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Smith AM, Marin A, DeCaro RE, Feinn R, Wack A, Hughes GI, Rivard N, Umashankar A, Turk KW, Budson AE. Algorithmic Spaced Retrieval Enhances Long-Term Memory in Alzheimer Disease: Case-Control Pilot Study. JMIR Form Res 2024; 8:e51943. [PMID: 39028554 PMCID: PMC11297374 DOI: 10.2196/51943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/13/2023] [Accepted: 06/08/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Spaced retrieval is a learning technique that involves engaging in repeated memory testing after increasingly lengthy intervals of time. Spaced retrieval has been shown to improve long-term memory in Alzheimer disease (AD), but it has historically been difficult to implement in the everyday lives of individuals with AD. OBJECTIVE This research aims to determine, in people with mild cognitive impairment (MCI) due to AD, the efficacy and feasibility of a mobile app that combines spaced retrieval with a machine learning algorithm to enhance memory retention. Specifically, the app prompts users to answer questions during brief daily sessions, and a machine learning algorithm tracks each user's rate of forgetting to determine the optimal spacing schedule to prevent anticipated forgetting. METHODS In this pilot study, 61 participants (young adults: n=21, 34%; healthy older adults: n=20, 33%; people with MCI due to AD: n=20, 33%) used the app for 4 weeks to learn new facts and relearn forgotten name-face associations. Participation during the 4-week period was characterized by using the app once per day to answer 15 questions about the facts and names. After the 4-week learning phase, participants completed 2 recognition memory tests approximately 1 week apart, which tested memory for information they had studied using the app as well as information they had not studied. RESULTS After using the mobile app for 1 month, every person with MCI due to AD demonstrated improvements in memory for new facts that they had studied via the app compared to baseline (P<.001). All but one person with MCI due to AD (19/20, 95%) showed improvements of more than 10 percentage points, comparable to the improvements shown by young adults and healthy older adults. Memory for name-face associations was similarly improved for all participant groups after using the app but to a lesser degree. Furthermore, for both new facts and name-face associations, we found no memory decay for any participant group after they took a break of approximately 1 week from using the app at the end of the study. Regarding usability, of the 20 people with MCI due to AD, 16 (80%) self-adhered to the app's automated practice schedule, and half of them (n=10, 50%) expressed an interest in continuing to use it. CONCLUSIONS These results demonstrate early evidence that spaced retrieval mobile apps are both feasible for people with early-stage AD to use in their everyday lives and effective for supporting memory retention of recently learned facts and name-face associations.
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Affiliation(s)
- Amy M Smith
- Blank Slate Technologies, LLC, Arlington, VA, United States
| | - Anna Marin
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, United States
- Alzheimer's Disease Research Center, Boston University, Boston, MA, United States
| | - Renee E DeCaro
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, United States
- Alzheimer's Disease Research Center, Boston University, Boston, MA, United States
| | - Richard Feinn
- Frank H Netter MD School of Medicine, Quinnipiac University, North Haven, CT, United States
| | - Audrey Wack
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, United States
- Alzheimer's Disease Research Center, Boston University, Boston, MA, United States
| | - Gregory I Hughes
- The US Army Combat Capabilities Development Command (DEVCOM) Soldier Center, Natick, MA, United States
- The Center for Applied Brain and Cognitive Sciences, Tufts University, Medford, MA, United States
| | | | - Akshay Umashankar
- Univerity of Texas at Austin College of Education, Austin, TX, United States
| | - Katherine W Turk
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, United States
- Alzheimer's Disease Research Center, Boston University, Boston, MA, United States
| | - Andrew E Budson
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, United States
- Alzheimer's Disease Research Center, Boston University, Boston, MA, United States
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Chen JW, Du WQ, Zhu K. Network meta-analysis of the effects of different cognitive trainings on the cognitive function of patients with mild cognitive impairment. J Psychiatr Res 2024; 174:26-45. [PMID: 38608550 DOI: 10.1016/j.jpsychires.2024.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/07/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE Examining the relationship between the responses of a number of different cognitive trainings on cognitive functioning in middle-aged and elderly patients with mild cognitive impairment. METHODS Randomized controlled experimental studies published publicly from the time of inception to October 30, 2023 were searched through Web of Science, PubMed, Embase, and Cochrane library databases. Traditional and network meta-analyses were performed using Stata 17.0 software. RESULTS Fifty papers on 4 types of cognitive training were included. Traditional meta-analysis showed that virtual reality training (SMD = 0.53, 95%CI: [0.36,0.70], P = 0.00), neuropsychological training (SMD = 0.44, 95%CI: [0.18,0.70], P = 0.00), cognitive strategy training (SMD = 0.26, 95%CI: [0.16,0.36], P = 0.00), and cognitive behavioral therapy (SMD = 0.25, 95%CI: [0.08,0.41], P = 0.00) all had significant improvement effects on the cognitive function of middle-aged and elderly patients with mild cognitive impairment. Network meta-analysis revealed neuropsychological training as the best cognitive training, and subgroup analysis of cognitive function subdimensions showed that neuropsychological training had the best effects on working memory, lobal cognitive function, memory, and cognitive flexibility improvement. Meanwhile, virtual reality training had the best effects on processing speed, verbal ability, overall executive function, spatial cognitive ability, and attention improvement. CONCLUSION Cognitive training can significantly improve the cognitive function of middle-aged and elderly patients with mild cognitive impairment, and neuropsychological training is the best intervention, most effective in interventions lasting more than 8 weeks.
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Affiliation(s)
- Ji-Wei Chen
- School of Physical Education, Shanghai University of Sport, Shanghai, China.
| | - Wen-Qian Du
- School of Physical Education, Shanghai University of Sport, Shanghai, China.
| | - Kun Zhu
- School of Physical Education, Shanghai University of Sport, Shanghai, China.
