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Mild Cognitive ImpairmentNCT03577717

Efficacy of Computerized Cognitive Training in the Elderly With Mild Cognitive Impairment

A study testing computerized cognitive training and occupational therapy in people with Mild Cognitive Impairment, run by Taipei Hospital, Taiwan at 1 site in Taiwan.

Terminated

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

Official record
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Trial summary

Mild cognitive impairment (MCI) is the prodrome of the cognitive function declining before Alzheimer's disease or other dementia showed up, the impairments of language, visuospatial relationship, attention, and memory included and instrumental activities of daily living (IADL) influenced. Read more about this study

Who is it for?
Ages 65 years and older
Conditions the study is for
Mild Cognitive Impairment
What is being tested?
computerized cognitive training and occupational therapy
Could I receive a placebo?
No, everyone receives an active treatment
How many people
7 participants
Where
1 siteTaiwan
Study dates
13 Jul 2018to 11 Mar 2019
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 65 years and older
  • All sexes
  • No healthy volunteers
  • Older adult

Who may be able to join

  • (1) were aged ≥65 years
  • (2) amnestic type MCI was made using National Institute on Aging-Alzheimer's Association workgroups diagnostic guidelines for Alzheimer's disease with the clinical dementia rating scale (CDR) global scores of 0.5
  • (3) could follow command, understand the content of the assessments, and cooperate with treatment interventions through verbal communication

Who cannot join

  • (1) had the score of Geriatric Depression Scale-Short Form (GDS-SF) > 7, indicating depression status
  • (2) had the score of Barthel Index (BI)≠100, indicating dependent basic daily living of activities
  • (3) were diagnosed with other MCI subtypes, including frontotemporal dementia or Lewy Body those present typically different MCI syndromes
  • (4) had other neuropsychotic diseases
  • (5) could not administrate with MEG
  • (6) could not participate due to severe health problem

Trial locations and contacts

1 site in 1 country.

Taiwan1 site
  • Taipei Hospital, Ministry of Health and Welfare

    New Taipei City, 24213

Other trials in Taiwan

About this study

Official title: Efficacy of Computerized Cognitive Training in the Elderly With Mild Cognitive Impairment: Clinical Outcomes and Magnetoencephalographic Imaging

Mild cognitive impairment (MCI) is the prodrome of the cognitive function declining before Alzheimer's disease or other dementia showed up, the impairments of language, visuospatial relationship, attention, and memory included and instrumental activities of daily living (IADL) influenced. MCI is considered as a transitional stage between normal aging and mild dementia, and the patients with MCI has differently fluctuated cognitive functions in a period of time, such as from normal cognition to MCI or developing to dementia. The annual conversion rate (ACR) of older adults with normal cognition developed to MCI is 30%, and 5% in clinical setting, and community, respectively. Not all of patients with MCI develop to Alzheimer's disease, the reversion of patients with MCI to normal cognition exists. However, MCI is a significant risk factor. The ACR of older adults with normal cognition or MCI developed to dementia is 1-2%, and 5-15%, respectively; moreover, about half of patients with MCI developed to dementia in 5 years.

Cognitive training (CT) improves cognitive functions with repetitive practicing standardized cognitive tasks of specific cognitive functions, such as memory, attention, or problem solving. CT has widely defined including strategy training, in which contained cognitive exercise, strategy indicating and practicing to reducing cognitive impairments and improving performances. CT is more effective for MCI. Recently, computer-based CT (CCT) with many advantages gradually replaced the traditional paper-pencil form. Brief systematic review showed that the computer-based intervention had positive effects on behavioral symptoms, such as depression and anxiety, in patients with MCI and/or dementia. Previous studies demonstrated that computer-based intervention exhibited moderate treatment effects on overall cognitive functions in patients with MCI, and also had positive effects on learning, short-term memory, and behavioral symptoms.

Older people with cognitive impairments is expected to increase by global aging. It is important for improving or maintaining cognitive functions of older adults with MCI. The efficacy of the CCT on cognitive functions, neuropsychiatric symptoms, daily functions, and brain activated imaging of the magnetoencephalography (MEG) of in older adults with MCI is worth to explore for busy clinical practice.

Read the detailed description

The study design was a prospective and single-blinded randomized controlled trial. 36 participants with MCI were recruited and demographic data (age, gender, education level /years of education, marriage status etc.) were also collected. The MCI participants underwent the comprehensive review at baseline including neuropsychological assessment and Magnetic Resonance Imaging or Computerized Tomogram. Randomization treatment assignment will be generated by the random number table and assign the patient's intervention group accordingly. Sealed opaque envelopes containing the CCT group, or the dosage-matched control group sheets will be prepared and given to the therapists.

