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Cognitive DysfunctionNCT02747784

Evaluation to Assess Cognitive Training for the Prevention of Post-operative Cognitive Decline

A study testing Cognitive training program RehaCom® in people with Cognitive Dysfunction, run by Charite University, Berlin, Germany at 1 site in Germany.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

The purpose of this open, monocentric randomized, parallel-group, controlled trial is to compare two different computer-based cognitive training programs regarding the efficacy to prevent the 3-months incidence of postoperative cognitive dysfunction in female patients after elective urogynecological or breast cancer… Read more about this study

Who is it for?
Ages 18 years and older, women only
Conditions the study is for
Cognitive Dysfunction
What is being tested?
Cognitive training program RehaCom®
Could I receive a placebo?
No, everyone receives an active treatment
How many people
19 participants
Where
1 siteGermany
Study dates
25 Jul 2017to 28 Sep 2018
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Pilot study: Female patients undergoing urogynecological or breast cancer surgery, screened at the Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany
  • Age 18 years or older
  • Montreal Cognitive Assessment Score (MOCA) > 25
  • Patient has access to Personal computer or Laptop with system software Windows XP Service Pack 3 (or newer); tablets or smart phones cannot by used.
  • Written informed consent to participate after having been properly instructed
  • Written informed consent that accidental clinically relevant diagnostic findings of MRI assessment are reported to the general practitioner of the patient
  • Sufficient health insurance to cover additional diagnostic assessments in case of an accidental clinically relevant diagnostic finding of MRI assessment
  • 24 female surgical control subjects from the POCD Register (EA1/104/169) and 24 female non-surgical control subjects

Who cannot join

  • Apparent dementia
  • Lacking willingness to take part in the study, or to have relevant study data collected, saved and analyzed for the purpose of the study
  • Lacking willingness to be contacted by telephone or mail.
  • Accommodation in an institution due to an official or judicial order
  • Insufficient knowledge of German language
  • Members of the hospital staff
Show all 16Show fewer
  • Admitted in police custody
  • Homelessness or other conditions that disable reachability for postoperative assessment by post or telephone
  • Illiteracy
  • Severe hearing impairment that affects the neuropsychological testing.
  • Severe visual impairment that affects the neuropsychological testing.
  • Participation in other prospective clinical interventional trials
  • Daltonism
  • Contra-indications against MRI assessment (claustrophobia, metallic implants, cardiac pacemaker, tatoos)
  • Motor impairment that affects the use of a computer
  • Regular use of psychotropic drugs (including sleep-inducing drugs and benzodiazepines) and substances which affect cognitive performance Control group

Trial locations and contacts

1 site in 1 country.

Germany1 site
  • Department of Anesthesiology and Intensive Care Medicine, CVK/CCM, Charité - University Medicine Berlin

    Berlin, 13353

Other trials in Germany

About this study

Official title: Randomized Evaluation to Assess Cognitive Training for the Prevention of Post-operative Cognitive Decline (REACT) - a Pilot Study

The purpose of this open, monocentric randomized, parallel-group, controlled trial is to compare two different computer-based cognitive training programs regarding the efficacy to prevent the 3-months incidence of postoperative cognitive dysfunction in female patients after elective urogynecological or breast cancer surgery.

Read the detailed description

The REACT trial has been designed as a feasibility study to investigate the impact of pre-, peri-, and postoperative computerized cognitive trainings on the incidence of postoperative cognitive dysfunction. Two different study groups (training programs) will be compared. Each group consists of two training modules of the validated computer based training program of cognitive functioning called RehaCom®. The experimental group consists of the modules 'Topological Memory (MEMO)' and 'Divided Attention 2 (GEA2)'. The active comparator group consists of the modules 'Topological Memory (MEMO)' and 'Working memory (WOME)'. 48 surgical patients undergoing elective urogynecological or breast cancer surgery will preoperatively be randomly assigned to one of two study groups. Before starting the training, patients will complete a neuropsychological test battery comprising the cognitive tests to measure POCD. The tests will be assessed at preoperative baseline visit and at 3-months follow-up. In order to correct change in cognitive performance for practice effects, a group of 24 female surgical control subjects will also prospectively be tested with the cognitive test battery at baseline and 3-months follow-up. The control subjects will be matched to the 2 study groups regarding health status, surgery and age, but will neither undergo the computerized cognitive training program RehaCom®. Further, 24 female control subjects are included from the POCD-Register (EA1/104/16) and will be matched to the 2 study groups as well.

After baseline assessment, the study group patients will be taught to use the training program RehaCom®, and training should start preoperatively as early as possible. The patients are recommended to perform the training daily during inpatient hospital stay, and at least three times a week for 30 to 60 minutes until month 3.

