Cognitive dysfunction, psychiatric symptoms, functional impairment, and disabilityfollowing COVID-19 negatively impact Veterans' community functioning and quality of life,contribute to significant human suffering, and are costly to VHA. Rehabilitation is acritical priority for Veterans with long COVID. One promising treatment to improvefunctioning in Veterans with post-COVID-19 cognitive symptoms is Compensatory CognitiveTraining (CCT). Previous studies have found that CCT is feasible, acceptable, andefficacious in Veteran populations with multiple sources of cognitive dysfunction. Thisrandomized controlled trial aims to address important RR&D priorities by examiningfeasibility, acceptability, and preliminary efficacy of a COVID-19-specificrehabilitation intervention, CCT for long COVID (CCT-C) compared to a robust controlcondition. The proposed study has the potential to improve cognitive function, functionalindependence, and quality of life for Veterans with late or delayed effects of secondaryconditions related to COVID-19 infections.
2-8% of the US population report "long COVID" symptoms - including "brain fog," thinking
difficulties, memory problems, and psychiatric symptoms such as sleep disturbance,
anxiety, and depression. Rates of post-COVID-19 symptoms are nearly double in the Veteran
population. These cognitive symptoms contribute to functional impairments, reduced
quality of life, poorer self-reported health status, psychological distress, delayed
return to work, new onset disability, reduced community integration, and increased
healthcare utilization. One promising treatment to improve both everyday functioning and
cognition secondary to post-COVID-19 symptoms is Compensatory Cognitive Training (CCT).
Previous studies have found that CCT is feasible, acceptable, and efficacious in Veteran
populations with multiple sources of cognitive dysfunction. The proposed CDA provides a
golden opportunity to evaluate CCT for Veterans with prolonged COVID-19 symptoms (CCT-C),
compared with a robust control condition, Holistic Cognitive Education (HCE). The project
closely aligns with current RR&D priorities, by "examining COVID-19-specific
rehabilitation interventions and responses to treatment" and by addressing "late or
delayed effects of secondary conditions related to COVID-19 infections on impairment and
disability." Specific aims are 1) to conduct a pilot randomized controlled trial of
remote CCT-C with 70 Veterans (35 CCT-C, 35 HCE) with post-COVID-19 cognitive symptoms to
examine feasibility, acceptability, and initial efficacy; 2) to examine the preliminary
efficacy of CCT-C in this population on overall functioning, as measured by the World
Health Organization's Disability Assessment Schedule (WHODAS 2.0), performance-based
measures of functional capacity, and secondary outcomes (cognitive performance, quality
of life, self-reported cognitive problems, psychiatric symptoms, sleep disturbance, and
engagement in work/community activities); and 3) to explore moderators of outcome (e.g.,
age, initial COVID-19 severity, baseline cognitive functioning, presence of PTSD/mTBI
history; biomarkers related to COVID-19 infection).
Behavioral: Compensatory Cognitive Training for COVID-19
CCT-C is a manualized group-based behavioral intervention (10 weeks, 2 hours per week, 20
hours total) designed to improve cognition and everyday functioning in patients with
prolonged COVID-19 symptoms
Other Name: CCT-C
Behavioral: Holistic Cognitive Education
HCE provides the same frequency and amount of therapist and other group member contact as
CCT-C, but does not provide training in cognitive or lifestyle strategies addressed in
CCT-C. The HCE intervention provides information and discussion regarding common causes
of and treatments for cognitive impairment.
Other Name: HCE
Inclusion Criteria:
- Veterans > 18 years old who are able to provide informed consent
- Prior participation in SF Parent Study or LA Parent Study
- Report of cognitive symptoms that Veteran attributes to COVID-19 infection
Exclusion Criteria:
- Current substance abuse disorder, psychotic disorder, dementia, etc.
- History of moderate to severe brain injury with loss of consciousness > 30 minutes
- Auditory or visual impairments that would prevent the ability to participate in
assessment procedures
- Invalid performance on one or more embedded performance validity tests (PVTs)
VA San Diego Healthcare System, San Diego, CA
San Diego, California, United States
Tara A Austin, AA, Principal Investigator
VA San Diego Healthcare System, San Diego, CA