The Benefits and Challenges of Implementing Motivational Features to Boost Cognitive Training Outcome

A multimodal group-based immersive virtual reality intervention for improving cognition and mental health in patients with post-covid-19 condition. A quasi-experimental design study

Introduction

Adults with Post-COVID-19 Condition (PCC) may show cognitive impairments in attention, processing speed, memory, and executive function. Multimodal programs that combine cognitive training, physical activity and emotional tasks, such as mindfulness-based interventions (MBIs), may offer a suitable alternative for improving PCC treatments. Immersive Virtual Reality (IVR) is a promising technology that can enhance traditional cognitive training, physical activity, and MBIs. The use of IVR technology may increase engagement with these interventions and potentially enhance the individual benefits of cognitive training, exercise and MBIs. The current study evaluated the impact of a multimodal IVR intervention, comparing this with a usual care intervention (control group), in order to assess changes in cognition and mental health in adults with PCC. We also aimed to assess user experience factors such as enjoyment, perceived improvement, and fatigue following each multimodal IVR session within the experimental group.

Method

Thirty-one participants with PCC symptoms were assigned to either the experimental group (IVR, n = 15) or the control group (usual care intervention, n = 16) in a quasi-experimental design study. The multimodal IVR intervention consisted of MBI, cognitive training and physical exercise and was delivered in a 60-min group session with 5 participants, twice a week, for 8 weeks (16 sessions in total). Measures of global cognition, attention, processing speed, verbal episodic memory and subjective memory complaints (primary measures), and depressive and anxiety symptoms and fatigue (secondary measures) were assessed at baseline and also after 8 weeks (post-intervention).

Results

Mixed between-group (group) and within-group (pre-post assessments) ANOVAs revealed significant group*time interactions in global cognition, simple attention, processing speed, memory and depressive symptoms, with large effect sizes (p < 0.05; partial η2 > 0.14). There was also a marginally significant group*time interaction for executive function (p = 0.05). Follow-up analyses comparing pre-and post-intervention outcomes for each group separately showed that the experimental group significantly improved in global cognition, processing speed, memory and depressive symptoms, while the control group showed no significant pre-post changes. Friedman tests showed a significant main effect of time (χ2(2) = 6.609, p = 0.04), with a gradual increase in enjoyment from the first, to the mid, and then to the final session. In addition, perceived improvement scores remained high throughout the intervention, and patient-reported fatigue levels did not fluctuate significantly throughout the intervention.

Conclusion

To our knowledge, no previous research has combined cognitive training, physical exercise and MBI using an IVR paradigm in adults with PCC. Despite their inherent limitations, our findings mark a pioneering step toward improving cognition and mental health outcomes in PCC through the innovative use of new technology and multimodal approaches. This first study should be accompanied by more extensive, randomized clinical trials aimed at further exploring and refining these interventions.

The Effects of Secondary Task Demands on Cybersickness in Active Exploration Virtual Reality Experiences

Active exploration in virtual reality (VR) involves users navigating immersive virtual environments, going from one place to another. While navigating, users often engage in secondary tasks that require attentional resources, as in the case of distracted driving. Inspired by research generally studying the effects of task demands on cybersickness (CS), we investigated how the attentional demands specifically associated with secondary tasks performed during exploration affect CS. Downstream of this, we studied how increased attentional demands from secondary tasks affect spatial memory and navigational performance. We discuss the results of a multi-factorial between-subjects study, manipulating a secondary task's demand across two levels and studying its effects on CS in two different sickness-inducing levels of an exploration experience. The secondary task's demand was manipulated by parametrically varying $n$ in an aural $n$-back working memory task and the provocativeness of the experience was manipulated by varying how frequently users experienced a yaw-rotational reorientation effect during the exploration. Results revealed that increases in the secondary task's demand increased sickness levels, also resulting in a higher temporal onset rate, especially when the experience was not already highly sickening. Increased attentional demand from the secondary task also vitiated navigational performance and spatial memory. Overall, increased demands from secondary tasks performed during navigation produce deleterious effects on the VR experience.

