Computerized Working Memory Training Improves Function in Adolescents Born at Extremely Low Birth Weight

doi:10.1016/j.jpeds.2010.09.060

The Journal of Pediatrics

Volume 158, Issue 4, April 2011, Pages 555-561.e4

https://doi.org/10.1016/j.jpeds.2010.09.060 Get rights and content

Objective

To evaluate the effect of a computerized working memory training program on both trained and non-trained verbal aspects of working memory and executive and memory functions in extremely low birth weight (ELBW; <1000 g) infants.

Study design

Sixteen ELBW infants and 19 term-born control subjects aged 14 to 15 years participated in the training program, and 11 adolescents were included as a non-intervention group. Extensive neuropsychological assessment was performed before and immediately after training and at a 6-month follow-up examination. Both training groups used the CogMed RM program at home 5 days a week for 5 weeks.

Results

Both groups improved significantly on trained and non-trained working memory tasks and on other memory tests indicating a generalizing effect. Working memory capacity was improved, and effects were maintained at the 6-month follow-up examination. There was no significant improvement in the non-intervention group at the 6-week follow-up examination.

Conclusions

The computerized training program Cogmed RM was an effective intervention tool for improving memory and reducing core learning deficits in adolescents born at ELBW.

Section snippets

Methods

Eligible for participation in this study were preterm adolescents born at ELBW, and term-born adolescents with normal birth weight born in 1992 to 1993, aged 14 to 16 years. Both groups used a computerized program intended to improve their working memory at home for 30 to 40 minutes daily, 5 days a week for 5 weeks. Neuropsychological assessments were performed before intervention, within 1 week after intervention, and at a 6-month follow-up visit. To assess the practice effect on the working

Results

At follow-up, there was no significant difference between subjects in the ELBW and control groups in mean age (ELBW: 14.1 years; SD: 0.6; Control: 14.3 years; SD: 0.7; P = .385) or in mean SES (ELBW: 2.8; SD: 1.2; Controls: 3.5; SD: 1.1; P = .082).

Discussion

Our main finding was that a group of ELBW children improved trained and non-trained working memory results after participation in the computerized Cogmed RM training program. Second, ELBW individuals with low IQ (<80) benefited significantly from the training, and third, the program was as effective in improving working memory in ELBW preterm children as in the control group. In addition, the program had a generalizing effect on verbal learning in the ELBW group, which is of major importance

