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A preliminary study of the effects of working memory training on brain function

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Abstract

Working memory (WM) training improves WM ability in Attention-Deficit/Hyperactivity Disorder (ADHD), but its efficacy for non-cognitive ADHD impairments ADHD has been sharply debated. The purpose of this preliminary study was to characterize WM training-related changes in ADHD brain function and see if they were linked to clinical improvement. We examined 18 adolescents diagnosed with DSM-IV Combined-subtype ADHD before and after 25 sessions of WM training using a frequently employed approach (Cogmed™) using a nonverbal Sternberg WM fMRI task, neuropsychological tests, and participant- and parent-reports of ADHD symptom severity and associated functional impairment. Whole brain SPM8 analyses identified ADHD activation deficits compared to 18 non-ADHD control participants, then tested whether impaired ADHD frontoparietal brain activation would increase following WM training. Post hoc tests examined the relationships between neural changes and neurocognitive or clinical improvements. As predicted, WM training increased WM performance, ADHD clinical functioning, and WM-related ADHD brain activity in several frontal, parietal and temporal lobe regions. Increased left inferior frontal sulcus region activity was seen in all Encoding, Maintenance, and Retrieval Sternberg task phases. ADHD symptom severity improvements were most often positively correlated with activation gains in brain regions known to be engaged for WM-related executive processing; improvement of different symptom types had different neural correlates. The responsiveness of both amodal WM frontoparietal circuits and executive process-specific WM brain regions was altered by WM training. The latter might represent a promising, relatively unexplored treatment target for researchers seeking to optimize clinical response in ongoing ADHD WM training development efforts.

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Acknowledgments

This research was supported by R21HD061915 and by R01MH081969. Preliminary results were presented at the annual meeting of the Society for Biological Psychiatry in June 2013 in San Francisco, CA.

Financial disclosures

The investigators have no conflicts of interest to declare.

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Authors and Affiliations

  1. Olin Neuropsychiatry Research Center, The Institute of Living / Hartford Hospital, 200 Retreat Avenue, Whitehall Building, Hartford, CT, 06106, USA

    Michael C. Stevens, Alexandra Gaynor, Katie L. Bessette & Godfrey D. Pearlson

  2. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

    Michael C. Stevens & Godfrey D. Pearlson

Authors
  1. Michael C. Stevens
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  2. Alexandra Gaynor
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  3. Katie L. Bessette
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  4. Godfrey D. Pearlson
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Correspondence to Michael C. Stevens.

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Supplementary Figure 1

Brain regions activated during the Encoding, Maintenance, and Retrieval conditions of the Sternberg working memory fMRI task for all n = 36 ADHD and non-ADHD participants (p < 0.05 uncorrected). (GIF 2.94 mb)

High resolution image file (TIFF 10.3 mb)

Supplementary Figure 2

Parametric effect of WM load on activation in Encoding, Maintenance, and Retrieval conditions of the Sternberg working memory fMRI task for all n = 36 ADHD and non-ADHD participants (p < 0.05 uncorrected). (GIF 2.86 mb)

High resolution image file (TIFF 10.3 mb)

Supplementary Figure 3

Brain regions where training-related changes in the brain’s response to task difficulty (i.e., parametric effect of WM load) correlated with improvement in the Cogmed Training change (p < 0.05 clusterwise significance threshold). (GIF 1.63 mb)

High resolution image file (TIFF 6.99 mb)

Tables S1-3

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Stevens, M.C., Gaynor, A., Bessette, K.L. et al. A preliminary study of the effects of working memory training on brain function. Brain Imaging and Behavior 10, 387–407 (2016). https://doi.org/10.1007/s11682-015-9416-2

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