Treatment Response Following Adaptive PASAT Training for Depression Vulnerability: a Systematic Review and Meta-Analysis

In recent years, cognitive control training (CCT) has gained momentum as an intervention to remediate cognitive impairments and decrease depressive symptoms. One promising operationalization to train cognitive control is the adaptive Paced Auditory Serial Addition Task (aPASAT). In this systematic review and meta-analysis of aPASAT training, the efficacy of the intervention and potential moderators were examined. The PsycINFO, MEDLINE, Embase, Web of Science and Cochrane Library electronic databases were searched for studies examining aPASAT training for depressive symptomatology or rumination. Nineteen studies (n = 1255) were included, comprising of depressed patients, remitted depressed patients, at-risk, and healthy participants. We found small significant effects directly after training for both depressive symptomatology and rumination, with similar effect sizes at follow-up. Subgroup analyses suggest a significantly higher mean effect of aPASAT training in non-healthy populations for rumination immediately following training, but not for depressive symptomatology. The amount of training sessions did not moderate effects of CCT. aPASAT has a small but significant effect on depressive symptoms, with direct effects immediately after training, as well as sustained long-term effects. It is currently unclear how many sessions are required for sustained effects due to heterogeneity in training dosage and absence of sufficient trials. Our results suggest that aPASAT training may be most effective for at-risk, remitted- and clinically depressed populations. The effect sizes resulting from this meta-analysis could be used to adequately power future research, which could investigate a dose-response relationship and examine potential treatment gains when combining CCT with other antidepressant interventions.

The relation between effortful control and executive function training in preschoolers

In recent years, the question of whether executive function (EF) is malleable has been widely documented. Despite using the same training tasks, transfer effects remain uncertain. Researchers suggested that the inconsistency might be attributed to individual differences in temperamental traits. In the current study, we investigated how effortful control, a temperamental trait, would affect EF training outcomes in children. Based on parent rating, 79 6-year-old preschoolers were identified as having higher or lower effort control and were assigned to three conditions: working memory (WM) training, inhibitory control (IC) training, and a business-as-usual control group. Children completed assessments at baseline, 1 week after intervention (posttest), and 3 months after intervention (follow-up). As compared with the control group, the WM and IC training groups showed improvement in both trained tasks and nontrained measures. At baseline, children with higher effortful control scores showed greater WM capacity and better IC. Furthermore, effortful control was positively correlated with training gain in both training groups, with children with higher effortful control benefitting more through training. In the WM training group, effortful control was positively correlated with near transfer on WM outcomes both immediately and longitudinally. At posttest, the WM and IC training groups showed a positive correlation between effortful control and fluid intelligence performance. Our results underscore the importance of individual differences in training benefits, in particular the role of effortful control, and further illustrate the potential avenues for designing more effective individualized cognitive training programs to foster learning and optimize children's development.

Investigating the Role of Individual Differences in Adherence to Cognitive Training

Consistent with research across several domains, intervention adherence is associated with desired outcomes. Our study investigates adherence, defined by participants' commitment to, persistence with, and compliance with an intervention's regimen, as a key mechanism underlying cognitive training effectiveness. We examine this relationship in a large and diverse sample comprising 4,775 adults between the ages of 18 and 93. We test the predictive validity of individual difference factors, such as age, gender, cognitive capability (i.e., fluid reasoning and working memory), grit, ambition, personality, self-perceived cognitive failures, socioeconomic status, exercise, and education on commitment to and persistence with a 20-session cognitive training regimen, as measured by the number of sessions completed. Additionally, we test the relationship between compliance measures: (i) spacing between training sessions, as measured by the average time between training sessions, and (ii) consistency in the training schedule, as measured by the variance in time between training sessions, with performance trajectories on the training task. Our data suggest that none of these factors reliably predict commitment to, persistence with, or compliance with cognitive training. Nevertheless, the lack of evidence from the large and representative sample extends the knowledge from previous research exploring limited, heterogenous samples, characterized by older adult populations. The absence of reliable predictors for commitment, persistence, and compliance in cognitive training suggests that nomothetic factors may affect program adherence. Future research will be well served to examine diverse approaches to increasing motivation in cognitive training to improve program evaluation and reconcile the inconsistency in findings across the field.