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In a single-center, randomized controlled trial, adolescents (13-16 years) with CHD were randomly assigned to either Cogmed (home-based 45-minutes sessions for 5-8 weeks) or to a control group. The primary outcome was working memory. Secondary outcomes included inhibitory control and cognitive flexibility as well as parent-reported executive function, symptoms of attention deficit hyperactivity disorder, and social outcomes. All measures were assessed at baseline, post-treatment (1-3 weeks post-training) and at 3-month follow-up. Data were analyzed using an intention-to-treat approach.
Sixty adolescents with CHD participated (28 assigned to Cogmed). No improvement at the post-treatment or 3-month follow-up assessments was found for the primary outcome measure of working memory. Compared with the control group, participants assigned to the intervention demonstrated benefits in inhibitory control and attention at the 3-month follow-up (P = .02) and in parent-reported cognitive regulatory skills at post-treatment and 3-month follow-up (P = .02 and P = .04, respectively). Preterm birth, biventricular CHD, and history of attention deficit hyperactivity disorder diagnosis were associated with improved response to the intervention.
Cogmed intervention produced improvements in the self-regulatory control abilities of adolescents with CHD. The training did not enhance other areas of executive function or behavioral outcomes. Further studies are needed to evaluate the longer-term potential benefits to other domains.
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Very preterm birth (<33 weeks of gestation) has been associated with alterations in structural and functional brain development in regions that are believed to underlie a variety of cognitive processes. While such alterations have been often studied in the context of cognitive vulnerability, early disruption to programmed developmental processes may also lead to neuroplastic and functional adaptations, which support cognitive performance. In this review, we will focus on executive function and intelligence as the main cognitive outcomes following very preterm birth in adolescence and adulthood in relation to their structural and functional neurobiological correlates. The neuroimaging modalities we review provide quantitative assessments of brain morphology, white matter macro and micro-structure, structural and functional connectivity and haemodynamic responses associated with specific cognitive operations. Identifying the neurobiological underpinning of the long-term sequelae associated with very preterm birth may guide the development and implementation of targeted neurobehaviourally-informed interventions for those at high risk.
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Citation Excerpt :
Madderom et al., 2016; Leeuwen et al., 2018; Schiller et al., 2016) As such deficits may have a significant impact on societal participation, it is imperative that we explore ways to improve neuropsychological outcome in adolescent survivors as well. In other patient groups, e.g. in preterm born adolescents, positive effects of CWMT have been found in both children and adolescents (Lohaugen et al., 2011; Grunewaldt et al., 2013). As we cannot make any statements about the effectivity of CWMT in adolescent survivors of neonatal ECMO and/or CDH due to differences in underlying etiology, it is important to assess the effectiveness of a cognitive training program over the long-term as well as at later stages of development in this patient group.
In a nationwide randomized controlled trial, white matter microstructure was assessed before and immediately after Cogmed Working-Memory Training (CWMT) in school-age neonatal critical illness survivors. Eligible participants were survivors (8–12 years) with an IQ ≥ 80 and a z-score of ≤ −1.5 on (working)memory test at first assessment. Diffusion Tensor Imaging was used to assess white matter microstructure. Associations between any training-induced changes and improved neuropsychological outcome immediately and one year post-CWMT were evaluated as well. The trial was conducted between October 2014–June 2017 at Erasmus MC-Sophia, Rotterdam, Netherlands. Researchers involved were blinded to group allocation. Participants were randomized to CWMT(n = 14) or no-intervention(n = 20). All children completed the CWMT. Global fractional anisotropy(FA) increased significantly post-CWMT compared to no-intervention(estimated-coefficient = .007, p = .015). Increased FA(estimated coefficient = .009, p = .033) and decreased mean diffusivity(estimated-coefficient = −.010, p = .018) were found in the left superior longitudinal fasciculus(SFL) post-CWMT compared no-intervention. Children after CWMT who improved with >1SD on verbal working-memory had significantly higher FA in the left SLF post-CWMT(n = 6; improvement = .408 ± .01) than children without this improvement post-CWMT(n = 6; no-improvement = .384 ± .02), F(1,12) = 6.22, p = .041, $η_{p}^{2}$  = .47. No other structure-function relationships were found post-CWMT. Our findings demonstrate that white matter microstructure and associated cognitive outcomes are malleable by CWMT in survivors of neonatal critical illness.
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: Funded by The Research Council of Norway (NevroNor), Norwegian University of Science and Technology, and the South-Eastern Norway Regional Health Authority. The Cogmed RM was purchased from the Cogmed Cognitive Medical Systems AB in Stockholm by our research group and given to each of the participants for free. The authors declare no conflicts of interest.

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Original ArticleComputerized Working Memory Training Improves Function in Adolescents Born at Extremely Low Birth Weight

Objective

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

J Am Acad Child Adolesc Psychiatry

Biol Psychol

Lancet Neurol

Neuroimage

J Am Acad Child Adolesc Psychiatry

Very-low-birthweight and term small-for-gestational-age adolescents: attention revisited

Acta Paediatr

Psychiatric symptoms in low birth weight adolescents, assessed by screening questionnaires

Eur Child Adolesc Psychiatry

Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children

Pediatrics

Executive function in very preterm children at early school age

J Abnorm Child Psychol

School difficulties at adolescence in a regional cohort of children who were extremely low birth weight

Pediatrics

Spatial working memory deficits in children at ages 3-4 who were low birth weight, preterm infants

Neuropsychology

Object working memory deficits predicted by early brain injury and development in the preterm infant

Brain

Neurobehavioral evidence for working-memory deficits in school-aged children with histories of prematurity

Dev Med Child Neurol

Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis

JAMA

Cognitive development in low risk preterm infants at 3-4 years of life

Arch Dis Child Fetal Neonatal Ed

Original Article
Computerized Working Memory Training Improves Function in Adolescents Born at Extremely Low Birth Weight