Neuroplasticity-Based Cognitive Remediation for Pediatric Brain Tumor Survivors

针对小儿脑肿瘤幸存者的基于神经可塑性的认知治疗

• 批准号: 8636657
• 负责人: Bruce E Compas
• 金额: $ 19.89万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-01-09 至 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8636657
• 关键词: 16 year old; Address; Adolescence; Adolescent; Adult; Adverse effects; Aftercare; Attention; Attention deficit hyperactivity disorder; Brain; Brain Neoplasms; Child; Childhood; Childhood Brain Neoplasm; Cognitive; Cognitive Therapy; Cognitive deficits; Cognitive remediation; Development; Diagnosis; Disease; Enrollment; Event; Face; Family; Functional Imaging; Future; Goals; Growth; Hemoglobin concentration result; Home environment; Impaired cognition; Individual; Intervention; Late Effects; Light; Matched Group; Measures; Methylphenidate; Near-Infrared Spectroscopy; Neurocognitive; Neurocognitive Deficit; Neuronal Plasticity; Newly Diagnosed; Operative Surgical Procedures; Pain; Parents; Participant; Patients; Pilot Projects; Psychotic Disorders; Public Health; Quality of life; Radiation therapy; Radiosurgery; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recovery; Recruitment Activity; Research; Research Personnel; Risk; Sampling; Schizophrenia; Shock; Short-Term Memory; Site; Source; Survival Rate; Survivors; Targeted Research; Testing; Therapeutic; Time; Training; Training Programs; Work; active control; base; chemotherapy; cognitive function; cognitive training; computerized; cost; demographics; design; disease characteristic; efficacy trial; executive function; experience; follow-up; frontal lobe function; imaging modality; improved; innovation; longitudinal design; meetings; neuroimaging; neurosurgery; novel; post intervention; prevent; programs; prospective; public health relevance; relating to nervous system; remediation; satisfaction; skills; success; survivorship

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.

描述(申请人提供)：在美国，每年有超过4,000名儿童被诊断患有脑瘤，治疗的进步显著提高了这些患者的存活率。然而，由于这种疾病以及手术、放疗和化疗的结果，儿童脑肿瘤患者的额叶功能出现缺陷，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。补救这些缺陷是研究的一个关键目标。大脑成熟和连接性的重大变化发生在儿童和青春期，这使得这可能是基于神经可塑性的认知干预支持整合多个关键区域的神经变化的关键机会之窗。计算机化的认知训练计划已经成功地用于精神分裂症患者、ADHD患者和有精神病风险的前驱青少年。然而，这些计划在儿科脑瘤幸存者中的应用一直受到限制，并且未在正在接受治疗的脑瘤患者中进行测试。在创新的纵向设计的背景下，我们的目标是测试基于神经可塑性的认知训练程序Cogmed的可行性、可接受性和初步疗效，以提高被诊断为脑瘤的儿童和青少年的工作记忆和注意力。我们将在确诊时招募72名患有脑瘤的儿童，并在基线(手术前)以及4、5和6个月的随访时进行认知测试。4个月后，一半将接受为期5周的Cogmed适应性计算机化认知训练(治疗条件)，另一半将被分配到控制条件(非适应性Cogmed版本)。认知干预结束时和干预后5周进行认知评估。我们将使用近红外光谱，这是一种非侵入性的功能成像方法，使用红外线来检测认知干预前后以及干预后5周皮质血红蛋白水平的变化。我们预计，将在家里实施的Cogmed Adaptive将是 大多数(85%或以上)的患者可行并可接受。此外，我们假设，与没有接受治疗计划的患者相比，接受治疗计划的脑肿瘤患者的认知适应性将有助于改善工作记忆和注意力技能，并增加额叶皮质活动。使用生长曲线分析，我们预计接受干预的患者将随着时间的推移显示认知功能的负面轨迹偏离。这项先导性研究的结果将被用于开发一项多地点随机临床试验的应用程序，以在儿童脑瘤患者的大样本中测试这种干预措施。