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Voinescu A, Papaioannou T, Petrini K, Stanton Fraser D. Exergaming for dementia and mild cognitive impairment. Cochrane Database Syst Rev 2024; 9:CD013853. [PMID: 39319863 PMCID: PMC11423707 DOI: 10.1002/14651858.cd013853.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
BACKGROUND Dementia and mild cognitive impairment are significant contributors to disability and dependency in older adults. Current treatments for managing these conditions are limited. Exergaming, a novel technology-driven intervention combining physical exercise with cognitive tasks, is a potential therapeutic approach. OBJECTIVES To assess the effects of exergaming interventions on physical and cognitive outcomes, and activities of daily living, in people with dementia and mild cognitive impairment. SEARCH METHODS On 22 December 2023, we searched the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science Core Collection (Clarivate), LILACS (BIREME), ClinicalTrials.gov, and the WHO (World Health Organization) meta-register the International Clinical Trials Registry Portal. SELECTION CRITERIA We included randomised controlled trials (RCTs) that recruited individuals diagnosed with dementia or mild cognitive impairment (MCI). Exergaming interventions involved participants being engaged in physical activity of at least moderate intensity, and used immersive and non-immersive virtual reality (VR) technology and real-time interaction. We planned to classify comparators as inactive control group (e.g. no treatment, waiting list), active control group (e.g. standard treatment, non-specific active control), or alternative treatment (e.g. physical activity, computerised cognitive training). Outcomes were to be measured using validated instruments. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, extracted data, assessed the risk of bias using the Cochrane risk of bias tool RoB 2, and assessed the certainty of the evidence using GRADE. We consulted a third author if required. Where possible, we pooled outcome data using a fixed-effect or random-effects model. We expressed treatment effects as standardised mean differences (SMDs) for continuous outcomes and as risk ratios (RRs) for dichotomous outcomes, along with 95% confidence intervals (CIs). When data could not be pooled, we presented a narrative synthesis. MAIN RESULTS We included 11 studies published between 2014 and 2023. Six of these studies were pre-registered. Seven studies involved 308 participants with mild cognitive impairment, and five studies included 228 individuals with dementia. One of the studies presented data for both MCI and dementia separately. Most comparisons exhibited a high risk or some concerns of bias. We have only low or very low certainty about all the results presented below. Effects of exergaming interventions for people with dementia Compared to a control group Exergaming may improve global cognitive functioning at the end of treatment, but the evidence is very uncertain (SMD 1.47, 95% 1.04 to 1.90; 2 studies, 113 participants). The evidence is very uncertain about the effects of exergaming at the end of treatment on global physical functioning (SMD -0.20, 95% -0.57 to 0.17; 2 studies, 113 participants) or activities of daily living (ADL) (SMD -0.28, 95% -0.65 to 0.09; 2 studies, 113 participants). The evidence is very uncertain about adverse effects due to the small sample size and no events. Findings are based on two studies (113 participants), but data could not be pooled; both studies reported no adverse reactions linked to the intervention or control group. Compared to an alternative treatment group At the end of treatment, the evidence is very uncertain about the effects of exergaming on global physical functioning (SMD 0.14, 95% -0.30 to 0.58; 2 studies, 85 participants) or global cognitive functioning (SMD 0.11, 95% -0.33 to 0.55; 2 studies, 85 participants). For ADL, only one study was available (n = 67), which provided low-certainty evidence of little to no difference between exergaming and exercise. The evidence is very uncertain about adverse effects of exergaming compared with alternative treatment (RR 7.50, 95% CI 0.41 to 136.52; 2 studies, 2/85 participants). Effects of exergaming interventions for people with mild cognitive impairment (MCI) Compared to a control group Exergaming may improve global cognitive functioning at the end of treatment for people with MCI, but the evidence is very uncertain, (SMD 0.79, 95% 0.05 to 1.53; 2 studies, 34 participants). The evidence is very uncertain about the effects of exergaming at the end of treatment on global physical functioning (SMD 0.27, 95% -0.41 to 0.94; 2 studies, 34 participants) and ADL (SMD 0.51, 95% -0.01 to 1.03; 2 studies, 60 participants). The evidence is very uncertain about the effects of exergaming on adverse effects due to a small sample size and no events (0/14 participants). Findings are based on one study. Compared to an alternative treatment group The evidence is very uncertain about global physical functioning at the end of treatment. Only one study was included (n = 45). For global cognitive functioning, we included four studies (n = 235 participants), but due to considerable heterogeneity (I² = 96%), we could not pool results. The evidence is very uncertain about the effects of exergaming on global cognitive functioning. No study evaluated ADL outcomes. The evidence is very uncertain about adverse effects of exergaming due to the small sample size and no events (n = 123 participants). Findings are based on one study. AUTHORS' CONCLUSIONS Overall, the evidence is very uncertain about the effects of exergaming on global physical and cognitive functioning, and ADL. There may be an improvement in global cognitive functioning at the end of treatment for both people with dementia and people with MCI, but the evidence is very uncertain. The potential benefit is observed only when exergaming is compared with a control intervention (e.g. usual care, listening to music, health education), and not when compared with an alternative treatment with a specific effect, such as physical activity (e.g. standing and sitting exercises or cycling). The evidence is very uncertain about the effects of exergaming on adverse effects. All sessions took place in a controlled and supervised environment. Therefore, we do not know if exergaming can be safely used in a home environment, unsupervised.
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Affiliation(s)
| | | | - Karin Petrini
- Department of Psychology, University of Bath, Bath, UK
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, UK
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D'Amore C, Lajambe L, Bush N, Hiltz S, Laforest J, Viel I, Hao Q, Beauchamp M. Mapping the extent of the literature and psychometric properties for the Physical Activity Scale for the Elderly (PASE) in community-dwelling older adults: a scoping review. BMC Geriatr 2024; 24:761. [PMID: 39277742 PMCID: PMC11401377 DOI: 10.1186/s12877-024-05332-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 08/26/2024] [Indexed: 09/17/2024] Open
Abstract
BACKGROUND Identifying valid and accessible tools for monitoring and improving physical activity levels is essential for promoting functional ability and healthy aging. The Physical Activity Scale for the Elderly (PASE) is a commonly used and recommended self-report measure of physical activity in older adults. The objective of this scoping review was to map the nature and extent to which the PASE has been used in the literature on community-dwelling older adults, including the evidence for its psychometric properties. METHODS Seven electronic databases (MEDLINE (Ovid), Embase (Ovid), AMED (Ovid), Emcare (Ovid), CINAHL (EBSCO), Ageline (EBSCO)) were searched from inception to January 25, 2023. Studies were included if physical activity was part of the aim(s) and measured using the PASE, participants had a mean age of 60 years or older and lived in the community, and papers were peer-reviewed journal articles published in English. Pairs of independent reviewers screened abstracts, full-texts, and extracted data. Where possible, weighted mean PASE scores were calculated for different subgroups based on age, sex, and clinical population. RESULTS From 4,124 studies screened, 232 articles from 35 countries met the inclusion criteria. Most studies were cross-sectional (60.78%), completed in high-income countries (86.4%) and in North America (49.57%). A variety of clinical conditions were included (n = 21), with the most common populations being osteoarthritis (n = 13), Parkinson's disease (n = 11), and cognitive impairment (n = 7). Psychometric properties of ten versions of the PASE were found. All versions demonstrated acceptable test-retest reliability. Evidence for construct validity showed moderate correlations with self-reported physical activity, fair to moderate with accelerometry derived activity and fair relationships with physical function and self-reported health. Pooled means were reported in graphs and forest plots for males, females, age groups, and several clinical populations. CONCLUSION The PASE was widely used in a variety of clinical populations and geographical locations. The PASE has been culturally adapted to several populations and evaluated for its reliability and convergent validity; however, further research is required to examine responsiveness and predictive validity. Researchers can use the weighted mean PASE scores presented in this study to help interpret PASE scores in similar populations. OSF REGISTRATION: osf.io/7bvhx.
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Affiliation(s)
- Cassandra D'Amore
- School of Rehabilitation Science, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, 1400 Main St. West Hamilton, Room 403, Hamilton, ON, L8S 1C7, Canada
| | - Lexie Lajambe
- School of Rehabilitation Science, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, 1400 Main St. West Hamilton, Room 403, Hamilton, ON, L8S 1C7, Canada
| | - Noah Bush
- School of Rehabilitation Science, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, 1400 Main St. West Hamilton, Room 403, Hamilton, ON, L8S 1C7, Canada
| | - Sydney Hiltz
- School of Rehabilitation Science, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, 1400 Main St. West Hamilton, Room 403, Hamilton, ON, L8S 1C7, Canada
| | - Justin Laforest
- School of Rehabilitation Science, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, 1400 Main St. West Hamilton, Room 403, Hamilton, ON, L8S 1C7, Canada
| | - Isabella Viel
- School of Rehabilitation Science, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, 1400 Main St. West Hamilton, Room 403, Hamilton, ON, L8S 1C7, Canada
| | - Qiukui Hao
- School of Rehabilitation Science, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, 1400 Main St. West Hamilton, Room 403, Hamilton, ON, L8S 1C7, Canada
| | - Marla Beauchamp
- School of Rehabilitation Science, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, 1400 Main St. West Hamilton, Room 403, Hamilton, ON, L8S 1C7, Canada.