Based on the t-test effect size of index d 1.00 indicates, an estimated 17 participants in each group will be required for a power of 0.80 with a two-sided type I error of 0.05. Considering the 5% (q) drop rate, we will need to recruit 18 participants (N/1-q) for each group. The participants were randomly allocated to either the CCT group (18 participants) or the dosage-matched control group (18 participants) with individualized intervention for 30 minutes a day, 3 times a week for 4 consecutive weeks. Clinical outcome measures, and the imaging of the MEG were administered at pre- treatment, post-treatment and 1-month follow-up for further analysis.

Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 19.0. In statistical testing, two-sided p value ≤ 0.05 was considered statistically significant. The distributional properties of continuous variables were expressed by mean ± standard deviation (SD), categorical variables were presented by frequency and percentage. The differences in the distributions of continuous variables, categorical variables between the treatment and control groups were examined using two-sample t-test, Wilcoxon rank-sum test (or Mann-Whitney U test), and chi-square test. In addition, the minimum norm estimates (MNE), source-based time-frequency analysis, cross-frequency coupling, and functional connectivity were used to explore the differences of the activation of brain functions in participants between different treatment groups. The t-test was used to explore the differences of reaction time, rate of correction, and physical signals in stimulus reaction test of the MEG between in participants between different treatment groups. The correlation statistics was used to explore relationships between the scores of outcome measurements and the physical signals.

Being tested
computerized cognitive training, occupational therapy
Medical subject headings
Cognitive Dysfunction

What participants receive

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

  • computerized cognitive trainingOther

    participants will be trained 30 minutes/day, 3 days/week for 4 consecutive weeks.

  • occupational therapyOther

    participants will receive craft activities of occupational therapy for 30 minutes/day, 3 days/week for 4 consecutive weeks.

Study groups in NCT03577717
Study groupRoleWhat they receive
computerized cognitive trainingExperimentalparticipants will be trained by the "Cookies for the brainy day", including memory, attention, calculation, executive functions, and language training.
Receives: Other: computerized cognitive training
occupational therapyActive comparatorparticipants will receive craft activities of occupational therapy, such as weaving, origami etc.
Receives: Other: occupational therapy

What is being measured

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

  1. Change scores of Quick Mild Cognitive Impairment screen

    The Quick Mild Cognitive Impairment (Qmci) screen , a performance test, contains 6 subtests: Orientation, Registration, Clock Drawing, Delayed Recall, Verbal Fluency, and Logical Memory. The Qmci can be administered and scored in less than 5 min. The Qmci was validated with sound reliability and validity. The Qmci screen scores ranged from 0 to 100, with a higher score indicating greater cognitive function.

    Measured: Baseline, 1 month, 2 months

  2. Change scores of Montreal Cognitive Assessment

    The Montreal Cognitive Assessment (MoCA), a performance test, is a standardized and validated tool designed to measure cognitive functions in visuospatial/executive, naming, memory, attention, language, abstraction, delayed recall, and orientation. The MoCA adds 1 score for those whose educational level ≤ 12 and scores ranged from 0 to 30, with a higher score indicating greater cognitive function.

    Measured: Baseline, 1 month, 2 months

Secondary outcomes (9)
  1. Change scores of Contextual Memory Test

    The Contextual Memory Test is a standardized tool to measure the short-term and long-term retrospective memory and metacognition. The immediate and delayed memory is administrated by remembering 20 items related to daily context in 90 seconds. The scores of memory score, perceptual memory scores, and strategy-use scores were recorded.

    Measured: Baseline, 1 month, 2 months

  2. Change scores of Color Trail Test

    The Color Trail Test has A, and B parts. Participants needs to orderly connect randomized arrangement numbers in part A, and orderly and alternately connect randomized arrangement numbers in different colors in part B. The finished time and amounts of hint, miss, color miss, and near miss were recorded.

    Measured: Baseline, 1 month, 2 months

  3. Change scores of Digits Span Tasks-forward and backward

    The longest digits of forward and backward are 10 and 9, respectively. The total scores are 10 and 9, with a higher score indicating greater digit span memory.

    Measured: Baseline, 1 month, 2 months

  4. Change scores of Cancellation Test

    The Cancellation Test presents 10 Arabic numerals (0-9) for 30 digits per row (8 rows) with 2 target numerals (2, 8) in 45 seconds. The amounts of correction and miss were recorded.