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Chan ATC, Ip RTF, Tran JYS, Chan JYC, Tsoi KKF. Computerized cognitive training for memory functions in mild cognitive impairment or dementia: a systematic review and meta-analysis. NPJ Digit Med 2024; 7:1. [PMID: 38172429 PMCID: PMC10764827 DOI: 10.1038/s41746-023-00987-5] [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: 06/29/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
Dementia is a common medical condition in the ageing population, and cognitive intervention is a non-pharmacologic strategy to improve cognitive functions. This meta-analysis evaluated the benefits of computerized cognitive training (CCT) on memory functions in individuals with MCI or dementia. The study was registered prospectively with PROSPERO under CRD42022363715 and received no funding. The search was conducted on MEDLINE, Embase, and PsycINFO on Sept 19, 2022, and Google Scholar on May 9, 2023, to identify randomized controlled trials that examined the effects of CCT on memory outcomes in individuals with MCI or dementia. Mean differences and standard deviations of neuropsychological assessment scores were extracted to derive standardized mean differences. Our search identified 10,678 studies, of which 35 studies were included. Among 1489 participants with MCI, CCT showed improvements in verbal memory (SMD (95%CI) = 0.55 (0.35-0.74)), visual memory (0.36 (0.12-0.60)), and working memory (0.37 (0.10-0.64)). Supervised CCT showed improvements in verbal memory (0.72 (0.45-0.98)), visual memory (0.51 (0.22-0.79)), and working memory (0.33 (0.01-0.66)). Unsupervised CCT showed improvement in verbal memory (0.21 (0.04-0.38)) only. Among 371 participants with dementia, CCT showed improvement in verbal memory (0.64 (0.02-1.27)) only. Inconsistency due to heterogeneity (as indicated by I2 values) is observed, which reduces our confidence in MCI outcomes to a moderate level and dementia outcomes to a low level. The results suggest that CCT is efficacious on various memory domains in individuals with MCI. Although the supervised approach showed greater effects, the unsupervised approach can improve verbal memory while allowing users to receive CCT at home without engaging as many healthcare resources.
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Affiliation(s)
- Aaron T C Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Roy T F Ip
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Joshua Y S Tran
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Joyce Y 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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Raimo S, Cropano M, Gaita M, Maggi G, Cavallo ND, Roldan-Tapia MD, Santangelo G. The Efficacy of Cognitive Training on Neuropsychological Outcomes in Mild Cognitive Impairment: A Meta-Analysis. Brain Sci 2023; 13:1510. [PMID: 38002471 PMCID: PMC10669748 DOI: 10.3390/brainsci13111510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
Mild cognitive impairment (MCI) or mild neurocognitive disorder is an intermediate stage of cognitive impairment between normal cognitive aging and dementia. Given the absence of effective pharmacological treatments for MCI, increasing numbers of studies are attempting to understand how cognitive training (CT) could benefit MCI. This meta-analysis aims to update and assess the efficacy of CT on specific neuropsychological test performance (global cognitive functioning, short-term verbal memory, long-term verbal memory, generativity, working memory, and visuospatial abilities) in individuals diagnosed with MCI, as compared to MCI control groups. After searching electronic databases for randomized controlled trials, 31 studies were found including 2496 participants. Results showed that CT significantly improved global cognitive functioning, short-term and long-term verbal memory, generativity, working memory, and visuospatial abilities. However, no significant effects were observed for shifting, abstraction ability/concept formation, processing speed, and language. The mode of CT had a moderating effect on abstraction ability/concept formation. The findings provide specific insights into the cognitive functions influenced by CT and guide the development of tailored interventions for MCI. While CT holds promise, further research is needed to address certain cognitive deficits and assess long-term effects on dementia progression.
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Affiliation(s)
- Simona Raimo
- Department of Psychology, ‘Luigi Vanvitelli’ University of Campania, 81100 Caserta, Italy; (M.C.); (M.G.); (G.M.); (N.D.C.)
| | - Maria Cropano
- Department of Psychology, ‘Luigi Vanvitelli’ University of Campania, 81100 Caserta, Italy; (M.C.); (M.G.); (G.M.); (N.D.C.)
| | - Mariachiara Gaita
- Department of Psychology, ‘Luigi Vanvitelli’ University of Campania, 81100 Caserta, Italy; (M.C.); (M.G.); (G.M.); (N.D.C.)
| | - Gianpaolo Maggi
- Department of Psychology, ‘Luigi Vanvitelli’ University of Campania, 81100 Caserta, Italy; (M.C.); (M.G.); (G.M.); (N.D.C.)
| | - Nicola Davide Cavallo
- Department of Psychology, ‘Luigi Vanvitelli’ University of Campania, 81100 Caserta, Italy; (M.C.); (M.G.); (G.M.); (N.D.C.)
| | | | - Gabriella Santangelo
- Department of Psychology, ‘Luigi Vanvitelli’ University of Campania, 81100 Caserta, Italy; (M.C.); (M.G.); (G.M.); (N.D.C.)
