Differential effects of a computerized cognitive stimulation program on older adults with mild cognitive impairment according to the severity of white matter hyperintensities
Received 21 September 2017
Accepted for publication 12 January 2018
Published 30 August 2018 Volume 2018:13 Pages 1543—1554
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Dr Richard Walker
Leila Djabelkhir-Jemmi,1,2 Ya-Huei Wu,1,2 Marouane Boubaya,3 Fabienne Marlats,1,2 Manon Lewis,1 Jean-Sébastien Vidal,1,2 Hermine Lenoir,1,2 Benoit Charlieux,1 Baptiste Isabet,1 Anne-Sophie Rigaud1,2
1Department of Clinical Gerontology, Broca Hospital-APHP, Paris, France; 2Research Team EA 4468, Alzheimer’s Disease, Vascular Risk Factors and Diagnostic Markers, Care and Support for Patients and Families, Institute of Psychology of Paris Descartes University, Paris, France; 3Clinical Research Unit, Avicenne Hospital, Bobigny, France
Objective: This study aimed to explore whether a computerized cognitive stimulation program (CCS) induced differential effects in older adults with mild cognitive impairment (MCI) according to the severity of white matter hyperintensities (WMH), which are associated with cognitive impairment and increased risk of progression to Alzheimer’s disease because of the damage they cause to cortical and subcortical networks.
Patients and methods: Twenty-nine MCI patients with no or little WMH (MCI-non-WMH) and 22 MCI patients with moderate or severe WMH (MCI-WMH) attended a 24-session CCS program (two sessions per week for a duration of 3 months) focused on executive functions, attention, and processing speed. Cognitive and psychosocial assessments were performed at baseline, postintervention, and 3 months after the intervention.
Results: Both groups improved on several cognitive measures after the intervention. However, the MCI-non-WMH group improved on a higher number of cognitive measures than the MCI-WMH group. At postintervention assessment, CCS had a more beneficial effect on the MCI-non-WMH group than on the MCI-WMH group with regard to improving categorical fluency (4.6±6.8 vs 0.4±6.4; effect size=0.37; p=0.002). During the 3-month follow-up assessment, significantly higher score improvements were observed in the MCI-non-WMH group for the paired-associate learning test (6.4±3 vs 4.7±3.5 points; effect size=0.43; p=0.005) as well as categorical fluency (3.8±7.8 vs -0.7±6 points; effect size=0.55; p=0.0003).
Conclusions: These findings suggest that WMH severity was related to cognitive improvement induced by a CCS program and highlight the importance of considering WMH in interventional studies on subjects with MCI.
Keywords: white matter hyperintensities, mild cognitive impairment, computerized cognitive interventions, brain lesions, Alzheimer’s disease
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