A Randomized Controlled Trial of Working Memory Training in Pediatric Sickle Cell Disease

Objective Youth with sickle cell disease (SCD) are at risk for neurocognitive deficits including problems with working memory (WM), but few interventions to improve functioning exist. This study sought to determine the feasibility and efficacy of home-based, digital WM training on short-term memory and WM, behavioral outcomes, and academic fluency using a parallel group randomized controlled trial design. Methods 47 children (7-16 years) with SCD and short-term memory or WM difficulties were randomized to Cogmed Working Memory Training at home on a tablet device (N= 24) or to a standard care Waitlist group (N= 23) that used Cogmed after the waiting period. Primary outcomes assessed in clinic included performance on verbal and nonverbal short-term memory and WM tasks. Secondary outcomes included parent-rated executive functioning and tests of math and reading fluency. Results In the evaluable sample, the Cogmed group (N= 21) showed greater improvement in visual WM compared with the Waitlist group (N=22; p = .03, d= 0.70 [CI95 = 0.08, 1.31]). When examining a combined sample of participants, those who completed >= 10 training sessions exhibited significant improvements in verbal short-term memory, visual WM, and math fluency. Adherence to Cogmed was lower than expected (M= 9.07 sessions, SD =7.77), with 19 participants (41%) completing at least 10 sessions. Conclusions: Visual WM, an ability commonly affected by SCD, is modifiable with cognitive training. Benefits extended to verbal short-term memory and math fluency when patients completed a sufficient training dose. Additional research is needed to identify ideal candidates for training and determine whether training gains are sustainable and generalize to real-world outcomes.

Automated summary

This study investigated the feasibility and efficacy of home-based, digital working memory training on youth with sickle cell disease. Results showed that visual working memory can be improved with cognitive training, and benefits extended to verbal short-term memory and math fluency with sufficient training dose. Further research is needed to identify ideal candidates for training and determine the sustainability and generalizability of training gains to real-world outcomes.