Working Memory Training Research Articles

Remember me - user-centered implementation of working memory architectures on an industrial robot.

The present research is innovative as we followed a user-centered approach to implement and train two working memory architectures on an industrial RB-KAIROS + robot: GRU, a state-of-the-art architecture, and WorkMATe, a biologically-inspired alternative. Although user-centered approaches are essential to create a comfortable and safe HRI, they are still rare in industrial settings. Closing this research gap, we conducted two online user studies with large heterogeneous samples. The major aim of these studies was to evaluate the RB-KAIROS + robot's appearance, movements, and perceived memory functions before (User Study 1) and after the implementation and training of robot working memory (User Study 2). In User Study 1, we furthermore explored participants' ideas about robot memory and what aspects of the robot's movements participants found positive and what aspects they would change. The effects of participants' demographic background and attitudes were controlled for. In User Study 1, participants' overall evaluations of the robot were moderate. Participant age and negative attitudes toward robots led to more negative robot evaluations. According to exploratory analyses, these effects were driven by perceived low experience with robots. Participants expressed clear ideas of robot memory and precise suggestions for a safe, efficient, and comfortable robot navigation which are valuable for further research and development. In User Study 2, the implementation of WorkMATe and GRU led to more positive evaluations of perceived robot memory, but not of robot appearance and movements. Participants' robot evaluations were driven by their positive views of robots. Our results demonstrate that considering potential users' views can greatly contribute to an efficient and positively perceived robot navigation, while users' experience with robots is crucial for a positive HRI.

Uncovering the reciprocal relationship between domain-specific and domain-general skills: Combined numerical and working memory training improves children’s mathematical knowledge

The acquisition of domain-specific number knowledge and domain-general cognitive processes, including working memory, have shown to contribute to math learning and achievement. Correlational work has emphasized a reciprocal relationship between these processes; however, little is known about their relative and causal contributions to math learning. Here, we test the individual and additive benefits of playing tablet-based games targeting domain-specific and domain-general skills to improve mathematical knowledge and working memory in a diverse population of kindergarten children (N = 235, 50 % female, 45 % Hispanic/Latino, 35 % African American/Black, 21 % White, 6 % biracial/mixed race, 51 % annual household income less than $30,000). Our results provide causal evidence for the reciprocal relations between numerical knowledge and working memory. Specifically, we found that playing a working memory game led to improvements in mathematical knowledge as compared to an active control and after taking into account baseline performance. Importantly, we also found that children who played both a working memory game and a numerical knowledge game showed the most pronounced and sustained benefits in mathematical knowledge, with benefits remaining present several weeks after intervention completion. Our findings illustrate the importance of targeting both domain-general and domain-specific skills in order to maximize the benefits of interventions to improve mathematical knowledge. Yet, given the inconsistent results across various studies, we argue that it is critical to further investigate underlying mechanisms and training features, as even subtle variations seem to dramatically affect training outcomes.

Lasting enhancements in neural efficiency by multi-session transcranial direct current stimulation during working memory training

The neural basis for long-term behavioral improvements resulting from multi-session transcranial direct current stimulation (tDCS) combined with working memory training (WMT) remains unclear. In this study, we used task-related electroencephalography (EEG) measures to investigate the lasting neurophysiological effects of anodal high-definition (HD)-tDCS applied over the left dorsolateral prefrontal cortex (dlPFC) during a challenging WMT. Thirty-four healthy young adults were randomized to sham or active tDCS groups and underwent ten 30-minute training sessions over ten consecutive days, preceded by a pre-test and followed by post-tests performed one day and three weeks after the last session, respectively, by performing high-load WM tasks along with EEG recording. Multi-session HD-tDCS significantly enhanced the behavioral benefits of WMT. Compared to the sham group, the active group showed facilitated increases in theta, alpha, beta, and gamma task-related oscillations at the end of training and significantly increased P300 response 3 weeks post-training. Our findings suggest that applying anodal tDCS over the left dlPFC during multi-session WMT can enhance the behavioral benefits of WMT and facilitate sustained improvements in WM-related neural efficiency.