The neuropsychological assessment will be performed at preoperative baseline and at three-months follow-up. Postoperative cognitive dysfunction (POCD) will be classified using the dichotomous approach established by Rasmussen et al in the International Study on postoperative cognitive deficits (ISPOCD) (Rasmussen et al. The assessment of postoperative cognitive function. Acta Anaesthesiol Scand. 2001 Mar;45(3):275-89.) This calculation method defines POCD as a reliable change in pre- and postoperative cognitive performance (difference scores) of each individual in the surgical patients cohort as compared to the changes in a non-surgical control group (reliable change index in either a composite score including cognitive test parameters from all tests in the cognitive test battery or in at least two of the chosen cognitive test parameters).

Secondary outcome measures of this trial comprise structural and functional MRI measures, Electroencephalogram simultaneous with fMRI, intraoperative cerebral oximetry and neuromonitoring, delirium, pain, sleep quality, postoperative complications, frailty, psychological distress, quality of life, training performance and evaluation of the training.

Being tested
Cognitive training program RehaCom®
Keywords
cognitive dysfunction, cognitive training
Medical subject headings
Cognitive Dysfunction

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Cognitive training program RehaCom®Behavioural

    Cognitive training program RehaCom®

Study groups in NCT02747784
Study groupRoleWhat they receive
Study group experimentalExperimental24 female patients aged 18 years or older undergoing urogynecological or breast cancer surgery; the patients are recommended to perform the RehaCom® training modules 'Topological Memory (MEMO)' and 'Divided Attention 2 (GEA2)' daily during inpatient hospital stay, and at least three times a week for 30 to 60 minutes until month 3.
Receives: Behavioral: Cognitive training program RehaCom®
Study group active comparatorActive comparator24 female patients aged 18 years or older undergoing urogynecological or breast cancer surgery; the patients are recommended to perform the RehaCom® training modules 'Topological Memory (MEMO)' and 'Working memory (WOME)' daily during inpatient hospital stay, and at least three times a week for 30 to 60 minutes until month 3.
Receives: Behavioral: Cognitive training program RehaCom®
Control groupNo intervention48 female control subjects aged 18 years or older (24 without surgery, 24 with urogynecological or breast cancer surgery) with a similar health status and age as the study group patients (similar distribution in the American Society of Anaesthesiologists physical status classification and relevant co-morbidities, e.g. diabetes, coronary artery disease, hypertension and hyperlipidemia). The patients are analyzed to correct for learning effects of the cognitive assessment testings in the study groups.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Incidence of postoperative cognitive dysfunction (POCD)

    Cognitive functioning will be measured with a battery of computerized neuropsychological tests, non-computerized and computer-based tests from the Cambridge Neuropsychological Test Automated Battery [CANTAB®]

    Measured: Up to 3 months

Secondary outcomes (38)
  1. Divided attention

    Divided attention will be measured in the pilot study with the Test of Attentional Performance - Mobility version (TAP-M), subtests divided attention and distractibility.

    Measured: Up to 3 months

  2. Incidence of postoperative delirium

    Postoperative delirium rate, defined according to Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and Chart Review

    Measured: Up to 7 days

  3. Intraoperative depth of sedation

    Intraoperative depth of sedation will be monitored in the pilot study with changes in the pattern off EEG-raw data measured with the Masimo SedLine® brain function monitoring for Root®.

    Measured: At time of surgery

  4. Depth of sedation on the Intensive Care Unit

    Depth of sedation will be measured in the pilot study with the Richmond Agitation Sedation Scale (RASS)

    Measured: Participants will be followed for the duration of intensive care unit stay, an expected average of 5 days

  5. Intraoperative cerebral oximetry

    Intraoperative cerebral oximetry will be measured in the pilot study by near-infrared spectroscopy (NIRS) developed for the Masimo Root® monitor.

    Measured: At time of surgery

  6. Quality of sleep

    Quality of sleep will be measured with the Insomnia Severity Index (ISI)

    Measured: Up to 3 months

  7. Anxiety

    Perioperative anxiety will be measured with the Faces Anxiety Scale (FAS) during hospital stay.

    Measured: Up to hospital discharge, an expected average of 7 days

  8. Intensive care unit length of stay

    Measured: Participants will be followed for the duration of intensive care unit stay, an expected average of 5 days

  9. Hospital length of stay

    Measured: Participants will be followed for the duration of hospital stay, an expected average of 7 days

  10. Evaluation of the cognitive training program RehaCom® by patient

    The evaluation will be measured with single items concerning patients' subjective rating of the quality of the training program, at least once during the week

    Measured: Up to 3 months

  11. Performance of cognitive training units of the program RehaCom®

    Data will be saved automatically by the computerized training program. The training performance will be measured as the highest level a patient has reached per training module, as well as number of mistakes within each level.

    Measured: Up to 3 months

  12. Duration of the cognitive training of the program RehaCom®

    Data will be saved automatically by the computerized training program. Duration will be measured as minutes per session and total sum of minutes of all sessions.

