title: Cognitive Training for Adults With Bothersome Tinnitus: A Randomized Clinical Trial.
abstract: Individuals with tinnitus have poorer working memory, slower processing speeds and reaction times, and deficiencies in selective attention, all of which interfere with readiness and performance. Brain Fitness Program-Tinnitus (BFP-T) is a cognitive training program specially designed to exploit neuroplasticity for preservation and expansion of cognitive health in adults with tinnitus.
  
  
  
  To evaluate the effect of the BFP-T on tinnitus.
  
  
  
  This open-label, intention-to-treat randomized clinical trial prescreened 191 patients with tinnitus and 64 healthy controls (HCs) from June 1, 2012, through October 31, 2013. Participants were 40 adults with bothersome tinnitus for more than 6 months and 20 age-matched HCs. Patients with tinnitus were randomized to a BFP-T or non-BFP-T control group. The BFP-T was completed online, and assessments were completed at Washington University School of Medicine.
  
  
  
  Participants in the intervention group were required to complete the BFP-T online 1 hour per day 5 days per week for 8 weeks. Tinnitus assessment, neuroimaging, and cognitive testing were completed at baseline and 8 weeks later. The HCs underwent neuroimaging and cognitive assessments.
  
  
  
  The primary outcome measure was the change in Tinnitus Handicap Inventory (THI) score. Behavioral measures, neuroimaging, and cognitive tests were performed before and after the intervention.
  
  
  
  A total of 40 patients with tinnitus and 20 HCs participated in the study (median [range] age, 56 [35-64] years in the BFP-T group, 52 [24-64] years in the non-BFP-T group, and 50 [30-64] years in the HC group; 13 [65%] in the BFP-T group, 14 [70%] in the non-BFP-T group, and 13 [65%] in the HC group were males; and 16 [80%] in the BFP-T group, 16 [80%] in the non-BFP-T group, and 15 [75%] in the HC group were white). There was a reduction in the THI score in the BFP-T group (median, 7; range, -16 to 64) and non-BFP-T group (median, 11; range, -6 to 26), but this reduction was not significantly different between the 2 groups (median difference, 0; 95% CI, -10 to 8). There was no difference in cognitive test scores and other behavioral measures. There was a significant difference between baseline and follow-up in functional connectivity in cognitive control regions in the BFP-T group but not in HCs or individuals with untreated tinnitus. Of the 20 patients in the BFP-T group, 10 (50%) self-reported improvement attributable to the intervention, and 6 (30%) reported to be much improved in the domains of tinnitus, memory, attention, and concentration.
  
  
  
  These findings suggest that the computer-based cognitive training program is associated with self-reported changes in attention, memory, and perception of tinnitus. A possible mechanistic explanation for these changes could be neuroplastic changes in key brain systems involved in cognitive control. Cognitive training programs might have a role in the future treatment of patients with tinnitus.
  
  
  
  clinicaltrials.gov Identifier: NCT01458821.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri2Statistics Editor, JAMA Otolaryngology-Head & Neck Surgery.
authors.forename: Dorina
authors.initials: D
authors.lastname: Kallogjeri
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri3Editor, JAMA Otolaryngology-Head & Neck Surgery.
authors.forename: Jay F
authors.initials: JF
authors.lastname: Piccirillo
authors.affiliation: Department of Mathematics, Washington University in St Louis, St Louis, Missouri.
authors.forename: Edward
authors.initials: E
authors.lastname: Spitznagel
authors.affiliation: Department of Psychology, Washington University in St Louis, St Louis, Missouri.
authors.forename: Sandra
authors.initials: S
authors.lastname: Hale
authors.affiliation: AbbVie Clinical Pharmacology Research Unit, Global Pharmaceutical R&D, Grayslake, Illinois.
authors.forename: Joyce E
authors.initials: JE
authors.lastname: Nicklaus
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Frances Mei
authors.initials: FM
authors.lastname: Hardin
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis, St Louis, Missouri.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Shimony
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis, St Louis, Missouri9Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Coalson
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis, St Louis, Missouri9Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri10Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri11Department of Neuroscience, Washington University School of Medicine in St Louis, St Louis, Missouri12Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri.
authors.forename: Bradley L
authors.initials: BL
authors.lastname: Schlaggar
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D009473:Neuronal Plasticity; D014012:Tinnitus / Q000628:therapy*; D016896:Treatment Outcome