Mild Cognitive Impairment Clinical Trial
— NDD2019Official title:
Evaluation of the Effectiveness of a Computerized Cognitive Training in the Early Stages of Neurodegenerative Diseases
The prevalence of neurodegenerative diseases is expected to increase over the next years, in
parallel to the aging of the world population. Therefore, research efforts need to be devoted
to evaluate intervention strategies that delay the onset of cognitive decline. Given the
paucity of pharmacological interventions, strategies for non-pharmacological enhancement,
such as cognitive training, are receiving increasing attention. Moreover, the advances in the
development of Information & Communication Technologies (ICT) has recently prompted the
possibility to develop computer-based solution, also called Serious Game (SG), for the
training of one or more cognitive functions. This approach could help overcome the limits of
traditional paper-and-pencil cognitive intervention techniques. However, the clinical,
ethical, economic and research impact of the use of these computer-based solutions in these
target populations is still under discussion. In order to acquire more academic and
professional credibility and acceptance, researchers need to collect more data to test and
evolve usability and usefulness of SG as clinical tools targeting people with
dementia-related disorders.
The general aim of this research is to evaluate the effects of a computer-supported Cognitive
Training (CT) compared to a paper-and-pencil CT, in the early stage of neurodegenerative
diseases. Patients with Mild Cognitive Impairment (MCI) are enrolled and randomly assigned to
the experimental group (CoRe software) or control group (paper-and-pencil CoRe version). All
patients are evaluated before (T0) and after (T1) treatment with an exhaustive
neuropsychological assessment. Furthermore, follow-up visits are scheduled 6 months (T2) and
12 months (T3) after the end of the treatment.
Status | Recruiting |
Enrollment | 40 |
Est. completion date | December 15, 2020 |
Est. primary completion date | December 15, 2020 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 50 Years to 85 Years |
Eligibility |
Inclusion Criteria: - diagnosis of idiopathic PD according to UKPDBB criteria (Hughes, Daniel, Kilford, & Lees, 1992) and Hoehn&Yahr scale=4 (Hoehn & Yahr, 1967); - presence of PD-MCI single-domain (executive) or PD-MCI multiple-domain with executive involvement (Litvan et al., 2012); - age between 50 and 85 years; - education level =5 years. Exclusion Criteria: - pre-existing cognitive impairment (e.g. aphasia,neglect); - severe disturbances in consciousness; - severe sensory or motor disturbances that do not allow the patient to control the trunk or to maintain the sitting position; in particular patients with disturbing resting and/or action tremor (corresponding to score 2-4 in the specific items of Unified Parkinson's Disease Rating Scale (UPDRS III) (Fahn,1987) were excluded; - concomitant severe psychiatric or neurological conditions; - patients with Deep Brain Stimulation. |
Country | Name | City | State |
---|---|---|---|
Italy | Struttura Semplice Neuropsicologia Clinica/ Centro UVA | Pavia |
Lead Sponsor | Collaborator |
---|---|
IRCCS National Neurological Institute "C. Mondino" Foundation |
Italy,
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Alloni A, Sinforiani E, Zucchella C, Sandrini G, Bernini S, Cattani B, Pardell DT, Quaglini S, Pistarini C. Computer-based cognitive rehabilitation: the CoRe system. Disabil Rehabil. 2017 Feb;39(4):407-417. doi: 10.3109/09638288.2015.1096969. Epub 2015 Oct 27. — View Citation
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Bernini S, Alloni A, Panzarasa S, Picascia M, Quaglini S, Tassorelli C, Sinforiani E. A computer-based cognitive training in Mild Cognitive Impairment in Parkinson's Disease. NeuroRehabilitation. 2019;44(4):555-567. doi: 10.3233/NRE-192714. — View Citation
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Jean L, Bergeron ME, Thivierge S, Simard M. Cognitive intervention programs for individuals with mild cognitive impairment: systematic review of the literature. Am J Geriatr Psychiatry. 2010 Apr;18(4):281-96. doi: 10.1097/JGP.0b013e3181c37ce9. Review. — View Citation
