JMIR Publications

ABSTRACT

Background:

Can home-based computerized cognitive training programs be a useful tool to sustain cognition and quality of life in patients with Alzheimer’s disease (AD) dementia? Until now, the progressive nature of the disease and the variability in intervention periods has resulted in discrepant findings. We investigated a potential tool to offset the challenges usually found when evaluating the effectiveness of home-based computerized trainings in the AD population. Constant Therapy is a remotely-delivered, cloud-based program developed for patients with speech and cognitive deficits.

Objective:

We aimed to assess the feasibility and effectiveness of a 24-week individualized Constant Therapy intervention program in patients with AD in the MCI and mild dementia stages.

Methods:

Data were collected over a 48-week period. Participants were assigned to either the Constant Therapy or Active Control group. The Constant Therapy group completed an individualized tablet-based training during the first 24 weeks; the second 24 weeks of computerized training were optional. The Active Control group completed paper and pencil games (e.g., sudokus, crosswords) during the first 24 weeks, and then completed the Constant Therapy training during the second 24 weeks. At weeks 0, 24 and 48, participants completed a neuropsychological battery to assess changes in cognition and functioning. In addition, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was administered every 6 weeks. We measured Constant Therapy rate of adherence and task performance, as well as RBANS scores differences between the Constant Therapy and Active Control groups over the first 24 weeks of training.

Results:

Data for 19 patients were analyzed, with 44% of the Constant Therapy group and 22% of the Active Control group completing the entire 48-week training program. Due to the high drop-out rate, further analysis was only computed for participants who completed 24 weeks of training. The Constant Therapy group spent on average 121 days across the 24 weeks, and an average 27 minutes daily on the app. These participants showed an overall improvement in accuracy and latency in the Constant Therapy tasks scores, as well as specific improvements in the Constant Therapy tasks of visual and auditory memory, attention, and arithmetic. The Constant Therapy group also improved in the RBANS coding subtest compared to the Active Control group.

Conclusions:

Long term (e.g., 24 weeks) computerized cognitive training using the Constant Therapy platform is feasible in patients with AD in the MCI and mild dementia stages. AD patients showed improvements on the Constant Therapy tasks over the 24 weeks and improved in one of the 12 RBANS subtests. These findings support the need for future research investigating the effects of long term individualized computerized programs as tools to sustain cognitive function and potentially quality of life in patients with AD. Clinical Trial: ClinicalTrials.gov NCT02521558