EngAge - A metacognitive intervention to supplement working memory training: A feasibility study in older adults

Working Memory (WM) training has shown promise in supporting cognitive functioning in older adult populations, but effects that generalize beyond the trained task have been inconsistent. Targeting cognitive processes in isolation might be a limiting factor given that metacognitive and motivational factors have been shown to impact older adults' engagement with challenging cognitive activities, such as WM training. The current feasibility study implemented a novel metacognitive intervention in conjunction with WM training in older adults and examined its potential amplifying short- and long-term effects on cognitive and self-report outcomes as compared to WM or active control training alone. One-hundred and nineteen older adults completed a cognitive training over the course of 20 sessions at home. The cognitive training targeted either WM or general knowledge. In addition, one of the WM training groups completed a metacognitive program via group seminars. We tested for group differences in WM, inhibitory control, and episodic memory, and we assessed participants' perceived self-efficacy and everyday memory failures. At post-test, we replicated earlier work by demonstrating that participants who completed the WM intervention outperformed the active control group in non-trained WM measures, and to some extent, in inhibitory control. However, we found no evidence that the supplemental metacognitive program led to benefits over and above the WM intervention. Nonetheless, we conclude that our metacognitive program is a step in the right direction given the tentative long-term effects and participants' positive feedback, but more longitudinal data with larger sample sizes are needed to confirm these early findings.

Perspectives on heterogeneity-informed cognitive training for attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (AD/HD) is a heterogeneous neurodevelopmental condition, posing a severe threat to quality of life. Pharmacological therapies are the front-line treatment; however, their shortages encourage the development of alternative treatments for AD/HD. One promising method of developing alternative treatments is cognitive training (CT). A CT-based therapy was recently approved by the US Food and Drug Administration. However, due to heterogeneity in AD/HD, a CT protocol is unlikely to provide a one-size-fits-all solution for all patients with AD/HD. Therefore, this article highlights key aspects that need to be considered to further develop CT protocols for AD/HD, regarding training content, timing, suitability, and delivery mode. The perspectives presented here contribute to optimizing CT as an alternative option for treating AD/HD.

Older adults with lower working memory capacity benefit from transcranial direct current stimulation when combined with working memory training: A preliminary study

Aging is a very diverse process: successful agers retain most cognitive functioning, while others experience mild to severe cognitive decline. This decline may eventually negatively impact one’s everyday activities. Therefore, scientists must develop approaches to counteract or, at least, slow down the negative change in cognitive performance of aging individuals. Combining cognitive training and transcranial direct current stimulation (tDCS) is a promising approach that capitalizes on the plasticity of brain networks. However, the efficacy of combined methods depends on individual characteristics, such as the cognitive and emotional state of the individual entering the training program. In this report, we explored the effectiveness of working memory training, combined with tDCS to the right dorsolateral prefrontal cortex (DLPFC), to manipulate working memory performance in older individuals. We hypothesized that individuals with lower working memory capacity would benefit the most from the combined regimen. Thirty older adults took part in a 5-day combined regimen. Before and after the training, we evaluated participants’ working memory performance with five working memory tasks. We found that individual characteristics influenced the outcome of combined cognitive training and tDCS regimens, with the intervention selectively benefiting old-old adults with lower working memory capacity. Future work should consider developing individualized treatments by considering individual differences in cognitive profiles.

Expectation effects in working memory training

There is a growing body of research focused on developing and evaluating behavioral training paradigms meant to induce enhancements in cognitive function. It has recently been proposed that one mechanism through which such performance gains could be induced involves participants' expectations of improvement. However, no work to date has evaluated whether it is possible to cause changes in cognitive function in a long-term behavioral training study by manipulating expectations. In this study, positive or negative expectations about cognitive training were both explicitly and associatively induced before either a working memory training intervention or a control intervention. Consistent with previous work, a main effect of the training condition was found, with individuals trained on the working memory task showing larger gains in cognitive function than those trained on the control task. Interestingly, a main effect of expectation was also found, with individuals given positive expectations showing larger cognitive gains than those who were given negative expectations (regardless of training condition). No interaction effect between training and expectations was found. Exploratory analyses suggest that certain individual characteristics (e.g., personality, motivation) moderate the size of the expectation effect. These results highlight aspects of methodology that can inform future behavioral interventions and suggest that participant expectations could be capitalized on to maximize training outcomes.

