is known of the factors associated with adherence in computerized cognitive training among healthy older adults in China. This study was designed to explore these factors utilizing a descriptive qualitative method. A semi-structured interview was used to interview 13 informants. The analysis suggested that factors associated with adherence to the computerized cognitive intervention, included 3 core themes:(1) individual characteristics, with three subthemes of “having free time”, “emotion”, and “persistence characteristics”; (2) encouragement, with three subthemes of “peer group support”, “support from healthcare professional”, and “supervision from facilitators”; and (3) self-recognized improvement related to training, with two subthemes of “better brain function” and “emotion improved”. The results revealed multi-factors promote adherence including personal and social aspects.

The Effect of Computerized Cognitive Training for Adults Over 40 with Dementia-Related Anxiety

Dementia-related anxiety (DRA) may occur when cognitive lapses are appraised as threatening. Individuals with DRA may seek activities to improve cognitive function, including popular computerized cognitive training programs like Lumosity©. We evaluated if DRA changed after eight weeks of Lumosity© use and whether changes were maintained over time. Participants aged 40 and older with pre-existing DRA participated via Amazon’s Mechanical Turk (T1 N = 395; age M = 52.49, SD = 8.71) and were randomly assigned to the experimental (Lumosity© software), active control (Lumosity© crossword puzzles), or no treatment group. Participants completed measures of DRA at T1 and at four follow-up points (T2 = 8 weeks; T3 = 12 weeks; T4 = 16 weeks; T5 = 20 weeks). Repeated measures ANOVAs were used to evaluate the change in DRA. A significant T1-T2 reduction in DRA occurred for the Lumosity© group only (p = .01, partial-eta2 = .03). Longitudinal changes were observed for the Lumosity© group only: DRA scores at T1 were significantly greater than at T2, T4, and T5 (ps < .05). A step-up test procedure was conducted to determine minimum treatment dose effects. A greater reduction in DRA occurred between the Lumosity© and crossword puzzle groups between 25.00 and 29.99 hours of software use (p = .05, partial-eta2 = .19). Lumosity© software outperformed crossword puzzles in DRA reduction from T1 to T2, which was maintained for 12 weeks post-software use. Independent of Lumosity’s intended purpose of supporting cognitive functioning, participants subjectively believe it helps and experience associated benefits.

Effectiveness of home-based electronic cognitive therapy in patients with Alzheimer’s disease dementia: A Feasibility Study (Preprint)

BACKGROUND Can home-based computerized cognitive training programs be a useful tool to sustain cognition and quality of life in patients with Alzheimer’s disease (AD) dementia? Until now, the progressive nature of the disease and the variability in intervention periods has resulted in discrepant findings. We investigated a potential tool to offset the challenges usually found when evaluating the effectiveness of home-based computerized trainings in the AD population. Constant Therapy is a remotely-delivered, cloud-based program developed for patients with speech and cognitive deficits. OBJECTIVE We aimed to assess the feasibility and effectiveness of a 24-week individualized Constant Therapy intervention program in patients with AD in the MCI and mild dementia stages. METHODS Data were collected over a 48-week period. Participants were assigned to either the Constant Therapy or Active Control group. The Constant Therapy group completed an individualized tablet-based training during the first 24 weeks; the second 24 weeks of computerized training were optional. The Active Control group completed paper and pencil games (e.g., sudokus, crosswords) during the first 24 weeks, and then completed the Constant Therapy training during the second 24 weeks. At weeks 0, 24 and 48, participants completed a neuropsychological battery to assess changes in cognition and functioning. In addition, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was administered every 6 weeks. We measured Constant Therapy rate of adherence and task performance, as well as RBANS scores differences between the Constant Therapy and Active Control groups over the first 24 weeks of training. RESULTS Data for 19 patients were analyzed, with 44% of the Constant Therapy group and 22% of the Active Control group completing the entire 48-week training program. Due to the high drop-out rate, further analysis was only computed for participants who completed 24 weeks of training. The Constant Therapy group spent on average 121 days across the 24 weeks, and an average 27 minutes daily on the app. These participants showed an overall improvement in accuracy and latency in the Constant Therapy tasks scores, as well as specific improvements in the Constant Therapy tasks of visual and auditory memory, attention, and arithmetic. The Constant Therapy group also improved in the RBANS coding subtest compared to the Active Control group. CONCLUSIONS Long term (e.g., 24 weeks) computerized cognitive training using the Constant Therapy platform is feasible in patients with AD in the MCI and mild dementia stages. AD patients showed improvements on the Constant Therapy tasks over the 24 weeks and improved in one of the 12 RBANS subtests. These findings support the need for future research investigating the effects of long term individualized computerized programs as tools to sustain cognitive function and potentially quality of life in patients with AD. CLINICALTRIAL ClinicalTrials.gov NCT02521558

