BrainFit, the effect of online cognitive training on cognition in patients with late life moodsymptoms.

Relevance
An effective therapeutic intervention for cognitive impairment is an important
unmet medical need in patients with late onset mood disorders (LLMD).
Cognitive impairment is a core feature of the illness and responsible for poor
outcome. By treating cognitive impairment we expect to improve cognition and
depressive symptoms in LLMD. Additionally, as cognition is related to social
functioning, an effect of cognitive training on improvement of social
functioning is to be expected. In current treatments, cognitive complaints are
highly underestimated, with a less positive prognoses for these patients.
Cognitive training has showed its benefits in other diseases. Our primary goal
is to investigate the effect on (subjective) cognitive symptoms. A secondary
goal is to explore the effect on objective cognitive functioning, moodsymptoms,
social functioning and the feasability of an online cognitive training for
depressed patients.

Our primary goal is to develop an easy access cognitive training for older
patients with mood disorders suffering from (subjective) cognitive complaints.
We want to study the effect on both objective and subjective functioning.
Secondary, we aim to study the effect on mood symptoms, social functioning and
the feeling of Mastery and quality of life. Furthermore we aim to study whether
the effects will last during 3 months after quitting the training. Also we want
to enlight the feasability of the online cognitive training for our study
population.

In this current dubbelblind, randomized controlled study patients will be
randomly assigned to the online cognitive training (BrainGymmer > executive
functioning, attention) versus the active control cognitive training (no
specific trainingseffect expected). We will stratify for polarity (unipolar and
bipolar depression). This active control condition is different from Care as
usual as control-condition, by profiding this active control training we hope
to rule out a-specific effects.
Patients will train 3 x/week 45 minutes for 8 weeks. We will do pre-post- and
follow-up measures three months after the last training.

Intervention
The training games are specifically designed to enhance attention, information
processing speed, working memory and executive functioning, cognitive domains
that are commonly affected in LLMD, by dynamically adjusting to the
individual*s performance. As a comparator we use an active control condition
where patients play games that do not make great demands on executive processes
(solitaire) or rely on general knowledge (hangman, trivia questions). The
training can be performed at the patient*s convenience at their preferred place
and time on a computer or tablet. Both conditions will last approximately 45
minutes, three times a week during eight weeks.

Risks
During the study, the participant will be asked to come over to GGZ inGeest for
four times. First for intake and neuropsychological assessment. If no inclusion
> questionnaires (1.5 - 2 hours). second for explanation of the training, third
and fourth for post-training measurements. On voluntary basis participants are
asked to joing mirror sessions or feedback sessions to evaluate the training in
a group ow fewllow participants.
If possible the visits will be combined with appointments that where already
planned for regular care. If traveling is too much of a burden for the
participants, the screening, neuropsychological assessment and questionnaires
can take place at home. During the intervention, participants need to train for
45 minutes, three times a week during 8 weeks. This can either be the online
cognitive trainingprogram or a 'control' training. We think the risk
negligible. Based on a previous study we do even expect beneifts for the
partcipants.