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Desai S, Mutsuddi R, Astell AJ. Enhancing prompt perception in dementia: a comparative study of mixed reality cue modalities. Front Sports Act Living 2024; 6:1419263. [PMID: 39184033 PMCID: PMC11344262 DOI: 10.3389/fspor.2024.1419263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/22/2024] [Indexed: 08/27/2024] Open
Abstract
Introduction Dementia impacts millions worldwide and is challenging individuals' ability to engage in daily activities. Active living is crucial in mitigating dementia's neurodegenerative effects, yet people with dementia often struggle to initiate and complete tasks independently. Technologies offer promising solutions to engage people with dementia in activities of active living and improving their quality of life through prompting and cueing. It is anticipated that developments in sensor and wearable technologies will result in mixed reality technology becoming more accessible in everyday homes, making them more deployable. The possibility of mixed reality technologies to be programmed for different applications, and to adapt them to different levels of impairments, behaviours and contexts, will make them more scalable. Objective The study aimed to develop a better understanding of modalities of prompts that people with dementia perceive successfully and correctly in mixed reality environments. It investigated interactions of people with dementia with different types of visual (graphics, animation, etc.) and sound (human voice, tones, etc.) prompts in mixed reality technologies. Methods We used the Research through Design (RtD) method in this study. This paper describes the findings from the user research carried out in the study. We conducted observation studies with twenty-two people with dementia playing games on off-the-shelf mixed reality technologies, including both Augmented Reality (HoloLens, ArKit on iPhone) and Augmented Virtuality (Xbox Kinect and Osmo) technologies. The interactions with the technologies during the gameplay were video recorded for thematic analysis in Noldus Observer XT (version 16.0) for successful and correct perception of prompts. Results A comparison of the probability estimates of correct perception of the prompts by people with dementia suggests that human voice, graphic symbols and text are the most prominently perceived modalities of prompts. Feedback prompts for every action performed by people with dementia on the technology are critical for successful perception and should always be provided in the design. Conclusion The study has resulted in recommendations and guidelines for designers to design prompts for people with dementia in mixed-reality environments. The work lays the foundation for considering mixed reality technologies as assistive tools for people with dementia, fostering discussions on their accessibility and inclusive design in technology development.
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Affiliation(s)
- Shital Desai
- Department of Computational Arts, School of Arts Media Performance and Design, York University, Toronto, ON, Canada
- Social and Technological Systems (SaTS) Lab, School of Arts Media Performance and Design, York University, Toronto, ON, Canada
| | - Rupsha Mutsuddi
- Social and Technological Systems (SaTS) Lab, School of Arts Media Performance and Design, York University, Toronto, ON, Canada
- Department of Design, School of Arts Media Performance and Design, York University, Toronto, ON, Canada
| | - Arlene J. Astell
- Department of Occupational Sciences & Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Psychology Department, Northumbria University, Newcastle, United Kingdom
- KITE Research Institute, University Health Network, Toronto, ON, Canada
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Zuo X, Tang Y, Chen Y, Zhou Z. Effects of Electronic Serious Games on Older Adults With Alzheimer's Disease and Mild Cognitive Impairment: Systematic Review With Meta-Analysis of Randomized Controlled Trials. JMIR Serious Games 2024; 12:e55785. [PMID: 39083796 PMCID: PMC11324188 DOI: 10.2196/55785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/19/2024] [Accepted: 06/26/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Serious games (SGs) are nonpharmacological interventions that are widely applied among older adults. To date, no evidence has been published regarding the effect of digital SGs on cognitive ability, daily behavioral capacity, or depression in older adults with Alzheimer's disease (AD) and mild cognitive impairment (MCI). OBJECTIVE This study aimed to assess the effect of SGs on older adults with AD and MCI by summarizing and pooling the results of previous studies. METHODS This meta-analysis examined the effectiveness of digital SGs in improving cognitive ability, enhancing daily behavioral capacity, and alleviating depression in older adults with AD and MCI. We searched the following databases up to December 31, 2023, to identify relevant high-quality randomized controlled trials (RCTs): PubMed, Embase, Web of Science, Scopus, and Cochrane Library. Stata 15.1 and Review Manager 5.3 were used to screen the 14 studies, extract data, code the data, and perform meta-analysis. Mean differences and standardized mean differences (SMDs) with 95% CIs were used to calculate continuous variables. The Cochrane risk-of-bias assessment tool was used to evaluate the risk of bias. Eligibility criteria were developed in accordance with the Population, Intervention, Comparison, Outcomes, and Study Design framework: (1) population (older adults with AD and MCI), (2) intervention (digital SG intervention), (3) comparison (digital SG intervention vs routine health care), (4) outcomes (cognitive ability, daily behavioral capacity, and depression), and (5) study or research design (RCT). Sensitivity analysis was performed, and a funnel plot was constructed. RESULTS From January 2017 to December 2023, we enrolled 714 individuals across 14 RCTs, with 374 (52.4%) in the severe game group using digital SGs and 340 (47.6%) in the control group using traditional methods. The results of our meta-analysis indicated that using digital SGs in older adults with AD and MCI is more effective than traditional training methods in several key areas. Specifically, digital SG therapy significantly increased cognitive ability, as found in the Mini-Mental State Examination (SMD 2.11, 95% CI 1.42-2.80; P<.001) and the Montreal Cognitive Assessment (SMD 2.75, 95% CI 1.98-3.51; P<.001), significantly increased daily behavioral capacity (SMD 0.53, 95% CI 0.06-0.99; P=.03), and significantly reduced depression (SMD -2.08, 95% CI -2.94 to -1.22; P<.001) in older adults with AD and MCI. No publication bias was detected based on the results of Begg and Egger tests. CONCLUSIONS Digital SGs offer a viable and effective nonpharmacological approach for older adults with AD and MCI, yielding better results compared to traditional formats. However, caution is warranted in interpreting these findings due to limited RCTs, small sample sizes, and low-quality meta-analyzed evidence. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews: CRDCRD42023486090; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=486090.
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Affiliation(s)
- Xinyi Zuo
- Sociology Department, School of Government, Shenzhen University, Shenzhen, Guangdong, China
| | - Yong Tang
- Sociology Department, School of Government, Shenzhen University, Shenzhen, Guangdong, China
| | - Yifang Chen
- Institution of Policy Studies, Lingnan University, Tuen Mun, Hong Kong SAR, China (Hong Kong)
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Ye JY, Chen R, Chu H, Lin HC, Liu D, Jen HJ, Banda KJ, Kustanti CY, Chou KR. Dual-task training in older adults with cognitive impairment: A meta-analysis and trial sequential analysis of randomized controlled trials. Int J Nurs Stud 2024; 155:104776. [PMID: 38703695 DOI: 10.1016/j.ijnurstu.2024.104776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To determine the effects of simultaneous dual-task training on cognitive function, physical function, and depression in older adults with mild cognitive impairment or dementia. METHODS Comprehensive database searches were conducted in PubMed, Embase, the Cochrane Library, CINAHL, Ovid-Medline, Web of Science, and Scopus up to December 2022. Randomized controlled trials were included to assess the efficacy of simultaneous dual-task training for older adults with mild cognitive impairment or dementia. The analysis utilized Comprehensive Meta-Analysis version 3.0, presenting Hedges' g and the corresponding 95 % confidence interval (CI) for the pooled effect size and, applying a random-effects model. The I2 and Cochran's Q tests were employed to evaluate heterogeneity. The Cochrane Risk of Bias 2.0 tool was employed to assess study quality. The Copenhagen Trial Unit (version 0.9.5.10 Beta) was employed for trial sequential analysis, providing a rigorous methodology for evaluating cumulative evidence from multiple studies. RESULTS Of the 1676 studies identified, 20 studies involving 1477 older adults with cognitive impairment were included. Dual-task training significantly enhanced global cognition (0.477, 95 % CI: 0.282 to 0.671), executive function (-0.310, 95 % CI: -0.586 to -0.035), working memory (0.714, 95 % CI: 0.072 to 1.355), gait (0.418, 95 % CI: 0.252 to 0.583), physical activity (0.586, 95 % CI: 0.012 to 1.16), and depression (-0.703, 95 % CI: -1.253 to -0.153). Trial sequential analyses revealed the robustness of this meta-analysis, which was based on a sufficient sample size from the included studies. Moreover, dual-task training demonstrated beneficial effects on global cognition, executive function, working memory, and gait. CONCLUSIONS Dual-task training improved cognition, physical function, and depression among older adults with cognitive impairment. Accordingly, dual-task training should be considered a clinical nonpharmacological intervention for older adults with mild cognitive impairment or dementia. Nevertheless, the trial sequential analysis results were consistent with those of the pairwise meta-analysis but only global cognition reached significance by crossing the trial sequential analysis boundary. Future studies with higher-quality designs and larger sample sizes are required to obtain more conclusive results regarding other outcomes. REGISTRATION PROSPERO CRD42023418598.