Goal Management Training and Computerized Cognitive Training in Depression—a 2-Year Follow-Up of a Randomized Controlled Trial

Objective: Information on the long-term effects of cognitive remediation (CR) in major depressive disorder (MDD) is lacking. The present study reports 2-year follow-up data from a previously published randomized controlled trial (RCT) from our research group, comparing Goal Management Training (GMT), a strategy-based CR intervention, to drill-and-practice computerized cognitive training (CCT). In previous work, we found comparable improvements in executive function (EF), in addition to reductions in depressive symptoms, following both GMT and CCT at 6-month follow-up.Methods: Forty-two participants of the RCT, all diagnosed with MDD, were invited to complete rating-scales pertaining daily-life EF, rumination, and depressive symptoms. Explorative analyses compared the 2-year follow-up with previously published baseline and 6-month follow-up data, using non-parametric statistics. Similarly, GMT and CCT were compared at the 2-year follow-up, and completers were compared with non-completers.Results: Twenty participants completed the study. Overall, completers (n = 20) and non-completers (n = 22) were similar. There were no significant differences between GMT (n = 11) and CCT (n = 9) for any outcome 2 years post-treatment. Reduction compared to baseline in depressive symptoms and rumination, but not in daily-life EFs, emerged for GMT only.Conclusions: Findings suggest long-term improvements in mental health following GMT, while improvements in everyday EFs might require additional treatment or maintenance to sustain. Caution is warranted in the interpretation due to the small sample size and high attrition rates.

Computerized Cognitive Training (CCT) versus Yoga Impact on 12 Month Post Intervention Cognitive Outcome in Individuals with Mild Cognitive Impairment

There is currently limited and mixed evidence for the cognitive benefits of Computerized Cognitive Training (CCT) and yoga in persons with Mild Cognitive Impairment (pwMCI). The objective of this study was to investigate the benefit of computerized cognitive training (CCT) vs. physical (yoga) intervention on cognitive abilities. Participants in this study were part of the larger Mayo Clinic’s Healthy Action to Benefit Independence and Thinking (HABIT) program comparative effectiveness trial. The HABIT program is designed for pwMCI and their care partner and consists of five behavioral interventions: CCT, Memory Support System-Calendar (MSS-Calendar), wellness education, support groups, and yoga. The subtractive study design randomly withheld one of the interventions for a total of five study arms. Longitudinal mixed-effects regression models were used to investigate the hypothesis that CCT and yoga has a greater positive impact on psychomotor and basic attention abilities at 12 months post-intervention as compared to the other HABIT interventions. Findings showed CCT had a positive impact compared to yoga on the Cogstate psychomotor/attention composite at 12 months post-intervention (ES = 0.54; unadjusted p value = 0.007, adjusted p value = 0.021). The impact of yoga or combining CCT with yoga did not show statistically significant improvement. Continued CCT practice at home showed further benefit on psychomotor/attention at 12 months post-intervention. There was no significant benefit of CCT or yoga on Cogstate learning/working memory composite.