4 Does Working Memory Training for Children Need to be Adaptive? A Randomised Controlled Trial

Objective:A common assumption to maximise cognitive training outcomes is that training tasks should be adaptive, with difficulty adjusted to the individual’s performance. This has only been tested once in adults (von Bastian & Eschen, 2016). We aimed to examine children’s outcomes of working memory training using adaptive, self-select and stepwise approaches to setting the difficulty of training tasks compared to an active control condition.Participants and Methods:In a randomised controlled trial (ACTRN 12621000990820), children in Grades 2-5 (7 to 11 years) were allocated to one of four conditions: adaptive working memory training, self-select working memory training, stepwise working memory training, or active control. An experimental intervention embedded in Minecraft was developed for teachers to deliver in the classroom over two weeks (10 x 20-minute sessions). The working memory training comprised two training tasks with processing demands similar to daily activities: backward span with digits and following instructions with objects. The control condition comprised creative building tasks. As part of a larger protocol, children completed at baseline and immediately post-intervention working memory measures similar to the training activities (primary outcome): backward span digits and letters versions, following instructions objects and letters versions. Primary analyses were intention-to-treat. Secondary analyses included only children who completed 10 sessions.Results:Of 204 children recruited into the study, 203 were randomised, with 95% retention at post-intervention. 76% of children completed all 10 training sessions. Comparisons between each working memory training condition and the active control on working memory measures were non-significant (f2 = 0.00), with one exception. Children in the self-select condition on average performed 1-point better than the controls on the following instructions objects measure (p = .02, f2 = 0.03). A pattern emerged that the self-select condition performed better on most measures.Conclusions:We found little evidence that an adaptive approach to setting the difficulty of training tasks maximises training outcomes for children. Findings suggest that working memory outcomes following training are limited and are not modulated by the approach to setting the difficulty of training tasks. This is consistent with findings from von Bastian & Eschen (2016), who also observed that the self-select condition (and not the adaptive condition) showed a slightly larger change in working memory performance following training than the control. It is helpful for clinicians to be aware that adaptive working memory training programs might not be superior in improving children’s working memory, and the benefits of programs are limited.

2 Higher White Matter Hyperintensity Load Adversely Affects Pre-Post Proximal Cognitive Training Performance in Healthy Older Adults

Objective:Cognitive training has shown promise for improving cognition in older adults. Aging involves a variety of neuroanatomical changes that may affect response to cognitive training. White matter hyperintensities (WMH) are one common age-related brain change, as evidenced by T2-weighted and Fluid Attenuated Inversion Recovery (FLAIR) MRI. WMH are associated with older age, suggestive of cerebral small vessel disease, and reflect decreased white matter integrity. Higher WMH load associates with reduced threshold for clinical expression of cognitive impairment and dementia. The effects of WMH on response to cognitive training interventions are relatively unknown. The current study assessed (a) proximal cognitive training performance following a 3-month randomized control trial and (b) the contribution of baseline whole-brain WMH load, defined as total lesion volume (TLV), on pre-post proximal training change.Participants and Methods:Sixty-two healthy older adults ages 65-84 completed either adaptive cognitive training (CT; n=31) or educational training control (ET; n=31) interventions. Participants assigned to CT completed 20 hours of attention/processing speed training and 20 hours of working memory training delivered through commercially-available Posit Science BrainHQ. ET participants completed 40 hours of educational videos. All participants also underwent sham or active transcranial direct current stimulation (tDCS) as an adjunctive intervention, although not a variable of interest in the current study. Multimodal MRI scans were acquired during the baseline visit. T1- and T2-weighted FLAIR images were processed using the Lesion Segmentation Tool (LST) for SPM12. The Lesion Prediction Algorithm of LST automatically segmented brain tissue and calculated lesion maps. A lesion threshold of 0.30 was applied to calculate TLV. A log transformation was applied to TLV to normalize the distribution of WMH. Repeated-measures analysis of covariance (RM-ANCOVA) assessed pre/post change in proximal composite (Total Training Composite) and sub-composite (Processing Speed Training Composite, Working Memory Training Composite) measures in the CT group compared to their ET counterparts, controlling for age, sex, years of education and tDCS group. Linear regression assessed the effect of TLV on post-intervention proximal composite and sub-composite, controlling for baseline performance, intervention assignment, age, sex, years of education, multisite scanner differences, estimated total intracranial volume, and binarized cardiovascular disease risk.Results:RM-ANCOVA revealed two-way group*time interactions such that those assigned cognitive training demonstrated greater improvement on proximal composite (Total Training Composite) and sub-composite (Processing Speed Training Composite, Working Memory Training Composite) measures compared to their ET counterparts. Multiple linear regression showed higher baseline TLV associated with lower pre-post change on Processing Speed Training sub-composite (ß = -0.19, p = 0.04) but not other composite measures.Conclusions:These findings demonstrate the utility of cognitive training for improving postintervention proximal performance in older adults. Additionally, pre-post proximal processing speed training change appear to be particularly sensitive to white matter hyperintensity load versus working memory training change. These data suggest that TLV may serve as an important factor for consideration when planning processing speed-based cognitive training interventions for remediation of cognitive decline in older adults.

