Effect of Attention Training in Mild Cognitive Impairment Patients with Subcortical Vascular Changes: The RehAtt Study

Leonardo Pantoni, Anna Poggesi, Stefano Diciotti, Raffaella Valenti, Stefano Orsolini, Eleonora Della Rocca, Domenico Inzitari, Mario Mascalchi, Emilia Salvadori, Leonardo Pantoni, Anna Poggesi, Stefano Diciotti, Raffaella Valenti, Stefano Orsolini, Eleonora Della Rocca, Domenico Inzitari, Mario Mascalchi, Emilia Salvadori

Abstract

Background and objective: Mild cognitive impairment (MCI) patients with small vessel disease (SVD) are at high dementia risk. We tested the effects of cognitive rehabilitation in these patients using the Attention Process Training-II (APT-II) program in a single-blinded, randomized clinical trial.

Methods: Patients were randomized to APT-II or standard care and evaluated at baseline, 6, and 12 months with functional, quality of life, cognitive tests, and resting state functional MRI (rsfMRI).

Results: Forty-six patients were enrolled and 43 (mean±SD age 75.1±6.8) completed the study. No change was seen in functionality and quality of life between treated and non-treated patients. However, the Rey Auditory-Verbal Learning Test immediate recall showed a significant improvement in treated compared to non-treated group (change score 6 versus 12 months: 1.8±4.9 and -1.4±3.8, p = 0.021; baseline versus 12 months: 3.8±6.1 and 0.2±4.4, p = 0.032). A higher proportion of treated patients had stable/better evaluation compared to non-treated group on Visual search test (6 versus 12 months: 95% versus 71%, p = 0.038) and Rey-Osterrieth Complex Figure copy (6 versus 12 months: 95% versus 67%, p = 0.027). RsfMRI, performed in a subsample, showed that the difference between follow-up and baseline in synchronization of activity in cerebellar areas was significantly greater in treated than in non-treated patients.

Conclusion: We were unable to show a significant effect in quality of life or functional status in treated patients with MCI and SVD. However, APT-II produces some beneficial effects in focused attention and working memory and seems to increase activity in brain circuits involved in cognitive processes.

Keywords: Cerebrovascular disorders; clinical trial; cognitive dysfunction; functional magnetic resonance imaging; rehabilitation.

Figures

Fig.1
Fig.1
Flow diagram showing patients’ attrition from the screening phase to follow-up assessments.
Fig.2
Fig.2
Improvement in long-term brain activity measured by ReHo of rsfMRI data. Between-group voxel-wise map (TFCE) showing significant (p < 0.05, corrected) evidence for a greater Z-transformed ReHo difference (12 months – baseline) in cerebellar areas (vermis VIIIb and bilateral VIIb lobule) involved in cognitive processes in the attention training group as compared to standard care group. The map is overlaid on the MNI152 template. In each cluster, the mean of the difference of the Z-transformed ReHo was positive for the attention training group (ReHo increased over time) and negative for the standard care group (ReHo decreased over time).

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