Computerized Cognitive Rehabilitation of Patients With Cognitive Deficits Due to the Human Immunodeficiency Virus

Official title

Combined Cognitive and Physical Training for the Neurorehabilitation of Patients With Cognitive Deficits Due to the Human Immunodeficiency Virus: a Pilot Study

Overview

WHO: 24 participants with cognitive deficits due to a Human Immunodeficiency Virus (HIV) infection, able to engage in moderate physical activity. WHY: The Human Immunodeficiency Virus is known to cause deficits in cognitive function, even under effective pharmacological viral load suppression. Cognitive dysfunction in patients with HIV is frequent and has a detrimental impact on their everyday personal and professional life. The purpose of this study is to evaluate two sets of computerized exercises combining cognitive and physical effort to see if they can improve executive function in patients with an HIV infection. WHAT: Study participants first undergo cognitive and physical assessments. Additional questionnaires will assess mood, everyday life cognition, function and quality. This will be followed by a 6 week training period with 2 training sessions a week. The effect of the physical and cognitive training will be measured in a post-training evaluation session. Six months after completion of the training, the study will evaluate cognitive and physical abilities of participants to study long-term effects of the respective training program. WHERE: Both the evaluation and the training sessions will be conducted on the premises of the Lausanne University Hospital (Rue du Bugnon 46, 1005 Lausanne, Switzerland)

Detailed description

This is an exploratory Randomized Controlled Trial with the purpose of evaluating the potential of two sets of gamified cognitive and physical exercises in the neurorehabilitation of cognitive deficits due to an infection with the Human Immunodeficiency Virus (HIV).

Upon recruitment, eligible study participants (see 'Eligibility Criteria') receive a detailed oral and written description about the scientific background, aims and methods of the study. Additional information will be provided about potential benefits and risks associated with study participation, as well as about the voluntary nature of participation throughout the study. The participant's written informed consent is required for study enrollment.

After inclusion in the study, participants are randomized into one of two different training programs with equal chance of attribution and without possibility of choosing:

* Program 1 involves brain training and guided, light physical exercise games on a tablet device. The exercise involves movements such as reaching, stepping, and stretching. Warm-up and cool down sessions are mandated prior to and following the tasks. * Program 2 involves gamified exercises displayed on a large screen. Participants use whole-body movements to complete the tasks. Tasks involve movements such as reaching, stepping, and jogging in place. These movements are tracked by a motion sensor. Warm-up and cool down sessions are mandated prior to and following the training sessions.

Independently of program attribution, participants engage in a pre-training assessment, a six-week training period, a post-training assessment and a 6-month-follow-up assessment.

Before the start of the training, participants are required to perform several cognitive and physical tests (including cyclo-ergospirometry) and fill out a number of questionnaires on subjective cognitive function, mood and quality of life. Additionally, an electroencephalography (EEG) will be performed to measure brain activity. The exercises, the questionnaires and the EEG serve as a baseline evaluation of cognitive, physical and neurophysiological function.

Following the first assessment, study participants engage in a six-week training period. In both programs, participants engage in two weekly trainings of ninety minutes duration each.

After completion of the training period, study participants engage in a post-training assessment to evaluate the effect of training on cognitive and physical performance. This session incorporates the same tasks and questionnaires as in the pre-training visit. An EEG will be used to characterize the training effects on dynamics of the underlying large-scale neuronal networks. The aim of the post-training assessment is to demonstrate immediate training effect of the two programs.

A final follow-up visit is scheduled 6 months after the completion of the last training session. The cognitive and physical testing together with the questionnaires and the EEG will be repeated to examine the long-term effects of the training programs.

Interventions

• Device Computerized Gaming Rehabilitation Program 1
  Brain training games displayed on a large screen paired with physical exercise component. The program involves movements such as reaching, stepping, or stretching in place.
• Device Computerized Gaming Rehabilitation Program 2
  Brain training games displayed on a tablet device paired with physical exercise component. The program involves movements such as reaching, stepping, or stretching.

Primary outcome measures

• Change in subjective everyday life cognition after a 6 weeks period of gamified cognitive and physical training (program 1 vs program 2) [Time frame: 6 weeks]
• Change in speed of information processing after a 6 weeks period of gamified cognitive and physical training [Time frame: 6 weeks]
• Change in cognitive flexibility after a 6 weeks period of cognitive and physical training (program 1 vs program 2) [Time frame: 6 weeks]
• Change in visuospatial short-term memory after a 6 weeks period of cognitive and physical training (program 1 vs program 2) [Time frame: 6 weeks]

Secondary outcome measures (12)