Cognitive remediation for depression vulnerability: Current challenges and new directions

It is increasingly acknowledged that cognitive impairment can play an important role in depression vulnerability. Therefore, cognitive remediation strategies, and cognitive control training (CCT) procedures have gained attention in recent years as possible interventions for depression. Recent studies suggest a small to medium effect on indicators of depression vulnerability. Despite initial evidence for the efficacy and effectiveness of CCT, several central questions remain. In this paper we consider the key challenges for the clinical implementation of CCT, including exploration of (1) potential working mechanisms and related to this, moderators of training effects, (2) necessary conditions under which CCT could be optimally administered, such as dose requirements and training schedules, and (3) how CCT could interact with or augment existing treatments of depression. Revisiting the CCT literature, we also reflect upon the possibilities to evolve toward a stratified medicine approach, in which individual differences could be taken into account and used to optimize prevention of depression.

Impact of Visual Game-Like Features on Cognitive Performance in a Virtual Reality Working Memory Task: Within-Subjects Experiment

BACKGROUND

Although the pursuit of improved cognitive function through working memory training has been the subject of decades of research, the recent growth in commercial adaptations of classic working memory tasks in the form of gamified apps warrants additional scrutiny. In particular, the emergence of virtual reality as a platform for cognitive training presents opportunities for the use of novel visual features.

OBJECTIVE

This study aimed to add to the body of knowledge regarding the use of game-like visual design elements by specifically examining the application of two particular visual features common to virtual reality environments: immersive, colorful backgrounds and the use of 3D depth. In addition, electroencephalography (EEG) data were collected to identify potential neural correlates of any observed changes in performance.

METHODS

A simple visual working memory task was presented to participants in several game-like adaptations, including the use of colorful, immersive backgrounds and 3D depth. The impact of each adaptation was separately assessed using both EEG and performance assessment outcomes and compared with an unmodified version of the task.

RESULTS

Results suggest that although accuracy and reaction time may be slightly affected by the introduction of such game elements, the effects were small and not statistically significant. Changes in EEG power, particularly in the beta and theta rhythms, were significant but failed to correlate with any corresponding changes in performance. Therefore, they may only reflect cognitive changes at the perceptual level.

CONCLUSIONS

Overall, the data suggest that the addition of these specific visual features to simple cognitive tasks does not appear to significantly affect performance or task-dependent cognitive load.

Effects of Working Memory Training on Children’s Memory and Academic Performance: the Role of Training Task Features and Trainee’s Characteristics

Learning and academic performance are explained mainly by basic limited-capacity processes, most notably by working memory (WM). Consequently, training WM has been considered a promising approach to fostering these abilities. However, school-based investigations are rare. This study examined the effects of training task features and trainees’ characteristics on transfer to cognitive and academic measures. Eighty-six typically developing 8–12-year-old children completed 6 weeks of either WM training with n-back and complex span tasks or a control training with perceptual-matching tasks in a regular school setting. The study also assessed some personal variables of the children, such as neuroticism, conscientiousness, joy of learning, and power of endurance. The WM training group showed increased WM and math performance compared to the control group. Also, there was a trend toward some improvements in vocabulary after WM training, and overall improvements after both trainings were observed in fluid intelligence and reading. Analyses of individual differences in the WM training group indicated increased training performance in relation to emotional stability, conscientiousness, power of endurance, as well as teacher-reported joy of learning and social integration of participants. Thus, the results indicate the potential of WM training to improve WM capacity and mathematical skills and reveal the impact of regulative, motivational, and social factors on cognitive training performance.

Baseline capacities and motivation in executive control training of healthy older adults

OBJECTIVES

Normal aging involves progressive prefrontal declines and impairments in executive control. This study aimed to examine the efficacy of an executive-control training focusing on working memory and inhibition, in healthy older adults, and to explore the role of individual differences in baseline capacities and motivation in explaining training gains.