Intermittent working memory training during adulthood protects against age-related long-term spatial reference memory decline in rats.

Engagement in cognitive activity in adulthood is one of the factors that enable successful cognitive aging, both in humans and rodents. However, some studies emphasize that the beneficial effect on cognition of such an activity may reflect carry over from one test situation to another, including memory for procedural aspects of the behavioral tasks, and thus question whether this effect can be limited to the trained cognitive domain or whether it can be transferred to an untrained ones. In the current study, we assessed whether adulthood intermittent working memory training has beneficial effect on long-term memory of aged rats using two very different test situations. To this aim, rats trained in a delayed non-matching to position task in operant box at 3 and 15months of age were tested in a place learning task in water maze when they were 24months. The two tasks differ with regard to the cognitive domain but also in their spatial ability requirement and the nature of the reinforcer used. During the memory tests, accuracy of the platform search indicated age-related impairment only in the aged-untrained group. Thus, intermittent training during adult life in a task involving working memory protects aged animals from the deleterious effects of aging on spatial reference memory. This result highlights the long-term beneficial effects of training on a working memory task on an untrained cognitive domain.

88 Considering Lateralization and Localization of Neurosurgical Intervention for Predicting Treatment Response to Computerized Cognitive Remediation (CCR) Targeting Attention and Working Memory: A Case Series

Objective:Lateralization and localization of neuropathology helps determine the extent to which eloquent cortex and diseased brain tissue share loci, important information for neurosurgical decision-making, and predicting neurocognitive outcomes. Emerging data suggest that lateralization and localization can inform specific neurorehabilitation approaches following acquired brain injury (ABI). In recent years, computerized cognitive remediation (CCR) of attention and working memory (WM) has been included among treatment guidelines to enhance cognition in post-acute recovery following ABI. Although CCR has shown promise for improving attention and executive functioning in ABI, it is unknown how treatment response may be predicted by locus of ABI. Even less is known about the effects of CCR following neurosurgery. The current study explores neurosurgical lateralization and localization as potential variables for predicting treatment response to CCR.Participants and Methods:Adult patients with a variety of neurological diagnoses (N = 17; ∼47% women) completed a full course of Cogmed Working Memory Training (CWMT) s/p neurosurgical intervention. All participants engaged in 30 sessions of CWMT over eight weeks, as well as neuropsychological (NP) assessment at pre-training baseline, immediate post-training, and at 3-month follow-up. Objective and subjective indices of attention, working memory, executive functioning, and emotional well-being were evaluated at three time-points. Neurosurgical loci included left-hemisphere frontal, temporal, and temporoparietal lobes, as well as right-hemisphere frontal, frontotemporal, and temporal lobes.Results:NP data were reviewed and yielded a clinical impression of cognitive and affective functioning for a cohort of patients with heterogeneous diagnoses (e.g., brain tumor, epilepsy, NPH). Preliminary NP findings suggested that treatment response to CCR for WM was consistent with extant literature on brain-behavior relationships according to lateralization and localization of neurosurgical intervention.Conclusions:Neurosurgical patients experience neurocognitive and affective dysfunction that may respond well to cognitive rehabilitation (CR) that includes CCR. Additionally, it is possible that lateralization and localization of surgical intervention may contribute to individual differences in treatment response. Further neurorehabilitation research is warranted to identify patients most likely to benefit from CCR and better tailor CR modalities to optimize recovery s/p neurological surgery.

