Working Memory Training in Huntington's Disease

Not Applicable

Completed

• Conditions: Huntington's Disease
• Interventions: Behavioral: Cogmed QM

• Registration Number: NCT02926820
• Lead Sponsor: York University

Brief Summary

There is a paucity of investigation into effective interventions to enhance cognitive function and/or mitigate cognitive decline in individuals with Huntington disease (HD). This study targeted working memory (WM), which is the ability to actively hold information in the mind in order to perform complex mental tasks, given reports of WM dysfunction in patients with HD. The investigators examined the feasibility of conducting a 5-week WM training program (Cogmed). Patient adherence and treatment tolerance were assessed. In addition, preliminary evidence for the efficacy of this training program on targeted cognitive abilities was examined. Nine patients with pre-manifest or early stage HD underwent training. Patients were assessed before the intervention and one week after completion.

Detailed Description

Huntington disease (HD) is associated with a variety of cognitive deficits, with prominent difficulties in working memory (WM). WM deficits are notably compromised in early-onset and prodromal HD patients. This study aimed to determine the feasibility of a computer-ized WM training program (Cogmed QM), novel to the HD population. Nine patients, aged 26-62, with early stage HD underwent a 25-session (5 days/week for 5 weeks) WM training program (Cogmed QM). Training exercises involved the manipulation and storage of verbal and visuospatial information, with difficulty adapted as a function of individual performance. Neuropsychological testing was conducted before and after training, and performance on criterion WM measures (Digit Span and Spatial Span) and near-transfer WM measures (Symbol Span and Auditory WM) were evaluated. Post-training inter-views about patient experience were thematically analyzed using NVivo software. Seven of nine patients demonstrated adherence to the training and completed all sessions within the recommended timeframe of 5 weeks. All adherent patients reported that they found training helpful (n=7), and almost all felt that their memory improved (n=6). Compared to baseline scores, patients showed significant improvement on the neuropsychological measures of verbal WM, including Digit Span (p = .047) and Auditory WM (p = .041). This pilot study provides support for feasibility of computerized WM training in early-stage patients with HD. Results suggest that HD patients can improve WM with intensive training, though a full-scale intervention project is needed to understand the reliability of changes over time.

Study Timeline

• Study Start: 2015-02
• Primary Completion: 2016-03
• Study Completion: 2016-03
• Study First Submitted: 2016-09-30
• Status Verified: 2016-10
• Study First Submitted QC: 2016-10-04
• Study First Posted: 2016-10-06
• Last Update Submitted: 2016-10-07
• Last Update Posted: 2016-10-10

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 9

Inclusion Criteria

1. Laboratory-confirmed gene expansion of at least 36 CAG repeats
2. Reported working memory difficulties on the Patient-Reported Outcomes in Cognitive Impairment (PROCOG) questionnaire
3. Total Functional Capacity (TFC) score of at least 3, taken from the UHDRS
4. Montreal Cognitive Assessment (MOCA) score of 19 or greater

Exclusion Criteria

1. History of head trauma/neurological event such as stroke
2. Untreated psychiatric symptoms or substance abuse
3. Visual or motor symptoms that would impede ability to complete the program and/or neuropsychological testing
4. Nonfluency in English

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Cognitive training	Cogmed QM	Participants will undergo five weeks of cognitive training using the Cogmed QM program. All patients complete the same intervention.

Primary Outcome Measures

Name	Time	Method
Adherence to training (defined by completing the intervention within the recommended time frame)	40 days	Adherence was defined as completion of at least 80% of the total 25 training sessions within 40 calendar days or less

Secondary Outcome Measures

Name	Time	Method
Symbol Digits Modalities Test (oral administration)	Baseline (time 0) versus Post-intervention test score (up to 45 days post-baseline)	This tests is used as a control task (i.e tests that do not directly assess working memory). Score will be reported in raw score units (total words produced)
Digit Span subtest from the Wechsler Memory Scales - third edition	Baseline (time 0) versus Post-intervention test score (up to 45 days post-baseline)	This test is used as a criterion measure (i.e. measure that closely resembles tasks in the Cogmed program). Scores will be reported in raw score units as the total correct responses.
Trail Making Test - Parts A and B	Baseline (time 0) versus Post-intervention test score (up to 45 days post-baseline)	This tests is used as a control task (i.e tests that do not directly assess working memory). Score will be reported in raw score units (total time in seconds)
Spatial Span subtest from the Wechsler Memory Scales - third edition	Baseline (time 0) versus Post-intervention test score (up to 45 days post-baseline)	This test is used as a criterion measure (i.e. measure that closely resembles tasks in the Cogmed program). Scores will be reported in raw score units as the total correct responses.
Auditory Working Memory from the Woodcock Johnson Tests of Cognitive Ability - third edition	Baseline (time 0) versus Post-intervention test score (up to 45 days post-baseline)	This test is used as a near transfer measure (i.e. test of verbal or visuospatial working memory that include stimuli that are similar to trained tasks). Scores will be reported in raw score units (total correct responses)
Verbal Fluency subtest from the Delis-Kaplan Executive Function System	Baseline (time 0) versus Post-intervention test score (up to 45 days post-baseline)	This tests is used as a control task (i.e tests that do not directly assess working memory). Score will be reported in raw score units (total words produced)
Word List Learning from the Hopkins Verbal Learning Test -Revised	Baseline (time 0) versus Post-intervention test score (up to 45 days post-baseline)	This tests is used as a control task (i.e tests that do not directly assess working memory). Score will be reported in raw score units (total words learned)
Symbol span subtest from the Wechsler Memory Scales - fourth edition, reported in raw score units (total correct responses)	Baseline (time 0) versus Post-intervention test score (up to 45 days post-baseline)	This test is used as a near transfer measure (i.e. test of verbal or visuospatial working memory that include stimuli that are similar to trained tasks). Scores will be reported in raw score units (total correct responses)

Trial Locations

Locations (1)

North York General Hospital; 🇨🇦 Toronto, Ontario, Canada