RECOVER-NEURO: Platform Protocol, Appendix_A to Measure the Effects of BrainHQ, PASC CoRE and tDCS Interventions on Long COVID Symptoms

July 20, 2026 updated by: Duke University

RECOVER-NEURO: A Platform Protocol for Evaluation of Interventions for Cognitive Dysfunction in Post-Acute Sequelae of SARS-CoV-2 Infection (PASC)

This platform protocol is designed to be flexible so that it is suitable for a wide range of settings within health care systems, for remote settings, and in community settings where it can be integrated into COVID-19 programs and subsequent treatment plans.

This protocol is a prospective, multi-center, multi-arm, randomized, controlled platform trial evaluating potential interventions for PASC-mediated cognitive dysfunction. The hypothesis is that PASC-associated dysfunction in cognitive domains, such as executive function and attention, may be improved by interventions that selectively focus on enhancing those domains.

This design seeks to evaluate each intervention relative to the Active Comparator. The BrainHQ (alone) arm is important because the intervention is commercially available, accessible, relatively inexpensive, and does not require trained personnel to administer. BrainHQ has been also been proven effective in other studies of cognitive dysfunction such as studies in aging, mild cognitive impairment, traumatic brain injury, among others. The BrainHQ + PASC CoRE arm and the BrainHQ + tDCS arms are suspected to provide cognitive improvements beyond BrainHQ alone through different mechanisms. Both PASC CoRE and tDCS have extensive prior use and have demonstrated utility in improving aspects of cognitive function in other clinical settings..

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Participants will be randomized to one of the intervention appendices that are actively enrolling at the time of randomization. Intervention appendices may be added or removed according to adaptive design and/or emerging evidence. Various interventions will be studied.

Participants will be randomized equally across the five arms:

  1. Active Comparator (video games)
  2. BrainHQ
  3. BrainHQ + PASC CoRE
  4. BrainHQ + tDCS-active
  5. BrainHQ + tDCS-sham

Study Type

Interventional

Enrollment (Actual)

328

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • North Carolina
      • Durham, North Carolina, United States, 27710
        • All sites listed under NCT05965752

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

1. See NCT05965752 for RECOVER-NEURO: Platform Protocol level inclusion criteria which applies to this appendix

Exclusion Criteria:

1. See NCT05965752 for RECOVER-NEURO: Platform Protocol level exclusion criteria which applies to this appendix

Additional Appendix (Sub-study) Level Exclusion Criteria:

  1. Presence of metal objects in the head or neck
  2. Skin disorders or skin-sensitive areas near tDCS stimulation locations that would interfere with electrode placement or increase the risk of stimulation-induced damage, at the investigator's discretion

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: BrainHQ Active Comparator
5 sessions/week at 30 min/session
Other: BrainHQ/Active Comparator Activity
BrainHQ platform provides a set of cognitive activities, like puzzles and games, that are cognitively stimulating and actively engage participants but do not continuously and adaptively challenge them. These activities are designed to be a face-valid, active comparison approach to cognitive therapy, thus participants are blinded, attention time is matched, and overall user experience is identical to the active arms.
Experimental: BrainHQ
5 sessions/week at 30 min/session
Other: BrainHQ
BrainHQ is an online cognitive training program, and has been used to improve cognitive function among persons with cognitive impairment based on principles of neuroplasticity.
Experimental: BrainHQ + PASC CoRE
BrainHQ plus 9 group sessions at 1.5 hr/session and 3 individual sessions at 1 hr/session
Other: BrainHQ
BrainHQ is an online cognitive training program, and has been used to improve cognitive function among persons with cognitive impairment based on principles of neuroplasticity.
Other: PASC CoRE
PASC CoRE is a manualized, adaptable cognitive rehabilitation intervention adapted from Goal Management Training and other evidence based programs that improve attention and executive functions, among other cognitive domains.
Experimental: Brain HQ + tDCS-active
2.0 mA stimulation delivered for 30 min during each BrainHQ session
Other: BrainHQ
BrainHQ is an online cognitive training program, and has been used to improve cognitive function among persons with cognitive impairment based on principles of neuroplasticity.
Device: tDCS-active

Transcranial direct current stimulation (tDCS) will use a device specifically for home-based use. This device delivers a weak electrical current of 2.0 mA passed through two electrodes placed on the scalp to target the dorsolateral prefrontal cortex region of the brain. The electrodes are single-use for each session and can be attached to a headset by snapping into place.

The device has a user-friendly interface and a large-button keypad, making it is easy to use at home.
Placebo Comparator: Brain HQ + tDCS-sham
Inactive stimulation delivered for 30 min during each BrainHQ session
Other: BrainHQ
BrainHQ is an online cognitive training program, and has been used to improve cognitive function among persons with cognitive impairment based on principles of neuroplasticity.
Device: tDCS-sham
tDCS devices used in the sham arm will be pre-programmed to deliver the same ramp up/down at the beginning/end of the 30-minute period as the active arm, except with no current otherwise delivered during the session.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Everyday Cognition 2 (ECog2)
Time Frame: Baseline to End of Intervention (EOI) (Day 70)
Everyday Cognition 2 (ECog2) is a self-report, 41-item questionnaire used to measure the participant's perceived capacity to perform activities related to cognitive function, which could impact major activities of daily living and independence. Score ranges from 1 to 5, with 5 being worst.
Baseline to End of Intervention (EOI) (Day 70)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Everyday Cognition 2 (ECog2)
Time Frame: Baseline, EOS (Day 160)
Everyday Cognition 2 (ECog2) is a self-report, 41-item questionnaire used to measure the participant's simple reaction time; respond when X happens and Choice reaction time; respond only if X happens.
Baseline, EOS (Day 160)
Change in PROMIS-cognitive Function - Short Form 8a (PROMIS-Cog) Total Score
Time Frame: Baseline, End of Intervention - EOI (Day 70), End of Study (EOS) (Day 160)
The PROMIS-Cog is the PROMIS short form for the cognitive function domain and is a self-report, 8-item questionnaire targeting cognitive function in the past seven days. Scores range from 22.4 to 63.5. Higher scores are better.
Baseline, End of Intervention - EOI (Day 70), End of Study (EOS) (Day 160)
Change on Auditory Verbal Learning Test
Time Frame: Baseline, End of Intervention - EOI (Day 70), End of Study (EOS) (Day 160)

