Computerized Working Memory Training Research Articles

Training working memory updating in Parkinson’s disease: A randomised controlled trial

ABSTRACTFrontostriatal dysfunction in Parkinson’s disease (PD) increases the risk for working memory (WM) impairment and depression, calling for counteractive measures. Computerised cognitive rehabilitation is a promising option, but targeted training protocols are lacking and lab-based training can be demanding due to the repeated visits. This study tested the feasibility and efficacy of home-based computerised training targeting mainly WM updating in PD. Fifty-two cognitively well-preserved PD patients were randomised to a WM training group and an active control group for five weeks of training (three 30-min sessions per week). WM training included three computerised adaptive WM tasks (two updating, one maintenance). The outcomes were examined pre- and post-training with trained and untrained WM tasks, tasks tapping other cognitive domains, and self-ratings of executive functioning and depression. Home-based training was feasible for the patients. The training group improved particularly on the updating training tasks, and showed posttest improvement on untrained WM tasks structurally similar to the trained ones. Moreover, their depression scores decreased compared to the controls. Our study indicates that patients with mild-to-moderate PD can self-administer home-based computerised WM training, and that they yield a similar transfer pattern to untrained WM tasks as has been observed in healthy older adults.

Aging and Network Properties: Stability Over Time and Links with Learning during Working Memory Training.

Growing evidence suggests that healthy aging affects the configuration of large-scale functional brain networks. This includes reducing network modularity and local efficiency. However, the stability of these effects over time and their potential role in learning remain poorly understood. The goal of the present study was to further clarify previously reported age effects on “resting-state” networks, to test their reliability over time, and to assess their relation to subsequent learning during training. Resting-state fMRI data from 23 young (YA) and 20 older adults (OA) were acquired in 2 sessions 2 weeks apart. Graph-theoretic analyses identified both consistencies in network structure and differences in module composition between YA and OA, suggesting topological changes and less stability of functional network configuration with aging. Brain-wide, OA showed lower modularity and local efficiency compared to YA, consistent with the idea of age-related functional dedifferentiation, and these effects were replicable over time. At the level of individual networks, OA consistently showed greater participation and lower local efficiency and within-network connectivity in the cingulo-opercular network, as well as lower intra-network connectivity in the default-mode network and greater participation of the somato-sensorimotor network, suggesting age-related differential effects at the level of specialized brain modules. Finally, brain-wide network properties showed associations, albeit limited, with learning rates, as assessed with 10 days of computerized working memory training administered after the resting-state sessions, suggesting that baseline network configuration may influence subsequent learning outcomes. Identification of neural mechanisms associated with learning-induced plasticity is important for further clarifying whether and how such changes predict the magnitude and maintenance of training gains, as well as the extent and limits of cognitive transfer in both younger and older adults.

Working Memory Interventions With Children: Classrooms or Computers?

The importance of working memory to classroom functioning and academic outcomes has led to the development of many interventions designed to enhance students’ working memory. In this article we briefly review the evidence for the relative effectiveness of classroom and computerised working memory interventions in bringing about measurable and sustainable benefits to students’ working memory, classroom engagement, and academic performance. Although there is considerable evidence that working memory is significantly linked to academic achievement, virtually no research has been undertaken within the classroom context, nor has the research had an intervention focus, nor has any research involved students themselves. Although there is a large amount of research on computerised working memory training programs, the evidence confirms that such programs rarely provide transferable or sustainable benefits to students’ working memory, classroom functioning, or academic performance. Positive evidence is provided for one classroom intervention specifically designed for personal and independent use by students, with their teachers’ support. Recommendations for classroom practice and directions for further research combining classrooms and computer interventions are discussed.