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Goumopoulos C, Skikos G, Frounta M. Feasibility and Effects of Cognitive Training with the COGNIPLAT Game Platform in Elderly with Mild Cognitive Impairment: Pilot Randomized Controlled Trial. Games Health J 2023; 12:414-425. [PMID: 37276027 DOI: 10.1089/g4h.2023.0029] [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: 06/07/2023] Open
Abstract
This study examines the effectiveness of a new multi-domain multimodal cognitive training game platform, COGNIPLAT, in improving cognitive performance in elderly with mild cognitive impairment (MCI). The platform combines standard serious games and cognitive stimulation leveraging virtual and augmented reality technologies. A double-arm, evaluator-blinded randomized controlled trial was conducted with 21 elderly participants in the MCI spectrum, with 11 in the intervention group (INT) and 10 in the control group (CTL). Feasibility was assessed in terms of adherence, effective learning, and perceived usefulness. The INT attended 24 training sessions, 60 minutes long, twice a week, whereas the CTL engaged in normal daily activities and usual care. Results showed that the INT had a statistically significant change in the Montreal Cognitive Assessment score, stages List B Recall, Short-term delayed Recall, and Long-term delayed Recall of the Rey Auditory Verbal Learning Test (RAVLT), Trail Making Test-A and B test scores, Digit Span Test (DST) Forward Span, and Functional Activities Questionnaire score. A trend level difference was also found for the RAVLT Recognition and the DST Backward Span. No significant differences were found for the CTL in any of the metrics. The completion rate of the INT was 91%, and the attendance rate was 100% for participants who completed the follow-up segment of the study. The engagement level was high, and effective learning was observed between the participants. The perceived usability and usefulness of the game platform was assessed as high. This study provides evidence of a positive effect of a multi-domain multimodal-based cognitive training program in elderly with MCI, with broader benefits on cognition by inducing more cooperative transfer effects over different domains.
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Affiliation(s)
- Christos Goumopoulos
- Information and Communication Systems Engineering Department, University of the Aegean, Samos, Greece
| | - Georgios Skikos
- Information and Communication Systems Engineering Department, University of the Aegean, Samos, Greece
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Nousia A, Martzoukou M, Petri MC, Messinis L, Nasios G. Face-to-face vs. Telerehabilitation language and cognitive training in patients with multi-domain amnestic mild cognitive impairment. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-9. [PMID: 37734418 DOI: 10.1080/23279095.2023.2259035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
The recent coronavirus emergency raised the question of whether telerehabilitation could be as effective as conventional face-to-face intervention. The aim of the present study was to compared language and cognitive training delivered to patients from a distance, through telecommunication systems, for the same intervention conducted on a face-to-face mode in patients with multi domain amnestic MCI (md-aMCI). To this end, 30 patients diagnosed with md-aMCI took part in the present study. The participants divided into two groups; one group received conventional face-to-face training and the other group received Telerehabilitation training. Both groups received language training using paper and pencil tasks and cognitive training using the Rehacom software. The training lasted 15 weeks and was delivered twice a week, for 60 minutes per session. The conventional face-to-face mode had a significant impact on cognitive (delayed and working memory, processing speed, executive function, and attention) and language domains (naming, word recognition, and semantic fluency). The telerehabilitation method had a beneficial impact on delayed memory, naming, and semantic fluency. The results of our study provide evidence that both telerehabilitation and face-to-face language and cognitive training seem to have a positive impact in patients with md-aMCI, with face-to-face training improving more domains than telerehabilitation.
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Affiliation(s)
- Anastasia Nousia
- Department of Speech and Language Therapy, University of Peloponnese, Kalamata, Greece
| | - Maria Martzoukou
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessalonike, Greece
| | - Maria Christina Petri
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessalonike, Greece
| | - Lambros Messinis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessalonike, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, University of Ioannina, Greece
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Abd-Alrazaq A, Abuelezz I, Al-Jafar E, Denecke K, Househ M, Aziz S, Ahmed A, Aljaafreh A, AlSaad R, Sheikh J. The performance of serious games for enhancing attention in cognitively impaired older adults. NPJ Digit Med 2023; 6:122. [PMID: 37422507 PMCID: PMC10329640 DOI: 10.1038/s41746-023-00863-2] [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: 09/25/2022] [Accepted: 06/15/2023] [Indexed: 07/10/2023] Open
Abstract
Attention, which is the process of noticing the surrounding environment and processing information, is one of the cognitive functions that deteriorate gradually as people grow older. Games that are used for other than entertainment, such as improving attention, are often referred to as serious games. This study examined the effectiveness of serious games on attention among elderly individuals suffering from cognitive impairment. A systematic review and meta-analyses of randomized controlled trials were carried out. A total of 10 trials ultimately met all eligibility criteria of the 559 records retrieved. The synthesis of very low-quality evidence from three trials, as analyzed in a meta-study, indicated that serious games outperform no/passive interventions in enhancing attention in cognitively impaired older adults (P < 0.001). Additionally, findings from two other studies demonstrated that serious games are more effective than traditional cognitive training in boosting attention among cognitively impaired older adults. One study also concluded that serious games are better than traditional exercises in enhancing attention. Serious games can enhance attention in cognitively impaired older adults. However, given the low quality of the evidence, the limited number of participants in most studies, the absence of some comparative studies, and the dearth of studies included in the meta-analyses, the results remain inconclusive. Thus, until the aforementioned limitations are rectified in future research, serious games should serve as a supplement, rather than a replacement, to current interventions.
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Affiliation(s)
- Alaa Abd-Alrazaq
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Doha, Qatar.
| | - Israa Abuelezz
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | | | - Kerstin Denecke
- Institute for Medical Informatics, Bern University of Applied Science, Bern, Switzerland
| | - Mowafa Househ
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Sarah Aziz
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Arfan Ahmed
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ali Aljaafreh
- Department of Management Information Systems, School of Business, Mutah University, Karak, Jordan
| | - Rawan AlSaad
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Javaid Sheikh
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Doha, Qatar
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Rute-Pérez S, Rodríguez-Domínguez C, Vélez-Coto M, Pérez-García M, Caracuel A. Effectiveness of Computerized Cognitive Training by VIRTRAEL on Memory and Executive Function in Older People: A Pilot Study. Brain Sci 2023; 13:brainsci13040684. [PMID: 37190649 DOI: 10.3390/brainsci13040684] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/15/2023] [Accepted: 04/16/2023] [Indexed: 05/17/2023] Open
Abstract
The prevalence of people over 60 years of age with cognitive impairment has increased in recent decades. As a consequence, numerous computerized cognitive trainings (CCT) have been developed. This pilot study aimed to determine the effectiveness of the CCT with VIRTRAEL in improving older adults' cognition. Fifty-five participants (x¯ = 72.7 years; SD = 6.5) underwent CCT, and twenty participants (x¯ = 76.1 years; SD = 7.6) received face-to-face cognitive stimulation with a paper-and-pencil methodology. Both trainings were conducted in nine sessions (45-60 min each). Participants completed a pre-post training neuropsychological assessment. ANCOVAs and the standardized clinical change were performed. VIRTRAEL's group showed a significant and greater improvement in verbal learning (p < 0.006) and delayed recall (p ≤ 0.001), working memory (p < 0.005), abstract (p < 0.002) and semantic reasoning (p < 0.015), and planning (p < 0.021). Additionally, more large clinical changes (d > 0.8) were found in the VIRTRAEL condition (in verbal learning and delayed free and cued recall) than in the standard group. Here we show that the CCT with VIRTRAEL is effective in improving cognitive function in older adults and is superior to the standard format. These preliminary findings indicate that CCT is a useful tool potentially applicable in the fight against cognitive symptomatology associated with aging and neurodegenerative diseases. VIRTRAEL represents a breakthrough in this field as it is inexpensive and easily accessible to any older person, regardless of whether they live far from health care resources.