Working memory training and evaluation based on brain-computer interface and virtual reality: our opinion.

Working memory training and evaluation based on brain-computer interface and virtual reality: our opinion.

Working memory training for reward processing in university students with subsyndromal depression: The influence of baseline severity of depression

Previous studies have tentatively suggested that working memory training (WMT) has the potential to improve reward processing, but it is not known how long this improvement lasts, whether there is a lag effect, or whether it is reflected in neurophysiological indicators. In this study, 40 university students with subsyndromal depression were randomly assigned to a training group or a control group and completed a 20-day working memory training task and a simple memory task, respectively. All participants completed the Temporal Experience of Pleasure Scale (TEPS) and a doors task with electroencephalogram (EEG) signals recorded simultaneously on a pre- and post-test and a 3-month follow-up. The reward-related positivity (RewP) amplitude, theta power, and their differences between conditions (i.e., ΔRewP and Δtheta power, respectively) in the doors task were the primary outcomes, and the score on TEPS was the secondary outcome. The results indicated no group-related effects were demonstrated in primary and secondary outcomes at post-test and 3-month follow-up. Furthermore, the differences in the pre- and post-test in Δtheta power were moderated by the baseline severity of depression. This was primarily driven by the fact that the change values in the control group increased with the severity of depression, while the change values in the training group had high homogeneity. Our findings did not provide support for the effect of WMT on reward processing across the whole sample, but without intervention, there would be high heterogeneity in the change in the cognitive control ability to loss feedback, which is detrimental to individuals with high depression severity.

Oligodendrocyte dynamics dictate cognitive performance outcomes of working memory training in mice

Previous work has shown that motor skill learning stimulates and requires generation of myelinating oligodendrocytes (OLs) from their precursor cells (OLPs) in the brains of adult mice. In the present study we ask whether OL production is also required for non-motor learning and cognition, using T-maze and radial-arm-maze tasks that tax spatial working memory. We find that maze training stimulates OLP proliferation and OL production in the medial prefrontal cortex (mPFC), anterior corpus callosum (genu), dorsal thalamus and hippocampal formation of adult male mice; myelin sheath formation is also stimulated in the genu. Genetic blockade of OL differentiation and neo-myelination in Myrf conditional-knockout mice strongly impairs training-induced improvements in maze performance. We find a strong positive correlation between the performance of individual wild type mice and the scale of OLP proliferation and OL generation during training, but not with the number or intensity of c-Fos+ neurons in their mPFC, underscoring the important role played by OL lineage cells in cognitive processing.

Is Training Working Memory in Children with Learning Disabilities a Viable Solution? A Systematic Review.

Working memory (WM) is one of the most influential cognitive functions in encoding, registering, and retrieving information. It influences the learning process in children. Its role becomes essential, especially in a child with a learning disability (LD). Researchers worldwide are giving much prominence to WM, especially in devising cognitive retraining strategies for better cognitive functioning and academic attainment in these children. This current study aims to explore globally used instruments to measure this construct and review effective WM training models in the cognitive rehabilitation of children with LD. This study used a systematic review, availing the elaborate "Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA)" guidelines. The databases of Google Scholar, PubMed, and Web of Science were searched thoroughly, and those studies, which met the inclusion criteria, were considered for this review. Out of 770 studies found with keywords, only six met the inclusion criteria and were selected for a detailed analysis. The outcome of the current review provides trustworthy evidence of poor performance, especially in tasks involving verbal and executive WM in children with all types of learning disabilities (LD) and difficulties. The studies reviewed support the hypothesis that WM can improve with training and significantly improve children's academic attainment. Further this review recommends that research and efforts must go into devising these cognitive training techniques. Children have high cerebral plasticity; hence, using cognitive training (emphasizing WM training and other cognitive functions) with them would enhance their cognitive functioning and capacity, improving their academic performance.

