The Cognition and Flow Study

Study design, recruitment

This will be a randomised clinical trial, undertaken at the University of Leicester, University Hospitals of Leicester (UHL) and Leicestershire Partnership National Health Service (NHS) Trusts (LPT). Following successful ethical approval, sponsorship, regulatory approvals, 40 participants with a diagnosis of MCI, or AzD, and 20 healthy volunteers will be recruited from memory clinics, general geriatric clinics, Join Dementia Research, community groups. Patients with a diagnosis of mild MCI, or mild to moderate AzD that are not under follow-up with the memory service will also be invited to participate in the study by letter invitation through their GP surgery.

Summary of the intervention

Lumosity© is a commercially available software, developed by a group of neuropsychologists, which has been used across several studies of brain training and disciplines. The brain training software targets multiple brain areas, is based online, and is relatively easy to use and administer. It has been designed to adapt to the individual's memory performance to personalise the training program to their needs. Brain exercises will be selected with the support of Lumosity© to target the following brain areas; attention, memory, visuospatial, verbal fluency, and language.

First Visit

Participants who meet the inclusion criteria, will undergo formal written consent with a member of the research team, or research delivery officer, either at home, designated LPT research space, memory service, or invited to attend the Leicester Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) research laboratory. Baseline assessments will be performed at this first visit including; background information on age, sex, ethnicity, medical conditions, and medication use, the Edinburgh handedness inventory (to determine left or right hand dominance), and questionnaires on mood, quality of life, and ability to carry out everyday activities. Participants who have had their baseline assessment at home will then be referred to the researcher to undertake a baseline assessment of brain blood flow at the CHiASM research space. This will be undertaken by performing selected questions from a memory test covering five major brain areas(attention, fluency, language, visuospatial and memory) with continuous TCD (ultrasound), heart rate (ECG), blood pressure (finger blood pressure monitor), and waste gases (CO2 - nasal tubes).

Randomisation

Following the collection of baseline information, participants will be chosen at random to either complete a brain training program or control. Randomisation will be performed using Sealed Envelope©. This is an online based randomisation tool which uses random permuted blocks to allocate participants to waiting list control or intervention. Participants will be enrolled and assigned a participant identification number (PIN) consecutively, and randomised to a treatment arm corresponding to the PIN. Given the nature of the trial, it is not possible to blind participants to the intervention. The Investigator will be providing weekly telephone support with the intervention, in addition to undertaking baseline and follow-up measurements, and therefore blinding of the investigator is also not possible. However, data analysis will be blinded by generating a batch anonymised data set. Randomisation will be undertaken at the initial visit. As this is an un-blinded trial, code breaking will not be required.

Intervention

Control participants will be waiting listed to receive the brain training program at the end of the study. Participants selected to brain training will be given instructions on how to access and use the program at home for 15-30minutes, 3-5 times per week for 8-12 weeks. Adherence to the program can be monitored through Lumosity©. During the 8-12 weeks participants will be provided with technical support by the investigator to minimise adherence issues and will be offered a weekly telephone call to assist with any issues that have arisen.

Follow-up

Participants will then be invited to follow up assessment at 8-12 weeks, where the TCD (ultrasound) assessment of brain blood flow will be repeated, in addition to memory testing, mood, quality of life, and ability to carry out daily activities. All travel and parking expenses to and from the study for assessments will be refunded to participants, and refreshments will be provided. No financial incentive will be offered for participating in this study. Participants will be provided with a lay summary of the results at the end of the study.

Qualitative sub-study

A qualitative study will be undertaken following the training program, which will take the form of interviews and a focus group to determine barriers and facilitators (benefits) to the brain training program. A sample of the participants who completed the brain training program and who are willing to return for interview will be included in this study. Participants will be recruited until thematic saturation is achieved (i.e. where no further themes arise from interviews or focus group). The maximum number of participants recruited to this arm would be twenty (only patient participants who have completed the intervention arm will be recruited). Where possible, the investigators will interview participants jointly with their carers in order to obtain a broader view of the impact of brain training on patients and their support network. This would allow the investigators to explore the potential wider impacts of these interventions on patients, and benefits not measured by the outcomes described above.