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Affiliation(s)
- Sandra Rute-Pérez
- CIMCYC-Mind, Brain and Behavior Research Center, University of Granada, 18011 Granada, Spain
- Department of Developmental and Educational Psychology, Faculty of Education Sciences, University of Granada, 18011 Granada, Spain
| | - Carlos Rodríguez-Domínguez
- Department of Computer Languages and Systems, Faculty of Education, Economy and Technology of Ceuta, University of Granada, 51001 Granada, Spain
| | - María Vélez-Coto
- Department of Psychology, Catholic University of Murcia, Guadalupe, 30107 Murcia, Spain
| | - Miguel Pérez-García
- CIMCYC-Mind, Brain and Behavior Research Center, University of Granada, 18011 Granada, Spain
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, 18011 Granada, Spain
| | - Alfonso Caracuel
- CIMCYC-Mind, Brain and Behavior Research Center, University of Granada, 18011 Granada, Spain
- Department of Developmental and Educational Psychology, Faculty of Education Sciences, University of Granada, 18011 Granada, Spain
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9
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Zuschnegg J, Schoberer D, Häussl A, Herzog SA, Russegger S, Ploder K, Fellner M, Hofmarcher-Holzhacker MM, Roller-Wirnsberger R, Paletta L, Koini M, Schüssler S. Effectiveness of computer-based interventions for community-dwelling people with cognitive decline: a systematic review with meta-analyses. BMC Geriatr 2023; 23:229. [PMID: 37041494 PMCID: PMC10091663 DOI: 10.1186/s12877-023-03941-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 03/29/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Cognitive deficits arise with age and can increase the risk for subjective cognitive decline (SCD) and mild cognitive impairment (MCI), which may result in dementia, leading to health problems, care dependency and institutionalization. Computer-based cognitive interventions (CCIs) have the potential to act as important counteraction functions in preserving or improving cognition concomitant to available pharmacological treatment. The aim was to assess the effectiveness of CCIs performed individually with a personal or tablet computer, game console, virtual, augmented, or mixed reality application on cognition in community-dwelling people with SCD, MCI and dementia. METHODS A systematic review with meta-analyses of randomized controlled trials (RCTs) was performed. The systematic literature search was conducted in MEDLINE, CINAHL, Embase, Cochrane CENTRAL, IEEE Xplore Digital Library, Web of Science, Scopus and PsycINFO. In addition, a search for gray literature and backward citation searching were carried out. To judge on the evidence, two reviewers independently used the Cochrane Risk of Bias Tool. The standardized mean difference (SDM) for pooling comparable studies using the random-effects model was applied. RESULTS Twenty-four RCTs were identified, of which 1 RCT examined CCIs in individuals with SCD, 18 RCTs with MCI, and 6 RCTs with dementia. Most interventions were conducted with personal computers. Meta-analyses with 12 RCTs showed significant effects of computer-based cognitive interventions for people with MCI in the domains memory, working memory, attention/concentration/processing speed and executive functioning, but no significant improvements in global cognition and language. Regarding dementia a meta-analysis pooled with 4 RCTs demonstrated a tendency towards, but no significant increase of memory functions (SMD 0.33, CI 95% [-0.10, 0.77]). One RCT regarding SCD reported significant improvements in memory functions for participants conducting a cognitive training on a personal computer. CONCLUSIONS The results demonstrated that CCIs have beneficial effects on domain-specific cognition in people with MCI but no significant effects on people with dementia. In terms of SCD, one study showed significant improvements in memory functions. It seems that the beneficial effect for cognitive preservation or improvement due to CCIs occurs at the earliest intervention state. However, more research on SCD is needed. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CDR42020184069.
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Affiliation(s)
- Julia Zuschnegg
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Neue Stiftingtalstraße 6, Graz, 8010, Austria
| | - Daniela Schoberer
- Institute of Nursing Science, Medical University of Graz, Neue Stiftingtalstraße 6, 8010, Graz, Austria
| | - Alfred Häussl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036, Graz, Austria
| | - Sereina A Herzog
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, 8010, Graz, Austria
| | - Silvia Russegger
- DIGITAL - Institute for Information and Communication Technologies, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Steyrergasse 17, 8010, Graz, Austria
| | - Karin Ploder
- Austrian Red Cross Organization, Styrian Branch, Merangasse 26, 8010, Graz, Austria
| | - Maria Fellner
- digitAAL Life GmbH, Schuberststraße 6a, 8010, Graz, Austria
| | | | - Regina Roller-Wirnsberger
- Department of Internal Medicine, Research Unit Aging and Old Age Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Lucas Paletta
- DIGITAL - Institute for Information and Communication Technologies, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Steyrergasse 17, 8010, Graz, Austria
| | - Marisa Koini
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Sandra Schüssler
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Neue Stiftingtalstraße 6, Graz, 8010, Austria.