Virtual reality working memory training improves cognitive performance of acute and remitted patients with major depressive disorder

BackgroundCognitive training is effective in treating neuropsychological impairment in patients with major depressive disorder (MDD), and virtual reality (VR) is a promising tool to provide such training. However, studies using VR-based working memory (WM) training in treating depressed patients' cognitive impairment are extremely scarce and how it affects cognitive performance remains unclear. Therefore, we aimed to determine the efficacy of VR-WM training in acute and remitted depressed patients and try to investigate its potential mechanisms. MethodsForty-two patients with MDD (22 acute patients and 20 remitted patients) received 20-session VR-WM training, while 22 healthy controls (HC) received no intervention. WM and other cognitive domains' performance were assessed by the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ) and the MATRICS Consensus Cognitive Battery (MCCB) before and after the intervention. Depressive symptoms were assessed by the 24-item Hamilton Depression Rating Scale (24-HDRS) at the same time points. ResultsAcute and remitted MDD patients both exhibited significant improvements from pre- to post-training in WM, processing speed, visual learning, reasoning and problem-solving, and total cognition (all p < 0.05). Significant groups-by-time interactions were observed for the 24-HDRS score (p < 0.05). Mediation analysis showed that 24-HDRS score partially mediated the association between the effect of VR-WM training on WM and total cognition performance in total depressive samples. ConclusionsVR-WM training effectively improved WM and other cognitive domains' performance in both acute and remitted MDD patients. Besides, VR-WM training improves WM and total cognition performance in MDD patients partially via the enhancement of depressive symptoms.

Utilization of a Cogmed working memory training program in patients with neurocognitive impairment following the resection of intracranial meningioma: Case series and review of the literature

Meningioma is the most common primary brain tumor in adults. Patients may become symptomatic due to the resultant mass effect and the peritumoral vasogenic edema. The majority of existing research on neurocognitive impairment in patients with brain tumors has focused on gliomas while less research has been conducted on the effects of tumor and/or surgical intervention on neurocognitive function in patients with meningioma. We conducted a prospective study on the utilization of the Cogmed Working Memory Training (CWMT) program in patients who underwent surgical resection of WHO grade I intracranial meningioma and experienced neurocognitive impairment after surgery. All patients had a significant improvement in their post-CWMT neurocognitive function evaluation compared to their baseline post-surgical neurocognitive evaluation, and the improvement was maintained at a three-month follow-up. This study is the first to evaluate the effectiveness of a neurocognitive rehabilitation program in augmenting the neurocognitive functioning of patients with Intracranial WHO Grade I Meningioma. The results of this study demonstrate the efficacy of the CWMT program in improving postoperative impaired neurocognitive function and potentially improving the quality of life of our patients.

The effects of emotional working memory training on internet use, impulsivity, risky decision-making, and cognitive emotion regulation strategies in young adults with problematic use of the internet: A preliminary randomized controlled trial study into possible mechanisms

AbstractIntroductionConsidering adverse correlates of problematic use of internet use (PUI), the present study evaluated an intervention aimed at PUI and several putative underpinnings.MethodsA randomized controlled trial study investigated the efficacy of emotional working memory training (eWMT) in improving impulsivity, risky decision-making, and cognitive emotion-regulation (CER) strategies among individuals with PUI in comparison with a placebo group. Young adults (N = 36) with PUI were either trained for 20 sessions in an n-back dual emotional task (eWMT; n = 18) or a feature-matching task (placebo; n = 18).ResultsTwenty continuous sessions of eWMT significantly improved participants' impulsivity, risky decision-making, CER, internet use and PUI symptoms in the short term, compared to the placebo condition.DiscussionThese preliminary results suggest that eWMT may constitute a promising intervention for PUI and improving cognitive and emotional functioning, and larger, longer studies are warranted.

작업기억훈련 효과의 메타분석: 초등학생 영재아동을 포함하여

작업기억훈련 효과의 메타분석: 초등학생 영재아동을 포함하여

Increased brain activation and functional connectivity after working memory training in patients with ischemic stroke: an fMRI study

