COGTIPS: a double-blind randomized active controlled trial protocol to study the effect of home-based, online cognitive training on cognition and brain networks in Parkinson's disease

Tim D van Balkom, Henk W Berendse, Ysbrand D van der Werf, Jos W R Twisk, Iris Zijlstra, Rob H Hagen, Tanja Berk, Chris Vriend, Odile A van den Heuvel, Tim D van Balkom, Henk W Berendse, Ysbrand D van der Werf, Jos W R Twisk, Iris Zijlstra, Rob H Hagen, Tanja Berk, Chris Vriend, Odile A van den Heuvel

Abstract

Background: Cognitive dysfunction is highly prevalent in Parkinson's disease (PD) and a large proportion of patients eventually develops PD-related dementia. Currently, no effective treatment is available. Cognitive training is effective in relieving cognitive dysfunctions in several -neurodegenerative- diseases, and earlier small-scale trials have shown positive results for PD. In this randomized controlled trial, we assess the efficacy of online home-based cognitive training, its long-term effects, as well as the underlying neural correlates in a large group of PD patients.

Methods: In this double-blind randomized controlled trial we will include 140 non-demented patients with idiopathic PD that experience significant subjective cognitive complaints. Participants will be randomized into a cognitive training group and an active control group. In both groups, participants will individually perform an online home-based intervention for eight weeks, three times a week during 45 min. The cognitive training consists of thirteen games that focus on executive functions, attention and processing speed with an adaptive difficulty. The active control comprises three games that keep participants cognitively engaged without a training component. Participants will be subjected to extensive neuropsychological assessments at baseline and after the intervention, and at six months, one year and two years of follow-up. A subset of participants (40 in each treatment condition) will undergo structural and functional magnetic resonance imaging. The primary outcome of this study is the performance on the Tower of London task. Secondary outcomes are objective and subjective cognitive functioning, conversion to PD-related mild cognitive impairment or dementia, functional and structural connectivity and network topological indices measured with magnetic resonance imaging. None of the outcome measures are part of the cognitive training program. Data will be analyzed using multivariate mixed-model analyses and odds ratios.

Discussion: This study is a large-scale cognitive training study in PD patients that evaluates the efficacy in relieving cognitive dysfunction, and the underlying mechanisms. The strengths of this study are the large sample size, the long follow-up period and the use of neuroimaging in a large subsample. The study is expected to have a low attrition and a high compliance rate given the home-based and easily-accessible intervention in both conditions.

Trial registration: ClinicalTrials.gov ID NCT02920632 . Registered September 30, 2016.

Keywords: Cognitive impairment; Cognitive rehabilitation; Cognitive training; MRI; Network; Neuroimaging; Neuropsychological assessment; Parkinson’s disease; RCT.

Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Working model of local compensatory brain activity (in yellow) that preserves intact cognitive functioning (in blue) but fails at later disease stage, while global brain network integrity gradually degenerates (in green). Dashed lines illustrate the hypothesized effects that CT may have on local and global brain infrastructure and on cognitive function. Adapted from [37]
Fig. 2
Fig. 2
Global overview of the COGTIPS time schedule

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