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Nousia A, Pappa E, Siokas V, Liampas I, Tsouris Z, Messinis L, Patrikelis P, Manouilidou C, Dardiotis E, Nasios G. Evaluation of the Efficacy and Feasibility of a Telerehabilitation Program Using Language and Cognitive Exercises in Multi-Domain Amnestic Mild Cognitive Impairment. Arch Clin Neuropsychol 2023; 38:224-235. [PMID: 36156732 DOI: 10.1093/arclin/acac078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the efficacy and feasibility of a telerehabilitation program in multi-domain amnestic Mild Cognitive Impairment (md-aMCI). The study sample consisted of 30 patients with md-aMCI and aged 60-80 years. METHODS The participants were randomly divided into two groups. The Training Group (TG), which received cognitive training by using the RehaCom software as well as paper-pencil language training and the Control Group (CG) which received standard clinical care (e.g., psychotherapy or/and physiotherapy). Duration of the telerehabilitation intervention was 15 weeks (twice a week for 60 min/session). RESULTS Our results revealed that the neuropsychological performance of the TG group after the telerehabilitation intervention improved on a statistically significant level on the domains of delayed and working memory, confrontation naming, verbal fluency, and global cognition. Comparison between the TG and CG revealed a significant impact of the telerehabilitation program on the domains of memory (delay and working) and language (naming and verbal fluency) as well as global cognition performance. CONCLUSION The findings of the study are promising in that the telerehabilitation intervention appears to be a useful method in improving or stabilizing cognitive decline in md-aMCI individuals and was a particularly effective alternative approach during the period of the pandemic lockdown. Specifically, the beneficial impact of the telerehabilitation intervention on episodic memory (which is one of the first domains to show impairment in md-aMCI patients) provides us with hope and evidence that these types of interventions may be applied with similar success using face-to-face interventions.
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Affiliation(s)
- Anastasia Nousia
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Evangelia Pappa
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Vasileios Siokas
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, Larissa, Greece
| | - Ioannis Liampas
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, Larissa, Greece
| | - Zisis Tsouris
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, Larissa, Greece
| | - Lambros Messinis
- Departement of Psychology, Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece
| | - Panayiotis Patrikelis
- Departement of Psychology, Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece
| | - Christina Manouilidou
- Department of Comparative and General Linguistics, University of Ljubljana, Ljubljana, Slovenia
| | - Efthimios Dardiotis
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, Larissa, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
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Bonnechère B, Klass M. Cognitive Computerized Training for Older Adults and Patients with Neurological Disorders: Do the Amount and Training Modality Count? An Umbrella Meta-Regression Analysis. Games Health J 2023; 12:100-117. [PMID: 36920851 DOI: 10.1089/g4h.2022.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Numerous applications have been created to train cognition and challenge the brain, a process known as computerized cognitive training (CCT). Despite potential positive results, important questions remain unresolved: the appropriate training duration, the efficacy of CCT depending on its type (commercial or developed in-house for the rehabilitation of specific patients) and delivery mode (at-home or on-site), and the patients most likely to benefit such intervention. This study aims to perform an umbrella meta-analysis and meta-regression to determine if the type of CCT, the delivery mode, the amount of training, and participants' age at inclusion influence the improvement of the cognitive function. To do so, we performed a umbrella meta-analysis. One hundred studies were included in this analysis representing 6407 participants. Statistical improvements were found for the different conditions after the training. We do not find statistical difference between the type of intervention or the delivery mode. No dose-response relationship between the total amount of training and the improvement of cognitive functions was found. CCT is effective in improving cognitive function in patients suffering from neurological conditions and in healthy aging. There is therefore an urgent need for health care systems to recognize its therapeutic potential and to evaluate at a larger scale their integration into the clinical pipeline as preventive and rehabilitation tool.
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Affiliation(s)
- Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.,Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, Hasselt University, Diepenbeek, Belgium
| | - Malgorzata Klass
- Laboratory of Applied Biology and Neurophysiology, ULB Neuroscience Institute (UNI), Université Libre de Bruxelles (ULB), Brussels, Belgium
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12
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Chae HJ, Lee SH. Effectiveness of online-based cognitive intervention in community-dwelling older adults with cognitive dysfunction: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2023; 38:e5853. [PMID: 36468299 PMCID: PMC10107881 DOI: 10.1002/gps.5853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) or mild dementia imposes a substantial burden on patients, families, and social systems. For MCI or mild dementia patient, cognitive training is required to prevent progression to dementia. With advances in digital health, cognitive interventions using information and communication technology (ICT) have become essential for maintaining independence and functioning in dementia patients. OBJECTIVES This study aimed to examine the effectiveness of an ICT-based cognitive intervention in community-dwelling older adults with MCI or mild dementia. METHODS A literature search was performed in four databases: Ovid-Medline, Ovid-EMBASE, Cochrane Library, and CINAHL. We selected studies published up to April 15, 2021, on topics related to cognitive interventions using ICT in older adults with MCI or mild dementia. RESULTS Forty-four studies were included in the analysis. Our meta-analysis showed that ICT-based cognitive interventions significantly improved the Mini-Mental State Examination score in the intervention group compared with that in the control group. Additionally, cognitive training using ICT was significantly effective for a period of more than 30 min, more than 6 weeks, and multi-domain content. Moreover, a significant reduction in depression was found in the intervention group compared with that in the control group. CONCLUSIONS ICT-based cognitive intervention had a positive effect on cognitive function, depression, and quality of life in older adults with MCI or mild dementia. Application of ICT-based cognitive training to community-dwelling older adults with MCI or mild dementia should be expanded, and nurses should play a pivotal role in mediating between these older adults.