Effects of working memory training on neural correlates of Go/Nogo response control in adults with ADHD: A randomized controlled trial

Working memory and response control are conceptualized as functions that are part of a closely connected and integrated executive function system mediated by the prefrontal cortex and other related brain structures. In the present paper, we asked whether effects of intensive and adaptive computerized working memory training (CWMT) would generalize to enhancements in response control at behavioral and neural levels. A total of 135 postsecondary students with Attention-Deficit/Hyperactivity Disorder (ADHD), a condition associated with executive function impairments, were randomized into a Standard-length CWMT (45-min /session, 25 sessions), Shortened-length CWMT (15min/session, 25 sessions), and a waitlist group. Both training groups received CWMT for 5 days a week for 5 weeks long. All participants completed a Go-Nogo task while neural activity was measured using Electroencephalography (EEG), before and after CWMT. Behavioral results showed trend level evidence (p=0.061) for benefits of CWMT on response control (i.e., improved accuracy of Go responses). Among several neural measures results showed statistically significant changes after CWMT only for the Go trial ERP N2 and P3 in frontal electrodes (p=0.039 and 0.001, respectively). However, given the lack of relationship between behavioral and neural changes and especially the clear lack of predicted does effects (i.e., standard length > short length > control), we conclude that there is no convincing evidence that the working memory training per se changes neural activation patterns in untrained executive functions. The positive finding of general training related changes in this study should have no clinical implications, but may contribute to the literature in better understanding the relationship between neural plasticity and transfer.

Initial Results of a Randomized Controlled Trial of Computerized Working Memory Training in Pediatric Sickle Cell Disease

Introduction: Disease-related neurocognitive deficits are common in sickle cell disease (SCD), even in the absence of stroke. Working memory (WM) is among the domains most commonly affected, likely a result of the high frequency of disease-related cerebral insults localized to the prefrontal cortex. Computerized cognitive training programs have garnered support for their efficacy in improving working memory across multiple pediatric populations, but have not been thoroughly explored in SCD. We present initial findings from a randomized controlled trial of the feasibility and efficacy of a home-based, computerized WM training intervention (Cogmed) with children with SCD.Methods: Youth with SCD between the ages of 7 and 16 years old were recruited to complete a randomized (intervention or waitlist-control), dose-controlled, home-based computerized WM training program (Cogmed). After an initial neuropsychological assessment, participants with WM deficits were loaned an iPad on which they accessed Cogmed at home. Cogmedconsists of 12 increasingly challenging exercises that target skills involving visuo-spatial and verbal WM, practiced over 25 training sessions. At the end of the training period, participants completed a post-intervention neuropsychological assessment, including tests of auditory WM (Digit Span subtest, Wechsler Intelligence Scale for Children - Fifth Edition [WISC-V]) and visuo-spatial WM (Picture Span subtest, WISC-V; and Block Design-Forward and Block Design-Backward subtests, Wechsler Intelligence Scale for Children - Fourth Edition [WISC-IV]). Subtest scores are represented using scaled scores (M = 10; SD = 2). Scores on WISC-V WM subtests were used to calculate a composite Working Memory Index (WMI), represented by a standard score (M = 100; SD = 15).Results: To date, 59 participants (M = 10.45, SD = 2.90; 53% female) have enrolled and completed a baseline neuropsychological assessment. Forty-nine percent (n = 29) exhibited WM deficits and were randomized to either begin Cogmed immediately (n = 14) or wait 5-8 weeks before beginning Cogmed (n = 15). Among those who have received the intervention and reached the end of their training (n = 24), 12 participants (50%) completed at least 10 sessions and 7 participants (29%) completed at least 20 sessions. The mean number of Cogmed sessions completed was 11.83 (SD = 7.97). As expected, participants in the waitlist condition did not exhibit improvements in WM, as demonstrated by stable performance on the WMI (t[8] = -1.520, p = .167), and on the Digit Span (t[9] = -0.449, p = .664), Picture Span (t[9] = -0.708, p = .497), Spatial Span-Forward (t[9] = 0.261, p = .802), and Spatial Span-Backward (t[7] = -0.261, p = .802) subtests. Participants who exhibited WM deficits at baseline and were given Cogmed exhibited reliable improvements in WMI (Baseline M = 89.79, SD = 12.36; Post-test M = 96.83, SD = 14.97), Digit Span (Baseline M = 7.62, SD = 2.24; Post-test M = 8.61, SD = 3.07), Picture Span (Baseline M = 8.93, SD = 2.87; Post-test M = 10.39, SD = 3.01), Block Design-Forward (Baseline M = 8.39, SD = 2.50; Post-test M = 9.06, SD = 3.35), and Block Design-Backward (Baseline M = 7.61, SD = 1.95; Post-test M = 9.39, SD = 2.62). Paired Samples t-tests conducted with participants who completed at least half of the Cogmed program (i.e., 10 sessions), revealed significant improvements on the WMI (t[7] = -3.361, p = .012), and on the Digit Span (t[7] = -3.175, p = .016), Spatial Span-Forward (t[7] = -2.448, p = .044), and Spatial Span-Backward (t[7] = -4.233, p = .004) subtests. Partial correlations controlling for respective baseline scores, indicated that the number of Cogmed sessions completed was positively correlated with post-test scores on the WMI (r = .568, p = .017), and on the Digit Span (r = .623, p = .008), Spatial Span-Forward (r = .518, p = .033), and Spatial Span-Backward (r = .612, p = .009) subtests.Conclusions: Children with SCD exhibit significant neurocognitive deficits, particularly in WM. Initial results suggest that a home-based, computerized WM training program leads to significant improvements in WM. A dose-effect was observed, as participants who completed more Cogmed sessions evidenced the greatest improvements in WM. Home-based cognitive training programs may ameliorate SCD-related WM deficits but innovative approaches to motivating and supporting patients as they complete home-based interventions are needed to enhance adherence. DisclosuresNo relevant conflicts of interest to declare.

