Improving Neurological Health in Aging Via Neuroplasticity-based Computerized Exercise (INHANCE)

Improving Neurological Health in Aging Via Neuroplasticity-based Computerized Exercise (INHANCE)

This study is a validation study to evaluate efficacy of a neuroplasticity-based, computerized cognitive training program INHANCE (Improving Neurological Health in Aging via Neuroplasticity-based Computerized Exercise) to improve neurological and neuropsychological health in older adults.

Study Overview

• Status: Completed
• Conditions: Healthy Aging
• Intervention / Treatment: Other: Commercially available computerized training; Other: Computerized Plasticity-Based Adaptive Cognitive Training

Detailed Description

The primary objective of this study is to evaluate the impact of a targeted speed and alertness training program (INHANCE) to improve cognition in healthy older adults, as evidenced by standard measures of cognition, and positive improvements in the neuromodulatory cholinergic system as measured via positron-emission tomography (PET).

The investigators will employ a double-blind, parallel-arm, placebo-controlled, randomized clinical trial design comprised of a treatment group using INHANCE, a computerized program that trains speed of processing and attention, compared to an active control group using computer games in 92 healthy older adults.

Approximately 108 participants will be consented to ensure the successful completion of 92 participants (post 20% attrition). Participants will then complete the Screening (V0) assessments to determine eligibility. Following inclusion, participants will complete the Baseline (V1) assessments, PET imaging and structural MRI scan; participants will then be randomized into either the INHANCE training or Computer Games, and will engage in approximately 35 hours of program use for the 10-week intervention period. Approximately halfway through the intervention period (~5 weeks), participants will complete Interim (V2) assessments to be compared to the Post-Intervention assessments. Following the 10-week intervention, participants will complete a Post-Intervention (V3) assessment and PET imaging to evaluate changes in cognitive function. Participants will then stop using their assigned program for 3 months and return for a Follow-up (V4) end-of-study assessment to evaluate the endurance of changes in cognitive function in the absence of further program use.

• Study Type: Interventional
• Enrollment (Actual): 93
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Quebec
    • Montreal, Quebec, Canada, H3A 2B4
      • McGill University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Potential participant must be 65+ years old at the time of study screening.
• Potential participant should achieve a score of ≥ 23 on the Montreal Cognitive Assessment (MoCA).
• Potential participant must be likely able to compete all primary outcome measures in the judgment of the consenting study staff person.
• Potential participant must demonstrate adequate decisional capacity, in the judgment of the consenting study staff member, to make a choice about participating in this research study.
• Potential participant must have the visual, auditory, and motors capacity to use the computerized intervention in the judgment of the consenting study staff person.
• Potential participant must already have, be willing to obtain, or be willing to travel to locations with WiFi connectivity to complete intervention activities.
• Potential participant must be able to communicate in either English or French.

Exclusion Criteria:

• Potential participant should not have an existing diagnosis of major or minor neurocognitive disorder at screening.
• Potential participants with active suicidal ideation with specific plan and intent or suicide-related behaviors within 2 months of consent as measured by the Columbia-Suicide Severity Rating Scale (C-SSRS)
• Potential participant should not have a Geriatric Depression Scale (GDS) score of >10.
• Potential participant should not have been treated within 5 years of the date of consent with a computer-based cognitive training program manufactured by Posit Science.
• Potential participant should not be participating in a concurrent clinical trial (involving an investigational pharmaceutical, behavioral treatment, medical device or other) that, in the judgment of the Site Principal Investigator, could affect the outcome of this study.
• Potential participant may not be pregnant and should not have claustrophobia or implantation with any medical devices above the waist that may concentrate radio frequency fields, or have other medical issues that may frustrate participation in MRI imaging procedures.
• Potential participant should not have medical illnesses deemed to interfere with participation in study activities and/or unstable and/or untreated conditions that may affect cognition, including substance abuse/dependence disorders, drugs that interfere with cholinergic function, ongoing chemotherapy or other cancer treatment.
• Potential participant who shows signs of intoxication due to current substance abuse (including alcohol and/or illegal drugs) will be excluded.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental Treatment; Computerized plasticity-based adaptive cognitive training requiring a total maximum of 70 treatment sessions, up to 7 sessions per week, 30 minutes per session.	Other: Computerized Plasticity-Based Adaptive Cognitive Training; Thirty minutes of training on computerized exercises that targets visual processing speed, memory, attention and alertness.
Active Comparator: Active Comparator; Commercially available computerized training requiring a total maximum of 70 treatment sessions, up to 7 sessions per week, 30 minutes per session.	Other: Commercially available computerized training; Thirty minutes of training on computerized, casual video games.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change Mean in FEOBV SUVR (Standardized Uptake Value Ratio) Through PET Imaging in the Anterior Cingulate Cortex	Change from baseline and 3 months (post-intervention) for the 18F-fluoroethoxybenzovesamicol (FEOBV) standardized uptake value ratio (SUVR) in the Anterior Cingulate Cortex as measured through Positron Emission Tomography (PET) ligand imaging. Higher score is better.	At 3 months (post-intervention)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change Mean in EXAMINER Executive Composite Score	The EXAMINER (Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research) is a computer-based battery of executive function tests yielding a single Executive Composite score across three subtests (Flanker, Anti-Saccades, Set-Shifting). The Executive Composite is a latent trait estimate using Empirical Bayes scoring from item-response theory and is therefore unitless and unbounded. For reference, validation studies report mean scores of 0.70 in healthy adults, 0.29 in patients with mild cognitive impairment, and -0.20 in patients with Alzheimer's disease. This outcome reports change in Executive Composite Score from baseline, calculated as the score at 3 months minus baseline and the score at 6 months minus baseline. Higher values indicate better executive functioning.	At 3 months (post-intervention) and at 6 months (follow-up)
Change Mean Score in Useful Field of View (UFOV) Assessment	This is a computerized assessment that serves as a positive control for task learning. Raw scores are defined as the exposure duration at approximately 80% criterion accuracy in milliseconds accuracy in identification of central and peripheral targets. The best possible raw score is 32 milliseconds, and the worst possible score is 3162 milliseconds. Change was calculated as the score at 3 months minus the score at baseline, and as the score at 6 months minus the score at baseline. Lower values in milliseconds reflect better Useful Field of View performance.	At 3 months (post-intervention) and at 6 months (follow-up)
Change Mean Target Frequency Level in Tonic and Phasic Alertness (TAPAT) Assessment	This is a computerized assessment that serves as a positive control for task learning. A single target frequency level required for users to achieve at least 80% accuracy in target and foil identification for a pre-specified target image presented among similar foil images. Target frequency level is recorded as an integer ranging from 1 to 7, where 1 corresponded to the easiest condition (40% target frequency among foils) and 7 represented the most challenging condition (10% target frequency among foils). Change was calculated as the score at 3 months minus the score at baseline, and as the score at 6 months minus the score at baseline. Higher scores indicate better performance.	At 3 months (post-intervention) and at 6 months (follow-up)