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Affiliation(s)
- Hee Jae Chae
- Department of Nursing Science, College of Nursing, Gachon University, Incheon, Korea
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon, Korea
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Alescio-Lautier B, Chambon C, Deshayes C, Anton JL, Escoffier G, Ferrer MH, Paban V. Problem-solving training modifies cognitive functioning and related functional connectivity in healthy adults. Neuropsychol Rehabil 2023; 33:103-138. [PMID: 34657550 DOI: 10.1080/09602011.2021.1987277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cognitive functioning evolves throughout life. Regular practice of stimulating activities maintains or even strengthens cognitive skills. This study investigated the effects of a cognitive training programme based on complex closed-ended problem solving on innovative thinking. To this end, using partial least squares variance-based structural equation modeling, we first evaluated in 83 healthy adults how inhibition, cognitive flexibility, and reasoning were related to the distinct dimensions of innovative thinking. Second, we assessed how these interactions were modified after cognitive training based on problem solving in a subgroup of 16 subjects compared to leisure activity based on crossword solving in another subgroup of 15 subjects. Third, in a pilot fMRI study, we evaluated changes in brain connectivity at rest as a result of training in the problem solving group. Data on cognitive measures showed that innovative thinking was influenced by reasoning in control subjects, whereas it was influenced by cognitive flexibility following problem-solving training. These findings highlight that a cognitive intervention based on complex closed-ended problem solving promotes innovative thinking by changing the way subjects recruit and use relevant cognitive processes. Modifications in the resting-state connectivity of attention, default mode and visual networks were observed in the problem solving group.
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Affiliation(s)
| | - Caroline Chambon
- Aix Marseille Univ, CNRS, LNC-UMR 7291, NeuroMarseille InCiam, Marseille, France
| | - Claire Deshayes
- Aix Marseille Univ, CNRS, LNC-UMR 7291, NeuroMarseille InCiam, Marseille, France
| | - Jean-Luc Anton
- Aix Marseille Univ, CNRS, Centre IRM-INT@CERIMED, Institut de Neurosciences de la Timone, UMR7289 CNRS & AMU, Faculté de Médecine de la Timone, Marseille
| | - Guy Escoffier
- Aix Marseille Univ, CNRS, INP, UMR 7051, Faculté de pharmacie, campus Timone Marseille, France
| | - Marie-Hélène Ferrer
- Département Neurosciences et Contraintes Opérationnelles (NCO), Institut de Recherche Biomédicale des Armées (IRBA) 91223 Brétigny-sur-Orge, Cedex, France
| | - Véronique Paban
- Aix Marseille Univ, CNRS, LNC-UMR 7291, NeuroMarseille InCiam, Marseille, France
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14
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Kim Y, Oh W, You JSH. Immediate effects of multimodal cognitive therapy in mild cognitive impairment. NeuroRehabilitation 2023; 53:297-308. [PMID: 37927283 DOI: 10.3233/nre-230127] [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: 11/07/2023]
Abstract
BACKGROUND Current therapeutic evidence suggests limited efficacy of the cognitive and exercise training in mild cognitive impairment (MCI) on depression, anxiety, memory retention, comprehension, calculation, concentration, orientation, dual-task performance, and sleep disorders. Nevertheless, the immediate effects of multimodal cognitive therapy (MCT) have recently developed and its individual effects remains unknown in MCI. OBJECTIVE This study aimed to compare the immediate effects of MCT on cognitive and psychological measures between young healthy and older adults with MCI. METHODS Forty young healthy and older adults with MCI underwent immediate MCT (5 minutes each), including transcranial direct current stimulation (tDCS), light therapy, computerized cognitive therapy (CCT), robotic-assisted gait training (RAGT), core breathing exercises (CBE), and music therapy. Outcome measures included memory retention, comprehension, calculation, attention, orientation, dual-task performance, awareness, depression, anxiety, and sleep disorders. The Mann-Whitney U test and Friedman's test were used at P < 0.05. RESULTS Significant differences in depression, anxiety, memory retention, comprehension, calculation, attention, orientation, dual-task performance, and awareness were observed between the tDCS, CCT, and music therapy groups (P < 0.05). CONCLUSION MCT was beneficial for mitigating depression, anxiety, memory retention, comprehension, calculation, attention, orientation, dual-task performance, and awareness.
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Affiliation(s)
- Yunhwan Kim
- Department of Physical Therapy, Sports Movement Artificial Robotics Technology (SMART) Institute, Yonsei University, Wonju, Republic of Korea
- Department of PhysicalTherapy, Yonsei University, Wonju, Republic of Korea
| | - Wonjun Oh
- Department of Physical Therapy, Sports Movement Artificial Robotics Technology (SMART) Institute, Yonsei University, Wonju, Republic of Korea
- Department of PhysicalTherapy, Yonsei University, Wonju, Republic of Korea
| | - Joshua Sung H You
- Department of Physical Therapy, Sports Movement Artificial Robotics Technology (SMART) Institute, Yonsei University, Wonju, Republic of Korea
- Department of PhysicalTherapy, Yonsei University, Wonju, Republic of Korea
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15
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Dai X, Wu L, Han Z, Li H. Cognitive Training Effect and Imaging Evidence. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1419:171-183. [PMID: 37418214 DOI: 10.1007/978-981-99-1627-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Cognitive intervention is a specific form of non-pharmacological intervention used to combat cognitive dysfunction. In this chapter, behavioral and neuroimaging studies about cognitive interventions are introduced. Regarding intervention studies, the form of intervention and the effects of the interventions have been systematically sorted out. In addition, we compared the effects of different intervention approaches, which help people with different cognitive states to choose appropriate intervention programs. With the development of imaging technology, many studies have discussed the neural mechanism of cognitive intervention training and the effects of cognitive intervention from the perspective of neuroplasticity. Behavioral studies and neural mechanism studies are used to improve the understanding of cognitive interventions for the treatment of cognitive impairment.