Does the computer say no? Considering the evidence for computerised working memory training programmes in paediatric populations

Does the computer say no? Considering the evidence for computerised working memory training programmes in paediatric populations

Working Memory Training-Induced Brain Plastic Changes in Acquired Brain Injury Patients

To explore the effects of computerized working memory training on working memory and brain functional activation for patients with acquired brain injury (ABI).

Long-term far-transfer effects of working memory training in children with ADHD: a randomized controlled trial

ADHD affects working memory (WM) and other executive functions (EFs) and thereby negatively impacts school performance, clinical symptoms and functional impairment. The main aim of this study was to analyse the efficacy of computerized WM training (CWMT) on EF rating scales. A secondary objective was to assess its efficacy on performance-based measures of EF (PBMEF), learning, clinical symptoms and functional impairment. 66 children with combined-type ADHD between 7 and 12years of age from the Child and Adolescent Psychiatric Unit (Spain) were included in this randomized, double-blind, placebo-controlled, parallel-group clinical trial. The participants were randomized (1:1) to an experimental group (EG) (CWMT) (n=36) or a control group (CG) (placebo training). Assessments were conducted at baseline (T0), 1-2weeks (T1), and 6months post-intervention (T2) with the administration of EF rating scales, PBMEF, measures of academic achievement, and questionnaires regarding clinical symptoms and functional impairment. Participants, parents, teachers and professionals who performed the cognitive assessments were blinded. Adjusted multiple linear regression analysis showed significant improvements in EF scales-parent version, from T1 to T2, on the metacognition index [p=0.03, d'=-0.78 (95% CI -1.28 to -0.27)] and on WM (also significant at T2-T0) and plan/organize subscales. Significant improvements were also noted in EF scales-teacher version, from T0 to T1 and T2, on the metacognitive index [p=0.05, d'=-0.37 (95% CI -0.86 to 0.12) T1-T0, p=0.02, d'=-0.81 (95% CI -1.31 to -0.30) T2-T0] and on the initiate, WM, monitor and shift subscales. There were also significant improvements in PBMEF, ADHD symptoms, and functional impairment. CWMT had a significant impact on ADHD deficits by achieving long-term far-transfer effects.

Cognitive rehabilitation of working memory in juvenile multiple sclerosis-effects on cognitive functioning, functional MRI and network related connectivity.

