Computerised cognitive training in late life

Computerised Cognitive Training in Late Life:
Efficacy and Domain-Specific
Timecourse of Benefits
Amit Lampit
Regenerative Neuroscience Group
University of Sydney
Delaying Decline in Global Cognition
The hallmark of dementia:
Simultaneous decline in
two or more cognitive
domains coupled with
functional impairment1
1 McKhann
et al Alzheimers Dement 2011;7(3):263-269
Delaying Decline in Global Cognition
2-year delay in
AD onset
≈
20% decrease
in prevalence
Vickland et al Dement Geriatr Cogn Disord 2010;29:123–130
Cognitive Activity and AD
• Cognitive inactivity is the leading modifiable risk
factor for AD
Barness & Yaffe Lancet Neurol 2011 10(9) 819-28
Cognitive Activity and AD
• Cognitive inactivity is the leading modifiable risk
factor for AD1
• An active cognitive lifestyle is associated with a
more favourable cognitive trajectory in older
persons2 and compression of morbidity3
• BUT NO LIFESTYLE INTERVENTION has been shown
to protect global cognition or alter dementia
incidence Barness & Yaffe Lancet Neurol 2011 10(9) 819-28
1
2 Marioni
3 Marioni
et al 2012 J Alzheimers Dis 2012 28(1) 223-230
et al 2012 PLoS ONE 7 (12) p. e50940
SO WHAT
DO WE
DO?
Computer-assisted Cognitive Training (CCT)
Key Questions: Optimising CCT
1.How much training?
2.How to train?
3.Can CCT protect global cognition?
Timecourse of CCT Trial
Aims
In older individuals with multiple risk factors:
1. To examine the efficacy of of centre-based, multi-domain CCT
on global cognition in comparison to active control (intensive
cognitive activity)
2. To analyse the timecourse of changes in global cognition and
component cognitive domains in order to understand the doseresponse relationship and post-training decay
Timecourse of CCT Trial
Design
Baseline
Follow-up 1
+3 weeks
Follow-up 2
+3months
Follow-up 3
-3 weeks
Follow-up 4
-3months
Follow-up 5
-12months
CCT
No-contact period
Active Control
Cognitive tests
+
MRI
Cognitive tests
+
MRI
Cognitive tests
+
MRI
Cognitive tests
Cognitive tests
Cognitive tests
+
B-ADL
• Randomised, double-blind longitudinal, active-controlled trial
• 80 community-dwelling older adults (aged >65)
• No evidence of depression, psychiatric or neurological disorder
Timecourse of CCT Trial
Outcomes
Global Cognition
Memory
Verbal memory
Immediate
Delayed
Processing speed
Non-verbal memory
Immediate
Delayed
Executive functioning
Stroop
Planning
Timecourse of CCT Trial
Interventions
60 min X 3/w X 12 weeks
= 36 1-hour sessions
Cognitive Training
Multidomain Computer-assisted exercises (COGPACK):
Memory, Attention, Processing Speed, Reasoning, Language
Instruction: Focused on strategy, motivation, meta-cognition
Active Control
Short educational videos followed
by learning questions.