    Measured: Baseline, 1 month, 2 months

  5. Change scores of Pattern Comparison

    The Pattern Comparisons presents 30 pairs of figures for distinguishing the same or not in 30 seconds. The amounts of correction, miss and total answers were recorded.

    Measured: Baseline, 1 month, 2 months

  6. Change scores of Everyday Memory Questionnaire

    Everyday Memory Questionnaire is a self-rated memory function questionnaire to reflect the frequency of memory miss in daily life. The frequency of memory miss, such as less than 1 time in 1-month, 2-3 times in 1-month, 1 time in 1 week, 2-6 times in 1 week, and more than 1 time in 1 day, in each situation scores ranged from 0 to 4 in 13 situations.

    Measured: Baseline, 1 month, 2 months

  7. Change scores of Neuropsychiatric Inventory Questionnaire

    The Neuropsychiatric Inventory Questionnaire (NPI-Q) measures symptoms severity and caregiver distress in 12 domains, such as apathy/indifference, appetite/eating problems, disinhibition, agitation/aggression, motor disturbance, anxiety, irritability, nighttime behaviors, depression/dysphoria, delusions, elation/euphoria, and hallucinations. The symptoms severity in each domain scores ranged from 1 to 3, with a higher score indicating more severe symptoms severity. In addition, the caregiver distress in each domain scores ranged from 0 to 5, with a higher score indicating more distress for caregiver.

    Measured: Baseline, 1 month, 2 months

  8. Change scores of Brief University of California San Diego (UCSD) Performance-based Skills Assessment

    The Brief University of California San Diego (UCSD) Performance-based Skills Assessment (UPSA-B) contains 2 aspects: financial skills, and communication skills. The UPSA-B can be administered and scored in 10-15 min and used to measure participants how to administrate daily activities and do it how well. The UPSA-B scores ranged from 0 to 100, with a higher score indicating greater daily function.

    Measured: Baseline, 1 month, 2 months

  9. Change scores of Disability Assessment for Dementia Questionnaire (DAD)

    The DAD contains 11 items of 3 domains: basic activity of daily living (dressing, hygiene, continence, eating), instrumental activity of daily living (meal preparation, telephoning, going on an outing, finance and correspondence, medications, and housework), and leisure activity (leisure). The scoring divides into 3 parts to measure about the initiation, planning and organization, and effective performance, and the scores of each part transforms to percentage for calculation. The higher percentage of each part indicates the less impairment in activities of daily living.

    Measured: Baseline, 1 month, 2 months

Timeline

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

  1. First posted5 Jul 2018
  2. Study start13 Jul 2018
  3. Primary completion13 Feb 2019
  4. Study completion11 Mar 2019

Why it stopped: This study was stopped due to time and budgetary constraints.

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
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
7 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03577717
Sponsor's protocol ID
201804
Status last verified
Feb 2020
First submitted
4 Jun 2018
Last updated
17 Feb 2020
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Data are available from the Institutional Review Board of the Taipei Hospital, Ministry of Health and Welfare for researchers who meet the criteria for access to confidential data.

Publications

  • Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, Gamst A, Holtzman DM, Jagust WJ, Petersen RC, Snyder PJ, Carrillo MC, Thies B, Phelps CH. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011 May;7(3):270-9. doi: 10.1016/j.jalz.2011.03.008. Epub 2011 Apr 21.

    PubMed 21514249
  • Bahar-Fuchs A, Clare L, Woods B. Cognitive training and cognitive rehabilitation for persons with mild to moderate dementia of the Alzheimer's or vascular type: a review. Alzheimers Res Ther. 2013 Aug 7;5(4):35. doi: 10.1186/alzrt189. eCollection 2013.

    PubMed 23924584
  • Barnes DE, Yaffe K, Belfor N, Jagust WJ, DeCarli C, Reed BR, Kramer JH. Computer-based cognitive training for mild cognitive impairment: results from a pilot randomized, controlled trial. Alzheimer Dis Assoc Disord. 2009 Jul-Sep;23(3):205-10. doi: 10.1097/WAD.0b013e31819c6137.

    PubMed 19812460
  • Bruscoli M, Lovestone S. Is MCI really just early dementia? A systematic review of conversion studies. Int Psychogeriatr. 2004 Jun;16(2):129-40. doi: 10.1017/s1041610204000092.

