Long COVID, Long COVID-19, Long COVID19
Conditions
Keywords
PASC, Cognitive
Brief summary
This platform protocol is designed to be flexible so that it is suitable for a wide range of settings within health care systems, for remote settings, and in community settings where it can be integrated into COVID-19 programs and subsequent treatment plans. This protocol is a prospective, multi-center, multi-arm, randomized, controlled platform trial evaluating potential interventions for PASC-mediated cognitive dysfunction. The hypothesis is that PASC associated dysfunction in cognitive domains, such as executive function and attention, may be improved by interventions that selectively focus on enhancing those domains.
Detailed description
Participants will be randomized to one of the intervention appendices that are actively enrolling at the time of randomization. Intervention appendices may be added or removed according to adaptive design and/or emerging evidence. Various interventions will be studied.
Interventions
BrainHQ platform provides a set of cognitive activities, like puzzles and games, that are cognitively stimulating and actively engage participants but do not continuously and adaptively challenge them. These activities are designed to be a face-valid, active comparison approach to cognitive therapy, thus participants are blinded, attention time is matched, and overall user experience is identical to the active arms.
OTHERBrainHQ
BrainHQ is an online cognitive training program, and has been used to improve cognitive function among persons with cognitive impairment based on principles of neuroplasticity.
OTHERPASC CoRE
PASC CoRE is a manualized, adaptable cognitive rehabilitation intervention adapted from Goal Management Training and other evidence based programs that improve attention and executive functions, among other cognitive domains.
DEVICEtDCS-active
Transcranial direct current stimulation (tDCS) will use a device specifically for home-based use. This device delivers a weak electrical current of 2.0 mA passed through two electrodes placed on the scalp to target the dorsolateral prefrontal cortex region of the brain. The electrodes are single-use for each session and can be attached to a headset by snapping into place. The device has a user-friendly interface and a large-button keypad, making it is easy to use at home.
DEVICEtDCS-sham
tDCS devices used in the sham arm will be pre-programmed to deliver the same ramp up/down at the beginning/end of the 30-minute period as the active arm, except with no current otherwise delivered during the session.
Sponsors
Duke University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Masking description
Participants assigned to active comparator will be considered part of pooled analyses if the intervention was active at the time of the participant's enrollment and the participants were eligible to receive that intervention. This will result in approximately a 1:1 allocation ratio for any intervention to pooled control. Sites will be informed to which intervention appendix participants are randomized, but, when applicable, not whether the participants are allocated to the active intervention arm or active comparator arm within that appendix. The participants and investigators will be blinded throughout the study, when possible. If open intervention appendices do not have the ability to pool controls but have independent controls, at the second stage participants will be randomized in a 1:1 ratio to intervention vs active comparator inside the specific intervention appendix the participants were randomized to at the first stage of the randomization procedure.
Intervention model description
To achieve blinding and an equitable randomization probability, a two-step randomization process will be used. The study will employ a simple (unstratified) randomization scheme. At the first stage, each participant will be assigned with equal probability to one of the intervention appendices for which the participant is eligible, after applying any intervention-specific safety exclusions. At the second stage, each participant will be assigned according to the specific appendix's randomization procedure. Participants will have an equal chance of being randomized into any of the intervention groups.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
In order to be eligible to participate in this study, an individual must meet all of the following criteria: 1. ≥ 18 years of age at the time of enrollment 2. PROMIS-Cog T-score \< 40 3. Previous suspected, probable, or confirmed SARS-CoV-2 infection, as defined by the Pan American Health Organization Suspected case of SARS-CoV-2 infection - three options, A through C: A. Met clinical OR epidemiological criteria: a. Clinical criteria: Acute onset of fever AND cough (influenza-like illness) OR Acute onset of ANY THREE OR MORE of the following signs or symptoms: fever, cough, general, weakness/fatigue, headache, myalgia, sore throat, coryza, dyspnea, nausea, diarrhea, anorexia; b. Epidemiological criteria: Contact of a probable or confirmed case or linked to a COVID-19 cluster; B. Presented acute respiratory infection with history of fever or measured fever of ≥ 38°C and cough, with onset within the last 10 days, and who requires hospitalization; or C. Presented with no clinical signs or symptoms, NOR