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Affiliation(s)
- Jia-You Ye
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hui-Chen Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Kondwani Joseph Banda
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Endoscopy Unit, Surgery Department, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Christina Yeni Kustanti
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum, Yogyakarta, Indonesia
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Research Center for Neuroscience, Taipei Medical University, Taipei, Taiwan.
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Chan JYC, Liu J, Chan ATC, Tsoi KKF. Exergaming and cognitive functions in people with mild cognitive impairment and dementia: a meta-analysis. NPJ Digit Med 2024; 7:154. [PMID: 38879695 PMCID: PMC11180097 DOI: 10.1038/s41746-024-01142-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 05/22/2024] [Indexed: 06/19/2024] Open
Abstract
Exergaming is a combination of exercise and gaming. Evidence shows an association between exercise and cognition in older people. However, previous studies showed inconsistent results on the cognitive benefits of exergaming in people with cognitive impairment. Therefore, this study aims to examine the effect of exergaming intervention on cognitive functions in people with MCI or dementia. A systematic literature search was conducted via OVID databases. Randomized controlled trials (RCTs) examined the effect of an exergaming intervention on cognitive functions in people with MCI or dementia were included. Subgroup analyses were conducted according to the type of intervention and training duration. Twenty RCTs with 1152 participants were identified, including 14 trials for MCI and 6 trials for dementia. In people with MCI, 13 studies used virtual-reality (VR)-based exergaming. Those who received VR-based exergaming showed significantly better global cognitive function [SMD (95%CI) = 0.67 (0.23-1.11)], learning and memory [immediate recall test: 0.79 (0.31-1.27); delayed recall test: 0.75 (0.20-1.31)], working memory [5.83 (2.27-9.39)], verbal fluency [0.58 (0.12-1.03)], and faster in executive function than the controls. For people with dementia, all studies used video-based exergaming intervention. Participants with exergaming intervention showed significantly better global cognitive function than the controls [0.38 (0.10-0.67)]. Subgroup analyses showed that longer training duration generated larger effects. The findings suggest that exergaming impacts cognitive functions in people with MCI and dementia. Cognitive benefits are demonstrated for those with a longer training duration. With technological advancement, VR-based exergaming attracts the attention of people with MCI and performs well in improving cognitive functions.
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Affiliation(s)
- Joyce Y C Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jiani Liu
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Aaron T C Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kelvin K F Tsoi
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, China.
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Yuan Y, Yang Y, Hu X, Zhang L, Xiong Z, Bai Y, Zeng J, Xu F. Effective dosage and mode of exercise for enhancing cognitive function in Alzheimer's disease and dementia: a systematic review and Bayesian Model-Based Network Meta-analysis of RCTs. BMC Geriatr 2024; 24:480. [PMID: 38824515 PMCID: PMC11143595 DOI: 10.1186/s12877-024-05060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/08/2024] [Indexed: 06/03/2024] Open
Abstract
OBJECTIVE Research the dose-response relationship between overall and certain types of exercise and cognitive function in older adults with Alzheimer's disease and dementia. DESIGN Systemic and Bayesian Model-Based Network Meta-Analysis. METHODS In our study, we analyzed data from randomized controlled trials investigating the effects of different exercises on cognitive outcomes in older adults with AD. We searched the Web of Science, PubMed, Cochrane Central Register of Controlled Trials, and Embase up to November 2023. Using the Cochrane Risk of Bias tool (Rob2) for quality assessment and R software with the MBNMA package for data analysis, we determined standard mean differences (SMDs) and 95% confidence intervals (95%CrI) to evaluate exercise's impact on cognitive function in AD. RESULTS Twenty-seven studies with 2,242 AD patients revealed a nonlinear relationship between exercise and cognitive improvement in AD patients. We observed significant cognitive enhancements at an effective exercise dose of up to 1000 METs-min/week (SMDs: 0.535, SD: 0.269, 95% CrI: 0.023 to 1.092). The optimal dose was found to be 650 METs-min/week (SMDs: 0.691, SD: 0.169, 95% CrI: 0.373 to 1.039), with AE (Aerobic exercise) being particularly effective. For AE, the optimal cognitive enhancement dose was determined to be 660 METs-min/week (SMDs: 0.909, SD: 0.219, 95% CrI: 0.495 to 1.362). CONCLUSION Nonlinear dose-response relationship between exercise and cognitive improvement in Alzheimer's disease, with the optimal AE dose identified at 660 METs-min/week for enhancing cognitive function in AD.
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Affiliation(s)
- Yuan Yuan
- Department of Physical Education, Kunsan National University, Daehak-RoJeollabuk-Do, Gunsan-Si, 541150, Korea
| | - Yong Yang
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Chaohu University, Hefei, 238000, China
| | - XiaoFei Hu
- The School of Physical Education, Handan University, Handan, 056005, China
| | - Lin Zhang
- Department of Rehabilitation, West China Hospital Sichuan University Jintang Hospital, Chengdu, 610499, China.
| | - Zhiyu Xiong
- The School of Physical Education and Health, East China Jiaotong University, Nanchang, 330013, China
| | - Ying Bai
- Department of Physical Education, Kunsan National University, Daehak-RoJeollabuk-Do, Gunsan-Si, 541150, Korea
| | - JiaLe Zeng
- The School of Physical Education, Jiangxi Normal University, Nanchang, 330224, China
| | - Feng Xu
- College of Physical Education, Fujian Normal University, FuZhou, 350007, China
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Kantola M, Ilves O, Honkanen S, Hakonen H, Yli-Ikkelä R, Köyhäjoki A, Anttila MR, Rintala A, Korpi H, Sjögren T, Karvanen J, Aartolahti E. The Effects of Virtual Reality Training on Cognition in Older Adults: A Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Controlled Trials. J Aging Phys Act 2024; 32:321-349. [PMID: 38242114 DOI: 10.1123/japa.2023-0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 01/21/2024]
Abstract
The aim of this systematic review, meta-analysis, and meta-regression was to examine the effects of virtual reality-based training on global cognition and executive function compared with conventional training or information-based treatment in older adults, regardless of cognitive level. A systematic literature search was conducted using four databases. A total of 31 randomized controlled trials were identified. Pooled effect sizes were calculated, the risk of bias was assessed, and evidence was graded. The primary analyses showed a small but statistically significant effect of virtual reality-based training compared with control on global cognition (Hedges' g 0.42, 95% confidence interval [0.17, 0.68], I2 = 70.1%, n = 876, 20 randomized controlled trials, low evidence) and executive function (Hedges' g 0.35, 95% confidence interval [0.06, 0.65], I2 = 68.4%, n = 810, 16 randomized controlled trials, very low evidence). Meta-regression yielded inconclusive results. Virtual reality-based training may be more effective than control in improving cognition in older adults; however, more high-quality studies are needed.
