Neuroplasticity-Based Cognitive Remediation for Pediatric Brain Tumor Survivors

描述（由申请人提供）：在美国，每年有超过4000名儿童被诊断患有脑肿瘤，治疗的进步使这些患者的生存率显著提高。然而，由于疾病和手术、放疗和化疗的治疗，儿童脑肿瘤患者表现出额叶功能的缺陷，包括执行功能的几个方面，随着时间的推移，表现出显著的下降。这些缺陷的补救是研究的关键目标。大脑成熟和连通性的主要变化发生在儿童和青少年时期，这使得基于神经可塑性的认知干预支持多个关键区域的神经变化成为潜在的关键机会窗口。计算机化的认知训练项目已经成功地应用于精神分裂症患者、多动症患者和有精神病风险的前驱青少年。然而，这些项目在儿童脑肿瘤幸存者中的应用受到限制，在正在接受治疗的脑肿瘤患者中也未经测试。在创新的纵向设计背景下，我们旨在测试基于神经可塑性的认知训练项目Cogmed的可行性、可接受性和初步疗效，以增强被诊断患有脑肿瘤的儿童和青少年的工作记忆和注意力。我们将招募72名诊断时患有脑肿瘤的儿童，并在基线（术前）和4、5、6个月的随访期间进行认知测试。在4个月时，一半将接受Cogmed适应性计算机认知训练（治疗条件），为期5周，另一半将被分配到对照条件（Cogmed的非适应性版本）。认知评估将在认知干预完成后和干预后5周进行。我们将使用近红外光谱，这是一种非侵入性功能成像方法，使用红外光检测认知干预前后和干预后5周皮质血红蛋白水平的变化。我们期望Cogmed adaptive，将会在家里使用

DESCRIPTION (provided by applicant): Over 4,000 children are diagnosed with brain tumors in the U.S. each year and advances in treatment have led to significant increases in survival rates for these patients. However, as a result of the disease and treatment with surgery, radiation and chemotherapy, pediatric brain tumor patients show deficits in frontal lobe functions including several aspects of executive function, showing significant declines over time. Remediation of these deficits is a critical target for research. Major changes in brain maturation and connectivity occur during childhood and adolescence, making this a potentially critical window of opportunity for neuroplasticity-based cognitive interventions to support the neural changes that integrate multiple key regions. Computerized cognitive training programs have been used successfully with the patients with schizophrenia, individuals with ADHD, and prodromal adolescents at risk for psychosis. However, these programs have been limited in their application to pediatric brain tumor survivors and untested in brain tumor patients who are undergoing treatment. In the context of an innovative longitudinal design, we aim to test the feasibility, acceptability, and initial efficacy of a neuroplasticiy-based cognitive training progrm, Cogmed, to enhance working memory and attention in children and adolescents who have been diagnosed with brain tumors. We will recruit 72 children with brain tumors at the time of their diagnosis and conduct cognitive testing at baseline (pre-surgery), and at 4-, 5-, and 6-month follow-ups. At 4 months, half will undergo Cogmed adaptive computerized cognitive training (treatment condition) for 5 weeks and half will be assigned to a control condition (the non-adaptive version of Cogmed). Cognitive assessments will be conducted at completion of the cognitive intervention and at 5-weeks post-intervention. We will use near infrared spectroscopy, a noninvasive functional imaging method that uses infrared light to detect changes in cortical hemoglobin levels at pre- and post-cognitive intervention and at 5-weeks post-intervention. We expect that Cogmed adaptive, which will be administered at home, will be feasible and acceptable for the majority (85% or more) of patients. Further, we hypothesize that Cogmed adaptive will help improve working memory and attention skills and increase frontal cortical activity in the brain tumor patients who receive the remediation program compared to those who do not. Using growth curve analyses, we expect that patients who receive the intervention will show a deflection in the negative trajectory of cognitive functions over time. Findings from this pilot study will be used to develop an application for a multi- site randomized clinical trial to test this intervention in a large sample of pediatric brain tumor patients.