METHODS

Forty-four healthy older adults were randomly assigned to an experimental (training executive control) or active control group (training processing speed). Participants completed six online training sessions distributed across two weeks. Transfer effects to working memory (Operation Span test), response inhibition (Stop-Signal test), processing speed (Pattern Comparison) and reasoning (Raven's Advanced Progressive Matrices and Cattell Culture Fair test) were evaluated. Furthermore, we explored individual differences in baseline capacities and assessed motivation during and after the intervention.

RESULTS

The experimental group, but not the active control, showed significant transfer to response inhibition. Moreover, a general compensation effect was found: older adults with lower baseline capacities achieved higher levels of training improvement. Motivation was not related to training performance.

CONCLUSION

Our results encourage the use of executive control training to improve cognitive functions, reveal the importance of individual differences in training-related gains, and provide further support for cognitive plasticity during healthy aging.

Training with an auditory perceptual learning game transfers to speech in competition

Understanding speech in the presence of acoustical competition is a major complaint of those with hearing difficulties. Here, a novel perceptual learning game was tested for its effectiveness in reducing difficulties with hearing speech in competition. The game was designed to train a mixture of auditory processing skills thought to underlie speech in competition, such as spectral-temporal processing, sound localization, and auditory working memory. Training on these skills occurred both in quiet and in competition with noise. Thirty college-aged participants without any known hearing difficulties were assigned either to this mixed-training condition or an active control consisting of frequency discrimination training within the same gamified setting. To assess training effectiveness, tests of speech in competition (primary outcome), as well as basic supra-threshold auditory processing and cognitive processing abilities (secondary outcomes) were administered before and after training. Results suggest modest improvements on speech in competition tests in the mixed-training compared to the frequency-discrimination control condition (Cohen’s d = 0.68). While the sample is small, and in normally hearing individuals, these data suggest promise of future study in populations with hearing difficulties.

Multisensory Facilitation of Working Memory Training

Research suggests that memorization of multisensory stimuli benefits performance compared to memorization of unisensory stimuli; however, little is known about multisensory facilitation in the context of working memory (WM) training and transfer. To investigate this, 240 adults were randomly assigned to an N-back training task that consisted of visual-only stimuli, alternating visual and auditory blocks, or audio-visual (multisensory) stimuli, or to a passive control group. Participants in the active groups completed 13 sessions of N-back training (6.7 hours in total) and all groups completed a battery of WM tasks: untrained N-back tasks, Corsi Blocks, Sequencing, and Symmetry Span. The Multisensory group showed similar training N-level gain compared to the Visual Only group, and both of these groups outperformed the Alternating group on the training task. As expected, all three active groups significantly improved on untrained visual N-back tasks compared to the Control group. In contrast, the Multisensory group showed significantly greater gains on the Symmetry Span task and to a certain extent on the Sequencing task compared to other groups. These results tentatively suggest that incorporating multisensory objects in a WM training protocol can benefit performance on the training task and potentially facilitate transfer to complex WM span tasks.

Using Patient and Public Involvement to Elicit Opinion on Cognitive Training Games and Assessment Technologies for Dementia (Preprint)

Background

Cognitive training and assessment technologies offer the promise of dementia risk reduction and a more timely diagnosis of dementia, respectively. Cognitive training games may help reduce the lifetime risk of dementia by helping to build cognitive reserve, whereas cognitive assessment technologies offer the opportunity for a more convenient approach to early detection or screening.

Objective

This study aims to elicit perspectives of potential end users on factors related to the acceptability of cognitive training games and assessment technologies, including their opinions on the meaningfulness of measurement of cognition, barriers to and facilitators of adoption, motivations to use games, and interrelationships with existing health care infrastructure.

Methods

Four linked workshops were conducted with the same group, each focusing on a specific topic: meaningful improvement, learning and motivation, trust in digital diagnosis, and barriers to technology adoption. Participants in the workshops included local involvement team members acting as facilitators and those recruited via Join Dementia Research through a purposive selection and volunteer sampling method. Group activities were recorded, and transcripts were analyzed using thematic analysis with a combination of a priori and data-driven themes. Using a mixed methods approach, we investigated the relationships between the categories of the Capability, Opportunity, and Motivation–Behavior change model along with data-driven themes by measuring the φ coefficient between coded excerpts and ensuring the reliability of our coding scheme by using independent reviewers and assessing interrater reliability. Finally, we explored these themes and their relationships to address our research objectives.

