Cognitive Training Program Provides Benefits for Young Fragile X Syndrome Patients, Trial Finds

A computer-based cognitive training program called Cogmed can improve working memory and cognition and increase the attention span of children and adolescents with fragile X syndrome, according to a clinical trial.

Findings from the trial were published in the study, “Cognitive training for children and adolescents with fragile X syndrome: a randomized controlled trial of Cogmed,” in the Journal of Neurodevelopmental Disorders.

Individuals with fragile X are thought to have abnormal neural circuits in the brain and experience problems with working memory, inhibitory control, cognition, and selective and divided attention.

Although pharmacological therapies have been developed for this disorder, these medications alone have not led to improvements in behavior or cognition.

Cogmed is a computer-based working memory training program, which has shown positive results in earlier controlled studies. This program, as well as other working memory training strategies, can improve working memory and academic achievement, reduce symptoms in children with attention deficit hyperactivity disorder (ADHD), increase auditory attention and working memory in preschool children, and improve attention in daily life.

Developed by the Pearson Corporation, Cogmed works as a game consisting of several different computerized visuospatial memory training tasks. These tasks involve temporary storage and manipulation of sequences in a game format, based on the individual’s developmental level.

Cogmed comes in two versions, one suitable for school-age children (older than 7) with higher functioning, called Cogmed RM, and a preschool version suitable for lower functioning children, called Cogmed JM.

Researchers at the MIND Institute, University of California Davis Medical Center, have now evaluated whether Cogmed could also have a positive impact on patients with fragile X.

“In this study we are filling a critical gap in our field by focusing on a non-pharmacological intervention, with the long-term concept that patients might show accelerated learning in combination with these targeted treatments,” David Hessel, PhD, a professor in the UC Davis department of psychiatry and behavioral sciences and the MIND Institute, said in a press release.

The study (NCT02747394) enrolled 100 children and adolescents with fragile X (63 boys and 37 girls, with a mean age of 15.28 years) from the United States and Canada.

Participants were randomized equally into two groups: the adaptive group, where difficulty increased according to patients’ performance, and a non-adaptive group where difficulty level wasn’t tailored to performance (control group).

Participants were assessed at home for working memory outcomes — both visual and auditory — objective measures of working memory, and executive function — distractibility, cognitive flexibility, and behavior. The measurements were made at the start of the trial, after caregiver-supported sessions over five to six weeks, and three months after completing training.

Regarding working memory, the team observed that patients in the adaptive group, who either started training in the Cogmed JM version or the Cogmed RM version, increased the maximum length of their attention span by the end of the trial. These improvements were maintained at follow-up three months after training was finished.

Parents and teachers reported significant reductions in problems with attention, working memory, and global executive functioning between the start and end of the trial.

However, both the adaptive and non-adaptive groups showed similar improvements in working memory and executive functions such as learning, socialization, and control of emotions.

“The hypothesis was that the adaptive group would significantly outperform the non-adaptive control group,” Hessl said. “However, it turned out that both groups showed significant gains, and overall we did not see a differential improvement above the control condition.”

“This study provides evidence that children and adolescents with [fragile X] can engage and make progress in an intensive web-based working memory training program, Cogmed, over a period of 5–6 weeks,” the researchers concluded in the study.