Cognitive Training Programs Have No Long-Term Benefit for Children Born Very Preterm

Cognitive training programs have no benefit for improving visuospatial processing for children born between 24- and 34-weeks’ gestation with working memory disorders, according to the results of a study published in JAMA Network Open.

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In the EPIREMED study (NCT02757794), the authors said that children born very preterm, defined as 24- and 34-weeks’ gestation, could have neurobehavioral problems and developmental dysfunctions, including language, praxis, executive function, attention, and behavioral disorders. Training and strengthening executive function have been investigated in numerous preschool studies, as well as throughout childhood and adolescence, with a study finding that training programs were significantly effective for children with developmental difficulties; however, this study did not include very preterm children.

Investigators of the study assessed the ability of computerized cognitive training programs to help improve working memory and long-term visuospatial abilities, which they said could be helpful in preventing cognitive impairment in children who were born very preterm.

The study included 18 units within French university hospitals and included 2 parallel groups: a control group who received the standard of care management and an intervention group who received the standard of care management and the cognitive training program, Cogmed JM. Enrollment criteria included a birth between 24- and 34-weeks’ gestation and completion of the EPIPAGE 2 assessment at 5.5 years of age, a full-scale intelligence quotient (FSIQ) greater than 70, and a working memory impairment, defined by a working memory index score of 85 or less.

Investigators enrolled individuals from November 2016 until April 2018, with a follow-up lasting until August 2019. There were 3 cognitive assessments, including an inclusion visit, after finishing training at 6 months, and a final visit at 16 months. The intervention group received 3 weekly 15-minute training sessions for 8 weeks, conducted either at home or at the inclusion center.

The primary outcome included the visuospatial index score from the Wechsler Preschool and Primary Scale of Intelligence, 4th Edition. Secondary outcomes included working memory, intellectual functioning, executive and attention processes, language skills, behavior, quality of life, and schooling.

There were 169 individuals included in the study with a mean age of 5 years and 11 months, FSIQ score of 88.5, and working memory score of 80. Among the total number, 84 individuals were randomized to the intervention group and 85 to the control group.

For those in the intervention group, there was a mean of 18.1 sessions completed, with 68% of children completing 15 or more sessions, 62% completing 20 or more sessions, and 51% completing 25 sessions, with mean progress index scores of 23.4, 23.8, and 24, respectively.

The investigators found that children whose parents were in a higher socioprofessional status tended to have better adherence. For the visuospatial index score, there was no group difference at 3 months or at 12.9 months after training. This included after adjustment for neurodevelopmental profile severity and multiple imputation. The sensitivity analysis adjustment confirmed the results as well as the analyses of 20 and 25 sessions.

However, investigators did find a positive effect of the cognition training on working memory, but the effect was not maintained long term. Additionally, there was a significant effect on marginal clinical effect on resource skill language and short-term mnemonic span. The authors reported that the trends persisted with the increasing number of sessions.

Investigators noted that improving executive function for children born very preterm is challenging, emphasizing the importance of a minimum adherence time for these training programs.

Reference

Gire C, Beltran Anzola A, Marret S, L’Hélias LF, et al. Cognitive training for visuospatial processing in children aged 5½ to 6 years born very preterm with working memory dysfunction: a randomized clinical trial. JAMA Netw Open. 2023;6(9):e2331988. doi:10.1001/jamanetworkopen.2023.31988