The Effects of Brain Training on Brain Blood Flow: The Cognition and Flow Study (CoGFlowS)

Introduction

Cognitive training (CT) is an emerging strategy to delay the onset or slow the progression of dementia. However, the effects of CT on cerebrovascular physiology remain unknown. The aim of this study was to investigate the effects of CT on cerebral blood flow velocity (CBFv) responses.

Methods

This was a feasibility randomised controlled trial of a twelve week, multi-domain CT programme in twenty healthy older adults (HOA), and 36 patients (24 Alzheimer’s disease, 12 mild cognitive impairment). Participants were randomised to CT or control and underwent assessments of cognition, mood, quality of life (QoL), activities of daily living, and neurovascular function (CBFv responses to five cognitive tasks). Data were analysed as peak percentage change in CBFv. A novel method was developed to objectively classify participants as “responders” to task-activation. The cumulative response rate (CRR) was calculated as the sum of responses to five tasks across both hemispheres. Participants underwent semi-structured interview with their carers posttraining, and data from the qualitative and quantitative components were integrated.

Results

Three participants with dementia dropped-out early from the training arm due to: difficulty with technology, stress and anxiety, carer strain, and severity of dementia. In the healthy group, QoL was higher, and peak CBFv response was reduced to the visuospatial task post-training. In patients, CRR was significantly increased post-training. Qualitative data demonstrated significant benefits to training (e.g. achievement, satisfaction, increased awareness), but barriers were also present (e.g. frustration,technology, apathy). Integrated quantitative and qualitative profiles did not identify a participant profile that selectively benefited from training, and an individualised approach should be taken.

Conclusions

CT was feasible in HOA and people living with dementia, and training effects on cerebrovascular responses were identified. Using a novel mixed-methods approach, tailored recommendations were devised on the design of CT programmes for people living with dementia.