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Affiliation(s)
- Xiangwei Dai
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative (BABRI) Centre, Beijing Normal University, Beijing, China
| | - Lingli Wu
- Beijing Aging Brain Rejuvenation Initiative (BABRI) Centre, Beijing Normal University, Beijing, China
- State Key Laboratory of Cognitive Neuroscience and Learning, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Zaizhu Han
- State Key Laboratory of Cognitive Neuroscience and Learning, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - He Li
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative (BABRI) Centre, Beijing Normal University, Beijing, China
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Devanand DP, Goldberg TE, Qian M, Rushia SN, Sneed JR, Andrews HF, Nino I, Phillips J, Pence ST, Linares AR, Hellegers CA, Michael AM, Kerner NA, Petrella JR, Doraiswamy PM. Computerized Games versus Crosswords Training in Mild Cognitive Impairment. NEJM EVIDENCE 2022; 1:10.1056/evidoa2200121. [PMID: 37635843 PMCID: PMC10457124 DOI: 10.1056/evidoa2200121] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND Mild cognitive impairment (MCI) increases the risk of dementia. The efficacy of cognitive training in patients with MCI is unclear. METHODS In a two-site, single-blinded, 78-week trial, participants with MCI - stratified by age, severity (early/late MCI), and site - were randomly assigned to 12 weeks of intensive, home-based, computerized training with Web-based cognitive games or Web-based crossword puzzles, followed by six booster sessions. In mixed-model analyses, the primary outcome was change from baseline in the 11-item Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) score, a 70 point scale in which higher scores indicate greater cognitive impairment at 78 weeks, adjusted for baseline. Secondary outcomes included change from baseline in neuropsychological composite score, University of California San Diego Performance-Based Skills Assessment (functional outcome) score, and Functional Activities Questionnaire (functional outcome) score at 78 weeks, adjusted for baseline. Changes in hippocampal volume and cortical thickness on magnetic resonance imaging were assessed. RESULTS Among 107 participants (n=51 [games]; n=56 [crosswords]), ADAS-Cog score worsened slightly for games and improved for crosswords at week 78 (least squares [LS] means difference, -1.44; 95% confidence interval [CI], -2.83 to -0.06; P=0.04). From baseline to week 78, mean ADAS-Cog score worsened for games (9.53 to 9.93) and improved for crosswords (9.59 to 8.61). The late MCI subgroup showed similar results (LS means difference, -2.45; SE, 0.89; 95% CI, -4.21 to -0.70). Among secondary outcomes, the Functional Activities Questionnaire score worsened more with games than with crosswords at week 78 (LS means difference, -1.08; 95% CI, -1.97 to -0.18). Other secondary outcomes showed no differences. Decreases in hippocampal volume and cortical thickness were greater for games than for crosswords (LS means difference, 34.07; SE, 17.12; 95% CI, 0.51 to 67.63 [hippocampal volume]; LS means difference, 0.02; SE, 0.01; 95% CI, 0.00 to 0.04 [cortical thickness]). CONCLUSIONS Home-based computerized training with crosswords demonstrated superior efficacy to games for the primary outcome of baseline-adjusted change in ADAS-Cog score over 78 weeks. (Supported by the National Institutes of Health, National Institute on Aging; ClinicalTrials.gov number, NCT03205709.).
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Affiliation(s)
- D P Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York
- Department of Psychiatry, Columbia University Medical Center, New York
| | - Terry E Goldberg
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York
- Department of Psychiatry, Columbia University Medical Center, New York
- Department of Anesthesiology, Columbia University Medical Center, New York
| | - Min Qian
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York
| | - Sara N Rushia
- The Graduate Center, City University of New York, New York
- Queens College, City University of New York, Flushing, NY
| | - Joel R Sneed
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York
- Department of Psychiatry, Columbia University Medical Center, New York
- Department of Anesthesiology, Columbia University Medical Center, New York
- The Graduate Center, City University of New York, New York
| | - Howard F Andrews
- Department of Psychiatry, Columbia University Medical Center, New York
| | - Izael Nino
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York
- Department of Psychiatry, Columbia University Medical Center, New York
| | - Julia Phillips
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York
- Department of Psychiatry, Columbia University Medical Center, New York
| | - Sierra T Pence
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC
| | - Alexandra R Linares
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC
| | - Caroline A Hellegers
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC
| | | | - Nancy A Kerner
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York
- Department of Psychiatry, Columbia University Medical Center, New York
| | | | - P Murali Doraiswamy
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC
- Duke Institute for Brain Sciences, Duke University, Durham, NC
- Center for the Study of Aging and Human Development and the Division of Geriatrics, Duke University School of Medicine, Durham, NC
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17
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Li R, Geng J, Yang R, Ge Y, Hesketh T. Effectiveness of Computerized Cognitive Training in Delaying Cognitive Function Decline in People With Mild Cognitive Impairment: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e38624. [DOI: 10.2196/38624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 09/05/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background
With no current cure for mild cognitive impairment (MCI), delaying its progression could significantly reduce the disease burden and improve the quality of life for patients with MCI. Computerized cognitive training (CCT) has recently become a potential instrument for improvement of cognition. However, the evidence for its effectiveness remains limited.
Objective
This systematic review aims to (1) analyze the efficacy of CCT on cognitive impairment or cognitive decline in patients with MCI and (2) analyze the relationship between the characteristics of CCT interventions and cognition-related health outcomes.
Methods
A systematic search was performed using MEDLINE, Cochrane, Embase, Web of Science, and Google Scholar. Full texts of randomized controlled trials of CCT interventions in adults with MCI and published in English language journals between 2010 and 2021 were included. Overall global cognitive function and domain-specific cognition were pooled using a random-effects model. Sensitivity analyses were performed to determine the reasons for heterogeneity and to test the robustness of the results. Subgroup analyses were performed to identify the relationship between the characteristics of CCT interventions and cognition-related effectiveness.
