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Evaluating a cognitive training programme on tinnitus

A computer-based cognitive training program is associated with self-reported changes in attention, memory, and perception of tinnitus, found a small Washington University study.

Individuals with tinnitus have poorer working memory, slower processing speeds and reaction times and deficiencies in selective attention. Neuroplasticity (the brain’s ability to reorganise itself by forming new neural connections) has been the foundation for the creation of several cognitive enhancement programmes intended to slow normal ageing and potentially improve disorders such as attention deficits. Brain Fitness Program-Tinnitus (BFP-T) is a cognitive training programme specially designed to exploit neuroplasticity for preservation and expansion of cognitive health in adults with tinnitus.

Dr Jay F Piccirillo, of the Washington University School of Medicine in St Louis and colleagues randomly assigned 40 adults with bothersome tinnitus for more than 6 months and 20 age-matched healthy controls to a BFP-T or non-BFP-T control group.

Participants in the intervention group were required to complete the BFP-T online one hour per day, five days per week for eight weeks. The BFP-T contains 11 interactive training exercises (simple acoustic stimuli, continuous speech, and visual stimuli) in an attempt to address the attentional effect of tinnitus. Tinnitus assessment, neuroimaging, and cognitive testing were completed at baseline and 8 weeks later. The controls underwent neuroimaging and cognitive assessments.

The researchers found that patients with tinnitus in the BFP-T group had improvements in tinnitus perception, memory, attention, and concentration compared with patients in the non-BFP-T control group. Neuroimaging changes in brain systems responsible for attention and cognitive control were observed in patients who used the BFP-T. “A possible mechanistic explanation for these changes could be neuroplastic changes in key brain systems involved in cognitive control,” the authors write.

No changes in behavioural measures were observed between the two tinnitus study groups.

“We believe that continued research into the role of cognitive training rehabilitation programs is supported by the findings of this study, and the role of neuroplasticity seems to hold a prominent place in the future treatments for tinnitus,” the researchers write. “On the basis of our broad recruitment and enrolment strategies, we believe the results of this study are applicable to most patients with tinnitus who seek medical attention.”

Abstract
Importance: Individuals with tinnitus have poorer working memory, slower processing speeds and reaction times, and deficiencies in selective attention, all of which interfere with readiness and performance. Brain Fitness Program–Tinnitus (BFP-T) is a cognitive training program specially designed to exploit neuroplasticity for preservation and expansion of cognitive health in adults with tinnitus.
Objective: To evaluate the effect of the BFP-T on tinnitus.
Design, Setting, and Participants: This open-label, intention-to-treat randomized clinical trial prescreened 191 patients with tinnitus and 64 healthy controls (HCs) from June 1, 2012, through October 31, 2013. Participants were 40 adults with bothersome tinnitus for more than 6 months and 20 age-matched HCs. Patients with tinnitus were randomized to a BFP-T or non–BFP-T control group. The BFP-T was completed online, and assessments were completed at Washington University School of Medicine.
Interventions: Participants in the intervention group were required to complete the BFP-T online 1 hour per day 5 days per week for 8 weeks. Tinnitus assessment, neuroimaging, and cognitive testing were completed at baseline and 8 weeks later. The HCs underwent neuroimaging and cognitive assessments.
Main Outcomes and Measures: The primary outcome measure was the change in Tinnitus Handicap Inventory (THI) score. Behavioral measures, neuroimaging, and cognitive tests were performed before and after the intervention.
Results A total of 40 patients with tinnitus and 20 HCs participated in the study (median [range] age, 56 [35-64] years in the BFP-T group, 52 [24-64] years in the non–BFP-T group, and 50 [30-64] years in the HC group; 13 [65%] in the BFP-T group, 14 [70%] in the non–BFP-T group, and 13 [65%] in the HC group were males; and 16 [80%] in the BFP-T group, 16 [80%] in the non–BFP-T group, and 15 [75%] in the HC group were white). There was a reduction in the THI score in the BFP-T group (median, 7; range, −16 to 64) and non–BFP-T group (median, 11; range, −6 to 26), but this reduction was not significantly different between the 2 groups (median difference, 0; 95% CI, −10 to 8). There was no difference in cognitive test scores and other behavioral measures. There was a significant difference between baseline and follow-up in functional connectivity in cognitive control regions in the BFP-T group but not in HCs or individuals with untreated tinnitus. Of the 20 patients in the BFP-T group, 10 (50%) self-reported improvement attributable to the intervention, and 6 (30%) reported to be much improved in the domains of tinnitus, memory, attention, and concentration.
Conclusions and Relevance: These findings suggest that the computer-based cognitive training program is associated with self-reported changes in attention, memory, and perception of tinnitus. A possible mechanistic explanation for these changes could be neuroplastic changes in key brain systems involved in cognitive control. Cognitive training programs might have a role in the future treatment of patients with tinnitus.

Authors
Dorina Kallogjeri; Jay F Piccirillo; Edward Spitznagel Jr; Sandra Hale; Joyce E Nicklaus; Frances Mei Hardin; Joshua S Shimony; Rebecca S Coalson; Bradley L Schlaggar

[link url="http://media.jamanetwork.com/news-item/computer-based-cognitive-training-program-may-help-patients-with-severe-tinnitus/"]JAMA material[/link]
[link url="http://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2597598"]JAMA Ortolaryngology-Head & Neck Surgery abstract[/link]

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