Collaborators and Investigators

• Sponsor: Posit Science Corporation
• Collaborators: McGill University; National Institute on Aging (NIA)
• Investigators: Principal Investigator: Mouna Attarha, PhD, Posit Science Corporation; Principal Investigator: Thomas Van Vleet, PhD, Posit Science Corporation

Publications and helpful links

General Publications

• Attarha M, de Figueiredo Pelegrino AC, Toussaint PJ, Grant SJ, Van Vleet T, de Villers-Sidani E. Improving Neurological Health in Aging Via Neuroplasticity-Based Computerized Exercise: Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2024 Aug 8;13:e59705. doi: 10.2196/59705.
• Attarha M, De Figueiredo Pelegrino A, Ouellet L, Toussaint PJ, Grant SJ, Van Vleet T, de Villers-Sidani E. Association of a Brief Computerized Cognitive Assessment With Cholinergic Neurotransmission: Assessment Validation Study. JMIR Form Res. 2025 Jul 7;9:e68374. doi: 10.2196/68374.
• Attarha M, Carolina de Figueiredo Pelegrino A, Ouellet L, Grant SJ, de Villers-Sidani E, Van Vleet T. Bringing Executive Function Testing Online: Assessment Validation Study. JMIR Form Res. 2025 Jul 14;9:e75687. doi: 10.2196/75687.
• Pelegrino AF, Attarha M, Toussaint PJ, Ouellet L, Grant SJ, Van Vleet T, de Villers-Sidani E. Cholinergic neurotransmission in the anterior cingulate cortex is associated with cognitive performance in healthy older adults: Baseline characteristics of the Improving Neurological Health in Aging via Neuroplasticity-based Computerized Exercise (INHANCE) trial. Neuroimage Rep. 2025 Mar;5(1):100234. doi: 10.1016/j.ynirp.2025.100234. Epub 2025 Jan 29.
• Attarha M, de Figueiredo Pelegrino A, Ouellet L, Toussaint PJ, Grant SJ, Van Vleet T, de Villers-Sidani E. Effects of Computerized Cognitive Training on Vesicular Acetylcholine Transporter Levels using [18F]Fluoroethoxybenzovesamicol Positron Emission Tomography in Healthy Older Adults: Results from the Improving Neurological Health in Aging via Neuroplasticity-based Computerized Exercise (INHANCE) Randomized Clinical Trial. JMIR Serious Games. 2025 Oct 13;13:e75161. doi: 10.2196/75161.

Helpful Links

• Two years after trial completion (on May 31, 2026), the INHANCE dataset will be made available to verified academic and industry researchers. Investigators can conduct both confirmatory and exploratory analyses using LORIS.

Study record dates

Study Major Dates

• Study Start (Actual): July 16, 2021
• Primary Completion (Actual): June 7, 2024
• Study Completion (Actual): June 7, 2024

Study Registration Dates

• First Submitted: October 28, 2019
• First Submitted That Met QC Criteria: October 30, 2019
• First Posted (Actual): November 4, 2019

Study Record Updates

• Last Update Posted (Actual): July 13, 2026
• Last Update Submitted That Met QC Criteria: June 15, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: PSC-0903-19; 5R44AG039965-06 (U.S. NIH Grant/Contract)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No