Abstract Details

Title Long COVID Brain Fog Treatment: Feasibility Metrics from An Early-phase Randomized Controlled Trial of Constraint-Induced Cognitive Therapy

Topic Infectious Disease

Presentation(s) S19 - Navigating Neuroinfectious Diseases (4:06 PM-4:18 PM)

Poster/Presentation
Number 004

Objective

This study’s objectives were to evaluate the feasibility of a new rehabilitation approach, Constraint-Induced Cognitive Therapy (CICT), for post-COVID-19 cognitive sequelae.

Background

Brain fog which is a common symptom of Long COVID, can be disabling. It is characterized by impairments in processing speed, executive function, and memory encoding on neuropsychological testing. CICT is a new rehabilitation method that has shown promising results in stroke survivors with mild-to-moderate cognitive impairment. CICT combines two interventions: Speed of Processing Training and a modified version of the Transfer Package of Constraint-Induced Movement Therapy focused on cognition.

Design/Methods

Community-residents ≥ 3-months post-COVID-19 infection with mild cognitive impairment and dysfunction in instrumental activities of daily living (IADL) were enrolled. Individuals with pre-existing conditions like dementia, traumatic brain injury, stroke, severe depression or frailty were excluded. Sixteen participants were randomized to Immediate-CICT or treatment-as-usual (TAU) with crossover to CICT. CICT was deemed feasible if (a) ≥80% of participants were adherent, (b) the same found treatment highly satisfying and at most moderately difficult, and (c) <2 study-related, serious adverse-events occurred. The primary outcome was IADL performance in daily life (Canadian Occupational Performance Measure). Employment status and brain fog (Mental Clutter Scale) were also assessed.

Results

Fourteen completed Immediate-CICT (n=7) or TAU (n=7); two withdrew from TAU before their second testing session. Completers were [M (SD)]: 10 (7) months post-COVID; 51 (13) years old; 10 females, 4 males; 1 African American, 13 European American. All the feasibility benchmarks were met. Immediate-CICT, relative to TAU, produced very large improvements in IADL performance (M=3.7 points, p<.001, d=2.6) and brain fog (M=-4 points, p<.001, d=-2.9). Four of five non-retired Immediate-CICT participants returned-to-work post-treatment; no TAU participants did, p=.048.

Conclusions

CICT recipients adhered to the protocol and were highly satisfied with their outcomes. Further study of CICT in Long COVID is warranted.

Authors/Disclosures
Shruti P. Agnihotri, MD PRESENTER	An immediate family member of Dr. Agnihotri has stock in Pfizer. The institution of Dr. Agnihotri has received research support from Roche/ Genentech.
Gitendra Uswatte, PhD	Prof. Uswatte has stock in GE. Prof. Uswatte has stock in Several companies. For example I won stock in Google. I am sure they have some health care products but I have no idea for certain or what they. That's probably true of every stock I own.. The institution of Prof. Uswatte has received research support from NIH. The institution of Prof. Uswatte has received research support from NIDILRR.
Karlene K. Ball, PhD	Dr. Ball has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Posit Science. Dr. Ball has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Posit Science. Dr. Ball has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Ageing and Longevity. Dr. Ball has stock in Visual Awareness Research Group. Dr. Ball has received intellectual property interests from a discovery or technology relating to health care.
Brandon Mitchell, BS	Mr. Mitchell has nothing to disclose.
Jason A. Blake, MA	Mr. Blake has nothing to disclose.
Staci Mckay, BS	Mrs. Mckay has nothing to disclose.
Fedora Biney, PhD	The institution of Dr. Biney has received research support from NIH.
Olesya Iosipchuk, BS	Ms. Iosipchuk has nothing to disclose.
Piper Hempfling, MBS	Ms. Hempfling has nothing to disclose.
Elise M. Harris, MSL	Mrs. Harris has nothing to disclose.
Anne E. Dickerson, PhD, Occupational Therapist	Dr. Dickerson has nothing to disclose.
Kristine Lokken, PhD	Dr. Lokken has nothing to disclose.
Amy J. Knight, PhD	Dr. Knight has nothing to disclose.
Victor W. Mark, MD (Univ Alabama-Birmingham)	Dr. Mark has nothing to disclose.
Gary R. Cutter, PhD (University of Alabama At Birmingham)	Dr. Cutter has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for onsulting or Advisory Boards: Alexion, Antisense Therapeutics/Percheron, Avotres, Biogen, Clene Nanomedicine, Clinical Trial Solutions LLC, Endra Life Sciences, Cognito Therapeutics, Genzyme, Genentech, Immunic, Klein-Buendel Incorporated, Kyverna Therapeutics, Inc. , Linical, Merck/Serono, Noema, Neurogenesis, Perception Neurosciences, Protalix Biotherapeutics, Regeneron, Revelstone Consulting, Roche, SAB Biotherapeutics, Sapience Therapeutics, Scott&Scott LLP, Tenmile.. Dr. Cutter has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Data and Safety Monitoring Boards: Applied Therapeutics, AI therapeutics, AMO Pharma, Argenx, Astra-Zeneca, Avexis Pharmaceuticals, Bristol Meyers Squibb, CSL Behring, Cynata Therapeutics, DiamedicaTherapeutics, Horizon Pharmaceuticals, Immunic, Inhibrix, Karuna Therapeutics, Kezar Life Sciences, Medtronic, Merck, Meiji Seika Pharma, Mitsubishi Tanabe Pharma Holdings, Prothena Biosciences, Novartis, Pipeline Therapeutics (Contineum), Regeneron, Sanofi-Aventis, Teva Pharmaceuticals, United BioSource LLC, University of Texas Southwestern.. Dr. Cutter has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JASN.

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