To assess possible effects of working memory (WM) training on cognitive functionality, functional MRI and brain connectivity in patients with juvenile MS. Cognitive status, fMRI and inter-network connectivity were assessed in 5 cases with juvenile MS aged between 12 and 18 years. Afterwards they received a computerized WM training for four weeks. Primary cognitive outcome measures were WM (visual and verbal) and alertness. Activation patterns related to WM were assessed during fMRI using an N-Back task with increasing difficulty. Inter-network connectivity analyses were focused on fronto-parietal (left and right), default-mode (dorsal and ventral) and the anterior salience network. Cognitive functioning, fMRI and inter-network connectivity were reassessed directly after the training and again nine months following training. Response to treatment was seen in two patients. These patients showed increased performance in WM and alertness after the training. These behavioural changes were accompanied by increased WM network activation and systematic changes in inter-network connectivity. The remaining participants were non-responders to treatment. Effects on cognitive performance were maintained up to nine months after training, whereas effects observed by fMRI disappeared. Responders revealed training effects on all applied outcome measures. Disease activity and general intelligence may be factors associated with response to treatment.

Computerized Training of Working Memory for Patients with Acquired Brain Injury

Background: Patients with acquired brain injury often experience impaired working memory (WM), a condition that can make everyday life activities and work difficult. Objectives: This study investigates the effects of computerized WM training on WM skills, cognitive tests, activity per- formance and estimated health and whether the effects of computerized WM training can be at- tributed to sex or time since injury. Methods: Forty-eight patients with acquired brain injury un- derwent computerized WM training. Patients were tested by a neuropsychologist and interviewed by an occupational therapist just prior and 20 weeks after completion of training. Results: Patients who participated in computerized WM training significantly improved their WM skills shown in WM index, their neuropsychological test scores, and their self-estimated health scores. They also significantly improved their performance of individually defined WM-related everyday activities and their satisfaction with the performance of these activities. There was a significant difference in terms of WM index, WM-related daily activity performance, and satisfaction with respect to time since injury. Conclusion: Computerized WM training can improve cognitive and everyday per- formance for patients with acquired brain injury. Patients can improve their cognitive functions a long time after suffering a brain injury or disease. This effect is greater if WM training is used early in the rehabilitation.

Computerized working memory training has positive long-term effect in very low birthweight preschool children.

Working memory deficits are frequently found in children born preterm and have been linked to learning disabilities, and cognitive and behavioural problems. Our aim was to evaluate if a computerized working memory training program has long-term positive effects on memory, learning, and behaviour in very-low-birthweight (VLBW) children at age 5 to 6 years. This prospective, intervention study included 20 VLBW preschool children in the intervention group and 17 age-matched, non-training VLBW children in the comparison group. The intervention group trained with the Cogmed JM working memory training program daily for 5 weeks (25 training sessions). Extensive neuropsychological assessment and parental questionnaires were performed 4 weeks after intervention and at follow-up 7 months later. For most of the statistical analyses, general linear models were applied. At follow-up, higher scores and increased or equal performance gain were found in the intervention group than the comparison group on memory for faces (p=0.012), narrative memory (p=0.002), and spatial span (p=0.003). No group differences in performance gain were found for attention and behaviour. Computerized working memory training seems to have positive and persisting effects on working memory, and visual and verbal learning, at 7-month follow-up in VLBW preschool children. We speculate that such training is beneficial by improving the ability to learn from the teaching at school and for further cognitive development.

Computerized Training of Working Memory for Patients with Acquired Brain Injury

Background: Patients with acquired brain injury often experience impaired working memory (WM), a condition that can make everyday life activities and work difficult. Objectives: This study investigates the effects of computerized WM training on WM skills, cognitive tests, activity performance and estimated health and whether the effects of computerized WM training can be attributed to sex or time since injury. Methods: Forty-eight patients with acquired brain injury underwent computerized WM training. Patients were tested by a neuropsychologist and interviewed by an occupational therapist just prior and 20 weeks after completion of training. Results: Patients who participated in computerized WM training significantly improved their WM skills shown in WM index, their neuropsychological test scores, and their self-estimated health scores. They also significantly improved their performance of individually defined WM-related everyday activities and their satisfaction with the performance of these activities. There was a significant difference in terms of WM index, WM-related daily activity performance, and satisfaction with respect to time since injury. Conclusion: Computerized WM training can improve cognitive and everyday performance for patients with acquired brain injury. Patients can improve their cognitive functions a long time after suffering a brain injury or disease. This effect is greater if WM training is used early in the rehabilitation.