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Affiliation(s)
- Mirjami Kantola
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Outi Ilves
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Department of Sports and Rehabilitation, South-Eastern Finland University of Applied Sciences, Savonlinna, Finland
| | - Sari Honkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Harto Hakonen
- Jamk University of Applied Sciences, LIKES, Jyväskylä, Finland
| | - Riku Yli-Ikkelä
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Anna Köyhäjoki
- Central Ostrobothnia Well-Being Service County "Soite", Kokkola, Finland
| | - Marjo-Riitta Anttila
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Aki Rintala
- Physical Activity and Functional Capacity Research Group, Faculty of Health Care and Social Services, LAB University of Applied Sciences, Lahti, Finland
| | - Hilkka Korpi
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Social and Healthcare Unit, Vaasa University of Applied Sciences, Vaasa, Finland
- Well-being and Culture Unit, Oulu University of Applied Sciences, Oulu, Finland
| | - Tuulikki Sjögren
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Juha Karvanen
- Faculty of Mathematics and Science, University of Jyväskylä, Jyväskylä, Finland
| | - Eeva Aartolahti
- Institute of Rehabilitation, Jamk University of Applied Sciences, Jyväskylä, Finland
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Yu D, Li X, He S, Zhu H, Lam FMH, Pang MYC. The effect of dual-task training on cognitive ability, physical function, and dual-task performance in people with dementia or mild cognitive impairment: A systematic review and meta-analysis. Clin Rehabil 2024; 38:443-456. [PMID: 38009067 DOI: 10.1177/02692155231216621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
OBJECTIVE To summarize the effect of dual-task training on cognitive, physical function, and dual-task performance in people with mild cognitive impairment or dementia. DATA SOURCES Embase, PEDro, PsycINFO, PubMed, CINAHL, The Cochrane Library, and a forward search conducted via Web of Science have been searched from inception to July 2023. REVIEW METHODS Good-quality randomized controlled trials compared dual-task training with no/placebo intervention or single-task training among people with a primary diagnosis of mild cognitive impairment or dementia were included. The PEDro scale was used to evaluate the methodological quality of individual studies. The Grading of Recommendations, Assessment, Development and Evaluations system was adopted to appraise the quality of evidence for each outcome. RESULTS Eighteen trials (1325 participants) were included, and 17 provided data for meta-analysis. Comparing with no intervention, dual-task training led to significant improvements on attention (mean difference (MD) = -20.66, 95%CI [-39.42, -1.90]), functional mobility (MD = -2.73; 95%CI [-3.98, -1.49]). Compared with single-task training, dual-task training had greater effects on overall cognitive function (standardized mean difference (SMD) = 0.29, 95%CI [0.09, 0.49]), balance (SMD = 0.78, 95%CI [0.40, 1.15]) and functional mobility (MD = -1.17; 95%CI [-1.77, -0.58]). Its effect on dual-task performance remains inconclusive due to the inconsistent results reported. CONCLUSION Low- to moderate-quality evidence supports that dual-task training has beneficial effects on cognitive function and physical function in individuals with dementia or mild cognitive impairment. The optimal training protocol of dual-task training on cognitive and physical functions, and dual-task performance remains uncertain. Well-designed, randomized studies with large enough sample sizes are warranted.
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Affiliation(s)
- Dan Yu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Xun Li
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Shutang He
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Huina Zhu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
- Department of Rehabilitation Technology, Fujian Putian Health School, Putian, Fujian Province, China
| | - Freddy Man Hin Lam
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Marco Yiu Chung Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
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van Santen J, Dröes RM, Blanson Henkemans O, Schoone M, Valk R, Straten AV, Meiland F. Implementation of exergaming for people with dementia: facilitators, barriers, and recommendations. Aging Ment Health 2024; 28:244-253. [PMID: 37493266 DOI: 10.1080/13607863.2023.2238259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/23/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES To identify facilitators, barriers, and formulate recommendations for the implementation of exergames for people with dementia (PWD) in day-care centers (DCCs). METHODS Within a randomized controlled trial into the effectiveness of exergaming, 73 PWD with their informal caregivers (IC) from 11 DCCs in the Netherlands and two exergame providers participated in a process evaluation. This was a mixed-methods study using focus groups, semi-structured interviews, the Measurement Instrument for Determinants of Innovations, forms for DCC staff, and a short satisfaction questionnaire. We used descriptive statistics for the quantitative outcomes, and thematic analysis for qualitative data. The Medical Research Council guidance for process evaluation was used to identify facilitators and barriers to the implementation, mechanisms of impact, and context. RESULTS Implementation-related facilitators and barriers were the availability of budget, staff, equipment, instructions, location, and supervision. Mechanisms of impact-related facilitators were experienced positive effects on physical functioning and mobility, cognitive, emotional, and social functioning, and quality of life. Barriers were mainly linked to the need to customize the intervention for each participant. Contextual facilitators were support and enthusiasm from others; barriers were costs and planning. Recommendations by DCC staff involved technical support, instructions, responsibility, location, supervision, planning, and exergaming as a group or individually. CONCLUSION Users, IC, and staff positively valued exergaming. We found various facilitators and barriers leading to recommendations for successful implementation. We recommend further research into tailoring exergaming to specific users and contexts, and into usability and cost-effectiveness. This may contribute to further dissemination and implementation of exergaming for PWD.
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Affiliation(s)
- Joeke van Santen
- Department of Psychiatry, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | | | - Ronald Valk
- HilverZorg-Day-Care Center Zonnehoeve, Hilversum, Netherlands
| | - Annemieke van Straten
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Clinical- Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, Netherlands
| | - Franka Meiland
- Department of Psychiatry, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Medicine for Older People, Gerion, Amsterdam, Netherlands
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11
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Xue D, Li PWC, Yu DSF, Lin RSY. Combined exercise and cognitive interventions for adults with mild cognitive impairment and dementia: A systematic review and network meta-analysis. Int J Nurs Stud 2023; 147:104592. [PMID: 37769394 DOI: 10.1016/j.ijnurstu.2023.104592] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Exercise and cognitive interventions are beneficial for adults with preclinical and clinical dementia, but it is unclear whether the combination of these two components could generate synergistic benefits and what intervention designs would optimize this effect. OBJECTIVES This review aims to compare the effects of combined exercise and cognitive interventions on cognitive, psychological, functional outcomes, and health-related quality of life with the corresponding single approach and control groups in adults with mild cognitive impairment and dementia. It also aims to identify the optimal intervention design and factors affecting treatment effects. METHODS A comprehensive search was conducted in ten databases from inception to 23rd November 2022. The methodological quality of studies was evaluated by the Cochrane risk of bias tool. Pairwise meta-analyses were performed to assess the effects of combined interventions relative to the single type of intervention and control groups, with further subgroup analysis to explore the factors affecting treatment effects. Network meta-analyses were used to identify the optimal intervention components. RESULTS Twenty-nine randomized controlled trials involving 2910 participants were included. The results of pairwise meta-analyses indicated that combined interventions were superior to exercise in improving response inhibition, working memory, and delayed recall, but were not superior to cognitive interventions in all outcomes. Combined interventions were superior to active/passive controls in improving global cognition, response inhibition, immediate recall, delayed recall, category fluency, processing speed, and visuospatial ability. Influences of the clinical severity of dementia (mild cognitive impairment vs dementia), combination format (sequential vs simultaneous combination), mode of delivery (group-based vs individual-based vs mixed), training duration (short: ≤12 weeks vs medium: 13-24 weeks vs long: >24 weeks), and types of control (active vs passive control) were not detected. The network meta-analysis results indicated that the optimal intervention components varied across different outcomes, with multimodal exercise combining cognitive training demonstrated the greatest effects among all other combined or single component interventions in improving global cognition. CONCLUSIONS This review suggests the advantage of combined interventions over exercise with comparable effects when compared with cognitive interventions in the population with mild cognitive impairment and dementia. Full scale multi-arm randomized controlled trials to compare the effects of combined interventions with cognitive interventions are warranted.
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Affiliation(s)
- Dandan Xue
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Polly W C Li
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Doris S F Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Rose S Y Lin
- University of Rochester School of Nursing, New York, USA.
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12
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Rocha R, Fernandes SM, Santos IM. The Importance of Technology in the Combined Interventions of Cognitive Stimulation and Physical Activity in Cognitive Function in the Elderly: A Systematic Review. Healthcare (Basel) 2023; 11:2375. [PMID: 37685409 PMCID: PMC10486873 DOI: 10.3390/healthcare11172375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/15/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Numerous studies have been developed in an attempt to understand which factors best predict improvements in cognitive function in the elderly such as exergaming. The aim of this study was to investigate and systematize literature on intervention programs that simultaneously include cognitive stimulation and physical activity, understand the importance of the use of new technology, including exergaming or computer programs, and understand their impact on cognitive function in older adults, giving indications about their contribution to healthy aging. METHODS A narrative approach was used for extraction and synthesis of the data. Relevant studies were identified from electronic databases such as PubMed, Scopus, Web of Science, and Academic Search Complete. RESULTS Thirty-two articles, involving 2815 participants, were identified. All selected studies were randomized controlled studies. The studies were published between 2011 and 2020. All studies included a combination of cognitive and physical interventions. Many of the studies used technology to administer the cognitive stimulation program. CONCLUSIONS Most of the analyzed studies used exergaming in physical and cognitive interventions, demonstrating that this new form of intervention exerts lasting and stable benefits in cognition. However, we concluded that more studies are needed to compare interventions that use exergaming or computer programs with traditional interventions.
