Division of Hematology, Children's National Hospital.
Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences.
J Pediatr Psychol. 2021 Aug 19;46(8):1001-1014. doi: 10.1093/jpepsy/jsab030.
Youth with sickle cell disease (SCD) are at risk for neurocognitive deficits including problems with working memory (WM), but few interventions to improve functioning exist. This study sought to determine the feasibility and efficacy of home-based, digital WM training on short-term memory and WM, behavioral outcomes, and academic fluency using a parallel group randomized controlled trial design.
47 children (7-16 years) with SCD and short-term memory or WM difficulties were randomized to Cogmed Working Memory Training at home on a tablet device (N = 24) or to a standard care Waitlist group (N = 23) that used Cogmed after the waiting period. Primary outcomes assessed in clinic included performance on verbal and nonverbal short-term memory and WM tasks. Secondary outcomes included parent-rated executive functioning and tests of math and reading fluency.
In the evaluable sample, the Cogmed group (N = 21) showed greater improvement in visual WM compared with the Waitlist group (N = 22; p = .03, d = 0.70 [CI95 = 0.08, 1.31]). When examining a combined sample of participants, those who completed ≥10 training sessions exhibited significant improvements in verbal short-term memory, visual WM, and math fluency. Adherence to Cogmed was lower than expected (M = 9.07 sessions, SD = 7.77), with 19 participants (41%) completing at least 10 sessions. Conclusions: Visual WM, an ability commonly affected by SCD, is modifiable with cognitive training. Benefits extended to verbal short-term memory and math fluency when patients completed a sufficient training dose. Additional research is needed to identify ideal candidates for training and determine whether training gains are sustainable and generalize to real-world outcomes.
患有镰状细胞病（SCD）的年轻人存在神经认知缺陷的风险，包括工作记忆（WM）问题，但改善功能的干预措施很少。本研究旨在确定基于家庭的数字 WM 训练对短期记忆和 WM、行为结果以及使用平行组随机对照试验设计的学术流畅性的可行性和疗效。
47 名患有 SCD 和短期记忆或 WM 困难的儿童（7-16 岁）被随机分配在家中使用平板电脑设备进行 Cogmed 工作记忆训练（N=24）或标准护理等待组（N=23），后者在等待期后使用 Cogmed。在诊所评估的主要结果包括口头和非口头短期记忆和 WM 任务的表现。次要结果包括父母评定的执行功能以及数学和阅读流畅性测试。
在可评估的样本中，Cogmed 组（N=21）的视觉 WM 改善程度大于等待组（N=22；p=0.03，d=0.70[CI95=0.08，1.31]）。当检查参与者的综合样本时，完成≥10 次训练课程的参与者在口头短期记忆、视觉 WM 和数学流畅性方面表现出显著改善。Cogmed 的依从性低于预期（M=9.07 次，SD=7.77），19 名参与者（41%）完成了至少 10 次。结论：视觉 WM 是一种常见受 SCD 影响的能力，可以通过认知训练进行调整。当患者完成足够的训练剂量时，益处扩展到口头短期记忆和数学流畅性。需要进一步研究以确定训练的理想人选，并确定训练收益是否可持续并推广到现实世界的结果。