Is working memory training effective? A study in a school setting.

We tested the effectiveness of an intensive, on average 17-session, adaptive and computerized working-memory training program for improving performance on untrained, paper and pencil working memory tasks, standardized school achievement tasks, and teacher ratings of classroom behavior. Third-grade children received either a computerized working memory training for about 30 minutes per session (n = 156) or participated in regular classroom activities (n = 126). Results indicated strong gains in the training task. Further, pretest and posttest transfer measures of working memory and school achievement, as well as teacher ratings, showed substantial correlations with training task performance, suggesting that the training task captured abilities that were relevant for the transfer tasks. However, effect sizes of training-specific transfer gains were very small and not consistent across tasks. These results raise questions about the benefits of intensive working-memory training programs within a regular school context.

Do children with cerebral palsy benefit from computerized working memory training? Study protocol for a randomized controlled trial.

BackgroundCerebral palsy (CP) is the most common motor disability in childhood (2 to 3 per 1000 live births), and is frequently accompanied by cognitive impairments and behavioural problems. Children with CP are at increased risk of attention deficit disorder with or without hyperactivity (Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD)) including working memory deficits. The primary aim of this study is to evaluate if cognitive training may improve working memory in children with CP.Methods/DesignsThe study is an investigator-blinded, randomized controlled trial with a stepped-wedge design that will include 115 schoolchildren with CP. Eligible for participation are children with CP, aged 7 to 15 years, who are able to follow instructions and handle a computer mouse. Exclusion criteria are the presence of photosensitive epilepsy, Gross Motor Function Classification System (GMFCS) level V (most severe CP) (Phys Ther 80: 974-985, 2000) and severe visual or hearing impairments. Following assessment of eligibility and baseline cognitive assessment the participants will be randomized to either cognitive working memory training or treatment-as-usual (‘control group’). The intervention is a computer-based working memory training program consisting of 25 daily sessions to be performed over a 5 to 6-week period at home. A neuropsychological assessment will be performed before and 4 to 6 weeks after completed training. When the latter assessment has been completed in the intervention group, the ‘control group’ will start on the same training program. Both groups will meet for a final neuropsychological assessment six months after completed training by an examiner unaware of group adherence.DiscussionThere is limited evidence for the effect of most interventions in children with CP, and evidence is completely lacking for interventions aiming to improve deficits in cognition, learning and behaviour. The proposed multicenter study, will bring forth comprehensive information about cognitive, neuropsychological, and daily-life functioning in children with CP aged between 7 and 15 years. In addition, the study will be the first to evaluate the effects of an intervention method to improve working memory in children with CP. If successful, computer-based working memory training may represent an efficient and cost-effective intervention for this group of children.Trial registrationClinicalTrials.gov Identifier: NCT02119364

Self-reported collision involvement associated with driving after alcohol use, cannabis use or both

Self-reported collision involvement associated with driving after alcohol use, cannabis use or both

The Memory Aid study: protocol for a randomized controlled clinical trial evaluating the effect of computer-based working memory training in elderly patients with mild cognitive impairment (MCI).

BackgroundMild cognitive impairment (MCI) is a condition characterized by memory problems that are more severe than the normal cognitive changes due to aging, but less severe than dementia. Reduced working memory (WM) is regarded as one of the core symptoms of an MCI condition. Recent studies have indicated that WM can be improved through computer-based training. The objective of this study is to evaluate if WM training is effective in improving cognitive function in elderly patients with MCI, and if cognitive training induces structural changes in the white and gray matter of the brain, as assessed by structural MRI.Methods/DesignsThe proposed study is a blinded, randomized, controlled trail that will include 90 elderly patients diagnosed with MCI at a hospital-based memory clinic. The participants will be randomized to either a training program or a placebo version of the program. The intervention is computerized WM training performed for 45 minutes of 25 sessions over 5 weeks. The placebo version is identical in duration but is non-adaptive in the difficulty level of the tasks. Neuropsychological assessment and structural MRI will be performed before and 1 month after training, and at a 5-month folllow-up.DiscussionIf computer-based training results in positive changes to memory functions in patients with MCI this may represent a new, cost-effective treatment for MCI. Secondly, evaluation of any training-induced structural changes to gray or white matter will improve the current understanding of the mechanisms behind effective cognitive interventions in patients with MCI.Trial registrationClinicalTrials.gov NCT01991405. November 18, 2013.