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Affiliation(s)
- Rute Rocha
- Centro Social e Paroquial de S. Mamede do Coronado, Aveiro University, 3810-193 Aveiro, Portugal
| | | | - Isabel M. Santos
- William James Center for Research, Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal;
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13
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Roy SK, Wang JJ, Xu YM. Effects of exercise interventions in Alzheimer's disease: A meta-analysis. Brain Behav 2023:e3051. [PMID: 37334441 DOI: 10.1002/brb3.3051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 06/20/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate the clinical efficacy of exercise intervention in the treatment of patients with Alzheimer's disease (AD) by meta-analysis. METHODS From January 2000 to January 2022, PubMed, Web of Science, Embase, CNKI, and WanFang databases were searched for all studies on the clinical efficacy of exercise intervention in the treatment of AD patients. Stata 17.0 statistical software was used for meta-analysis. RESULTS Specifically, data of 983 patients were subjected to meta-analysis, including 463 patients in the control group (conventional drug therapy) and 520 patients in the treatment group (physical exercise on the basis of conventional therapy). The results of meta-analysis showed that Mini-Mental State Examination (MMSE) score and Activities of Daily Living Scale (ADL) score in the treatment group were significantly higher than those in the control group. Further subgroup analysis of exercise intervention >16 weeks found that MMSE and ADL scores in the treatment group were significantly higher than those in the control group. Subgroup analysis of exercise intervention ≤16 weeks demonstrated that MMSE and ADL in the treatment group were higher than those in the control group. In addition, the treatment group had a significant lower Neuropsychiatric Inventory (NPI) score compared with the control group (SMD = -0.76, 95% CI (-1.37, -0.16), p = .013); subgroup analysis showed that the NPI score in the treatment group were lower than that in the control group when exercise intervention was >16 weeks [SMD = -1.01, 95% CI (-1.99, -0.04), p = .042] and ≤16 weeks [SMD = 0.43, 95% CI (-0.82, -0.03), p = .034]. CONCLUSION Exercise intervention can improve the neuropsychiatric symptoms, activities of daily living and cognitive function of AD patients, but the improvement is not significant in case of exercise intervention ≤16 weeks.
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Affiliation(s)
- Sagor Kumar Roy
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jing-Jing Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yu-Ming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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14
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Cai Z, Ma Y, Li L, Lu GZ. Effects of exergaming in older individuals with mild cognitive impairment and dementia: A systematic review and meta-analysis. Geriatr Nurs 2023; 51:351-359. [PMID: 37099867 DOI: 10.1016/j.gerinurse.2023.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Non-pharmaceutical interventions have been implemented for people with dementia or mild cognitive impairment (MCI). Researchers have used exergaming in dementia to alleviate cognitive decline in patients with dementia. AIMS We assessed the effects of exergaming interventions on MCI and dementia. METHODS We conducted a systematic review and meta-analysis (PROSPERO [CRD42022347399]). PubMed, Cochrane Library, Web of Science, CINAHL, and Embase electronic databases were searched for randomized controlled trials (RCTs). The impact of exergaming on cognitive function, physical performance, and quality of life in patients with MCI and dementia was investigated. RESULTS Ten RCTs met the eligibility criteria and were included in our systematic review. The results of the meta-analysis demonstrated a statistically significant difference in the Mini-mental State Examination, Montreal Cognitive Assessment, Trail Making Test, Chinese version of the Verbal Learning Test, Berg Balance Scale, Short Physical Performance Battery, and Physical Activity Scale for the Elderly in people with dementia and MCI who participated in exergaming. However, there were no significant improvements in the Activities of Daily Living, Instrumental Activity of Daily Living or Quality of Life. CONCLUSION Although there were significant differences in cognitive and physical functions, these results should be interpreted with caution because of heterogeneity. The additional benefits of exergaming remain to be confirmed in future studies.
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Affiliation(s)
- Zhi Cai
- The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Yanling Ma
- West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Lei Li
- Sichuan Vocational college of Health and rehabilitation, Zigong, Sichuan, China.
| | - Gui-Zhi Lu
- The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
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15
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Steichele K, Keefer A, Dietzel N, Graessel E, Prokosch HU, Kolominsky-Rabas PL. The effects of exercise programs on cognition, activities of daily living, and neuropsychiatric symptoms in community-dwelling people with dementia—a systematic review. Alzheimers Res Ther 2022; 14:97. [PMID: 35869496 PMCID: PMC9306176 DOI: 10.1186/s13195-022-01040-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
The prevalence of dementia is expected to increase dramatically. Due to a lack of pharmacological treatment options for people with dementia, non-pharmacological treatments such as exercise programs have been recommended to improve cognition, activities of daily living, and neuropsychiatric symptoms. However, inconsistent results have been reported across different trials, mainly because of the high heterogeneity of exercise modalities. Thus, this systematic review aims to answer the questions whether exercise programs improve cognition, activities of daily living as well as neuropsychiatric symptoms in community-dwelling people with dementia.
Methods
Eight databases were searched for articles published between 2016 and 2021 (ALOIS, CENTRAL, CINAHL, Embase, MEDLINE, PsycINFO, PubMed, Web of Science). Randomized controlled trials evaluating the effects of any type of physical activity on cognition, activities of daily living, or neuropsychiatric symptoms in community-dwelling people with a formal diagnosis of dementia were included in this systematic review. Two authors independently assessed eligibility and quality of the studies. The methodology was in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.
Results
Eight publications covering seven trials were included in this review with the majority investigating either a combination of strength and aerobic exercise or aerobic exercise alone. This review revealed that there is no clear evidence for the beneficial effects of exercise on cognition. None of the included trials found an impact on activities of daily living. Although different randomized controlled trials reported inconsistent results, one trial indicated that especially aerobic exercise may improve neuropsychiatric symptoms.
Conclusion
Our systematic review did not confirm the impact of exercise on cognition and activities of daily living in community-dwelling people with dementia. The results suggested that aerobic exercise might be effective to reduce neuropsychiatric symptoms. Well-designed trials including only community-dwelling people with a formal diagnosis of dementia, large samples, long-term follow-ups, and detailed description of adherence to the intervention are needed to improve the scientific evidence on the best type of exercise modality.
Trial registration
PROSPERO, CRD42021246598.
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van Santen J, Meiland FJM, Dröes R, van Straten A, Bosmans JE. Cost-effectiveness of exergaming compared to regular day-care activities in dementia: Results of a randomised controlled trial in The Netherlands. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1794-e1804. [PMID: 34657346 PMCID: PMC9544668 DOI: 10.1111/hsc.13608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 10/04/2021] [Indexed: 06/02/2023]
Abstract
The growing number of people living with dementia will result in increased costs of dementia worldwide. The e-Health intervention 'Exergaming' may improve health and quality of life of people with dementia, but the cost-effectiveness is unknown. We assessed the cost-effectiveness of exergaming compared to regular activities from a societal perspective in day-care centres (DCC) for people with dementia and their informal caregivers (IC) alongside a cluster randomised controlled trial. We included 112 dyads (person with dementia and IC) from 20 psychogeriatric DCCs (11 exergaming, 9 control) across the Netherlands. Exergaming consisted of interactive cycling at least twice a week for 6 months. Measurements were conducted at baseline (T0), after 3 (T1) and 6 (T2) months. Primary outcomes were minutes of physical activity, mobility of the participants with dementia (Short Physical Performances Battery, SPPB), and Quality-Adjusted Life-Years (QALYs) of participants with dementia and ICs. ICs filled out cost diaries to measure healthcare and informal care utilisation during the study. There were no statistically significant differences in outcomes or costs between the groups at the level of participants with dementia, the ICs or the dyad. With regard to QALYs and SPPB, the probability that exergaming is cost-effective compared to control was low for all possible willingness-to-pay (WTP) thresholds. However, for physical activity at WTP thresholds of 0, 50 and 250 Euros per additional minute of physical activity, the probability of cost-effectiveness is 0.46, 0.84 and 0.87, respectively. Exergaming in DCC was not cost-effective compared to usual activities. However, considering the small sample size and the large number of missing observations, findings should be interpreted with caution. Future studies with larger samples are recommended to obtain definitive answers on the cost-effectiveness of exergaming. This trial was registered in the Netherlands Trial Register (NTR5537/NL5420).
