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P2‐026: DIFFERENTIAL EFFECTS OF PHARMACOLOGIC AND NON‐PHARMACOLOGIC TREATMENTS OF ALZHEIMER'S DISEASE: A COMPREHENSIVE SUMMARY OF EVIDENCE AND META‐ANALYSIS
Author(s) -
Ivashchenko Anna V.,
Brooks Logan,
Tran Zung Vu
Publication year - 2018
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2018.06.710
Subject(s) - medicine , data extraction , disease , quality of life (healthcare) , psychological intervention , clinical trial , medline , psychiatry , nursing , political science , law
no treatment available for VCIND. The Cog-VACCINE study was the first registered randomized controlled trial to evaluate the efficacy of computerized cognitive training in patients with VCIND. Methods: This was a double-blinded, randomized, placebo training controlled trial. Participants were randomized to two groups: a multi-domain, adaptive, computerized cognitive training, or processing speed and attention tasks with a fixed, primary difficulty level, for 30 minutes over 35 sessions, 5 days/week. Primary outcomes assessed were global cognitive function measured by the Montreal Cognitive Assessment (MoCA) and executive function measured by the Trail Making Test (TMT) B-A. Secondary outcomes included neuroplasticity changes, as assessed by structural and functional MRI. Clinicaltrials.gov Identifier: NCT02640716. Results:Sixty patients with VCIND were randomized to computerized cognitive training group or placebo training group (mean age 65.8 (7.5) years, 41% female, n1⁄430 per group). At the end of the intervention, the training group showed significantly improved MoCA (from 21.1 to 24.4) compared with placebo group (from 21.4 to 21.7), with a significant group by time interaction (p1⁄40.004), while no significant improvement was observed in TMT B-A (training group from 73.9 to 66.6, placebo group from 75.9 to 66.9, group by time interaction, p1⁄40.92). Examination of secondary measures showed significant group by time interaction, with reduced lower amplitude of low-frequency fluctuations in right precuneus in the training group only and decreased axial diffusivity in fornix tract and right uncinated fasciculus in the placebo group only, but no significant group by time interaction in terms of voxel based morphometry or vertex-based hippocampus intensity. For other neuropsychological tests, the training group showed significant improvement in Boston Naming Test (training group from 22.6 to 24.9, placebo group from 22.7 to 22.4, group by time interaction, p1⁄40.002). Conclusions: In patients with VCIND, 7weeks ofmulti-domain, adaptive, computerized cognitive training was associated with significant improvements in global cognitive function and language. The cognitive training may block the white matter integrity decrease and enhance functional efficiency.