None listed
Conditions
Brief summary
Dementia is a disorder with huge, growing, global economic burden. There are no effective treatments as yet, to combat or alter the course of dementia- the development of such treatments is an inter-governmentally agreed global public health priority. Clinicians have long delineated a prodromal condition with cognitive symptoms prior to the onset of dementia and Alzheimer’s disease (AD). This condition is known as Mild Cognitive Impairment (MCI). Individuals in this clinical staging present with subjective cognitive impairments and/or objective evidence of impaired cognitive testing whilst still being able to function. Whilst not all rigorously defined MCI patients progress into dementia, the rate of progression to AD is most probably, while the rate of reversion is least. Cognitive inactivity is estimated to be the most prevalent modifiable dementia risk factor worldwide. Our meta-analysis of 18 prospective longitudinal studies found high levels of complex mental activity was associated with a 46% decreased risk of incident dementia. Similarly, a systematic review based on aggregated data of 47,000 individuals followed for an average of 5 years revealed that lifespan complex mental activity slows the rate of cognitive decline in otherwise healthy older individuals. MCI has been associated with other neuropsychiatric conditions (as have dementia and AD). There is increasing evidence to suggest that sleep quality also plays an important role in cognitive health in ageing. Recently it was revealed that people with MCI are almost twice as likely to have sleep disturbance than those with normal cognition. This study also provides evidence to suggest that sleep disturbance is predictive of cognitive decline in older adults and those with neurodegenerative disorders. It has been identified that changes in sleeping patterns occur in MCI in the form of poor sleep efficiency, fragmented sleep, increased frequency of daytime napping, propensity to fall asleep and wake up earlier, and decreased levels of slow wave sleep. In AD, there are the same alterations in sleeping patterns, but to a higher intensity. One positive aspect of these knowledge combined, is that these are modifiable and manageable risk factors that contribute to hastened cognitive decline. Therefore, by treating these modifiable risk factors, we hypothesise that this may help prevent against the development of dementia and AD. One such intervention that is able to target these risk factors is Computerised Cognitive training (CCT). We hypothesis that by carrying out CCT we will reduce the cognitive deficits associated with MCI and sleep disturbance in individuals with this condition
Interventions
Computerise Cognitive Training (CCT) is a cognitive intervention that uses computerised platforms including audiovisual stimuli, videogames or virtual reality. It involves repeated exercises on one or multiple cognitive domains such memory, executive functions or processing speed. The advantages of using this intervention is that it is safe, scalable, versatile, adaptive, and relatively inexpensive.
The intervention will utilise the NHMRC-funded Maintain Your Brain Trial’s “Brain Training Syst
Computerise Cognitive Training (CCT) is a cognitive intervention that uses computerised platforms including audiovisual stimuli, videogames or virtual reality. It involves repeated exercises on one or multiple cognitive domains such memory, executive functions or processing speed. The advantages of using this intervention is that it is safe, scalable, versatile, adaptive, and relatively inexpensive. The intervention will utilise the NHMRC-funded Maintain Your Brain Trial’s “Brain Training System (BTS)”, designed by CI Valenzuela that implements exercises from NeuroNation. BTS CCT involves online, guided, drill-and-practice standardised tests that load on specific cognitive processes. These cognitively challenging tasks usually are conducted without explicit instruction of problem-solving strategies. The exercises target either working memory, logic, attention and verbal skills or a combination. Examples of these exercises include memorising shopping lists and selecting items from shelves (verbal memory), clicking a button when a circular object skips a point in a circle (attention), figuring out which of 3 choices is a rotated version of an object as quick as possible (logic). The BTS system is a personalised cognitive training program run as flash files meaning that the training regime is based on the participants’ baseline cognitive profile and continues to evolve in response to within-training task performance. Performance across verbal executive, speed, verbal memory, visual executive, visual memory and visual attention are ranked in descending order. The training session will ‘sandwich’ the weaker cognitive abilities in the middle of the training session with the participants stronger cognitive task at the beginning and end of the session. Task difficulty and task type will be recalculated throughout the training depending on the participants’ improvement. BTS is therefore designed to be automatically adaptive to a participant’s baseline score and progress during training. Participants will complete supervised, centre-based BTS CCT twice a week, between 45 mins to one hour sessions, for a total of twelve weeks (24 sessions). This will be conducted in a computer room within the Brain and Mind Centre individually, with supervision from a 'trainer'. If participants have access to a home computer and internet it will be optional for participants to complete one session per week from home after completing successfully 6 supervised sessions. They will be shown and allowed to practice accessing the intervention as if they were at home. Each session is roughly 45 minutes long and will comprise of 17 exercises. Subjects will be randomly allocated in a 1:1 ratio to either 3-months of supervised, centre-based, multidomain CCT (ARM A) or wait-list control (ARM B). After 3-months the wait list control will undergo the same intervention as Arm A
Sponsors
University of Sydney
Study design
Allocation
Randomised controlled trial
Intervention model
Crossover
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
55 Years to No maximum
Healthy volunteers
No
Inclusion criteria
• Multi-domain amnestic MCI with sleep disturbance • Amnestic features defined by impairment in recall tasks. • Other cognitive domains impairment on representative neuropsychological tests • Sleep disturbance as measured by the Pittsburgh Sleep Quality Index (PSQI) 20 score of > 5 • If using Hypnotics, sedating antihistamines, antipsychotics etc for sleep medication, use must be stable for 3-months (any changes in sleep medication will be monitored during intervention and followup)
Exclusion criteria
• History of dementia of any aetiology • History of stroke in last 12 months • Major neurological disorder requiring current treatment (e.g. epilepsy, Parkinson’s disease) • Major psychiatric disorder requiring current treatment (e.g. schizophrenia, bipolar disorder) • Current major depression as measured by the 15-item Geriatric Depression Scale (score of > 10) or the 17-item Hamilton Rating Scale for Depression (score of > 12) • Physical (sensory or motor) impairment that would restrain training • Current alcohol dependence or abuse • Currently undertaking external computerised cognitive training and unwilling to cease during trial engagement
Outcome results
None listed