Brain Training Improves Memory in Childhood Cancer Survivors

Program takes advantage of neuroplasticity to train the brain to work more efficiently.

An intensive, adaptive computer-based cognitive training program has been proven to help improve working memory and other cognitive functionality of childhood cancer survivors and holds hope for revolutionizing management of the late side effects of the disease treatment.

The computer-based training sessions improved the working memories of those childhood cancer survivors who completed between 20 and 30 of them. The sessions involved verbal and visual-spatial exercises and lasted between 30 and 45 minutes.

The idea is to present the exercises as games, but they are designed to improve working memory. The improvements to working memory and attention from the training were comparable to gains reported in prior studies of stimulant medications.

The gains from cognitive training moved performance of the 30 survivors who completed the training into normal range. Caregivers also reported an improvement to the executive functioning of those who had completed training versus those who had not.

Executive functioning includes skills like planning and focus needed to juggle multiple tasks and get things done.

The intervention may work by taking advantage of neuroplasticity to train the brain to work more efficiently. These assumptions are made based on changes in brain activity during brain imaging.

“These results suggest that computerized cognitive training may help fill a void in management of cognitive late effects that impact quality of life for childhood cancer survivors, such as the likelihood they will complete school and live independently,” said first and corresponding author Heather Conklin, PhD, an associate member of the St. Jude Department of Psychology. “While medication and therapist-led interventions have shown some benefit for select survivors, online training makes a significant advance by giving survivors convenient access to an effective intervention.”

Previous research indicated that individuals with developmental and acquired attention disorders benefited from intensive computer-based cognitive training using repetitive exercises of graded difficulty.

The study in question used a program called Cogmed, the largest yet involving cancer survivors. The programs are not, however, covered by insurance.

Sixty-eight childhood cancer survivors participated in the study and received cranial irradiation, intrathecal chemotherapy or both for treatment of acute lymphoblastic leukemia (ALL) or brain tumors.

Intrathecal chemotherapy involves administering anti-cancer drugs directly into the cerebrospinal fluid surrounding the brain and spine.

These treatments leave cancer survivors at an increased risk for cognitive dysfunction that reduces academic, social and work-related achievements.

Patients in the study were between the ages of 8 and 16 and had completed treatment and been free of disease for at least 1 year. Additionally, each participant scored below expectations on measures of working memory prior to joining the study.

The patients were randomly assigned to either begin the intervention immediately or begin 6 months later. The training included weekly coaching by telephone for survivors and families.

Those who began immediately also had brain imaging MRIs performed before and shortly after completion of the intervention. The imaging analyzed brain activity while the survivors completed a working memory exercise.

The findings suggested that their brains may be working more efficiently due to the intervention.

“That suggests the intervention exercised and strengthened the well-established working memory network. The implication is that the brain may operate more efficiently and have less need for compensatory strategies,” Conklin said. “Such training-induced neuroplasticity suggests the benefits might be sustained going forward.”

The next step for researchers is to study the possible benefits of starting brain training during treatment or combining brain training with other interventions. Researchers also hope to track whether cognitive benefits are sustained and turn into the improved academic performance reported for other populations.

In this particular study, improvements in working memory, attention, and processing speed did not correlate to improved math or reading performance.

Conklin agrees that overall the results are good news for the nation’s growing population of childhood cancer survivors, now estimated at around 420,000 individuals.

“Computerized cognitive training is a more feasible, portable and efficient intervention than we’ve had in the past and is likely to result in meaningful improvement in the cognitive problems survivors experience,” Conklin said.