Video game-based intervention improves attention, cognition in major depression

An investigational digital intervention delivered through a video game–based interface, called AKL-T03, significantly improves attention span and cognitive functioning among patients with major depression when compared to a control condition, a study has shown. In addition, it is well tolerated and has minimal adverse events.

“AKL-T03 is a safe digital intervention that is effective in the treatment of cognitive impairment associated with major depression,” the researchers said.

“The digital nature of the intervention could help to increase access for patients who otherwise might not find a solution for their depression-related cognitive difficulties,” they added.

AKL-T03 was designed to target the fronto-parietal network to enhance functional domains for attentional control. The researchers tested the intervention in adults aged 25‒55 years on a stable antidepressant medication regimen with residual mild to moderate depression and an objective impairment in cognition, as measured by the symbol coding test.

Participants were randomly assigned to either AKL-T03 or an expectation-matched digital control intervention. They were evaluated at baseline and after completion of the 6-week at-home intervention. Improvement in sustained attention, as measured by the Test of Variables of Attention (TOVA), was the primary outcome measure.

Treatment with AKL-T03 resulted in a statistically significant medium-effect size improvement in sustained attention relative to the control intervention on the TOVA primary outcome (partial eta-squared=0.11). [Am J Psychiatry 2022;doi:10.1176/appi.ajp.21020125]

A composite score derived from all cognitive measures also showed significant improvement with AKL-T03 compared with the control condition.

Secondary outcomes

In terms of individual secondary and exploratory outcome measures targeting a variety of cognitive domains, including working memory, processing speed, task switching, depressive symptoms, and subjective cognitive symptoms and quality of life, AKL-T03 was not superior to control intervention.

In addition, serious adverse events were not recorded, but two patients (5.5 percent) in the AKL-T03 group experienced an intervention-related headache.

“Post hoc analysis indicated a significant difference between interventions on a general composite measure of cognition in favour of AKL-T03, although this result should be interpreted with caution as it may be driven by the improvement in sustained attention,” the researchers said.

These findings support those of earlier studies that involved different age groups with a variety of inclusion criteria. Moreover, both interventions were well tolerated. [Depress Anxiety 2017;34:508-517; Transl Psychiatry 2021;11:269]

Cognitive impairments

Of note, patients with depressive episodes and those who have recovered from such often complain of cognitive impairments. This impairment contributes to weakened psychosocial functioning and a higher rate of relapse, even beyond the effect of depressive symptoms. [Psych Res 2006;145:39-48; Psychol Med 2004;34:1453-1463; CNS Neurol Disord Drug Targets 2014;13:1804-1818; Ann Gen Psychiatry 2015;14:27; Can J Psychiatry 2014;59:649-654; CNS Drugs 2015;29:577-589]

“AKL-T03 shows promise for reducing cognitive impairment during a current episode of depression,” the researchers said.

“Further research looking at longitudinal data and durability of effect is needed to confirm the hypothesis that cognitive improvements may have an impact on functional outcomes and potentially on future relapses,” they added.