    Measured: Up to 3 months

  13. Frequency of the cognitive training of the program RehaCom®

    Data will be saved automatically by the computerized training program. Frequency will be measured as number of sessions and number of weeks with at least 1 session per week.

    Measured: Up to 3 months

  14. MRI assessment

    Functional MRI: Changes in neural activations in temporal and fronto-parietal brain regions during recognition in a face-name association task at baseline and three months after baseline assessment

    Measured: Up to 3 months

  15. MRI assessment

    Structural MRI: Changes in gray and white matter.

    Measured: Up to 3 months

  16. MRI assessment

    Functional MRI: Changes in neural activations in temporal and fronto-parietal brain regions during memory encoding at baseline and three months after baseline assessment

    Measured: Up to 3 months

  17. Barthel Activities of Daily Living (ADL) Index

    Functional Status will be assessed with the Barthel Activities of Daily Living (ADL) Index

    Measured: Up to 3 months

  18. Instrumented Activities of Daily Living (IADL)

    Functional Status will be assessed with the Instrumented Activities of Daily Living (IADL) scores

    Measured: Up to 3 months

  19. Frailty

    Frailty will be measured by modified Fried's criteria (Physical Frailty Phenotype)

    Measured: Up to 3 months

  20. Generalized anxiety

    Measured: Up to 3 months

  21. Depression

    Depression will be measured with the Patient Health Questionnaire 9-Item Scale (PHQ-9).

    Measured: Up to 3 months

  22. Quality of life

    Quality of life will be measured with a standardized instrument for use as a measure of health outcome EQ-5D

    Measured: Up to 3 months

  23. Routine laboratory

    No additional blood samples will be taken in the pilot study

    Measured: Up to hospital discharge, an expected average of 7 days

  24. Organ dysfunctions

    Organ dysfunctions are evaluated according to the Clavien-Dindo classification of surgical complications

    Measured: Up to hospital discharge, an expected average of 7 days

  25. Mortality

    Mortality is evaluated in the pilot study

    Measured: Up to three months

  26. Postoperative pain

    Postoperative pain will be measured with the Numeric Rating Scale (NRS-V) and validated scores

    Measured: Up to 3 months

  27. Mild cognitive impairment

    Mild cognitive impairment will be measured by impaired performance in neuropsychological testing (neurocognitive test battery), level of functionality (ADL, IADL) and self report on cognitive impairment (Metamemory and FEDA questionnaire) and related to performance in the MOCA cognitive screening tool.

    Measured: Up to 3 months

  28. Timed up and go test

    Measured: Up to 3 months

  29. Continence

    Measured by Deutscher Beckenboden-Fragebogen

    Measured: Up to 3 months

  30. Self report on cognitive deficits

    Fragebogen erlebter Defizite der Aufmerksamkeit (FEDA)

    Measured: Up to 3 months

  31. Metamemory

    Multifactorial Memory Questionnaire

    Measured: Up to 3 months

  32. Fatigue

    2 questions

    Measured: Up to 3 months

  33. Assessment on cognitive deficits by Proxy (IQCODE)

    Informant Questionnaire on Cognitive Decline in the Elderly

    Measured: Up to 3 months

  34. BIA (Bio-Impedanz-Analysis)

    Measured: Up to 3 months

  35. MNA Mini nutritional assessment-MNA short form)

    Measured: Up to 3 months

  36. Risk factors of dementia

    Risk factors of dementia are analysed by blood levels of APOE-4, BDNF, Kynurenine, Zonulin, Endocan and Tryptophan

    Measured: Up to 3 months

  37. Pro- und anti-inflammatory cytokines

    Measured: Up to 3 months

  38. micro-RNA

    Measured: Up to 3 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Apr 2016 (estimated)
  2. Study start25 Jul 2017
  3. Primary completion7 Sep 2018
  4. Study completion28 Sep 2018

Why it stopped: Lack of recruitment

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
19 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02747784
Sponsor's protocol ID
REACT
Status last verified
Nov 2020
First submitted
30 Mar 2016
Last updated
25 Nov 2020
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Rasmussen LS, Larsen K, Houx P, Skovgaard LT, Hanning CD, Moller JT; ISPOCD group. The International Study of Postoperative Cognitive Dysfunction. The assessment of postoperative cognitive function. Acta Anaesthesiol Scand. 2001 Mar;45(3):275-89. doi: 10.1034/j.1399-6576.2001.045003275.x.

    PubMed 11207462

Questions about this trial

What is this clinical trial studying?

A study testing Cognitive training program RehaCom® in people with Cognitive Dysfunction, run by Charite University, Berlin, Germany at 1 site in Germany.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 25 Nov 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Germany. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study was stopped early (reason given: Lack of recruitment). Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of postoperative cognitive dysfunction (POCD) (time frame: Up to 3 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02747784, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Nov 2020.

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