Feasibility of Cognitive Training to Promote Recovery in Cancer-Related Cognitive Impairment in Adolescent and Young Adult Patients

Abstract

Background:Computer-based cognitive rehabilitation programs may help adolescent and young adult (AYA) patients with cancer-related cognitive impairment. This pilot study investigated the feasibility of cognitive rehabilitation as a preventive intervention for AYA patients receiving chemotherapy. Explorative objectives included the correlation of cognitive performance with serum brain-derived neurotrophic factor (BDNF). Methods: This pilot prospective study included English-speaking patients 12-25 years of age with a fist diagnosis of cancer requiring chemotherapy. Participants enrolled in the intervention arm participated in a computer-based neurocognitive training program for 20-30 minutes daily for 16 weeks. Outcome measures, including engagement with and completion of computerized neurocognitive testing and serum BDNF levels, were obtained within the first month following diagnosis, ∼16 and 24 weeks from enrollment.Results: Fourteen of 18 eligible patients provided consent, with 7 patients assigned to each the intervention arm and nonintervention arm. Seventy-one percent of the patients in the intervention arm completed at least 80% of the required activities. Compared to baseline, patients in the nonintervention arm demonstrated higher prevalence of impairment in four of the six cognitive domains (processing speed, visual attention, attention/working memory, and executive function) at the end of the study period. There was a nonstatistically significant reduction of serum BDNF levels over time, which was observed in both intervention and nonintervention arms. Conclusion:This pilot study provides some evidence that it is feasible for AYAs with new cancer diagnoses to receive standardized cognitive rehabilitation. Patients receiving cognitive activities experienced less impairment in numerous cognitive domains.

BDNF Augmentation Using Riluzole Reverses Doxorubicin-Induced Decline in Cognitive Function and Neurogenesis

“…Physical exercise or running has been shown to increase BDNF levels which is linked with improved synaptic plasticity, spinogenesis, dentate neurogenesis, and improved cognitive function in rodents [50]. Several human studies evaluated the role of non-pharmacological interventions such as cognitive training or integrative therapies to mitigate CRCI by increasing BDNF levels [44,[51][52][53][54]. Taken together, these pre-clinical and clinical studies supported our pharmacological approach to augment BDNF in vivo to protect from the loss of neurogenesis and thereby cognitive function following exposure to chemotherapy.…”

Young Adults’ Lived Experiences with Cancer-Related Cognitive Impairment: An Exploratory Qualitative Study

“…Systematic reviews of CRCI studies with adults [ 67 ] and breast cancer survivors [ 68 ] have identified cognitive training as an effective rehabilitation strategy for strengthening specific cognitive domains. Pilot data from adolescent and young adult cancer survivors [ 69 ] suggests it may also be a feasible, possibly beneficial CRCI prehabilitation tool; however, evidence is needed to confirm the effectiveness of cognitive training in young adults. Likewise, cognitive relaxation techniques were seen as beneficial to “calm the brain” (and in turn, help improve memory), supporting prior research (e.g., [ 70 ]).…”

Psychological Outcomes in Adolescent and Young Adult Cancer Survivors

“…Future research should aim to characterize CRCI among AYAs in large longitudinal studies powered to accommodate the heterogeneity of diagnoses and treatments in this group. Intervention studies for CRCI have been limited 20,21 (Table 1) and should carefully consider the varying developmental stages of cognitive abilities and brain structures as well as external cognitive demands (school v work) as these vary throughout the AYA period.…”