meeting epidemiologic criteria with a positive professional use or self-test SARS-CoV-2 Antigen-Rapid Diagnostic Test. Probable case of SARS-CoV-2 infection, defined as having met clinical criteria above AND was a contact of a probable or confirmed case or was linked to a COVID-19 cluster. Confirmed case of SARS-CoV-2 infection - two options, A through B: A. Presented with a positive nucleic acid amplification test, regardless of clinical criteria OR epidemiological criteria; or B. Met clinical AND/OR epidemiological criteria (See suspected case A.a.), with a positive professional use or self-test SARS-CoV-2 Antigen-Rapid Diagnostic Test. \* Suspected and probable cases will only be allowed if they occurred before May 1, 2021, and will be limited to 10% of the study population. Otherwise, confirmed cases are required. 4. Cognitive dysfunction symptoms following a SARS-CoV-2 infection that have persisted for at least 12 weeks and are still present at the time of consent 5. Fluent in English or Spanish language 6. Willing and able to provide informed consent, complete the intervention, complete the intervention assessments, and return for all of the necessary follow-up visits
Exclusion criteria
An individual who meets any of the following criteria will be excluded from participation in this study: 1. Prior or active unstable or progressive major psychiatric or neurologic condition that would not show improvement and could hide treatment effect and is not related to SARS-CoV-2 infection, at the investigator's discretion, including, but not limited to, the following examples: a. Progressive neurodegenerative disease, such as Alzheimer's disease, Parkinson's disease, etc. b. Past traumatic brain injury occurrence still associated with active post-concussive symptoms c. Uncontrolled seizure disorder, such as having at least one seizure in the last year that is adjudicated by clinical judgement d. Post-stroke deficits that may interfere with assessment, such as language or communication difficulties, aphasia, etc. e. Formal thought disorders, such as schizophrenia, etc. f. Any neuropsychiatric or neurologic disorder uncontrolled for the previous six months or that may interfere with assessment, at discretion of the investigator 2. Known prior diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome, not related to SARS-CoV-2 infection 3. Known active acute SARS-CoV-2 infection ≤ 4 weeks from consent 4. Current use of symptomatic therapies including prescribed or illicit stimulants, amantadine, N-methyl-D-aspartate receptor antagonists (e.g., memantine, dissociative drugs) 5. Current use of a stimulant for treating any PASC-related symptom 6. Current diagnosis of alcohol and substance use disorders a. Prior use disorders acceptable if abstinence achieved and maintained for at least 12 months before study enrollment 7. Insufficient visual, auditory, and motor function to participate in intervention and assessments 8. Known pregnancy 9. Current or recent use (within the last 2 months) of intervention\* 10. Known allergy/sensitivity/hypersensitivity to components of the intervention or comparator\* 11. Currently receiving/using intervention from another clinical trial, such as another RECOVER trial 12. Any condition that would make the participant, in the opinion of the investigator, unsuitable for the study 1. The site investigator has the discretion to determine whether a participant is too cognitively impaired to participate and should instead be referred for clinical evaluation. Exclusions specific to intervention appendices are listed in each appendix. \* Relevant if only one intervention appendix is open at the time of enrollment, though exclusion may be qualified in the appendix. If multiple intervention appendices are open, a participant may be excluded from any intervention appendix based on contraindications listed in the intervention appendix, current use of intervention, or known allergy/sensitivity/hypersensitivity and still remain eligible for the remaining intervention appendices.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total Number of Participants Enrolled in Each Appendix | 160 Days | Appendix-specific outcome measure data will be reported under the associated NCT ID. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| BrainHQ Active Comparator 5 sessions/week at 30 min/session
BrainHQ/Active Comparator Activity: BrainHQ platform provides a set of cognitive activities, like puzzles and games, that are cognitively stimulating and actively engage participants but do not continuously and adaptively challenge them. These activities are designed to be a face-valid, active comparison approach to cognitive therapy, thus participants are blinded, attention time is matched, and overall user experience is identical to the active arms. | 64 |
| BrainHQ 5 sessions/week at 30 min/session
BrainHQ: BrainHQ is an online cognitive training program, and has been used to improve cognitive function among persons with cognitive impairment based on principles of neuroplasticity. | 67 |
| BrainHQ + PASC CoRE BrainHQ plus 9 group sessions at 1.5 hr/session and 3 individual sessions at 30 min/session
BrainHQ: BrainHQ is an online cognitive training program, and has been used to improve cognitive function among persons with cognitive impairment based on principles of neuroplasticity.
