Speed of Processing Training to Improve Cognitive Functioning and Driving Performance in Head and Neck Cancer Survivors

If participants agree to participate in the study by signing the informed consent, participants will be randomly assigned (similar to flipping a coin) to one of the two video game cognitive exercise groups. The only difference between these two groups is the intensity of training on reaction time to video game events.

participants will complete questionnaires (socio-demographic information, four short cognitive assessments) and a driving assessment using a high-fidelity motion-based virtual reality driving simulator in the UAB Driver Simulation Lab at baseline. After completing the baseline cognitive and driving evaluations, participants will receive an electronic tablet loaded with access to the assigned video game program and a workbook with instructions and explanations. A staff member will assist participants in logging in, demonstrate the video game cognitive exercises, and show participants how to play a trial game session.

At home, participants will complete 30-minute video game-based cognitive exercises twice weekly for 10 weeks (20 sessions, totaling 10 hours). The software will automatically record the actual session duration. One week after the baseline appointment, the staff will contact participants to address any technical problems. The staff will then contact participants monthly to monitor progress and answer study-related questions.

After the 10-week video game cognitive exercise program, participants will be invited to the UAB Driver Simulation Lab to complete the four short cognitive assessments and a driving assessment as participants did 10 weeks ago.

Inclusion criteria

• confirmed HNC diagnosis
• aged ≥ 18 years of all racial, ethnic, and sex/gender categories
• ≥ 6 months post radiation or chemoradiation
• self-reported CRCI, defined as a score of ≥ 60 in the FACT-Cog Perceived Cognitive Impairment subscale
• thyroid-stimulating hormone levels within normal limits
• visual acuity of at least 20/40 using a Snellen eye chart
• functional peripheral vision as indicated by the confrontation field test
• functional hearing sufficient to engage in daily conversation in English for ≥ 15 minutes
• intact lower extremity function (Rapid Pace Walk test ≤ 9 sec)
• stable home internet
• sufficient English proficiency to read and understand informed consent materials

Exclusion criteria

• significant neurologic or psychiatric comorbidities, including psychotic disorders, bipolar disorders, Alzheimer's disease or related dementias, developmental disorders, seizure disorders, vestibular disorders, prior brain tumor or brain surgery, or poorly controlled metabolic disease
• current use of antipsychotic or mood-stabilizing medications due to potential effects on driving performance
• anticipated life expectancy of < 6 months based on physician prognosis.