    PubMed 15318760
  • Caviness JN, Driver-Dunckley E, Connor DJ, Sabbagh MN, Hentz JG, Noble B, Evidente VG, Shill HA, Adler CH. Defining mild cognitive impairment in Parkinson's disease. Mov Disord. 2007 Jul 15;22(9):1272-7. doi: 10.1002/mds.21453.

    PubMed 17415797
  • Chen Y, Denny KG, Harvey D, Farias ST, Mungas D, DeCarli C, Beckett L. Progression from normal cognition to mild cognitive impairment in a diverse clinic-based and community-based elderly cohort. Alzheimers Dement. 2017 Apr;13(4):399-405. doi: 10.1016/j.jalz.2016.07.151. Epub 2016 Aug 30.

    PubMed 27590706
  • Cheng CH, Baillet S, Hsiao FJ, Lin YY. Effects of aging on neuromagnetic mismatch responses to pitch changes. Neurosci Lett. 2013 Jun 7;544:20-4. doi: 10.1016/j.neulet.2013.02.063. Epub 2013 Apr 2.

    PubMed 23562510
  • Cheng CH, Baillet S, Hsiao FJ, Lin YY. Effects of aging on the neuromagnetic mismatch detection to speech sounds. Biol Psychol. 2015 Jan;104:48-55. doi: 10.1016/j.biopsycho.2014.11.003. Epub 2014 Nov 15.

    PubMed 25451380
  • Cheng CH, Baillet S, Lin YY. Region-specific reduction of auditory sensory gating in older adults. Brain Cogn. 2015 Dec;101:64-72. doi: 10.1016/j.bandc.2015.10.004. Epub 2015 Oct 24.

    PubMed 26507900
  • Davis RN, Massman PJ, Doody RS. Cognitive intervention in Alzheimer disease: a randomized placebo-controlled study. Alzheimer Dis Assoc Disord. 2001 Jan-Mar;15(1):1-9. doi: 10.1097/00002093-200101000-00001.

    PubMed 11236819
  • De Vreese LP, Neri M, Fioravanti M, Belloi L, Zanetti O. Memory rehabilitation in Alzheimer's disease: a review of progress. Int J Geriatr Psychiatry. 2001 Aug;16(8):794-809. doi: 10.1002/gps.428.

    PubMed 11536347
  • Gaitan A, Garolera M, Cerulla N, Chico G, Rodriguez-Querol M, Canela-Soler J. Efficacy of an adjunctive computer-based cognitive training program in amnestic mild cognitive impairment and Alzheimer's disease: a single-blind, randomized clinical trial. Int J Geriatr Psychiatry. 2013 Jan;28(1):91-9. doi: 10.1002/gps.3794. Epub 2012 Apr 3.

    PubMed 22473855
  • Galante E, Venturini G, Fiaccadori C. Computer-based cognitive intervention for dementia: preliminary results of a randomized clinical trial. G Ital Med Lav Ergon. 2007 Jul-Sep;29(3 Suppl B):B26-32.

    PubMed 18575355
  • Gauthier S, Reisberg B, Zaudig M, Petersen RC, Ritchie K, Broich K, Belleville S, Brodaty H, Bennett D, Chertkow H, Cummings JL, de Leon M, Feldman H, Ganguli M, Hampel H, Scheltens P, Tierney MC, Whitehouse P, Winblad B; International Psychogeriatric Association Expert Conference on mild cognitive impairment. Mild cognitive impairment. Lancet. 2006 Apr 15;367(9518):1262-70. doi: 10.1016/S0140-6736(06)68542-5.

    PubMed 16631882
  • Garcia-Casal JA, Loizeau A, Csipke E, Franco-Martin M, Perea-Bartolome MV, Orrell M. Computer-based cognitive interventions for people living with dementia: a systematic literature review and meta-analysis. Aging Ment Health. 2017 May;21(5):454-467. doi: 10.1080/13607863.2015.1132677. Epub 2016 Jan 25.

    PubMed 26806365

Questions about this trial

What is this clinical trial studying?

A study testing computerized cognitive training and occupational therapy in people with Mild Cognitive Impairment, run by Taipei Hospital, Taiwan at 1 site in Taiwan.

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 3 inclusion and 6 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 17 Feb 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 Taiwan. 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: This study was stopped due to time and budgetary constraints.). 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?

Change scores of Quick Mild Cognitive Impairment screen (time frame: Baseline, 1 month, 2 months). The study lists 2 primary outcomes in all. 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 NCT03577717, which also lists 56 linked publications.

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 17 Feb 2020.

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