Results

In addition to discussions around the capability, motivation, and opportunity categories, several important themes emerged during the workshops: family and friends, cognition and mood, work and hobbies, and technology. Group participants mentioned the importance of functional and objective measures of cognitive change, the social aspect of activities as a motivating factor, and the opportunities and potential shortcomings of digital health care provision. Our quantitative results indicated at least moderate agreement on all but one of the coding schemes and good independence of our coding categories. Positive and statistically significant φ coefficients were observed between several coding themes between categories, including a relatively strong positive φ coefficient between capability and cognition (0.468; P<.001).

Conclusions

The implications for researchers and technology developers include assessing how cognitive training and screening pathways would integrate into existing health care systems; however, further work needs to be undertaken to address barriers to adoption and the potential real-world impact of cognitive training and screening technologies.

International Registered Report Identifier (IRRID)

RR2-10.1007/978-3-030-49065-2_4

Development and testing of a game-based digital intervention for working memory training in autism spectrum disorder

Autism spectrum disorder (ASD) is prevalent globally, yet it lacks cost-effective treatment approaches. Deficits in executive functions occur frequently in autism spectrum disorder and present a target for intervention. Here we report the design and development of five smartphone-based games for training working memory in children with ASD. These open-source games, available free of cost to the community, were designed to match the behavioral preferences and sensorimotor abilities of children with ASD. We then conducted a preliminary trial to test the effectiveness of a month-long intervention using these games. Although we did not see a significant change in the working memory of all children with a month-long training, children who performed better on the games also showed more improvement in their working memory, suggesting that a longer intervention with the games might be useful in improving working memory. Using a Hindi translation of the autism treatment evaluation checklist, we also tested the collateral gains of the training in reducing autistic symptoms. We found no significant change in the autistic symptoms after the intervention. Further, there was no correlation between the change in the working memory and the change in the autistic symptoms.

Exploring Individuals' Willingness to Engage in Interventions to Improve Cognitive Health and Prolong Late-Life Independence: An Extension of Harrell, Kmetz, and Boot (2019)

Interventions designed to preserve cognition have become increasingly popular as our population ages. In exploring intervention effectiveness, however, researchers have often overlooked a potentially important factor: willingness to engage. Recent findings from Harrell, Kmetz, Boot (2019) showed that perceived cognitive deficits and perceived training efficacy were significant predictors of willingness to engage in a brain training intervention designed to preserve cognition. However, they did not explore another potentially important factor: anticipated intervention enjoyment. In the current study, younger, middle-aged, and older adults (N = 169) completed surveys that assessed their willingness to engage in different types of training (aerobic exercise, brain, meditation) to improve cognition and the extent that factors such as health, perceived cognitive deficits, belief in training efficacy, and personality contributed to willingness to engage. Participants reported being least willing to engage in meditation training and meditation training was rated by participants as the least likely to improve cognition. Anticipated training enjoyment was the overriding factor that predicted willingness. These findings provide additional insights into why, and for how long, individuals may be willing to engage in training to prolong independence and have implications for understanding intervention adoption and adherence.

Assessing the Effect of Training on the Cognition and Brain of Older Adults: Protocol for a Three-Arm Randomized Double-Blind Controlled Trial (ACTOP)

BACKGROUND

To prevent age-related cognitive impairment, many intervention programs offer exercises targeting different central cognitive processes. However, the effects of different process-based training programs are rarely compared within equivalent experimental designs.

OBJECTIVE

Using a randomized double-blind controlled trial, this project aims to examine and compare the impact of 2 process-based interventions, inhibition and updating, on the cognition and brain of older adults.

