An interactive video game was more effective than a word game at improving processing speeds in multiple sclerosis (MS) patients with cognitive difficulties, and gains measured were longer lasting, a small clinical trial reports.
These results were in the study “A novel in-home digital treatment to improve processing speed in people with multiple sclerosis: A pilot study,” published in the Multiple Sclerosis Journal.
Almost half of all with MS experience cognitive impairments that can affect both employment and life quality. Digital technologies are emerging as potential therapies to improve patients’ processing, or thinking, speed.
Researchers at the Weill Institute for Neurosciences at the University of California San Francisco noted a strong enthusiasm for at-home, digital approaches that work like a tablet video game among MS patients in a prior open-label study. But that trial lacked a control group for comparison.
To address this, these researchers conducted a randomized and somewhat larger clinical trial (NCT03569618) that compared the efficacy of a video game-like therapy to that of a digital but more traditional one. The study assessed changes in patients’ processing speed, and factors that might predict how well a person responds to the intervention.
This trial included 44 patients, with an average age of 51.7 and disease duration of 13.2 years. All had mild to moderate cognitive impairment, as measured by the Symbol Digit Modalities Test (SDMT), a validated test of memory and processing speed.
Of this group, 23 people were randomized to the experimental video game, dubbed AKL-T03. The other 21 were given access to the control word game, called AKL-T09.
AKL-T03 is an investigational medical software developed by Akili Interactive and designed to engage frontal neural networks through sensory and motor tasks. The game tailors its difficulty level based on user responses for a personalized treatment experience, and allows for real-time monitoring of patient progress. This built-in adaptability is also meant to prevent the test from becoming either too easy or too difficult, encouraging users to improve their performance.
AKL-T09 consists of connecting letters on a grid to spell as many words as possible. Points are earned by tracing words of two or more letters in any direction.
Patients were asked to do their assigned therapy for up to 25 minutes each day, five days a week, for six weeks. This amounted to a total of about 375 minutes of the intervention for each group.
Cognitive abilities were measured at three appointments: at the study’s start (visit 1, establishing a baseline measure), after six weeks (visit 2), and after 14 weeks (visit 3, assessing the persistence of effects over time).
SDMT scores increased significantly in both groups between the first and second visits, by a mean of 6.10 points for the AKL-T03 group and 3.55 points for the control group. However, the degree of improvement — the study’s primary outcome — was “not significantly different between groups,” the researchers wrote.
Those who showed the greatest improvements in SDMT scores tended to be employed, older, to have higher levels of education, and higher modified fatigue impact scores.
Although a lower T2 lesion volume — indicative of brain damage caused by inflammation — associated with greater SDMT score improvement, this association was also not statistically significant.
“These demographic and clinical features can be used in larger clinical trials and real world clinical settings to determine selection criteria for participants most likely to improve,” the researchers wrote.
At the final visit, 70% of participants using the experimental video game intervention maintained a SDMT score increase of at least four points above their baseline, compared with 37% of those in the control group.
“Taken together, our findings suggest that this enjoyable, low-risk, non-pharmacological intervention could represent a clinically valuable approach to improving processing speed in adults with MS experiencing a range of minor to moderate impairment in processing speed,” the researchers concluded.
They plan to initiate a larger, randomized, and controlled clinical trial to further investigate the ideal conditions and cycle intervals for such digital therapies, as well as the mechanisms that underly the observed improvements.
The National MS Society reported in a release on its website that an Akili medical device software became the first game-based therapeutic approved by the U.S. Food and Drug Administration for any type of condition — in this case, the device recognized is an intervention for children with attention deficit hyperactivity disorder.
The therapeutic software, called Endeavor, will now be tested in a small study (NCT04445116) in children with MS to determine if it can treat cognitive impairments. Contact information for this single-site study, sponsored by New York University Langone Health, is here.
A grant from Akili Interactive supported this study.
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