Mayeux R, Stern Y. Epidemiology of Alzheimer disease. Cold Spring Harb Perspect Med. 2012 Aug 1;2(8). pii: a006239. doi: 10.1101/cshperspect.a006239. Review. — View Citation
Robert PH, König A, Amieva H, Andrieu S, Bremond F, Bullock R, Ceccaldi M, Dubois B, Gauthier S, Kenigsberg PA, Nave S, Orgogozo JM, Piano J, Benoit M, Touchon J, Vellas B, Yesavage J, Manera V. Recommendations for the use of Serious Games in people with Alzheimer's Disease, related disorders and frailty. Front Aging Neurosci. 2014 Mar 24;6:54. doi: 10.3389/fnagi.2014.00054. eCollection 2014. — View Citation
Walton CC, Naismith SL, Lampit A, Mowszowski L, Lewis SJ. Cognitive Training in Parkinson's Disease. Neurorehabil Neural Repair. 2017 Mar;31(3):207-216. doi: 10.1177/1545968316680489. Epub 2016 Dec 13. Review. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Change in Global cognitive functioning measured by Mini-Mental State Examination (MMSE) | It is a 30-point questionnaire that is used extensively in clinical and research settings to measure cognitive impairment. The score is between 0-30. Lower score is worse cognitive functioning. | After 3 -week rehabilitative program (T1), 6 months (T2) and 1 year (T3) after the end of rehabilitation program | |
Primary | Change in Global cognitive functioning measured by Montreal Overall Cognitive Assessment (MoCA) | It is a widely used screening assessment for detecting cognitive impairment. It assesses several cognitive domains: The short-term memory recall task (5 points). Visuospatial abilities a clock-drawing task (3 points) and a three-dimensional cube copy (1 point). Multiple aspects of executive functions are assessed using an alternation task adapted from the trail-making B task (1 point), a phonemic fluency task (1 point), and a two-item verbal abstraction task (2 points). Attention, concentration, and working memory are evaluated using a sustained attention task ( 1 point), a serial subtraction task (3 points), and digits forward and backward (1 point each). Language is assessed using a three-item confrontation naming task with low-familiarity animals (3 points), repetition of two syntactically complex sentences (2 points), and the aforementioned fluency task. Finally, orientation to time and place (6 points). Low score is worse outcome. |
After 3 -week rehabilitative program (T1), 6 months (T2) and 1 year (T3) after the end of rehabilitation program | |
Secondary | Change in Memory | Verbal and spatial span; verbal long-term memory; spatial long-term memory by using scales. Higher scores are better outcomes | after 3 -week rehabilitative program (T1), 6 months (T2) and 1 year (T3) after the end of rehabilitation program | |
Secondary | Change in executive functions | Logical-executive functions; attention; visuospatial abilities by using scales. Higher scores are better outcomes | after 3 -week rehabilitative program (T1), 6 months (T2) and 1 year (T3) after the end of rehabilitation program | |
Secondary | Change in Mood (assessed by Beck Depression Inventory - BDI) | Contains 21 questions. The items are rated on a 4-point severity scale (0-3) and are summed to give a total score (range 0-63). A higher score denotes more severe depression. | after 3 -week rehabilitative program (T1), 6 months (T2) and 1 year (T3) after the end of rehabilitation program | |
Secondary | Change in Quality of life (assessed by Short Form-36 Health Survey - SF-36) | Health Survey is a 36-item, patient-reported survey of patient health. The SF-36 consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. Low score is worse quality of life. | after 3 -week rehabilitative program (T1), 6 months (T2) and 1 year (T3) after the end of rehabilitation program | |
Secondary | Change in The evolution of cognitive profile (assessed by Clinical Dementia Rating Scale - CDR) | CDR is a widely utilized clinical tool for grading the relative severity of dementia with scores that range from 0 (no impairment) to 3 (severe impairment). | after 3 -week rehabilitative program (T1), 6 months (T2) and 1 year (T3) after the end of rehabilitation program |
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