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Affiliation(s)
- Joeke van Santen
- Department of PsychiatryAmsterdam UMCAmsterdamThe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Franka J. M. Meiland
- Department of PsychiatryAmsterdam UMCAmsterdamThe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Department of Medicine for Older People, Amsterdam UMCAmsterdamThe Netherlands
| | - Rose‐Marie Dröes
- Department of PsychiatryAmsterdam UMCAmsterdamThe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Annemieke van Straten
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Department of Clinical‐, Neuro‐ and Developmental PsychologyFaculty of Behavioural and Movement SciencesVU University AmsterdamAmsterdamThe Netherlands
| | - Judith E. Bosmans
- Department of Health SciencesFaculty of ScienceVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
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Abd-Alrazaq A, Alhuwail D, Ahmed A, Househ M. Effectiveness of Serious Games for Improving Executive Functions Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis. JMIR Serious Games 2022; 10:e36123. [PMID: 35877166 PMCID: PMC9361143 DOI: 10.2196/36123] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/07/2022] [Accepted: 03/16/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Executive functions are one of the known cognitive abilities that decline with age. They are the high-order cognitive processes that enable an individual to concentrate, plan, and take action. Serious games, which are games developed for specific purposes other than entertainment, could play a positive role in improving executive functions. Several systematic reviews have pooled the evidence about the effectiveness of serious games in improving executive functions; however, they are limited by some weaknesses. OBJECTIVE This study aims to investigate the effectiveness of serious games for improving executive functions among older adults with cognitive impairment. METHODS A systematic review of randomized controlled trials (RCTs) was conducted. To retrieve relevant studies, 8 electronic databases were searched. Further, reference lists of the included studies and relevant reviews were screened, and we checked studies that cited our included studies. Two reviewers independently checked the eligibility of the studies, extracted data from the included studies, assessed the risk of bias, and appraised the quality of the evidence. We used a narrative and statistical approach, as appropriate, to synthesize results of the included studies. RESULTS Of 548 publications identified, 16 RCTs were eventually included in this review. Of the 16 studies, 14 studies were included in 6 meta-analyses. Our meta-analyses showed that serious games are as effective as no or passive interventions at improving executive functions (P=.29). Surprisingly, conventional exercises were more effective than serious games at improving executive functions (P=.03). Our subgroup analysis showed that both types of serious games (cognitive training games, P=.08; exergames, P=.16) are as effective as conventional exercises at improving executive functions. No difference was found between adaptive serious games and nonadaptive serious games for improving executive functions (P=.59). CONCLUSIONS Serious games are not superior to no or passive interventions and conventional exercises at improving executive functions among older adults with cognitive impairment. However, our findings remain inconclusive due to the low quality of the evidence, the small sample size in most included studies, and the paucity of studies included in the meta-analyses. Accordingly, until more robust evidence is available, serious games should not be offered by health care providers nor used by patients for improving executive functions among older adults with cognitive impairment. Further reviews are needed to assess the long-term effect of serious games on specific executive functions or other cognitive abilities among people from different age groups with or without cognitive impairment. TRIAL REGISTRATION PROSPERO CRD42021272757; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=272757.
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Affiliation(s)
- Alaa Abd-Alrazaq
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Doha, Qatar
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Dari Alhuwail
- Information Science Department, College of Life Sciences, Kuwait University, Kuwait, Kuwait
- Health Informatics Unit, Dasman Diabetes Institute, Kuwait, Kuwait
| | - Arfan Ahmed
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Mowafa Househ
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
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Di Lorito C, Bosco A, Rai H, Craven M, McNally D, Todd C, Booth V, Cowley A, Howe L, Harwood RH. A systematic literature review and meta-analysis on digital health interventions for people living with dementia and Mild Cognitive Impairment. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5730. [PMID: 35588315 PMCID: PMC9321868 DOI: 10.1002/gps.5730] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/27/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Digital health interventions enable services to support people living with dementia and Mild Cognitive Impairment (MCI) remotely. This literature review gathers evidence on the effectiveness of digital health interventions on physical, cognitive, behavioural and psychological outcomes, and Activities of Daily Living in people living with dementia and MCI. METHODS/DESIGN Searches, using nine databases, were run in November 2021. Two authors carried out study selection/appraisal using the Critical Appraisal Skills Programme checklist. Study characteristics were extracted through the Cochrane handbook for systematic reviews of interventions data extraction form. Data on digital health interventions were extracted through the template for intervention description and replication (TIDieR) checklist and guide. Intervention effectiveness was determined through effect sizes. Meta-analyses were performed to pool data on intervention effectiveness. RESULTS Twenty studies were included in the review, with a diverse range of interventions, modes of delivery, activities, duration, length, frequency, and intensity. Compared to controls, the interventions produced a moderate effect on cognitive abilities (SMD = 0.36; 95% CI = -0.03 to 0.76; I2 = 61%), and a negative moderate effect on basic ADLs (SMD = -0.40; 95% CI = -0.86 to 0.05; I2 = 69%). Stepping exergames generated the largest effect sizes on physical and cognitive abilities. Supervised training produced larger effect sizes than unsupervised interventions. CONCLUSION Supervised intervention delivery is linked to greatest benefits. A mix of remote and face-to-face delivery could maximise benefits and optimise costs. Accessibility, acceptability and sustainability of digital interventions for end-users must be pre-requisites for the development of future successful services.
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Affiliation(s)
| | | | - Harleen Rai
- Computer and Information SciencesUniversity of StrathclydeGlasgowUK
| | | | - Donal McNally
- Faculty of EngineeringUniversity of NottinghamNottinghamUK
| | - Chris Todd
- School of Health SciencesUniversity of ManchesterManchesterUK
| | - Vicky Booth
- School of MedicineUniversity of NottinghamNottinghamUK
| | - Alison Cowley
- Nottingham University Hospitals NHS TrustNottinghamUK
| | - Louise Howe
- School of MedicineUniversity of NottinghamNottinghamUK
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Abd-alrazaq A, Ahmed A, Alali H, Aldardour AM, Househ M. The effectiveness of serious games in improving processing speed among elderly people with cognitive impairment: A systematic review and meta-analysis (Preprint).. [DOI: 10.2196/preprints.36754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND
Cognitive processing speed is known to decline by age. Processing speed refers to the time that an individual takes from receiving a stimulus to reacting to it. Serious games, which are video games employed for training and educational purposes, have the potential in improving processing speed. Numerous systematic reviews have summarized the evidence about the effectiveness of serious games in improving processing speed, but they are undermined by some limitations.
OBJECTIVE
This study aims to pool the evidence about the effectiveness of serious games in improving processing speed among elderly people with cognitive impairment.
METHODS
A systematic review of randomized controlled trials (RCTs) was undertaken. Two search sources were used in this review: 8 electronic databases as well as backward and forward reference list checking. Two reviewers independently checked the eligibility of the studies, extracted data from the included studies, and appraised the risk of bias and quality of the evidence. Evidence from the included studies was synthesized using a narrative and statistical approach (i.e., meta-analysis), as appropriate.
RESULTS
Out of 548 publications identified, 16 RCTs eventually met all eligibility criteria. Very low-quality evidence from 8 RCTs and 6 RCTs showed no statistically significant effect of serious games on the processing speed as compared with no or passive interventions groups (P=0.77) and conventional exercises (P=0.58), respectively. A subgroup analysis showed that both types of serious games (cognitive training games (P=0.26) and exergames (P=0.88)) are as effective as conventional exercises in improving processing speed.
CONCLUSIONS
There is no superiority of serious games over no or passive interventions and conventional exercises in improving processing speed among older adults with cognitive impairment. Yet, our findings remain inconclusive due to the low quality of the evidence, the small sample size in most included studies, and the paucity of studies included in the meta-analyses. Therefore, until more robust evidence is published, serious games should be offered or used as an adjunct to existing interventions. Further trials should be undertaken to investigate the effect of serious games that target specifically processing speed rather than cognitive abilities in general.
