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Expectancy Does Not Predict 18-month Treatment Outcomes with Cognitive Training in Mild Cognitive Impairment

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Abstract

Background

Computerized cognitive training (CCT) has emerged as a potential treatment option for mild cognitive impairment (MCI). It remains unclear whether CCT’s effect is driven in part by expectancy of improvement.

Objectives

This study aimed to determine factors associated with therapeutic expectancy and the influence of therapeutic expectancy on treatment effects in a randomized clinical trial of CCT versus crossword puzzle training (CPT) for older adults with MCI.

Design

Randomized clinical trial of CCT vs CPT with 78-week follow-up.

Setting

Two-site study - New York State Psychiatric Institute and Duke University Medical Center.

Participants

107 patients with MCI.

Intervention

12 weeks of intensive training with CCT or CPT with follow-up booster training over 78 weeks.

Measurements

Patients rated their expectancies for CCT and CPT prior to randomization.

Results

Patients reported greater expectancy for CCT than CPT. Lower patient expectancy was associated with lower global cognition at baseline and older age. Expectancy did not differ by sex or race. There was no association between expectancy and measures of everyday functioning, hippocampus volume, or apolipoprotein E genotype. Expectancy was not associated with change in measures of global cognition, everyday functioning, and hippocampus volume from baseline to week 78, nor did expectancy interact with treatment condition.

Conclusions

While greater cognitive impairment and increased age was associated with low expectancy of improvement, expectancy was not associated with the likelihood of response to treatment with CPT or CCT.

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Funding

Funding: This work is supported by National Institute on Aging grant number 1R01AG052440-01A1 and National Institute of Mental Health grant number 2T32MH020004-21. Lumos Labs provided the gaming platform at no cost. Lumos Labs had no role in the design and conduct of the study; in the collection, analysis, and interpretation of data; in the preparation of the manuscript; or in the review or approval of the manuscript.

Author information

Author notes

  1. Both authors contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA

    Jeffrey N. Motter, C. Ndouli, T. E. Goldberg & D. P. Devanand

  2. Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, USA

    Jeffrey N. Motter, C. Ndouli, T. E. Goldberg & D. P. Devanand

  3. University of Massachusetts Chan Medical School, Worcester, USA

    S. N. Rushia

  4. Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York, USA

    M. Qian

  5. Duke University School of Medicine and the Duke Institute for Brain Sciences, Durham, USA

    A. Nwosu, J. R. Petrella & P. M. Doraiswamy

Authors
  1. Jeffrey N. Motter
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  2. S. N. Rushia
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  3. M. Qian
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  4. C. Ndouli
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  5. A. Nwosu
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  6. J. R. Petrella
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  7. P. M. Doraiswamy
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  8. T. E. Goldberg
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  9. D. P. Devanand
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Corresponding author

Correspondence to Jeffrey N. Motter.

Ethics declarations

Ethical standards: Study protocols were approved by the Columbia University/New York State Psychiatric Institute and Duke University Medical Center Institutional Review Boards, and all participants provided informed consent before completing any study procedures.

Conflict of interest: Dr. Motter reports grants from National Institute of Mental Health, during the conduct of the study. Dr. Rushia has nothing to disclose. Dr. Qian has nothing to disclose. Charlie Ndouli has nothing to disclose. Adaora Nwosu has nothing to disclose. Dr. Petrella reports grants from National Institute on Aging, during the conduct of the study; grants from National Science Foundation, personal fees from Biogen, personal fees from Icometrix, other from Cortechs.ai, outside the submitted work. Dr. Doraiswamy reports grants from National Institute of Health, other from Lumos Labs, during the conduct of the study; grants from National Institute of Health, grants from Lilly/Advid, grants from US Highbush Blueberry Council, grants from Cure Alzheimer’s Fund, grants from Karen L Wrenn Trust, grants from Steve Aoki Fund, personal fees from Lumos Labs, personal fees from UMethod, personal fees from Vivli, personal fees from Nutricia, personal fees from Clearview, personal fees from Brain Forum, personal fees from Otsuka, personal fees from Cornell, personal fees from Nestle, non-financial support from AHEL, non-financial support from Live Love Laugh, other from Alzheon, other from Lumos Labs, other from Lululemon, other from Transposon, from Apollo, from Live Laugh Love, from Goldie Hawn Foundation, other from Transposon, other from UMethod, other from Evidation, other from Marvel Biome, other from Alzheon, outside the submitted work; In addition, Dr. Doraiswamy has a patent Diagnosis and treatment of dementia. Dr. Goldberg has nothing to disclose. Dr. Devanand reports grants from National Institute on Aging, during the conduct of the study; grants from Alzheimer’s Association, personal fees from Acadia, personal fees from Eisai, personal fees from Genentech, personal fees from Jazz, personal fees from TauRx, personal fees from Novo, personal fees from Nordisk, personal fees from Biogen, personal fees from BioExcel, outside the submitted work.

Additional information

Trial registration: ClinicalTrials.gov identifier (NCT03205709).

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Motter, J.N., Rushia, S.N., Qian, M. et al. Expectancy Does Not Predict 18-month Treatment Outcomes with Cognitive Training in Mild Cognitive Impairment. J Prev Alzheimers Dis 11, 71–78 (2024). https://doi.org/10.14283/jpad.2023.62

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  • DOI: https://doi.org/10.14283/jpad.2023.62

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