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4，000名儿童被诊断患有脑肿瘤，治疗的进步导致这些患者的存活率显着增加。然而，由于疾病和手术，放疗和化疗的治疗，儿童脑肿瘤患者显示额叶功能的缺陷，包括执行功能的几个方面，随着时间的推移显着下降。补救这些缺陷是研究的一个关键目标。大脑成熟和连接的主要变化发生在儿童和青少年时期，这使得这成为基于神经可塑性的认知干预的潜在关键机会窗口，以支持整合多个关键区域的神经变化。计算机化的认知训练程序已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期青少年。然而，这些程序在儿科脑肿瘤幸存者中的应用受到限制，并且未在正在接受治疗的脑肿瘤患者中进行测试。在一个创新的纵向设计的背景下，我们的目标是测试的可行性，可接受性和初步疗效的神经可塑性为基础的认知训练程序，Cogmed，以提高工作记忆和注意力的儿童和青少年谁被诊断为脑肿瘤。我们将招募72名确诊时患有脑肿瘤的儿童，并在基线（术前）以及4个月、5个月和6个月随访时进行认知测试。 在4个月时，一半将接受Cogmed自适应计算机认知训练（治疗条件）5周，另一半将被分配到对照条件（Cogmed的非自适应版本）。认知评估将在认知干预完成时和干预后5周进行。我们将使用近红外光谱，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。我们预计，Cogmed自适应，这将是在家里管理，将 对于大多数患者（85%或以上）是可行和可接受的。此外，我们假设Cogmed自适应将有助于改善工作记忆和注意力技能，并增加接受补救计划的脑肿瘤患者的额叶皮层活动。使用生长曲线分析，我们预计接受干预的患者随着时间的推移，认知功能的负面轨迹将出现偏差。这项试点研究的结果将用于开发一项多中心随机临床试验的应用程序，以在大样本的儿科脑肿瘤患者中测试这种干预措施。

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.