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Abd-Alrazaq A, Ahmed A, Alali H, Aldardour AM, Househ M. The effectiveness of serious games on the cognitive processing speed among elderly people with cognitive impairment: A systematic review and meta-analysis (Preprint). JMIR Serious Games 2022; 10:e36754. [PMID: 36083623 PMCID: PMC9508673 DOI: 10.2196/36754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/23/2022] [Accepted: 04/07/2022] [Indexed: 12/22/2022] Open
Abstract
Background Human cognitive processing speed is known to decline with age. Human cognitive processing speed refers to the time that an individual takes from receiving a stimulus to reacting to it. Serious games, which are video games used for training and educational purposes, have the potential to improve processing speed. Numerous systematic reviews have summarized the evidence regarding the effectiveness of serious games in improving processing speed, but they are undermined by some limitations. Objective This study aimed to examine the effectiveness of serious games on the cognitive processing speed of an older adult population living with cognitive impairment. Methods A systematic review of randomized controlled trials (RCTs) was conducted. Two search sources were used in this review: 8 electronic databases and backward and forward reference list checking. A total of 2 reviewers independently checked the eligibility of the studies, extracted data from the included studies, and appraised the risk of bias and quality of the evidence. Evidence from the included studies was synthesized using a narrative and statistical approach (ie, meta-analysis), as appropriate. Results Of the 548 publications identified, 16 (2.9%) RCTs eventually met all eligibility criteria. Very-low-quality evidence from 50% (8/16) and 38% (6/16) of the RCTs showed no statistically significant effect of serious games on processing speed compared with no or passive intervention groups (P=.77) and conventional exercises (P=.58), respectively. A subgroup analysis showed that both types of serious games (cognitive training games: P=.26; exergames: P=.88) were as effective as conventional exercises in improving processing speed. Conclusions There is no superiority of serious games over no or passive interventions and conventional exercises in improving processing speed among older adults with cognitive impairment. However, our findings remain inconclusive because of the low quality of the evidence, the small sample size in most of the included studies, and the paucity of studies included in the meta-analyses. Therefore, until more robust evidence is published, serious games should be offered or used as an adjunct to existing interventions. Further trials should be undertaken to investigate the effect of serious games that specifically target processing speed rather than cognitive abilities in general. Trial Registration PROSPERO CRD42022301667; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=301667
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Affiliation(s)
- Alaa Abd-Alrazaq
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Arfan Ahmed
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Haitham Alali
- Health Management Department, Faculty of Medical and Health Sciences, Liwa College of Technology, Abu Dhabi, United Arab Emirates
| | | | - Mowafa Househ
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
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Abd-alrazaq A, Alhuwail D, Ahmed A, Househ M. Effectiveness of Serious Games for Improving Executive Functions Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis (Preprint).. [DOI: 10.2196/preprints.36123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND
Executive functions are one of the known cognitive abilities that decline with age. They are the high-order cognitive processes that enable an individual to concentrate, plan, and take action. Serious games, which are games developed for specific purposes other than entertainment, could play a positive role in improving executive functions. Several systematic reviews have pooled the evidence about the effectiveness of serious games in improving executive functions; however, they are limited by some weaknesses.
OBJECTIVE
This study aims to investigate the effectiveness of serious games for improving executive functions among older adults with cognitive impairment.
METHODS
A systematic review of randomized controlled trials (RCTs) was conducted. To retrieve relevant studies, 8 electronic databases were searched. Further, reference lists of the included studies and relevant reviews were screened, and we checked studies that cited our included studies. Two reviewers independently checked the eligibility of the studies, extracted data from the included studies, assessed the risk of bias, and appraised the quality of the evidence. We used a narrative and statistical approach, as appropriate, to synthesize results of the included studies.
RESULTS
Of 548 publications identified, 16 RCTs were eventually included in this review. Of the 16 studies, 14 studies were included in 6 meta-analyses. Our meta-analyses showed that serious games are as effective as no or passive interventions at improving executive functions (<i>P</i>=.29). Surprisingly, conventional exercises were more effective than serious games at improving executive functions (<i>P</i>=.03). Our subgroup analysis showed that both types of serious games (cognitive training games, <i>P</i>=.08; exergames, <i>P</i>=.16) are as effective as conventional exercises at improving executive functions. No difference was found between adaptive serious games and nonadaptive serious games for improving executive functions (<i>P</i>=.59).
CONCLUSIONS
Serious games are not superior to no or passive interventions and conventional exercises at improving executive functions among older adults with cognitive impairment. However, our findings remain inconclusive due to the low quality of the evidence, the small sample size in most included studies, and the paucity of studies included in the meta-analyses. Accordingly, until more robust evidence is available, serious games should not be offered by health care providers nor used by patients for improving executive functions among older adults with cognitive impairment. Further reviews are needed to assess the long-term effect of serious games on specific executive functions or other cognitive abilities among people from different age groups with or without cognitive impairment.
CLINICALTRIAL
PROSPERO CRD42021272757; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=272757
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Abd-Alrazaq A, Alajlani M, Alhuwail D, Toro CT, Giannicchi A, Ahmed A, Makhlouf A, Househ M. The effectiveness and safety of serious games in improving cognitive abilities among elderly people with cognitive impairment: A systematic review and meta-analysis (Preprint). JMIR Serious Games 2021; 10:e34592. [PMID: 35266877 PMCID: PMC8949701 DOI: 10.2196/34592] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/25/2021] [Accepted: 12/30/2021] [Indexed: 12/13/2022] Open
Abstract
Background Cognitive impairment is a mental disorder that commonly affects elderly people. Serious games, which are games that have a purpose other than entertainment, have been used as a nonpharmacological intervention for improving cognitive abilities. The effectiveness and safety of serious games for improving cognitive abilities have been investigated by several systematic reviews; however, they are limited by design and methodological weaknesses. Objective This study aims to assess the effectiveness and safety of serious games for improving cognitive abilities among elderly people with cognitive impairment. Methods A systematic review of randomized controlled trials (RCTs) was conducted. The following 8 electronic databases were searched: MEDLINE, Embase, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also screened reference lists of the included studies and relevant reviews, as well as checked studies citing our included studies. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies. Results Fifteen studies met the eligibility criteria among 466 citations retrieved. Of those, 14 RCTs were eventually included in the meta-analysis. We found that, regardless of their type, serious games were more effective than no intervention (P=.04) and conventional exercises (P=.002) for improving global cognition among elderly people with cognitive impairment. Further, a subgroup analysis showed that cognitive training games were more effective than no intervention (P=.05) and conventional exercises (P<.001) for improving global cognition among elderly people with cognitive impairment. Another subgroup analysis demonstrated that exergames (a category of serious games that includes physical exercises) are as effective as no intervention and conventional exercises (P=.38) for improving global cognition among elderly people with cognitive impairment. Although some studies found adverse events from using serious games, the number of adverse events (ie, falls and exacerbations of pre-existing arthritis symptoms) was comparable between the serious game and control groups. Conclusions Serious games and specifically cognitive training games have the potential to improve global cognition among elderly people with cognitive impairment. However, our findings remain inconclusive because the quality of evidence in all meta-analyses was very low, mainly due to the risk of bias raised in the majority of the included studies, high heterogeneity of the evidence, and imprecision of total effect sizes. Therefore, psychologists, psychiatrists, and patients should consider offering serious games as a complement and not a substitute to existing interventions until further more robust evidence is available. Further studies are needed to assess the effect of exergames, the safety of serious games, and their long-term effects.
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Affiliation(s)
- Alaa Abd-Alrazaq
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Mohannad Alajlani
- Warwick Manufacturing Group, Institute of Digital Healthcare, University of Warwick, Warwick, United Kingdom
| | - Dari Alhuwail
- Information Science Department, College of Life Sciences, Kuwait University, Kuwait, Kuwait
- Health Informatics Unit, Dasman Diabetes Institute, Kuwait, Kuwait
| | - Carla T Toro
- Warwick Manufacturing Group, Institute of Digital Healthcare, University of Warwick, Warwick, United Kingdom
| | - Anna Giannicchi
- Behavioral Health Services and Policy Research Department, New York State Psychiatric Institute, New York, NY, United States
| | - Arfan Ahmed
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ahmed Makhlouf
- Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Mowafa Househ
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
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Abd-alrazaq A, Alajlani M, Alhuwail D, Toro CT, Giannicchi A, Ahmed A, Makhlouf A, Househ M. The Effectiveness and Safety of Serious Games for Improving Cognitive Abilities Among Elderly People With Cognitive Impairment: Systematic Review and Meta-Analysis (Preprint).. [DOI: 10.2196/preprints.34592] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND
Cognitive impairment is a mental disorder that commonly affects elderly people. Serious games, which are games that have a purpose other than entertainment, have been used as a nonpharmacological intervention for improving cognitive abilities. The effectiveness and safety of serious games for improving cognitive abilities have been investigated by several systematic reviews; however, they are limited by design and methodological weaknesses.
OBJECTIVE
This study aims to assess the effectiveness and safety of serious games for improving cognitive abilities among elderly people with cognitive impairment.
METHODS
A systematic review of randomized controlled trials (RCTs) was conducted. The following 8 electronic databases were searched: MEDLINE, Embase, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also screened reference lists of the included studies and relevant reviews, as well as checked studies citing our included studies. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies.
RESULTS
Fifteen studies met the eligibility criteria among 466 citations retrieved. Of those, 14 RCTs were eventually included in the meta-analysis. We found that, regardless of their type, serious games were more effective than no intervention (<i>P</i>=.04) and conventional exercises (<i>P</i>=.002) for improving global cognition among elderly people with cognitive impairment. Further, a subgroup analysis showed that cognitive training games were more effective than no intervention (<i>P</i>=.05) and conventional exercises (<i>P</i><.001) for improving global cognition among elderly people with cognitive impairment. Another subgroup analysis demonstrated that exergames (a category of serious games that includes physical exercises) are as effective as no intervention and conventional exercises (<i>P</i>=.38) for improving global cognition among elderly people with cognitive impairment. Although some studies found adverse events from using serious games, the number of adverse events (ie, falls and exacerbations of pre-existing arthritis symptoms) was comparable between the serious game and control groups.
