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Trial record 3 of 155 for:    "Huntington disease"

Working Memory Training in Huntington's Disease

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ClinicalTrials.gov Identifier: NCT02926820
Recruitment Status : Completed
First Posted : October 6, 2016
Last Update Posted : October 10, 2016
Sponsor:
Collaborator:
North York General Hospital
Information provided by (Responsible Party):
Christine Till, 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.

Condition or disease Intervention/treatment Phase
Huntington's Disease Behavioral: Cogmed QM Not Applicable

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 Type : Interventional  (Clinical Trial)
Actual Enrollment : 9 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Working Memory Training in Individuals With Huntington's Disease: A Pilot Project
Study Start Date : February 2015
Actual Primary Completion Date : March 2016
Actual Study Completion Date : March 2016

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Cognitive training
Participants will undergo five weeks of cognitive training using the Cogmed QM program. All patients complete the same intervention.
Behavioral: Cogmed QM
The intervention consisted of 25 Cogmed sessions, typically completed over a five week period (i.e. 5 days per week), with each session lasting between 40-50 minutes per day. The program consists of 12 exercises that target visuo-spatial or verbal working memory. At each training session, participants completed 8 of the 12 exercises (order selected by the user), with 15 trials per exercise. Cogmed QM is an adaptive program, wherein task difficulty is adjusted to performance on each trial. The level of difficulty adjusts continuously and automatically, ensuring that each session provides an engaging, challenging level of WM capacity. Breaks were permitted, and encouraged, at the participants' discretion throughout the session.




Primary Outcome Measures :
  1. Adherence to training (defined by completing the intervention within the recommended time frame) [ 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 :
  1. Digit Span subtest from the Wechsler Memory Scales - third edition [ Time Frame: 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.

  2. Spatial Span subtest from the Wechsler Memory Scales - third edition [ Time Frame: 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.

  3. Auditory Working Memory from the Woodcock Johnson Tests of Cognitive Ability - third edition [ Time Frame: 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)

  4. Symbol span subtest from the Wechsler Memory Scales - fourth edition, reported in raw score units (total correct responses) [ Time Frame: 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)

  5. Verbal Fluency subtest from the Delis-Kaplan Executive Function System [ Time Frame: 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)

  6. Symbol Digits Modalities Test (oral administration) [ Time Frame: 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)

  7. Word List Learning from the Hopkins Verbal Learning Test -Revised [ Time Frame: 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)

  8. Trail Making Test - Parts A and B [ Time Frame: 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)


Other Outcome Measures:
  1. Qualitative experiences of training program as reported by the patient [ Time Frame: Post-interview follow-up, up to 45 days following baseline visit ]
    Keywords were used to elicit themes that were indicative of participant attitude and motivation for training

  2. Tolerance (ratio of training time to breaks per day) [ Time Frame: Per session and through completion of training program, up to 40 days ]
    To assess tolerance, the ratio of active training time to breaks per day was examined (Cogmed guidelines suggest at most a 2:1 ratio of active training time and breaks per sessions).

  3. Cogmed Improvement Index [ Time Frame: Through completion of training program, up to 40 days ]
    The Improvement Index represents average improvement over the course of the training. It is calculated automatically by the program by subtracting the Start Index (score on third day of training) from the Max Index (best score throughout training).



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Ages Eligible for Study:   20 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

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

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02926820


Locations
Canada, Ontario
North York General Hospital
Toronto, Ontario, Canada, M2K 1E1
Sponsors and Collaborators
York University
North York General Hospital
Investigators
Principal Investigator: Christine Till, PhD York University

Study Data/Documents: Study Protocol  This link exits the ClinicalTrials.gov site
The lead investigator, Dr. Christine Till, can be contacted by email (ctill@yorku.ca) for a copy of the Informed Consent Form or study protocol.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Christine Till, Associate Professor, Department of Psychology, York University
ClinicalTrials.gov Identifier: NCT02926820     History of Changes
Other Study ID Numbers: NYGH 15-0001
First Posted: October 6, 2016    Key Record Dates
Last Update Posted: October 10, 2016
Last Verified: October 2016
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Keywords provided by Christine Till, York University:
Huntington disease
cognitive rehabilitation
cognitive dysfunction

Additional relevant MeSH terms:
Huntington Disease
Basal Ganglia Diseases
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Dementia
Chorea
Dyskinesias
Movement Disorders
Heredodegenerative Disorders, Nervous System
Neurodegenerative Diseases
Genetic Diseases, Inborn
Cognition Disorders
Neurocognitive Disorders
Mental Disorders