METHODS

A total of 90 healthy older adults were randomly assigned to 1 of 3 training conditions: (1) inhibition (Stroop-like exercises), (2) updating (N-back-type exercises), and (3) control active (quiz game exercise). Training was provided in 12 half-hour sessions over 4 weeks. First, the performance gain observed will be measured on the trained tasks. We will then determine the extent of transfer of gain on (1) untrained tasks that rely on the same cognitive process, (2) complex working memory (WM) measurements hypothesized to involve 1 of the 2 trained processes, and (3) virtual reality tasks that were designed to mimic real-life situations that require WM. We will assess whether training increases cortical volume given that the volume of the cortex is determined by cortical area and thickness in regions known to be involved in WM or changes task-related brain activation patterns measured with functional magnetic resonance imaging. Dose effects will be examined by measuring outcomes at different time points during training. We will also determine whether individual characteristics moderate the effect of training on cognitive and cerebral outcomes. Finally, we will evaluate whether training reduces the age-related deficit on transfer and brain outcomes, by comparing study participants to a group of 30 younger adults.

RESULTS

The project was funded in January 2017; enrollment began in October 2017 and data collection was completed in April 2019. Data analysis has begun in June 2020 and the first results should be published by the end of 2020 or early 2021.

CONCLUSIONS

The results of this study will help understand the relative efficacy of 2 attentional control interventions on the cognition and the brain of older adults, as well as the moderating role of individual characteristics on training efficiency and transfer.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03532113; https://clinicaltrials.gov/ct2/show/NCT03532113.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/20430.

N-Back Related ERPs Depend on Stimulus Type, Task Structure, Pre-processing, and Lab Factors

The N-Back, a common working memory (WM) updating task, is increasingly used in basic and applied psychological research. As such, an increasing number of electroencephalogram (EEG) studies have sought to identify the electrophysiological signatures of N-Back task performance. However, stimulus type, task structure, pre-processing methods, and differences in the laboratory environment, including the EEG recording setup employed, greatly vary across studies, which in turn may introduce inconsistencies in the obtained results. Here we address this issue by conducting nine different variations of an N-Back task manipulating stimulus type and task structure. Furthermore, we explored the effect of the pre-processing method used and differences in the laboratory environment. Results reveal significant differences in behavioral and electrophysiological signatures in response to N-Back stimulus type, task structure, pre-processing method, and laboratory environment. In conclusion, we suggest that experimental factors, analysis pipeline, and laboratory differences, which are often ignored in the literature, need to be accounted for when interpreting findings and making comparisons across studies.

The Effects of Gamification on Computerized Cognitive Training: Systematic Review and Meta-Analysis

Background

There has been a growing interest in the application of gamification (ie, the use of game elements) to computerized cognitive training. The introduction of targeted gamification features to such tasks may increase motivation and engagement as well as improve intervention effects. However, it is possible that game elements can also have adverse effects on cognitive training (eg, be a distraction), which can outweigh their potential motivational benefits. So far, little is known about the effectiveness of such applications.

Objective

This study aims to conduct a systematic review and meta-analysis to investigate the effect of gamification on process outcomes (eg, motivation) and on changes in the training domain (eg, cognition), as well as to explore the role of potential moderators.

Methods

We searched PsycINFO, Cumulative Index to Nursing and Allied Health Literature, ProQuest Psychology, Web of Science, Scopus, PubMed, Science Direct, Excerpta Medica dataBASE, Institute of Electrical and Electronics Engineers Xplore, Association for Computing Machinery, and a range of gray-area literature databases. The searches included papers published between 2008 and 2018. Meta-analyses were performed using a random-effects model.

Results

The systematic review identified 49 studies, of which 9 randomized controlled trials were included in the meta-analysis. The results of the review indicated that research in this context is still developing and lacks well-controlled empirical studies. Gamification in cognitive training is applied to a large range of age groups and audiences and is mostly delivered at a research site through computers. Rewards and feedback continue to dominate the gamification landscape, whereas social-oriented features (eg, competition) are underused. The meta-analyses showed that gamified training tasks were more motivating/engaging (Hedges g=0.72) and more demanding/difficult (Hedges g=–0.52) than non- or less-gamified tasks, whereas no effects on the training domain were found. Furthermore, no variables moderated the impact of gamified training tasks. However, meta-analytic findings were limited due to a small number of studies.

Conclusions

Overall, this review provides an overview of the existing research in the domain and provides evidence for the effectiveness of gamification in improving motivation/engagement in the context of cognitive training. We discuss the shortcomings in the current literature and provide recommendations for future research.