Improving foster children’s school performance: a replication of the Helsingborg study

A replication of the Helsingborg study (Tideman, et al., 2011) was conducted in the municipality of Norrköping in 2008–2011. Results confirm the conclusions from the original study that children in foster care can benefit from a working model aimed to improve school performance. Furthermore, a possible way to address poor numeracy skills by computerised working memory training was identified. Implications for further research in active interventions to address underachieving foster children are discussed.

Working memory training with tDCS improves behavioral and neurophysiological symptoms in pilot group with post-traumatic stress disorder (PTSD) and with poor working memory

This pilot study investigated the feasibility of treating people suffering from both post-traumatic stress disorder (PTSD) and poor working memory by employing a combination of computerized working memory training and transcranial direct current stimulation (tDCS). After treatment, all four participants showed clinically significant improvements on a range of cognitive and emotional performance measures. Moreover, these improvements were accompanied by theoretically significant neurophysiological changes between pre- and post-treatment electroencephalographic (EEG) recordings. Specifically, the P3a component of participants’ event related potentials (ERP) in response to novelty stimuli, characteristically abnormal in this clinical population, shifted significantly toward database norms. So, participants’ initially slow alpha peak frequency (APF), theorized to underlie impaired cognitive processing abilities, also increased in both frequency and amplitude as a result of treatment. On the basis of these promising results, more extensive controlled studies are warranted.

Working Memory Training in College Students With ADHD or LD

Objective: The objective of this study was to determine the feasibility and effectiveness of working memory (WM) training in college students with ADHD or learning disabilities (LD). Method: A total of 62 students (21 males, 41 females) were randomized to a 5-week intensive WM training program or a wait-list control group. Participants were evaluated before treatment, 3 weeks after completion, and at 2-month follow-up. The criterion measures were standardized tests of auditory-verbal and visual-spatial WM. Near transfer measures included other cognitive tasks; far transfer measures included academic tasks and behavioral rating scales. Results: Intent-to-treat analysis revealed that participants receiving WM training showed significantly greater improvements on the criterion WM measures and self-reported fewer ADHD symptoms and cognitive failures. The follow-up assessment indicated that gains in WM were maintained, as were improvements in cognitive failures. Conclusion: Computerized WM training is a feasible and possibly viable approach for enhancing WM in college students with ADHD or LD.

A randomized study of computerized working memory training and effects on functioning in everyday life for patients with brain injury

Background: Working memory (WM) problems influence most activities of daily living. The aim was to evaluate if computerized working memory training after brain injury has a significant effect on functioning in daily life.Method: Outpatients with WM deficits, aged 22–63 years, were randomized to either intervention group (IG, n = 20) or control group (CG, n = 18) and received 5 weeks standard rehabilitation. The IG also received WM training with the Cogmed QM training program. Assessments were made before (A1), immediately (A2) and 3 months (A3) after intervention. After follow-up, the CG was offered the computerized training and assessed after this (A4; n = 8). Assessments included the WAIS-III Digit span reversed, Fatigue Impact Scale (FIS), Assessment of Motor and Process Skills (AMPS), Rivermead Behavioural Memory Test-II (RBMT-II) and a WM questionnaire.Results: The IG improved on digit span and FIS, A1–A2, and significantly more than the CG on the WM questionnaire, A1–A3. Both groups improved in AMPS motor skill and the AMPS process skill score tended towards significant improvement in the IG, from A1–A3. After training (A3–A4), the CG improved in digit span and RBMT-II.Conclusion: The WM training seems to have a generalized effect on functional activity and lessens fatigue.