A University of Utah lab has received a $7.5 million grant from the National Institute of Mental Health to conduct clinical trials for Neurogrow – a video game designed to treat mental illness. depression in the elderly.
Neurogrow invites players to tend a virtual garden with changing needs and conditions – targeting and strengthening the frontal circuits of the brain in depressed older adults. The game was developed by the Laboratory of Therapeutic Applications and Games in the United States based on research by Dr. Sarah Shizuko Morimoto, an associate professor in the Department of Population Health Sciences.
The $7.5 million grant will fund two clinical studies — one in the U.S. and one at the University of Connecticut. Researchers are currently facing a critical phase of testing to further evaluate the game’s effectiveness, thereby determining how it could be delivered in the future, including as a medical treatment. potential.
Morimoto and her team received the grant in April and began the clinical trial in August. She said receiving the grant marked a “coronary achievement” in her career.
“We are doing the medical work here,” said Roger Altizer, director of digital medicine at the Center for Health Innovation. “And it just happened with software instead of drugs.”
On the first try
Morimoto devoted more than a decade to explore how video games can revive damaged circuits in the frontal lobes that could block the effectiveness of antidepressants. She began working on the project in 2007 at the Weill Cornell Institute for Geriatric Psychiatry, run by Dr. George Alexopoulos, a leading researcher in the field of geriatric depression.
Morimoto says that the repair mechanisms in the brain that help people overcome depression can wear down as they age. Known as the “disuseful atrophy hypothesis,” the deterioration can be countered by targeting and rebuilding aging circuits.
Morimoto compared circuits in the brain to a telephone line. If the line is cut, it doesn’t matter what happens at both ends of the call: The line needs repair. Antidepressants can help improve a patient’s mood, but without the proper cognitive infrastructure, the medication loses its effectiveness.
“We come in artificially from the outside and make you exercise these parts of the brain,” says Morimoto.
In an initial clinical trial before Morimoto arrived in Utah, the game was tested with antidepressants with patients who had not responded to the medication before. According to Morimoto, between 60% and 70% of patients say the game provides at least some relief. She conducted another clinical trial, this time testing a game with a typically irritating computer program, and found that 60% to 70% of patients reported a 50% reduction in symptoms. depression.
Morimoto approaches aging as a brain disease and takes a targeted approach to help people stay functional and enjoy the rest of their lives.
“I hate it when people say it. “Oh, I’m rejuvenating your brain,” or, “We’ll make you young again,” says Morimoto. “That’s not what we’re doing. We’re strengthening your ability to use parts of your brain that have become less useful as you get older. “
Morimoto was conducting another clinical trial in the U.S. when COVID-19 shut down in March 2020. She stopped the trial to protect her patients and applied for a grant from the National Institutes of Mental Health. by the data obtained in that test.
Normally, a prescription molecule or a psychotherapy would be tested with a placebo and would stay the same throughout the clinical trial, but Morimoto knew that Neurogrow would have to be regularly updated to treat it. effective treatment for everyone.
“Ask the study reviewers to accept that we’re saying, ‘Hey, we want to test the effectiveness of this, but we’re not going to tell you exactly what it will end up like’ – it’s a difficult concept to get behind,” said Morimoto.
Morimoto wrote the request for funding “from the heart,” against the advice of several researchers she knew. In medical research, funding providers often ask researchers to update their methodology upon the first request for funding, Morimoto said. The National Institute of Mental Health approved Morimoto’s request for a 5-year stipend on her first attempt.
“We got it on the first try, it was super fun and also scary,” says Morimoto.
Morimoto received the news in October 2020 and is working with the University of Connecticut to conduct the trial at two sites, which means she won’t be able to oversee day-to-day operations at one site. important test of how effective Neurogrow is. self-treatment of the patient.
“For me, it was anxiety. Constant anxiety, because, you know, it’s my baby,” Morimoto said.
One of the hardest parts of implementing the program was training staff to fully explain how the game worked to patients who had never touched a video game before.
The trial at the University of Connecticut is being conducted by Dr. David Steffens, chair of the Department of Psychiatry at the School of Medicine, who Morimoto calls a world-renowned expert in geriatric psychiatry. Morimoto met Steffens after receiving an award from the American Academy of Geriatrics in 2008 during her time at Cornell, and he was her mentor for many years.
Morimoto hopes to one day administer the game in community clinics across the country, but she says she wants to make sure the game has been experimentally proven to help patients before it’s made available. grant.
How testing works
The Utah trial is underway at the Huntsman Institute of Mental Health, though patients can also participate remotely.
It starts with an initial cognitive test. The patient then undergoes a six-week clinical trial where they played Neurogrow and other included games for about 30 hours over the course of four weeks.
The patient then takes another cognitive test to see what has changed, if anything. Trial administrators then place follow-up calls over the next two weeks to see how the patients are doing, followed by three-month and one-year voluntary follow-up visits for patients who wish to do so. re-evaluated.
Game patients at the Huntsman Mental Health Institute are treated to “comfortable chairs and snacks,” Morimoto said. Those who prefer to play remotely will be given a tablet with the game installed and can Zoom with the admin as they play in case they have questions.
Morimoto hopes that at least 250 people will take part in the trial, but she notes that recruiting is challenging. Any older adult facing depression can call 801-746-9588 to be considered for the trial.
Previously, Morimoto had only tested Neurogrow on patients who were taking medication to treat depression, but the trial will also apply to people who are not taking the drug. Morimoto said her team will work with the patient’s doctor to monitor their progress and help them move forward once the trial is over.
“We really hope that we get as many people as we can to try this movie,” Morimoto said. “And, you know, they really have nothing to lose. There are really no side effects other than being a little frustrating from time to time. ”
The treatment is free for the patient. In fact, patients get reimbursed for the time they spend playing games and taking mood-rating tests, which amounts to about $250 for all six weeks of the test, Morimoto said.
She noted that her team is working with a language professor to translate the game into Spanish to reach more potential participants. The Spanish version of the game will be ready for testing within about six months.
“I would say that the majority of depression apps do not target the neurobiology of the disease,” says Morimoto. “They’re doing psychotherapy on the web or giving you cognitive or behavioral tools for you to use during the day… What we’re doing is like a completely different ball game.”
Morimoto says that most universities don’t have the resources to try to get Food and Drug Administration approval to market a game as a cure-all. She is grateful that the University of Utah has been “a special place” to develop Neurogrow.
Games as a medical treatment can also offer big savings for both patients and the healthcare system, Altizer said, noting that both he and Morimoto believe digital medicine ” will be the future”.
“Wouldn’t it be great if taking care of your health was fun?” Altizer said.
https://www.sltrib.com/news/education/2022/01/03/software-instead-pills/ Video game developed at University of Utah to treat depression receives $7.5 million grant