ObjectiveWorking memory (WM) impairment is common in patients after a stroke. WM training (WMT) has been suggested as a way to improve cognitive function. However, the neural effects following WMT in stroke patients remain largely unclear. This study aimed to explore the behavioral changes and neural effects of WMT on patients with chronic ischemic stroke.MethodsFifty first-ever ischemic stroke patients with WM deficits in the chronic stage were randomly assigned to either a 4-week WMT group or a control group. Verbal n-back, digital and spatial memory-span, Raven's standard progressive matrices, and the Stroop color-word test, as well as task-state and resting-state fMRI were assessed for all patients at baseline and after the intervention.ResultsThe WMT group showed improvements in WM, fluid intelligence, and attention after training. Additionally, the WMT group exhibited increased activation in the left middle frontal gyrus (MFG) and middle occipital gyrus after training. At baseline, all patients were impaired in their abilities to elevate activation in their WM network as a response to increasing WM load. However, in the WMT group, increased activation was observed in the left cerebellum anterior lobe, right cerebellum posterior lobe (CPL), and MFG in the 2-back vs. 1-back contrast after WMT. We also found increased functional connectivity between the left MFG and the left inferior parietal lobule (IPL), and between the bilateral IPL and the right CPL after training in the WMT group.ConclusionOur study supported that WMT potentially improved WM capacity in ischemic stroke patients during the chronic stage, and that the training effects might transfer to fluid intelligence and attention ability. Our results also demonstrated that repeated WMT potentially increased brain activation and resting-state functional connectivity within the WM network in patients with ischemic stroke. These findings provided robust evidence to support WMT as an effective intervention to enhance cognitive rehabilitation and shed light on the functional neuroplasticity mechanism of WMT on cognitive recovery after ischemic stroke.

Working Memory Training in Norwegian Children with Cerebral Palsy (CP) Show Minimal Evidence of Near and No Far Transfer Effects

ABSTRACT In children with cerebral palsy (CP), learning disabilities are well documented, and impairments in executive functions, such as attention, inhibition, shifting and working memory, represent significant burdens on patients, their families and the society. The aim of this study was to evaluate whether Cogmed RM working memory training could improve working memory in children with CP and investigate whether increased working memory capacity would generalize to other cognitive functions. Twenty-eight children completed the training and the results were compared to a waitlist control group (n = 32). The results yielded three main findings. First, children with CP improved with practice on trained working memory tasks. Second, the intervention group showed minimal near transfer effects to non-trained working memory tasks. Third, no effects on cognitive and behavioral far transfer measures were found.

The relation between effortful control and executive function training in preschoolers

In recent years, the question of whether executive function (EF) is malleable has been widely documented. Despite using the same training tasks, transfer effects remain uncertain. Researchers suggested that the inconsistency might be attributed to individual differences in temperamental traits. In the current study, we investigated how effortful control, a temperamental trait, would affect EF training outcomes in children. Based on parent rating, 79 6-year-old preschoolers were identified as having higher or lower effort control and were assigned to three conditions: working memory (WM) training, inhibitory control (IC) training, and a business-as-usual control group. Children completed assessments at baseline, 1 week after intervention (posttest), and 3 months after intervention (follow-up). As compared with the control group, the WM and IC training groups showed improvement in both trained tasks and nontrained measures. At baseline, children with higher effortful control scores showed greater WM capacity and better IC. Furthermore, effortful control was positively correlated with training gain in both training groups, with children with higher effortful control benefitting more through training. In the WM training group, effortful control was positively correlated with near transfer on WM outcomes both immediately and longitudinally. At posttest, the WM and IC training groups showed a positive correlation between effortful control and fluid intelligence performance. Our results underscore the importance of individual differences in training benefits, in particular the role of effortful control, and further illustrate the potential avenues for designing more effective individualized cognitive training programs to foster learning and optimize children’s development.

Working Memory Training for Children Using the Adaptive, Self-Select, and Stepwise Approaches to Setting the Difficulty Level of Training Activities: Protocol for a Randomized Controlled Trial.