PASC CoRE: PASC CoRE is a manualized, adaptable cognitive rehabilitation intervention adapted from Goal Management Training and other evidence based programs that improve attention and executive functions, among other cognitive domains. | 66 |
| Brain HQ + tDCS-active 2.0 mA stimulation delivered for 30 min during each BrainHQ session
BrainHQ: BrainHQ is an online cognitive training program, and has been used to improve cognitive function among persons with cognitive impairment based on principles of neuroplasticity.
tDCS-active: Transcranial direct current stimulation (tDCS) will use a device specifically for home-based use. This device delivers a weak electrical current of 2.0 mA passed through two electrodes placed on the scalp to target the dorsolateral prefrontal cortex region of the brain. The electrodes are single-use for each session and can be attached to a headset by snapping into place.
The device has a user-friendly interface and a large-button keypad, making it is easy to use at home. | 66 |
| Brain HQ + tDCS-sham Inactive stimulation delivered for 30 min during each BrainHQ session
BrainHQ: BrainHQ is an online cognitive training program, and has been used to improve cognitive function among persons with cognitive impairment based on principles of neuroplasticity.
tDCS-sham: tDCS devices used in the sham arm will be pre-programmed to deliver the same ramp up/down at the beginning/end of the 30-minute period as the active arm, except with no current otherwise delivered during the session. | 65 |
| Total | 328 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 |
|---|---|---|---|---|---|---|
| Overall Study | Adverse Event | 0 | 1 | 0 | 1 | 3 |
| Overall Study | Did Not Want to be Randomized to Intervention | 0 | 0 | 0 | 0 | 1 |
| Overall Study | Disease Relapse | 1 | 0 | 1 | 0 | 0 |
| Overall Study | Early Termination | 0 | 0 | 1 | 0 | 0 |
| Overall Study | Failure to Meet Randomization Criteria | 0 | 1 | 0 | 1 | 0 |
| Overall Study | Lost to Follow-up | 2 | 0 | 1 | 1 | 1 |
| Overall Study | Reported Unwanted Symptoms | 0 | 0 | 0 | 0 | 1 |
| Overall Study | Unable to Return for Study Visits | 0 | 1 | 0 | 3 | 1 |
| Overall Study | Withdrawal by Subject | 2 | 2 | 1 | 5 | 0 |
Baseline characteristics
| Characteristic | Brain HQ + tDCS-sham | Total | BrainHQ Active Comparator | BrainHQ | BrainHQ + PASC CoRE | Brain HQ + tDCS-active |
|---|---|---|---|---|---|---|
| Age, Continuous | 49.0 years | 48.0 years | 44.5 years | 49.0 years | 53.0 years | 47.0 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 14 Participants | 52 Participants | 6 Participants | 12 Participants | 9 Participants | 11 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 51 Participants | 274 Participants | 57 Participants | 55 Participants | 56 Participants | 55 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 2 Participants | 1 Participants | 0 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 4 Participants | 1 Participants | 2 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 3 Participants | 15 Participants | 2 Participants | 2 Participants | 6 Participants | 2 Participants |
| Race (NIH/OMB) Black or African American | 12 Participants | 47 Participants | 6 Participants | 12 Participants | 7 Participants | 10 Participants |
| Race (NIH/OMB) More than one race | 2 Participants | 15 Participants | 5 Participants | 3 Participants | 2 Participants | 3 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 1 Participants | 1 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 5 Participants | 11 Participants | 2 Participants | 2 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) White | 43 Participants | 235 Participants | 47 Participants | 46 Participants | 49 Participants | 50 Participants |
| Region of Enrollment United States | 65 Participants | 328 Participants | 64 Participants | 67 Participants | 66 Participants | 66 Participants |
| Sex: Female, Male Female | 45 Participants | 241 Participants | 52 Participants | 49 Participants | 49 Participants | 46 Participants |
| Sex: Female, Male Male | 20 Participants | 87 Participants | 12 Participants | 18 Participants | 17 Participants | 20 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk |
|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 64 | 0 / 67 | 0 / 66 | 0 / 66 | 0 / 65 |
| other Total, other adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
Primary
Total Number of Participants Enrolled in Each Appendix
Appendix-specific outcome measure data will be reported under the associated NCT ID.
Time frame: 160 Days
Population: Enrolled participants.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| BrainHQ Active Comparator | Total Number of Participants Enrolled in Each Appendix | 64 Participants |
| BrainHQ | Total Number of Participants Enrolled in Each Appendix | 67 Participants |
| BrainHQ + PASC CoRE | Total Number of Participants Enrolled in Each Appendix | 66 Participants |
| Brain HQ + tDCS-active | Total Number of Participants Enrolled in Each Appendix | 66 Participants |
| Brain HQ + tDCS-sham | Total Number of Participants Enrolled in Each Appendix | 65 Participants |