Trials #1-#5 report the total number correct across 5 trials. Trials #1-5 generate one total score, the individual scores for each trial are not analyzed. The Score for Trials #1-#5 range from 0-75; higher scores are better.

Trial #8 reports the total number correct. Scores range from 0-15; higher scores are better.

Trial #9 reports the total number correct recognition hits minus false positive. Scores range from 0-15; higher scores are better.
Baseline, End of Intervention - EOI (Day 70), End of Study (EOS) (Day 160)
Change on Symbol Digit Modalities Test
Time Frame: Baseline, End of Intervention - EOI (Day 70), End of Study (EOS) (Day 160)
The Symbol Digit Modalities Test reports the total number correct on the test. Scores range from 0-110. Higher scores are better.
Baseline, End of Intervention - EOI (Day 70), End of Study (EOS) (Day 160)
Change in Verbal Fluency
Time Frame: Baseline, End of Intervention - EOI (Day 70), End of Study (EOS) (Day 160)
The Verbal Fluency Semantic reports the total number correct. Scores range from 0-110. Higher scores are better.
Baseline, End of Intervention - EOI (Day 70), End of Study (EOS) (Day 160)
Change in Total Time to Complete the Digit Vigilance Test
Time Frame: Baseline, End of Intervention - EOI (Day 70), End of Study (EOS) (Day 160)
Baseline, End of Intervention - EOI (Day 70), End of Study (EOS) (Day 160)
Change on NIH Toolbox Flanker Inhibitory Control and Attention Test
Time Frame: Baseline, End of Intervention - EOI (Day 70), End of Study (EOS) (Day 160)
The Flanker Inhibitory Control and Attention Test Computed Score ranges from 0-10. Higher scores are better.
Baseline, End of Intervention - EOI (Day 70), End of Study (EOS) (Day 160)
Change in CogState Detection Score
Time Frame: Baseline, End of Intervention - EOI (Day 70), End of Study (EOS) (Day 160)
CogState Detection Score is the mean of log10 transformed reaction times. Lower values are better.
Baseline, End of Intervention - EOI (Day 70), End of Study (EOS) (Day 160)
Change in CogState Identification Score
Time Frame: Baseline, End of Intervention - EOI (Day 70), End of Study (EOS) (Day 160)
CogState Identification Score is the mean of log10 transformed reaction times for correct responses. Lower values are better.
Baseline, End of Intervention - EOI (Day 70), End of Study (EOS) (Day 160)
Change in CogState One Back Primary Score
Time Frame: Baseline, End of Intervention - EOI (Day 70), End of Study (EOS) (Day 160)
CogState One Back Primary Score is the arcsine transformation of the square root of the proportion of correct responses. The scale ranges from 0 to π/2. Higher scores are better.
Baseline, End of Intervention - EOI (Day 70), End of Study (EOS) (Day 160)
Total Number of Serious Adverse Events (SAEs) or Unanticipated Adverse Device Effects (UADEs)
Time Frame: Baseline to EOS (Day 160)
An SAE or serious suspected adverse reaction (SAR) or serious adverse reaction an AE that results in any of the following serious outcomes: Death, life-threatening, persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions, inpatient hospitalization or prolongation of existing hospitalization, congenital abnormality or birth defect, important medical event that may not result in one of the above outcomes, but may jeopardize the health of the study participant or require medical or surgical intervention to prevent one of the above outcomes from occurring. A UADE is any serious adverse effect, problem, or death caused by or associated with a device if that effect was not previously identified in the investigational plan or application (including a supplementary plan or application), or any other unanticipated serious problem associated with a device that relates to the rights, safety, or welfare of subjects.
Baseline to EOS (Day 160)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Duke University

Collaborators

National Heart, Lung, and Blood Institute (NHLBI)

Investigators

  • Study Chair: Kanecia Zimmerman, MD PhD, Duke University
  • Study Chair: Daniel Laskowitz, MD MHS, Duke University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

September 1, 2023

Primary Completion (Actual)

September 19, 2024

Study Completion (Actual)

December 17, 2024

Study Registration Dates

First Submitted

July 25, 2023

First Submitted That Met QC Criteria

July 25, 2023

First Posted (Actual)

July 28, 2023

Study Record Updates

Last Update Posted (Actual)

August 11, 2026

Last Update Submitted That Met QC Criteria

July 20, 2026

Last Verified

July 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Pro00112477_A
  • 1OT2HL156812-01 (U.S. NIH Grant/Contract)
  • OTA-21-015G (Other Grant/Funding Number: NIH grant to RTI; RTI subcontracting with DCRI)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

The investigators will share the summary of results on the study website: https://recovercovid.org/

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

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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