Training-induced white matter microstructure changes in survivors of neonatal critical illness: A randomized controlled trial

• Published in: Developmental cognitive neuroscience Vol. 38; p. 100678
• Main Authors: Schiller, Raisa M., IJsselstijn, Hanneke, Madderom, Marlous J., van Rosmalen, Joost, van Heijst, Arno F.J., Smits, Marion, Verhulst, Frank, Tibboel, Dick, White, Tonya
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.08.2019; Elsevier
• Subjects: Adolescent; Anisotropy; Child; Cognitive remediation; Critical care outcomes; Critical Illness - therapy; Diffusion tensor imaging; Diffusion Tensor Imaging - methods; Diffusion Tensor Imaging - trends; Female; Humans; Infant, Newborn; Learning - physiology; Male; Memory; Memory, Short-Term - physiology; Neurodevelopmental disorders; Neuroimaging; Neuronal Plasticity - physiology; Neuropsychology; Original Research; Survivors; White Matter - diagnostic imaging; White Matter - physiology; Neuroimaging; Cognitive remediation; Memory; Critical care outcomes; Neuropsychology; Neurodevelopmental disorders; Diffusion tensor imaging
• ISSN: 1878-9293; 1878-9307
• DOI: 10.1016/j.dcn.2019.100678

•Neurodevelopment is malleable with Cogmed in neonatal critical illness survivors.•Global and specific changes in white matter microstructure immediately post-Cogmed.•Increased FA in the SLF was associated with better verbal working-memory post-Cogmed. In a nationwide randomized controlled trial, white matter microstructure was assessed before and immediately after Cogmed Working-Memory Training (CWMT) in school-age neonatal critical illness survivors. Eligible participants were survivors (8–12 years) with an IQ ≥ 80 and a z-score of ≤ −1.5 on (working)memory test at first assessment. Diffusion Tensor Imaging was used to assess white matter microstructure. Associations between any training-induced changes and improved neuropsychological outcome immediately and one year post-CWMT were evaluated as well. The trial was conducted between October 2014–June 2017 at Erasmus MC-Sophia, Rotterdam, Netherlands. Researchers involved were blinded to group allocation. Participants were randomized to CWMT(n = 14) or no-intervention(n = 20). All children completed the CWMT. Global fractional anisotropy(FA) increased significantly post-CWMT compared to no-intervention(estimated-coefficient = .007, p = .015). Increased FA(estimated coefficient = .009, p = .033) and decreased mean diffusivity(estimated-coefficient = −.010, p = .018) were found in the left superior longitudinal fasciculus(SFL) post-CWMT compared no-intervention. Children after CWMT who improved with >1SD on verbal working-memory had significantly higher FA in the left SLF post-CWMT(n = 6; improvement = .408 ± .01) than children without this improvement post-CWMT(n = 6; no-improvement = .384 ± .02), F(1,12) = 6.22, p = .041, ηp2 = .47. No other structure-function relationships were found post-CWMT. Our findings demonstrate that white matter microstructure and associated cognitive outcomes are malleable by CWMT in survivors of neonatal critical illness.