A common yet untested assumption of cognitive training in children is that activities should be adaptive, with difficulty adjusted to the individual's performance in order to maximize improvements on untrained tasks (known as transfer). Working memory training provides the ideal testbed to systematically examine this assumption as it is one of the most widely studied domains in the cognitive training literature, and is critical for children's learning, including following instructions and reasoning. This trial aimed to examine children's outcomes of working memory training using adaptive, self-select (child selects difficulty level), and stepwise (difficulty level increases incrementally) approaches to setting the difficulty of training activities compared to an active control condition immediately and 6-month postintervention. While the aim is exploratory, we hypothesized that children allocated to a working memory training condition would show greater improvements: (1) on near transfer measures compared to intermediate and far transfer measures and (2) immediately postintervention compared to 6-month postintervention. This double-blinded, active-controlled, parallel-group randomized trial aimed to recruit 128 children aged 7 to 11 years from 1 metropolitan primary school in Melbourne, Australia. Following baseline testing, children were randomized into 1 of 4 conditions: adaptive, self-select, or stepwise working memory training, or active control. An experimental intervention embedded in Minecraft was developed for teachers to deliver in class over 2 consecutive weeks (10 × 20-minute sessions). The working memory training comprised 2 training activities with processing demands similar to daily activities: backward span and following instructions. The control comprised creative activities. Pre- and postintervention, children completed a set of working memory tests (near and intermediate transfer) and the Raven's Standard Progressive Matrices (far transfer) to determine training outcomes, as well as motivation questionnaires to determine if motivations toward learning and the intervention were similar across conditions. Caregivers completed the ADHD-Rating Scale-5 to measure their child's attention (far transfer). Statistical analysis will include traditional null hypothesis significance testing and Bayesian methods to quantify evidence for both the null and alternative hypotheses. Data collection concluded in December 2022. Data are currently being processed and analyzed. This trial will determine whether the adaptive approach to setting the difficulty of training activities maximizes cognitive training outcomes for children. This trial has several strengths: it adopts best practices for cognitive training studies (design, methods, and analysis plan); uses a range of measures to detect discrete levels of transfer; has a 6-month postintervention assessment; is appropriately powered; and uses an experimental working memory training intervention based on our current understanding of the cognitive mechanisms of training. Findings will inform future research and design of cognitive training interventions and highlight the value of the evidence-based principles of cognitive training. Australian New Zealand Clinical Trials Registry, ACTRN12621000990820; https://www.anzctr.org.au/ACTRN12621000990820.aspx. DERR1-10.2196/47496.

Cognitive Training for Visuospatial Processing in Children Aged 5½ to 6 Years Born Very Preterm With Working Memory Dysfunction

Compared with term-born peers, children born very preterm generally perform poorly in executive functions, particularly in working memory and inhibition. By taking advantage of neuroplasticity, computerized cognitive training of working memory in those children could improve visuospatial processing by boosting visual inhibition via working memory. To evaluate the long-term effect of cognitive working memory training on visuospatial processing in children aged 5½ to 6 years born very preterm who have working memory impairment. This multicenter (18 French university hospitals), open-label randomized clinical trial with 2 parallel groups (EPIREMED) was conducted from November 2016 to April 2018, with the last follow-up during August 2019. Eligible children from the EPIPAGE 2 cohort were aged 5½ to 6 years, were born between 24 and 34 weeks' gestation, and had a global intelligence quotient greater than 70 and a working memory index less than 85. Data were analyzed from February to December 2020. Children were randomized 1:1 to standard care management and a working memory cognitive training program (Cogmed software) for 8 weeks (25 sessions) (intervention) or to standard management (control). The primary outcome was the visuospatial index score from the Wechsler Preschool and Primary Scale of Intelligence, 4th Edition. Secondary outcomes were working memory, intellectual functioning, executive and attention processes, language skills, behavior, quality of life, and schooling. Neurobehavioral assessments were performed at inclusion and after finishing training at 6 months (intermeditate assessment; secondary outcomes) and at 16 months (final assessment; primary outcome). There were 169 children randomized, with a mean (SD) age of 5 years 11 months (2 months); 91 (54%) were female. Of the participants, 84 were in the intervention group (57 of whom [68%] completed at least 15 cognitive training sessions) and 85 were in the control group. The posttraining visuospatial index score was not different between groups at a mean (SD) of 3.0 (1.8) months (difference, -0.6 points; 95% CI, -4.7 to 3.5 points) or 12.9 (2.6) months (difference, 0.1 points; 95% CI, -5.4 to 5.1 points). The working memory index score in the intervention group significantly improved from baseline at the intermediate time point (difference, 4.7 points; 95% CI, 1.2-8.1 points), but this improvement was not maintained at the final assessment. This randomized clinical trial found no lasting effect of a cognitive training program on visuospatial processing in children aged 5½ to 6 years with working memory disorders who were born very preterm. The findings suggest that this training has limited long-term benefits for improving executive function. Transient benefits seemed to be associated with the developmental state of executive functions. ClinicalTrials.gov Identifier: NCT02757794.