Effects of brain training on brain blood flow (The Cognition and Flow Study—CogFlowS): protocol for a feasibility randomised controlled trial of cognitive training in dementia

Abstract

IntroductionCognitive training is an emerging non-pharmacological treatment to improve cognitive and physical function in mild cognitive impairment (MCI) and early Alzheimer’s disease (AD). Abnormal brain blood flow is a key process in the development of cognitive decline. However, no studies have explored the effects of cognitive training on brain blood flow in dementia. The primary aim of this study is to assess the feasibility for a large-scale, randomised controlled trial of cognitive training in healthy older adults (HC), MCI and early AD.Methods and analysisThis study will recruit 60 participants, in three subgroups of 20 (MCI, HC, AD), from primary, secondary and community services. Participants will be randomised to a 12-week computerised cognitive training programme (five × 30 min sessions per week), or waiting-list control. Participants will undergo baseline and follow-up assessments of: mood, cognition, quality of life and activities of daily living. Cerebral blood flow will be measured at rest and during task activation (pretraining and post-training) by bilateral transcranial Doppler ultrasonography, alongside heart rate (3-lead ECG), end-tidal CO2 (capnography) and beat-to-beat blood pressure (Finometer). Participants will be offered to join a focus group or semistructured interview to explore barriers and facilitators to cognitive training in patients with dementia. Qualitative data will be analysed using framework analysis, and data will be integrated using mixed methods matrices.Ethics and disseminationBradford Leeds Research Ethics committee awarded a favourable opinion (18/YH/0396). Results of the study will be published in peer-reviewed journals, and presented at national and international conferences on ageing and dementia.Trials registration number NCT03656107; Pre-results.

“The Wandering Nerve Linking Heart and Mind” – The Complementary Role of Transcutaneous Vagus Nerve Stimulation in Modulating Neuro-Cardiovascular and Cognitive Performance

“…Both dementia and even its prodromal stage, MCI, are characterized by a reduction in cerebral blood flow ( Mazza et al, 2011 ; Sierra-Marcos, 2017 ). A meta-analysis of twenty-six studies investigating CBF in MCI found overall reduced tissue oxygenation, CBF and velocity in MCI compared to healthy controls ( Beishon et al, 2017 ) and studies are underway investigating the CBF changes that may occur with cognitive stimulation in MCI and dementia ( Beishon et al, 2019 ). Similar findings have been noted in patients with Alzheimer’s disease, with reduced CBF in many cortical regions including temporal ( Sandson et al, 1996 ; Alsop et al, 2000 ; Asllani et al, 2008 ; Yoshiura et al, 2009 ; Ding et al, 2014 ) parietal ( Alsop et al, 2000 ; Johnson et al, 2005 ) and other regions including precuneus, frontal and posterior cingulate cortex ( Alsop et al, 2008 ; Yoshiura et al, 2009 ).…”

The Cognition and Flow Study (CogFlowS): A Mixed Method Evaluation of a Randomized Feasibility Trial of Cognitive Training in Dementia

“…The study had research ethics committee approval (Bradford Leeds ref: YH/18/0396), and all study procedures were conducted in accordance with the declaration of Helsinki. The protocol for the study has been published previously [15]. In total, 20 healthy older adults, 24 people living with dementia, and 12 with MCI were recruited to the study.…”

“…In addition, participants underwent an assessment of their neurovascular function using transcranial Doppler ultrasonography measured task-activation. Detailed methods and results from the quantitative phase of the study have been published [14,15]. In brief, participants underwent a ve minute resting baseline recording with continuous monitoring of cerebral blood ow velocity (CBFv, transcranial Doppler ultrasound), blood pressure (BP, Finometer), end-tidal CO 2 (ETCO 2 , nasal capnography).…”

The Cognition and Flow Study (CogFlowS): A Mixed Method Evaluation of A Randomised Feasibility Trial of Cognitive Training in Dementia

“…In addition, participants underwent an assessment of their neurovascular function using transcranial Doppler ultrasonography measured task-activation. Detailed methods and results from the quantitative phase of the study have been published [14,15]. In brief, participants underwent a ve minute resting baseline recording with continuous monitoring of cerebral blood ow velocity (CBFv, transcranial Doppler ultrasound), blood pressure (BP, Finometer), end-tidal CO 2 (ETCO 2 , nasal capnography).…”