The purpose of this study is to examine cognitive and brain changes in individuals with bipolar disorder as a result of a cognitive training intervention.
Participants will only include people who are fluent speakers of English, as not all of the standardized and experimental cognitive tests have been normed for non-English speakers. Participants will be screened for significant medical, neurological, or psychiatric illness other than bipolar disorder. Participants will complete baseline cognitive testing. Reasoning training will take place in small groups, once a week for 2hr/session. After the training, participants will complete the cognitive testing again. A subset of participants who qualify for the brain imaging component will also complete a pre-post resting state brain scan. Training effects will be measured behaviorally in trained areas (reasoning \& physical) and untrained cognitive areas. Additionally, structural and functional brain imaging will measure changes in cerebral blood flow, global and regional brain volume, white matter tracts, efficiency, activation patterns, and blood oxygenation with a particular focus on changes to frontal regions. Screening Session: A research assistant will conduct screening procedures over the phone including a brief medical questionnaire covering their history, current medications and any pre-existing conditions. Prior diagnosis of bipolar disorder and euthymic state will be confirmed with participant's psychiatrist or treating physician. Neurocognitive Testing Session: A clinician will administer a group of standardized and experimental tests to each participant for each of the cognitive testing sessions. This session may last up to 3 hours, depending on the pace of the participant's response times. The intent of the tasks is to assess higher level thinking skills, working memory, and selective learning. Functional magnetic resonance imaging (fMRI): Participants will have fMRI, at each aforementioned time point in the study, during which they will lie in the scanner while images of their brain will be recorded. Each session will take up to 90 minutes. During the fMRI and during the diffusion tensor imaging (DTI) the patient will be asked just to lie still. Cognitive reasoning training: The gist-based reasoning training will be delivered in one, two hour session each week over 4 weeks. It is strategy-based rather than content-based so that the focus is not content specific or situation-dependent. Gist-based reasoning has been linked to frontal lobe activation and to measures of executive function. Post Intervention: Following the intervention, patients will repeat the cognitive neuropsychological assessment and fMRI identical to the pre-training assessment. Participants are not paid for any of these tests or training sessions.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
27
This is a strategy-based intervention to enhance frontal lobe function. Strategies equip participants to improve their strategic attention, integrated reasoning, and innovation abilities.
Change From Baseline: Test of Strategic Learning
Complex abstraction subtest: After reading a complex text, participants generate a high-level synthesis of abstracted ideas (versus recall of concrete details). \[raw scores, min value = 0, max value = 10, higher indicates better performance\]
Time frame: Pre and within 2 weeks post intervention
Change From Baseline: Wechsler Adult Intelligence Scale (WAIS), Similarities Subtest
Participants are provided with two words/concepts and must state how they are alike; \[scaled scores, min value = 0, max value = 19, higher indicates better performance\]
Time frame: Pre and within 2 weeks post intervention
Change From Baseline: Delis-Kaplan Executive Function System (DKEFS) Card Sorting
Participants must sort a set of cards into as many groups as possible, based on certain parameters. This score reflects the correct number of sorts generated. \[scaled scores, min value = 0, max value = 19, higher indicates better performance\]
Time frame: Pre and within 2 weeks post intervention
Change From Baseline: Working Memory (Digits Backwards)
Participants must recite number sequences in reverse order; \[scaled scores, min value = 0, max value = 19, higher indicates better performance\]
Time frame: Pre and within 2 weeks post intervention
Change From Baseline: Delis-Kaplan Executive Function System (DKEFS) Color-Word, Inhibition & Switching Subtest
Participants must either state color of word or read the word presented; \[scaled scores, min value = 0, max value = 19, higher indicates better performance\]
Time frame: Pre and within 2 weeks post intervention
Change From Baseline: Divided Attention
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Participants connect letters and numbers in ascending order as quickly as they can; \[raw score in seconds, min value = 0, max value = 200, lower indicates better performance\]
Time frame: Pre and within 2 weeks post intervention
Change From Baseline: Verbal Fluency
Participants had to generate as many words as possible in one minute that fit task parameters; \[scaled scores, min value = 0, max value = 19, higher indicates better performance\]
Time frame: Pre and within 2 weeks post intervention
Change From Baseline: Rey Auditory Verbal Learning Test (RAVLT)
Participants are asked to recall a list of words they heard 20 minutes earlier; \[raw scores, min value = 0, max value = 15, higher indicates better performance\]
Time frame: Pre and within 2 weeks post intervention
Change From Baseline: Logical Memory
Participants are asked to recall the details of a story they were read 20 minutes earlier; \[scaled scores, min value = 0, max value = 19, higher indicates better performance\]
Time frame: Pre and within 2 weeks post intervention
Change From Baseline: Quality of Life in Bipolar Disorder (QoL.BD)
Participants fill out a self-report questionnaire assessing different domains of quality of life; \[raw score; min value = 0, max value = 280, higher score indicates higher reported quality of life\]
Time frame: Pre and within 2 weeks post intervention
Resting State Relative Cerebral Brain Blood Flow (rCBF)
Mean-level change in resting state relative cerebral brain blood flow (rCBF) in left Inferior frontal gyrus (min value = 0, max value = 2, lower value indicates decreased cerebral blood flow and higher indicates increased cerebral blood flow)
Time frame: Pre (from baseline) and within 2 weeks post intervention
Change From Baseline: Delis-Kaplan Executive Function System (DKEFS) Accurate Description of Sorts
Participants must sort a set of cards into as many groups as possible, based on certain parameters, and state why it is an accurate sort. This score reflects the accuracy of the sort description. \[scaled scores, min value = 0, max value = 19, higher indicates better performance\]
Time frame: Pre and within 2 weeks post intervention
Change From Baseline: Delis-Kaplan Executive Function System (DKEFS) Accurate Recognition of Sorts
After proctor has sorted cards, participants must state why sort is accurate/how cards are alike. \[scaled scores, min value = 0, max value = 19, higher indicates better performance\]
Time frame: Pre and within 2 weeks post intervention