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Evaluating depressive symptoms, BDNF Val66Met, and APOE-ε4 as moderators of response to computerized cognitive
Susan J Pressler1, Miyeon Jung1, Bruno Giordani2
1Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States.
Insights
This study found that depressive symptoms, BDNF Val66Met, and APOE-ε4 did not moderate computerized cognitive training (CCT) response in heart failure (HF) patients. Further research is needed to understand cognitive dysfunction in HF.
Area of Science:
- Cardiology
- Neurology
- Psychiatry
Background:
- Heart failure (HF) patients may experience cognitive dysfunction.
- Depressive symptoms, brain-derived neurotrophic factor (BDNF) Val66Met, and apolipoprotein (APOE)-ε4 are potential moderators of intervention response.
- Computerized cognitive training (CCT) is a potential intervention for cognitive deficits in HF.
Purpose of the Study:
- To examine moderators of intervention response to CCT over 8 months in HF patients.
- To assess the impact of CCT on memory, serum BDNF, working memory, instrumental activities of daily living (IADLs), and health-related quality of life (HRQL).
Main Methods:
- A 3-arm randomized controlled trial involving 256 HF patients.
- Intervention groups included CCT, a computerized crossword puzzle active control, and usual care.
- Mixed-effects models were used to evaluate moderators over 8 months.
Main Results:
- No statistically significant group-by-time effects were observed for any outcome across the three groups.
- Depressive symptoms, BDNF Val66Met, and APOE-ε4 were not significant moderators of intervention response.
- Post hoc analyses found no significant moderation by baseline global cognitive function, gender, age, or HF severity, though HF severity was imbalanced.
Conclusions:
- Current CCT interventions did not show significant moderation by the studied factors in HF patients.
- Further research is needed to elucidate biological mechanisms of cognitive dysfunction in HF.
- Novel interventions and stratification by HF severity may be necessary for future trials.
Background:
Depressive symptoms, brain-derived neurotrophic factor (BDNF) Val66Met, and apolipoprotein (APOE)-ε4 may moderate response to computerized cognitive training (CCT) interventions among patients with heart failure (HF).
Objectives:
The purpose of this study was to examine moderators of intervention response to CCT over 8 months among patients with HF enrolled in a 3-arm randomized controlled trial. Outcomes were memory, serum BDNF, working memory, instrumental activities of daily living (IADLs), and health-related quality of life (HRQL).
Methods:
256 patients with HF were randomized to CCT, computerized crossword puzzles active control, and usual care control groups for 8 weeks. Data were collected at enrollment, baseline, 10 weeks, and 4 and 8 months. Mixed effects models were computed to evaluate moderators.
Results:
As previously reported, there were no statistically significant group by time effects in outcomes among the 3 groups over 8 months. Tests of moderation indicated that depressive symptoms and presence of BDNF Val66Met and APOE-ε4 were not statistically significant moderators of intervention response in outcomes of delayed recall memory, serum BDNF, working memory, IADLs, and HRQL. In post hoc analysis evaluating baseline global cognitive function, gender, age, and HF severity as moderators, no significant effects were found. HF severity was imbalanced among groups (P = .049) which may have influenced results.
Conclusions:
Studies are needed to elucidate biological mechanisms of cognitive dysfunction in HF and test novel interventions to improve memory, serum BDNF, working memory, IADLs and HRQL. Patients may need to be stratified or randomized by HF severity within intervention trials.