Performed in lab with supervision
Results
Participant characteristics
Demographics
Age (years)
Female Sex, No. (%)
NART-r (SD)
Clinical
IQCODE score (SD)
GPCOG examination score (SD)
MMSE (SD)
B-ADL (SD)
GDS (15-item) (SD)
CCT (n = 39)
AC (n=38)
72.2 (7.1)
29 (74)
112.6 (10.1)
71.9 (5.3)
24 (63)
112.3 (11.0)
3.05 (0.12)
7.9 (1.3)
28.2 (1.4)
1.6 (0.5)
1.7 (1.4)
3.1 (0.13)
8.05 (1.0)
27.8 (1.8)
1.6 (0.65)
1.3 (1.5)
Results
Dementia risk factors
Results
#FU4#
GLOBAL COGNITION
Mean#change#from#baseline#
Global Cognition
15#
Net Effect Size (dCCT - dAC)
Global Cognition
0.5
0.4
10#
Group#X#Time##
#p#=#0.003#
5#
CCT#
AC#
0#
BL#
!5#
0.3
0.2
0.1
onths -3 weeks
0.0
Training ON -3
+3 weeks
months
Training OFF
+3 months -3 weeks
-3 months
#FU1#
#FU2#
#FU3#
#FU4#
Results
MEMORY
Global Cognition
Cognition
Global
Net Effect Size (dCCT - dAC)
Memory
Global Cognition
Memory
0.5
0.4
0.3
0.2
0.1
onths -3
-3 weeks
weeks
onths
0.0
Training ON -3
-3 months
months
+3 weeks
Training OFF
+3 months -3 weeks
-3 months
Mean)change)from)b
Results
5)
0)
BL)
)FU2)
)FU3)
)FU4
)FU2)
)FU3)
)FU4)
'5)
SPEED
Mean)change)from)baseline)
Memory
20)
Global Cognition15)
Processing Speed
Memory
0.5
Group)X)Time))
)p)=)0.03)
10)
Processing Speed 5)
0.4
0)
BL)
'5)
0.3
0.2
0.1
onths -3
-3 weeks
weeks
onths
0.0
)FU1)
IPSM
Global Cognition
Cognition
Global
Net Effect Size (dCCT - dAC)
10)
Training ON -3
-3 months
months
+3 weeks
Training OFF
+3 months -3 weeks
-3 months
)FU1)
Results
EXECUTIVE
Global Cognition
Cognition
Global
Memory
Global Cognition
Net Effect Size (dCCT - dAC)
Processing Speed
0.5
Memory
Executive Function
Processing Speed
Executive Function
0.4
0.3
0.2
0.1
onths -3
-3 weeks
weeks
onths
0.0
Training ON -3
-3 months
months
+3 weeks
Training OFF
+3 months -3 weeks
-3 months
Group X Time
p = 0.267
Therapeutic Heuristic for
CCT in At-risk Elders
Peak-finding Dose
through Titration
Maintenance Dose
during slow decay phase
Peak Response after unknown
number of sessions
Diminishing
returns with
further training
0.4
Rapid decay of portion of
gains after training ceases
0.2
Slow decay of residual gains
Rapid gains
Some gains may be
durable over the
long term
Sessions/Time
Training ON
Training OFF
80
70
60
50
40
30
20
10
0.0
0
Therapeutic Effect (Cohen's net d)
Loading
Dose
Conclusions
1. In healthy elderly at-risk, multidomain, computer-assisted
supervised cognitive training is a safe and effective
intervention to enhance global cognition, the main area of
impairment in dementia.
Conclusions
1. In healthy elderly at-risk, multidomain, computer-assisted
supervised cognitive training is a safe and effective
intervention to enhance global cognition, the main area of
impairment in dementia.
2. Understanding of the dose-response characteristics of CCT
will be vital for the development of more effective
interventions.
3. The next step is to examine the preventative role of CCT on
halting cognitive decline and delaying dementia onset.
Acknowledgements
Supervisors
Michael Valenzuela
Sharon Naismith
Students
Harry Hallock
Emilie Tang
Rebecca Moss
Sindy Kwok
Alana Kohn
Matthew Lukjanenko
Michael Rosser
Collaborators
Henry Brodaty (UNSW)
Chao Suo (Monash)
Claus Ebster (U. Vienna)
Suzi Parker (Burger Centre)
Funding
Dementia Collaborative
Research Centres
The Dreikurs Bequest
Montefiore Jewish Home
This project is being funded by the DCRC – ABC as part of the Australian Government’s Dementia
Initiative.
The views expressed in this work are the views of its author/s and not necessarily those of the
Australian Government.
© The University of New South Wales, as represented by the Dementia Collaborative Research
Centre – Assessment and Better Care (2012).