• Change in sustained attention after a 6 weeks period of gamified cognitive and physical training (program 1 vs program 2) [Time frame: 6 weeks]
• Change in cognitive interference after a 6 weeks period of gamified cognitive and physical training (program 1 vs program 2) [Time frame: 6 weeks]
• Change in design fluency after a 6 weeks period of gamified cognitive and physical training (program 1 vs program 2) [Time frame: 6 weeks]
• Change in cognitive flexibility after a 6 weeks period of gamified cognitive and physical training (program 1 vs program 2) [Time frame: 6 weeks]
• Change in visuo-spatial and verbal working memory control after a 6 weeks period of gamified cognitive and physical training (program 1 vs program 2) [Time frame: 6 weeks]
• Change in divided attention after a 6 weeks period of gamified cognitive and physical training (program 1 vs program 2) [Time frame: 6 weeks]
• Change in body composition (body fat and muscle mass) after a 6 weeks period of gamified cognitive and physical training (program 1 vs program 2) [Time frame: 6 weeks]
• Change in risk of falls after a 6 weeks period of gamified cognitive and physical training (program 1 vs program 2) [Time frame: 6 weeks]
• Change in limits of postural stability after a 6 weeks period of gamified cognitive and physical training (program 1 vs program 2) [Time frame: 6 weeks]
• Change in dynamic stability after a 6 weeks period of gamified cognitive and physical training (program 1 vs program 2) [Time frame: 6 weeks]
• Change in ability to perform a cognitive and physical dual task after a 6 weeks period of gamified cognitive and physical training (program 1 vs program 2) [Time frame: 6 weeks]
• Change in heart rate variability after a 6 weeks period of gamified cognitive and physical training (program 1 vs program 2) [Time frame: 6 weeks]

Eligibility criteria

Inclusion criteria

• Age ≥ 18 years
• Diagnosis of an HIV infection
• Undetectable HIV load in the serum (<50 copies/mL) over the last 6 months prior to study inclusion.
• Z-score ≤ -1.0 in at least one of the three following tests:

• Color Trail Test (CTT) Flexibility Index
• subtest Code of the Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV)
• subtest Digit Span of the WAIS-IV
• Z-score ≤ -1.0 in at least one of the following tests:

• Symbol Digits Modalities Test (SDMT)
• Brief Visuospatial Memory Test Revised (BVMT-R)
• CTT Flexibility Index
• Stroop Color-Word interference test

Exclusion criteria

• Clinically defined cause for cognitive deficits other than HIV
• Diagnosis of severe depression according to a cut-off score of ≥ 27 of the Center for epidemiological studies - depression questionnaire (CES-D; Metral et al., 2020; Radloff, 1977)
• Diagnosis of HIV-associated dementia according to the Frascati Critera (Antinori et al., 2007)
• Current psychotic symptoms according to the Mini-International Neuropsychiatric Interview (M.I.N.I. - L, Sheehan et al., 1998) subscale of psychotic symptoms
• Antidepressive, anxiolytic or cART medication that has been changed over the last month
• Thoracic pain and/or heart palpitations at rest, during or following a physical effort (based on self-report)
• For patients without known and clinically stable cardio-vascular disease: abnormal rest electrocardiogram readings suggestive of second degree type Mobitz or third degree atrioventricular blocking, pathological repolarization (T-wave inversion, ST elevation, abnormal QT lengthening in at least two corresponding leads), or typical features of channelopathies
• Premature termination of maximal effort test due to cardiac problems
• Falls in the past 12 weeks as evaluated in the enrolment interview (Hopkins Falls Grading Scale, Grade >1)
• High risk of falling according a cutoff score > 15 sec in the Four Square Step Test (Dite \& Temple, 2002)
• Incapacity to discriminate colors or insufficient visual acuity that cannot be corrected
• Incapacity or unwillingness to provide informed consent
• Insufficient knowledge of French to understand and follow instructions

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Triple blind

Primary purpose

Treatment

Study locations

Switzerland · 1 center

• Lausanne University Hospital (CHUV) — Lausanne

Publications

• Smith, A. (1982). Symbol digit modalities test (SDMT) manual (revised) Western psychological services. Los Angeles.
• Delis DC, Kramer JH, Kaplan E, Holdnack J. Reliability and validity of the Delis-Kaplan Executive Function System: an update. J Int Neuropsychol Soc. 2004 Mar;10(2):301-3. doi: 10.1017/S1355617704102191. No abstract available. PMID 15012851
• Benedict, R. H. (1997). Brief Visuospatial Memory Test-Revised (BVMT-R). Odessa, FL: Psychological Assessment Resources. In: Inc
• Vallat-Azouvi C, Pradat-Diehl P, Azouvi P. The Working Memory Questionnaire: a scale to assess everyday life problems related to deficits of working memory in brain injured patients. Neuropsychol Rehabil. 2012;22(4):634-49. doi: 10.1080/09602011.2012.681110. Epub 2012 Apr 27. PMID 22537095
• Brandt, J. (1991). The hopkins verbal learning test: Development of a new memory test with six equivalent forms. Clinical Neuropsychologist, 5(2), 125-142.
• Rieu D, Bachoud-Levi AC, Laurent A, Jurion E, Dalla Barba G. [French adaptation of the Hopkins Verbal Learning Test]. Rev Neurol (Paris). 2006 Jun;162(6-7):721-8. doi: 10.1016/s0035-3787(06)75069-x. French. PMID 16840980
• Greenberg, L., Kindschi, C., & Corman, C. (1996). TOVA clinical guide. Los Alamitos, CA: Universal Attention Disorders.
• Kollins SH, DeLoss DJ, Canadas E, Lutz J, Findling RL, Keefe RSE, Epstein JN, Cutler AJ, Faraone SV. A novel digital intervention for actively reducing severity of paediatric ADHD (STARS-ADHD): a randomised controlled trial. Lancet Digit Health. 2020 Apr;2(4):e168-e178. doi: 10.1016/S2589-7500(20)30017-0. Epub 2020 Feb 24. PMID 33334505

Identifiers

NCT: NCT06603727 · CHUV-DNC-CCT-HIV-2022

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