SAN FRANCISCO – In a treatment breakthrough that could lead to a large impact on the speed and cost of recovery following patient stays in intensive care units (ICUs), researchers have published the first-ever results on using computerized cognitive rehabilitation (CCR) to address the cognitive impairment and delirium often associated with ICU stays. The brain exercises used were from the BrainHQ web and mobile app, distributed by Posit Science.
Nearly a third of patients who survive ICU stays report newly-acquired or accelerated cognitive impairment, and between a third and half of those who survive critical care are newly unemployed 12 months later, often due to cognitive recovery issues. ICU stays are widely known to result in long and costly paths to full recovery.
Researchers from Vanderbilt University, working with researchers at Posit Science, enrolled 33 patients who were ICU survivors with persistent long-term cognitive impairment in the Returning to Everyday Tasks Using Rehabilitation Networks (RETURN-CCR) study. RETURN-CCR was an exploratory pilot study that used a convenience sample drawn from other studies for before-and-after CCR intervention evaluation. A report on its results have just published in Annals of the American Thoracic Society.
Patients were assigned 42 minutes of training, five days a week, for 12 weeks (for a total of 42 hours of training). Intelligent algorithms in BrainHQ automatically adapted each exercise based on the patient’s ongoing performance, and adjusted the rotation of 18 BrainHQ exercises into daily regimens of seven exercises for six minutes each.
Study participants were aged 52 to 70 (with an average age of 60), 96% Caucasian, and 52% male, with an average of 16 years of education. They had spent 7 to 21 days in the hospital (average of 15 days) and 3 to 16 days (average of 6 days) in the ICU.
Study participants showed a significant improvement in all four cognitive domains using directly trained assessments of attention, processing speed, memory, and executive function, comparing pre-training to post-training composite scores.
When comparing scores on untrained neuropsychological assessments, researchers found significant improvement on one assessment of executive function, with non-significant improvements on the other assessments. In their report, the researchers note (as a reason for a larger study) that the pilot was not powered to show significance on these measures. The amount of improvement on untrained measures correlated to the amount of training, with a sub–group that trained the most (twice as much as the average participant) showing significantly more improvement than those training the normal amount.
“This is an important pilot,” said Dr. Henry Mahncke, CEO of Posit Science. “Any patient (or family member of a patient) who has experienced post-ICU cognitive impairment or delirium knows how frightening that experience can be, and that we currently lack interventional tools to address it. This exploratory study provides a clear roadmap for changing that. We are in active discussions to advance this research into real-world, post-ICU interventions.”