CONCLUSIONS
Serious games and specifically cognitive training games have the potential to improve global cognition among elderly people with cognitive impairment. However, our findings remain inconclusive because the quality of evidence in all meta-analyses was very low, mainly due to the risk of bias raised in the majority of the included studies, high heterogeneity of the evidence, and imprecision of total effect sizes. Therefore, psychologists, psychiatrists, and patients should consider offering serious games as a complement and not a substitute to existing interventions until further more robust evidence is available. Further studies are needed to assess the effect of exergames, the safety of serious games, and their long-term effects.
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Ferreira-Brito F, Ribeiro F, Aguiar de Sousa D, Costa J, Caneiras C, Carriço L, Verdelho A. Are Video Games Effective to Promote Cognition and Everyday Functional Capacity in Mild Cognitive Impairment/Dementia Patients? A Meta-Analysis of Randomized Controlled Trials. J Alzheimers Dis 2021; 84:329-341. [PMID: 34542073 DOI: 10.3233/jad-210545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) and dementia are associated with increased age. MCI is a clinical entity described as a transitional state between normal cognition and dementia. Video games (VGs) can potentially promote cognition and functional capacity since multiple cognitive domains are recruited during gameplay. However, there is still a lack of consensus regarding the efficacy of VGs as therapeutic tools, particularly in neurodegenerative diseases. OBJECTIVE We aimed to analyze the impact of VGs on cognition and functional capacity outcomes in MCI/dementia patients. METHODS We conducted a systematic review and meta-analysis study (PROSPERO [CRD42021229445]). PubMed, Web of Science, Epistemonikos, CENTRAL, and EBSCO electronic databases were searched for RCT (2000-2021) that analyzed the impact of VGs on cognitive and functional capacity outcomes in MCI/dementia patients. RESULTS Nine studies were included (n = 409 participants), and Risk of Bias (RoB2) and quality of evidence (GRADE) were assessed. Data regarding attention, memory/learning, visual working memory, executive functions, general cognition, functional capacity, quality of life were identified, and pooled analyses were conducted. An effect favoring VGs interventions was observed on Mini-Mental State Examination (MMSE) score (MD = 1.64, 95%CI 0.60 to 2.69). CONCLUSION Although promising, the effects observed should be interpreted with caution since serious methodological shortcomings were identified in the studies included. Nonetheless, the effect observed is higher than the minimum clinically important difference (1.4 points) established to MMSE. Future studies on the current topic urge. Recommendations for the design and conduction of cognitive RCT studies are presented.
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Affiliation(s)
- Filipa Ferreira-Brito
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Filipa Ribeiro
- Center for Interdisciplinary Research in Health, Instituto de Ciências da Saúde, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Diana Aguiar de Sousa
- Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisboa, Lisbon, Portugal
| | - João Costa
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Centro Colaborador Português da Rede Cochrane Iberoamericana, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Cátia Caneiras
- Laboratório de Investigação em Microbiologia na Saúde Ambiental (EnviHealthMicro Lab), Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Healthcare Department, Nippon Gases Portugal, Vila Franca de Xira, Portugal
| | - Luís Carriço
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Verdelho
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Neurology Service, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
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Swinnen N, Vandenbulcke M, de Bruin ED, Akkerman R, Stubbs B, Firth J, Vancampfort D. The efficacy of exergaming in people with major neurocognitive disorder residing in long-term care facilities: a pilot randomized controlled trial. Alzheimers Res Ther 2021; 13:70. [PMID: 33785077 PMCID: PMC8008333 DOI: 10.1186/s13195-021-00806-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/10/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND It is currently unknown whether exergaming is efficacious in people with major neurocognitive disorder (MNCD) residing in long-term care facilities. This pilot randomized controlled trial (RCT) explored the efficacy of a stepping exergame program on gait speed, balance, mobility, reaction time, cognitive and neuropsychiatric outcomes, quality of life, and daily life functioning in people with MNCD residing in long-term care facilities. METHODS Participants were randomly assigned to 8 weeks, three times weekly, 15 min of exergaming versus watching preferred music videos. The exergame device consisted of a pressure-sensitive step training platform on which participants performed stepping movements to play the games. The device automatically adapted the training level to the participants' capabilities. The Short Physical Performance Battery (SPPB), step reaction time test (SRTT), Montréal Cognitive Assessment (MoCA), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), Dementia Quality of Life (DQoL), and Katz Activities of Daily Living (Katz ADL) were assessed at baseline and post-intervention. A Quade's non-parametric ANCOVA controlling for baseline values with post hoc Bonferroni correction (p < 0.00625) was used to analyze pre- and post-differences between the groups. Partial eta-squared (η2p) effect sizes were calculated. RESULTS Forty-five of 55 randomized inpatients with mild to moderate MNCD (Mini-Mental State Examination score = 17.2 ± 4.5; aged 70-91; 35 women) completed the study. The exergame group (n = 23) demonstrated improvements in gait speed (p < 0.001, η2p = 0.41), total SPPB (p < 0.001, η2p = 0.64), SRTT (p<0.001, η2p = 0.51), MoCA (p<0.001, η2p = 0.38), and reductions in CSDD (p<0.001, η2p = 0.43) compared to the control group (n = 22). There were no differences in NPI (p = 0.165, η2p = 0.05), DQoL (p = 0.012, η2p = 0.16), and ADL (p = 0.008, η2p = 0.16) post-intervention scores between the experimental and control group, albeit DQol and ADL measures showed large effect sizes in the exergame group. The mean attendance rate was 82.9% in the exergame group and 73.7% in the music control group. There were no study-related adverse events reported by the participants, nor observed by the research team. CONCLUSIONS The findings of this pilot RCT suggest that an individually adapted exergame training improves lower extremity functioning, cognitive functioning and step reaction time and symptoms of depression in inpatients with MNCD residing in long-term care facilities. TRIAL REGISTRATION ClinicalTrials.gov, NCT04436302.
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Affiliation(s)
- Nathalie Swinnen
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Leuven, Kortenberg, Belgium
| | - Mathieu Vandenbulcke
- University Psychiatric Centre KU Leuven, Leuven, Kortenberg, Belgium
- KU Leuven Department of Neurosciences, Leuven, Belgium
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zürich, Switzerland.
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
| | | | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Joseph Firth
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NICM Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Leuven, Kortenberg, Belgium
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Appel L, Ali S, Narag T, Mozeson K, Pasat Z, Orchanian-Cheff A, Campos JL. Virtual reality to promote wellbeing in persons with dementia: A scoping review. J Rehabil Assist Technol Eng 2021; 8:20556683211053952. [PMID: 35024166 PMCID: PMC8743938 DOI: 10.1177/20556683211053952] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/12/2021] [Accepted: 10/01/2021] [Indexed: 11/17/2022] Open
Abstract
Virtual Reality (VR) technologies have increasingly been considered potentially valuable tools in dementia-related research and could serve as non-pharmacological therapy to improve quality of life (QoL) and wellbeing for persons with dementia (PwD). In this scoping review, we summarize peer-reviewed articles published up to Jan-21, 2021, on the use of VR to promote wellbeing in PwD. Eighteen manuscripts (reporting on 19 studies) met the inclusion criteria, with a majority published in the past 2 years. Two reviewers independently coded the articles regarding A) intended clinical outcomes and effectiveness of the interventions, B) study sample (characteristics of the participants), C) intervention administration (by whom, what setting), D) experimental methods (design/instruments), and E) technical properties of the VR-systems (hardware/devices and software/content). Emotional outcomes were by far the most common objectives of the interventions, reported in seventeen (89.5%) of the included articles. Outcomes addressing social engagement and personhood in PwD have not been thoroughly explored using VR. Based on the positive impact of VR, future opportunities lie in identifying special features and customization of the hardware/software to afford the most benefit to different sub-groups of the target population. Overall, this review found that VR represents a promising tool for promoting wellbeing in PwD, with positive or neutral impact reported on emotional, social, and functional aspects of wellbeing.
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Affiliation(s)
- Lora Appel
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Suad Ali
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
| | - Tanya Narag
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
| | - Krystyna Mozeson
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
| | - Zain Pasat
- McMaster University, Hamilton, ON, Canada
| | | | - Jennifer L Campos
- KITE Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
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