Abstract
Non-invasive methods, such as neurofeedback training, could support cognitive symptom management in Huntington’s disease by targeting brain regions whose function is impaired. The aim of our single-blind, sham-controlled study was to collect rigorous evidence regarding the feasibility of neurofeedback training in Huntington’s disease by examining two different methods, activity and connectivity real-time functional MRI neurofeedback training. Thirty-two Huntington’s disease gene-carriers completed 16 runs of neurofeedback training, using an optimized real-time functional MRI protocol. Participants were randomized into four groups, two treatment groups, one receiving neurofeedback derived from the activity of the supplementary motor area, and another receiving neurofeedback based on the correlation of supplementary motor area and left striatum activity (connectivity neurofeedback training), and two sham control groups, matched to each of the treatment groups. We examined differences between the groups during neurofeedback training sessions and after training at follow-up sessions. Transfer of training was measured by measuring the participants’ ability to upregulate neurofeedback training target levels without feedback (near transfer), as well as by examining change in objective, a priori defined, behavioural measures of cognitive and psychomotor function (far transfer) before and at 2 months after training. We found that the treatment group had significantly higher neurofeedback training target levels during the training sessions compared to the control group. However, we did not find robust evidence of better transfer in the treatment group compared to controls, or a difference between the two neurofeedback training methods. We also did not find evidence in support of a relationship between change in cognitive and psychomotor function and learning success. We conclude that although there is evidence that neurofeedback training can be used to guide participants to regulate the activity and connectivity of specific regions in the brain, evidence regarding transfer of learning and clinical benefit was not robust.
Highlights
Neurofeedback training (NFT) is a non-invasive intervention used to train participants in a closedloop design to regulate their own brain activity(Sitaram et al, 2017)
There was a significant main effect of group, where the treatment group had greater neurofeedback training (NFT) target levels overall compared to the control group across all visits (t(29.1) = 2.79, p = 0.009
There was no difference in NFT target levels between the groups (F(1, 28) = 0.20, p = 0.655; see supplementary materials), our findings suggest that the effects of receiving neurofeedback occurred within the first training session and were stable across training sessions
Summary
Neurofeedback training (NFT) is a non-invasive intervention used to train participants in a closedloop design to regulate their own brain activity(Sitaram et al, 2017). The underlying principle is that by regulating different aspects of their brain activity, e.g. regional activation or inter-regional connectivity, participants would implicitly regulate associated cognitive function. There are currently no treatments for cognitive impairment in HD and the effect of diseasemodifying therapies, such as antisense-oligonucleotide approaches (ASO (Tabrizi et al, 2019b)), on cognitive function is, at present, unknown. Our motivation for testing NFT, is that it, if successful, it could be used as an adjunct treatment to invasive, disease-modifying therapies(Linden and Turner, 2016, Tabrizi et al, 2019a). There are several challenges in designing effective NFT trials and testing their efficacy, including the choice of an appropriate NFT target for the specified clinical population
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