COG-REAGENT: COGnitive tRaining in patiEnts With Amnestic Mild coGnitive impairmENT

The Efficacy of COGnitive tRaining in patiEnts With Amnestic Mild coGnitive impairmENT (COG-REAGENT): a Multi-center Randomized Controlled Trial

This study evaluates the efficacy and mechanism of internet-based cognitive training in patients with amnestic mild cognitive impairment (aMCI). Half of participants will receive multi-domain adaptive internet-based training program, while the other half will receive a fixed, primary difficulty level task.

Study Overview

• Status: Recruiting
• Conditions: Amnestic Mild Cognitive Impairment
• Intervention / Treatment: Behavioral: multi-domain internet-based adaptive training program; Behavioral: active-control program

Detailed Description

Background: Alzheimer's disease (AD) is the most common dementia and the major cause for senile dementia. With the increase of life expectancy, AD has become a global problem. However, to date, drug therapies only have modest benefits for patients with AD. Recently, researchers have begun to focus on early intervention of AD at its preclinical stages. Individuals with amnestic mild cognitive impairment (aMCI), often the prodromal stage of AD, report mild short-term memory difficulties but preserved independence in activities of daily living. The aMCI stage is important to slow or even prevent the development of AD. Some previous studies have suggested cognitive training is a potential non-pharmacological intervention for aMCI, however, the results were inconsistent. Thus, investigators will conduct this multi-center randomized controlled trial to explore whether and how cognitive training improves cognitive function in patients with aMCI.

Objectives: The first aim of this multi-center single-blinded, randomized controlled trial is to assess whether internet-based cognitive training improves cognitive abilities in patients with aMCI. Furthermore, the second objective is to evaluate the effect of cognitive training on neural plasticity, including brain activation and white matter integrity, which are assessed by functional and structural MRI.

Patients and Methods: The study will include 260 patients diagnosed with aMCI from eight centers around China. The patients will be randomized to either a cognitive training group or an active-control group. The intervention is 12-week internet-based cognitive training performed for 40 minutes per day, 4 days a week. Within each task, high accuracy (80%) is required to upgrade to the next difficulty level. The active- control group will receive five processing speed and attention tasks, whose duration also total to 40 min each training day. However, these tasks are set to a fixed, primary difficulty level across the study.

Neuropsychological assessments and structural and functional magnetic resonance imaging (MRI) will be performed at the baseline, end of intervention, and 6 months after randomization to measure long-term resilience of the effect.

Relevance: Early intervention of aMCI has the potential to delay or even prevent the development of dementia. Some previous studies have suggested cognitive training is a potential non-pharmacological intervention for aMCI, however, the results were inconsistent. Thus, the proposed study is to determine the efficacy of cognitive training in patients with aMCI. Secondly, using functional and structural MRI, this study is to reveal the potential mechanisms underlying cognitive training.

• Study Type: Interventional
• Enrollment (Estimated): 260
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Yi Tang, M.D., Ph.D.; Phone Number: 008613811021432; Email: tangyixw@vip.163.com
• Study Contact Backup: Name: Yi Xing, M.D.; Phone Number: 008613269627589; Email: xingyi_211@163.com

Study Locations

• China
  • Beijing, China, 100053
    • Recruiting
    • Xuanwu Hospital, Capital Medical University
    • Contact: Yi Tang, M.D., Ph.D.; Phone Number: 008613811021432; Email: tangyixw@vip.163.com
    • Contact: Yi Xing, M.D.; Phone Number: 008613269627589; Email: xingyi_211@163.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 50 years to 85 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Literate Han Chinese, 50-85 years of age with a caregiver that accompanies the subject consistently at least 4 days a week;
2. Complaint and/or informant report of a cognitive impairment lasting for at least 3 months;
3. Clinical diagnosis of MCI according to the MCI core clinical criteria of the National Institute on Aging-Alzheimer's Association (NIA-AA) guidelines;
4. A prominent manifestation of memory deficit with or without other cognitive domain impairments;
5. Mini-Mental State Examination (MMSE) score ≥24, and Clinical dementia rating (CDR) = 0.5, and
6. Normal or slightly impaired activities of daily living as defined by a total score of ≤ 1.5 on the three functional CDR domains (home and hobbies, community affairs, and personal care).

Exclusion Criteria:

1. Severe aphasia, physical disabilities, or any other disease that may preclude completion of neuropsychological testing;
2. A medical history of stroke with focal neurological features including hemiparesis, sensory loss, visual field deficits, and evidence of responsible lesions on MRI;
3. Significant white matter lesions (Fazekas score = 3-6);
4. Disorders other than aMCI that may affect cognition;
5. Depression or other psychiatric disorders;
6. Clinically significant gastrointestinal, renal, hepatic, respiratory, infectious, endocrine, or cardiovascular diseases, cancer, alcoholism, drug addiction;
7. Use of medications that may affect cognitive functioning, including tranquilizers, anti-anxiolytics, hypnotics, nootropics, and cholinomimetic agents;
8. Inability to undergo a brain MRI; and
9. Other conditions that in the investigator's opinion might not be suitable for the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cognitive training group; Multi-domain adaptive internet-based training program, including processing speed, attention, long-term memory, working memory, flexibility, calculation, and problem solving. 4 x 40 minutes per week, for 12 weeks.	Behavioral: multi-domain internet-based adaptive training program; The training paradigms include a time perception task, visual search task, rapid serial presentation task, delayed match to sample task, paired-associate recall task, attention span task, digit span task, go-no go task, Stroop task, task switching, auditory span task and n-back working memory task. Each task has several difficulty levels. The tasks are grouped in different cognitive domains including: processing speed, attention, perception, long-term memory, working memory, calculation, executive control, reasoning, and problem-solving. Participants in the cognitive training group will complete 40 min of training daily, 4 days a week for 12 weeks. When a high accuracy (80%) is achieved for each task, the level of difficulty will be upgraded for that task.
Active Comparator: Active-control group; Fixed, primary difficulty level tasks. 4 x 40 minutes per week, for 12 weeks.	Behavioral: active-control program; For the control group, tasks for processing speed and attention are included. Importantly, a fixed, primary difficulty level for all participants in the control group is set.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Montreal Cognitive Assessment	Montreal Cognitive Assessment (MoCA) will be used to evaluate the general cognitive function. MoCA ranges from 0 to 30, and higher value represents a better outcome.	12 weeks (end of intervention)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-cog, 11-items version).	ADAS-cog 11 scale ranges from 0 to 70, and higher value represents a worse outcome. This study will use ADAS-cog to assess changes in the global cognitive function after intervention.	12 weeks (end of intervention), 6 months
Change in brain volume and white matter integrity	Structural MRI will be used to measure brain volume and white matter integrity.	12 weeks (end of intervention), 6 months
Change in brain connectivity	Functional MRI will be used to measure brain connectivity.	12 weeks (end of intervention), 6 months
Change in Mini-mental State Examination	Mini-mental State Examination (MMSE) will be used to evaluate the general cognitive function. MMSE ranges from 0 to 30, and higher value represents a better outcome.	12 weeks (end of intervention), 6 months
Change in Montreal Cognitive Assessment	Montreal Cognitive Assessment (MoCA) will be used to evaluate the general cognitive function. MoCA ranges from 0 to 30, and higher value represents a better outcome.	6 months
Change in memory function	WHO-UCLA Auditory Verbal Learning Test will be used to assess memory function. It ranges from 0 to 45, and higher value represents a better outcome.	12 weeks (end of intervention), 6 months
Change in Digit span forward	Digit span will be used to assess attention. It ranges from 3 to 10, and higher value represents a better outcome.	12 weeks (end of intervention), 6 months
Change in Digit span backward	Digit span backward will be used to assess executive function. It ranges from 2 to 8, and higher value represents a better outcome.	12 weeks (end of intervention), 6 months
Change in Trail Making Test	Trail-Making Test B minus A score will be used to assess executive function. Trail-Making Test B minus A ranges from -150 to 300, higher value represents a worse outcome.	12 weeks (end of intervention), 6 months
Change in Boston Naming Test	Boston Naming Test will be used to assess language function. It ranges from 0 to 30, and higher value represents a better outcome.	12 weeks (end of intervention), 6 months
Change in Activities of Daily Living	Activities of Daily Living (ADL) scale will be used to assess the change of life quality. It ranges from 20 to 80. The "20" represents normal life ability and the higher score presents the worse life ability.	12 weeks (end of intervention), 6 months
Change in Clinical Dementia Rating Scale sum of the boxes	Clinical Dementia Rating Scale sum of the boxes (CDR-SB) will be used to evaluate the general cognitive function. CDR-SB ranges from 0 to 18, and higher value represents a worse outcome.	12 weeks (end of intervention), 6 months
Change in Quality of Life-Alzheimer's Disease (QoL-AD) Scale	Quality of Life-Alzheimer's Disease (QoL-AD) Scale will be used to evaluate the life quality of the patients. The total score is 13-52, with higher scores indicating better QoL.	12 weeks (end of intervention), 6 months
Change in Cookie Theft picture description task	Cookie Theft picture description task will be used to evaluate spontaneous discourse. We will analyze the total number of syllables produced, the total number of information units produced, and the total time taken to describe the picture	12 weeks (end of intervention), 6 months

Collaborators and Investigators

• Sponsor: Xuanwu Hospital, Beijing
• Collaborators: Wuhan University; Beijing Friendship Hospital; First Affiliated Hospital Xi'an Jiaotong University; First Affiliated Hospital of Zhejiang University; Shandong Provincial Hospital; The First Hospital of Jilin University; The First Affiliated Hospital of Shanxi Medical University
• Investigators: Principal Investigator: Yi Tang, M.D., Ph.D., Xuanwu Hospital, Beijing

Publications and helpful links

General Publications

• Xing Y, Zhu Z, Du Y, Zhang J, Qu Q, Sun L, Li Y, Guo Y, Peng G, Liu Y, Yu Y, Qiao Y, Xie B, Shi X, Lu J, Jia J, Tang Y. The Efficacy of COGnitive tRaining in patiEnts with Amnestic mild coGnitive impairmENT (COG-REAGENT): Protocol for a Multi-Center Randomized Controlled Trial. J Alzheimers Dis. 2020;75(3):779-787. doi: 10.3233/JAD-191314.

Study record dates

Study Major Dates

• Study Start (Actual): November 6, 2019
• Primary Completion (Estimated): December 1, 2023
• Study Completion (Estimated): December 1, 2023

Study Registration Dates

• First Submitted: August 19, 2019
• First Submitted That Met QC Criteria: August 19, 2019
• First Posted (Actual): August 21, 2019

Study Record Updates

• Last Update Posted (Actual): July 19, 2023
• Last Update Submitted That Met QC Criteria: July 17, 2023
• Last Verified: July 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Neurocognitive Disorders; Cognition Disorders; Cognitive Dysfunction
• Other Study ID Numbers: 2019042-XZ1

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No