Application of Machine Learning Models for Tracking Participant Skills in Cognitive Training

A key need in cognitive training interventions is to personalize task difficulty to each user and to adapt this difficulty to continually apply appropriate challenges as users improve their skill to perform the tasks. Here we examine how Bayesian filtering approaches, such as hidden Markov models and Kalman filters, and deep-learning approaches, such as the long short-term memory (LSTM) model, may be useful methods to estimate user skill level and predict appropriate task challenges. A possible advantage of these models over commonly used adaptive methods, such as staircases or blockwise adjustment methods that are based only upon recent performance, is that Bayesian filtering and deep learning approaches can model the trajectory of user performance across multiple sessions and incorporate data from multiple users to optimize local estimates. As a proof of concept, we fit data from two large cohorts of undergraduate students performing WM training using an N-back task. Results show that all three models predict appropriate challenges for different users. However, the hidden Markov models were most accurate in predicting participants' performances as a function of provided challenges, and thus, they placed participants at appropriate future challenges. These data provide good support for the potential of machine learning approaches as appropriate methods to personalize task performance to users in tasks that require adaptively determined challenges.

Racing dragons and remembering aliens: Benefits of playing number and working memory games on kindergartners' numerical knowledge

Sources that contribute to variation in mathematical achievement include both numerical knowledge and general underlying cognitive processing abilities. The current study tested the benefits of tablet-based training games that targeted each of these areas for improving the mathematical knowledge of kindergarten-age children. We hypothesized that playing a number-based game targeting numerical magnitude knowledge would improve children's broader numerical skills. We also hypothesized that the benefits of playing a working memory (WM) game would transfer to children's numerical knowledge given its important underlying role in mathematics achievement. Kindergarteners from diverse backgrounds (n = 148; 52% girls; M_age  = 71.87 months) were randomly assigned to either play a number-based game, a WM game, or a control game on a tablet for 10 sessions. Structural equation modeling was used to model children's learning gains in mathematics and WM across time. Overall, our results suggest that playing the number game improved kindergarten children's numerical knowledge at the latent level, and these improvements remained stable as assessed 1 month later. However, children in the WM group did not improve their numerical knowledge compared to children in the control condition. Playing both the number game and WM game improved children's WM at the latent level. Importantly, the WM group continued to improve their WM for at least a month after playing the games. The results demonstrate that computerized games that target both domain-specific and domain-general skills can benefit a broad range of kindergarten-aged children.

Divergent Research Methods Limit Understanding of Working Memory Training

Working memory training has been a hot topic over the last decade. Although studies show benefits in trained and untrained tasks as a function of training, there is an ongoing debate on the efficacy of working memory training. There have been numerous meta-analyses put forth to the field, some finding overall broad transfer effects while others do not. However, discussion of this research typically overlooks specific qualities of the training and transfer tasks. As such, there has been next to no discussion in the literature on what training and transfer tasks features are likely to mediate training outcomes. To address this gap, here, we characterized the broad diversity of features employed in N-back training tasks and outcome measures in published working memory training studies. Extant meta-analyses have not taken into account the diversity of methodology at this level, primarily because there are too few studies using common methods to allow for a robust meta-analysis. We suggest that these limitations preclude strong conclusions from published data. In order to advance research on working memory training, and in particular, N-back training, more studies are needed that systematically compare training features and use common outcome measures to assess transfer effects.

Effects of non-symbolic arithmetic training on symbolic arithmetic and the approximate number system

The approximate number system (ANS) is an innate cognitive template that allows for the mental representation of approximate magnitude, and has been controversially linked to symbolic number knowledge and math ability. A series of recent studies found that an approximate arithmetic training (AAT) task that draws upon the ANS can improve math skills, which not only supports the existence of this link, but suggests it may be causal. However, no direct transfer effects to any measure of the ANS have yet been reported, calling into question the mechanisms by which math improvements may emerge. The present study investigated the effects of a 7-day AAT and successfully replicated previously reported transfer effects to math. Furthermore, our exploratory analyses provide preliminary evidence that certain ANS-related skills may also be susceptible to training. We conclude that AAT has reproducible effects on math performance, and provide avenues for future studies to further explore underlying mechanisms - specifically, the link between improvements in math and improvements in ANS skills.