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Region Hovedstaden - en del af Københavns Universitetshospital

CAVIR (part 2)

Projekt: Typer af projekter

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Intro:
Cognitive impairments across memory, concentration and planning skills are a core feature of neuropsychiatric disorders, including affective disorders and psychosis spectrum disorders. These impairments contribute to poor quality of life and reduced vocational functioning, which is the largest socio-economic burden of these disorders. Despite a pressing need for cognition treatments, there are no available treatments with robust, replicated cognitive benefits in affective disorders. In psychosis spectrum disorders, the effects of cognitive remediation programs are variable and often not accompanied by functional improvements. Two key methodological problems in the field are: (I) suboptimal outcome measures in cognition intervention trials, involving neuropsychological tests that have limited resemblance to daily life cognitive challenges, and (II) lack of the possibility in current interventions to directly train cognitive functions within challenging daily life situations. We recently developed and tested an ecologically valid virtual reality cognition test, the Cognition Assessment VIrtual Reality test (CAVIR) in a pilot study. This revealed that the CAVIR is a sensitive to cognitive impairment in affective and psychosis spectrum disorders and correlates with patients’ daily life functioning (Miskowiak et al, in review). In a smaller pilot study, we also found that one week of cognitive training with our new prototype of a virtual reality training programme improved some aspects of cognition (Jespersen et al, in prep). In the proposed project, we aim to: (I) conduct national and international validation studies of a refined version of the CAVIR test and (II) develop and test the efficacy of a four-week virtual reality cognition training programme with simulated real-life scenarios.
Metoder:
Study 1: national and international validation of the refined CAVIR test
In a Danish validation study, an optimised version of the CAVIR test will be assessed in 100 patients with an ICD-10 diagnosis of AD (n = 50) or PD (n = 50) as part of the baseline assessments for the intervention trial (see description of the trial later) and 50 healthy controls (HC) with no personal or first-degree family history of psychiatric disorder. The international validation of the CAVIR test will be conducted in a collaboration with two research sites at the Barcelona University Hospital, Spain, and Harvard University, USA, respectively. The two sites will each recruit and assess 40 patients with and ICD-10 or DSM-5 diagnosis of AD and 40 HC. Patients with AD must be in full or partial remission. Healthy control participants will be matched to patients on age, gender and IQ.
Intro:
Cognitive impairments across memory, concentration and planning skills are a core feature of neuropsychiatric disorders, including affective disorders and psychosis spectrum disorders. These impairments contribute to poor quality of life and reduced vocational functioning, which is the largest socio-economic burden of these disorders. Despite a pressing need for cognition treatments, there are no available treatments with robust, replicated cognitive benefits in affective disorders. In psychosis spectrum disorders, the effects of cognitive remediation programs are variable and often not accompanied by functional improvements. Two key methodological problems in the field are: (I) suboptimal outcome measures in cognition intervention trials, involving neuropsychological tests that have limited resemblance to daily life cognitive challenges, and (II) lack of the possibility in current interventions to directly train cognitive functions within challenging daily life situations. We recently developed and tested an ecologically valid virtual reality cognition test, the Cognition Assessment VIrtual Reality test (CAVIR) in a pilot study. This revealed that the CAVIR is a sensitive to cognitive impairment in affective and psychosis spectrum disorders and correlates with patients’ daily life functioning (Miskowiak et al, in review). In a smaller pilot study, we also found that one week of cognitive training with our new prototype of a virtual reality training programme improved some aspects of cognition (Jespersen et al, in prep). In the proposed project, we aim to: (I) conduct national and international validation studies of a refined version of the CAVIR test and (II) develop and test the efficacy of a four-week virtual reality cognition training programme with simulated real-life scenarios.
Metoder:
Study 1: national and international validation of the refined CAVIR test
In a Danish validation study, an optimised version of the CAVIR test will be assessed in 100 patients with an ICD-10 diagnosis of AD (n = 50) or PD (n = 50) as part of the baseline assessments for the intervention trial (see description of the trial later) and 50 healthy controls (HC) with no personal or first-degree family history of psychiatric disorder. The international validation of the CAVIR test will be conducted in a collaboration with two research sites at the Barcelona University Hospital, Spain, and Harvard University, USA, respectively. The two sites will each recruit and assess 40 patients with and ICD-10 or DSM-5 diagnosis of AD and 40 HC. Patients with AD must be in full or partial remission. Healthy control participants will be matched to patients on age, gender and IQ.
Study 2: developing and testing the efficacy of a VR-based cognitive training programme
Based on the promising findings in our pilot study of a prototype VR training scenario, we will move on to develop a full VR-based training programme in Oculus Quest software. We will investigate the effects of four weeks of virtual reality cognition training compared with treatment as usual in a randomised, controlled, outcome-assessor-blind, parallel-group trial. See Figure 4 for a flow diagram and study events. The study will include 50 patients with either depression or bipolar disorder in full or partial remission and 50 patients with either schizotypal disorder or schizophrenia (psychosis spectrum disorders).
Resultater (forventede):
The proposed project tackles two major challenges in cognition trials that impede development of new effective treatments for cognitive impairments in patients with affective or psychosis spectrum disorders: First, trials targeting cognition lack ecologically valid cognition assessment tools to demonstrate efficacy of patients’ real-life cognitive functioning; Secondly, cognitive remediation interventions have not had the opportunity to involve direct training of cognitive abilities in daily life settings.
Diskussion/Impact (forventet):
The perspectives are: (I) development of the first ecologically valid test of real-life cognitive functions, which can be implemented in intervention trials and clinical settings in Denmark and internationally, and (II) a novel, engaging and cost-effective virtual reality cognition training programme that is likely to produce real-life benefits for patients.
StatusIgangværende
Periode01/09/202101/09/2024

    Forskningsområder

  • Sundhedsvidenskab - Mood Disorders, Psychotherapy, Psychological assessment and psychometrics, Cognition, Observational study

ID: 61746948