Computerized working memory training for hypertensive individuals with executive function impairment: a randomized clinical trial

Regina Silva Paradela; Brenno Cabella; Mariana Penteado Nucci; Naomi Vidal Ferreira; Laura Aló Torres; Luiza Menoni Martino; Fernanda Marciano Consolim-Colombo; Luiz Aparecido Bortolotto; Danielle Irigoyen da Costa; Maria Claudia Irigoyen

doi:10.3389/fnins.2023.1185768

Computerized working memory training for hypertensive individuals with executive function impairment: a randomized clinical trial

Front Neurosci. 2023 Jul 7:17:1185768. doi: 10.3389/fnins.2023.1185768. eCollection 2023.

Affiliations

¹ Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
² Institute of Theoretical Physics, São Paulo State University (IFT-UNESP), São Paulo, Brazil.
³ Laboratory of Medical Investigations on Magnetic Resonance Imaging (LIM-44), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
⁴ Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil.
⁵ Research Affairs Office, Amazonia Adventist College, Benevides, Pará, Brazil.
⁶ Brain Institute (InsCer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.

Abstract

Background: Hypertension is associated with working memory (WM) impairment. However, the benefits of Cogmed WM training for the hypertensive population are unknown. Therefore, we aimed to evaluate Cogmed's effects on the WM performance of hypertensive individuals with executive function (EF) impairment.

Methods: We included 40 hypertensive patients (aged 40-70 years, 68% female) with EF impairment. They were randomized in a 1:1 ratio to receive 10 weeks of adaptive Cogmed training or a non-adaptive control training based on online games. The primary outcome was the WM performance. The secondary outcomes were verbal memory, visuospatial ability, executive function, global cognition, and the neuronal activity measured using functional magnetic resonance imaging (fMRI) under two WM task conditions: low (memorization of 4 spatial locations) and high (memorization of 6 spatial locations). An intention-to-treat (ITT) and per-protocol (PP) analysis were performed.

Results: Cogmed did not show a significant effect on WM or any other cognitive outcome post-training. However, under the WM-low load and WM-high load conditions of the fMRI, respectively, the Cogmed group had an activation decrease in the right superior parietal lobe (ITT and PP analyses) and left inferior frontal lobe (PP analysis) in comparison to the control group.

Conclusion: The Cogmed showed no effects on the WM performance of hypertensive individuals with EF impairment. However, activation decreases were observed in frontoparietal areas related to the WM network, suggesting a more efficient neuronal activity after training.

Keywords: cognitive dysfunction; executive function; hypertension; magnetic resonance imaging; rehabilitation.