Results
A total of 18 studies with 1059 participants were included in this review. According to the meta-analysis, CCT intervention provided a significant but small increase in global cognitive function compared to that in the global cognitive function of the control groups (standardized mean difference=0.54, 95% CI 0.35-0.73; I2=38%). CCT intervention also resulted in a marginal improvement in domain-specific cognition compared to that in the control groups, with moderate heterogeneity. Subgroup analyses showed consistent improvement in global cognitive behavior in the CCT intervention groups.
Conclusions
This systematic review suggests that CCT interventions could improve global cognitive function in patients with MCI. Considering the relatively small sample size and the short treatment duration in all the included studies, more comprehensive trials are needed to quantify both the impact of CCT on cognitive decline, especially in the longer term, and to establish whether CCT should be recommended for use in clinical practice.
Trial Registration
PROSPERO International Prospective Register of Systematic Reviews CRD42021278884; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=278884
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18
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Abd-alrazaq A, Abuelezz I, Alsaad R, Al-jafar E, Ahmed A, Aziz S, Nashwan A, Sheikh J. Serious Games for Learning Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis (Preprint).. [DOI: 10.2196/preprints.43607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND
Learning disabilities are among the major cognitive impairments caused by aging. Among the interventions used to improve learning among older adults are serious games, which are participative electronic games designed for purposes other than entertainment. Although some systematic reviews have examined the effectiveness of serious games on learning, they are undermined by some limitations, such as focusing on older adults without cognitive impairments, focusing on particular types of serious games, and not considering the comparator type in the analysis.
OBJECTIVE
This review aimed to evaluate the effectiveness of serious games on verbal and nonverbal learning among older adults with cognitive impairment.
METHODS
Eight electronic databases were searched to retrieve studies relevant to this systematic review and meta-analysis. Furthermore, we went through the studies that cited the included studies and screened the reference lists of the included studies and relevant reviews. Two reviewers independently checked the eligibility of the identified studies, extracted data from the included studies, and appraised their risk of bias and the quality of the evidence. The results of the included studies were summarized using a narrative synthesis or meta-analysis, as appropriate.
RESULTS
Of the 559 citations retrieved, 11 (2%) randomized controlled trials (RCTs) ultimately met all eligibility criteria for this review. A meta-analysis of 45% (5/11) of the RCTs revealed that serious games are effective in improving verbal learning among older adults with cognitive impairment in comparison with no or sham interventions (<i>P</i>=.04), and serious games do not have a different effect on verbal learning between patients with mild cognitive impairment and those with Alzheimer disease (<i>P</i>=.89). A meta-analysis of 18% (2/11) of the RCTs revealed that serious games are as effective as conventional exercises in promoting verbal learning (<i>P</i>=.98). We also found that serious games outperformed no or sham interventions (4/11, 36%; <i>P</i>=.03) and conventional cognitive training (2/11, 18%; <i>P</i><.001) in enhancing nonverbal learning.
CONCLUSIONS
Serious games have the potential to enhance verbal and nonverbal learning among older adults with cognitive impairment. However, our findings remain inconclusive because of the low quality of evidence, the small sample size in most of the meta-analyzed studies (6/8, 75%), and the paucity of studies included in the meta-analyses. Thus, until further convincing proof of their effectiveness is offered, serious games should be used to supplement current interventions for verbal and nonverbal learning rather than replace them entirely. Further studies are needed to compare serious games with conventional cognitive training and conventional exercises, as well as different types of serious games, different platforms, different intervention periods, and different follow-up periods.
CLINICALTRIAL
PROSPERO CRD42022348849; https://tinyurl.com/y6yewwfa
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Marin A, DeCaro R, Schiloski K, Elshaar A, Dwyer B, Vives-Rodriguez A, Palumbo R, Turk K, Budson A. Home-Based Electronic Cognitive Therapy in Patients With Alzheimer Disease: Feasibility Randomized Controlled Trial. JMIR Form Res 2022; 6:e34450. [PMID: 36094804 PMCID: PMC9513684 DOI: 10.2196/34450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Can home-based computerized cognitive training programs be a useful tool to sustain cognition and quality of life in patients with Alzheimer disease (AD)? To date, the progressive nature of the disease has made this question difficult to answer. Computerized platforms provide more accessibility to cognitive trainings; however, the feasibility of long-term, home-based computerized programs for patients with AD dementia remains unclear. OBJECTIVE We aimed to investigate the feasibility of a 24-week home-based intervention program using the Constant Therapy app and its preliminary efficacy on cognition in patients with AD. Constant Therapy is a program developed for patients with speech and cognitive deficits. We hypothesized that patients with AD would use Constant Therapy daily over the course of the 24-week period. METHODS Data were collected over a 48-week period. We recruited participants aged between 50 and 90 years with a diagnosis of mild cognitive impairment due to AD or mild AD dementia. Participants were randomly assigned to either the Constant Therapy (n=10) or active control (n=9) group. The Constant Therapy group completed a tablet-based training during the first 24 weeks; the second 24 weeks of computerized training were optional. The active control group completed paper-and-pencil games during the first 24 weeks and were invited to complete an optional Constant Therapy training during the second 24 weeks. Every 6 weeks, the participants completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The participants independently accessed Constant Therapy using an Apple iPad. Our primary feasibility outcomes were the rate of adherence and daily use of Constant Therapy over 24 weeks. Our secondary outcomes were Constant Therapy performance over 24 weeks and change in RBANS scores between the 2 experimental groups. RESULTS Feasibility analyses were computed for participants who completed 24 weeks of Constant Therapy. We found that long-term use of the Constant Therapy program was feasible in patients with AD over 24 weeks (adherence 80%; program use 121/168 days, for 32 minutes daily). These participants showed an overall improvement in accuracy and latency (P=.005) in the Constant Therapy scores, as well as specific improvements in visual and auditory memory, attention, and arithmetic tasks. The Constant Therapy group showed improvement in the RBANS coding subtest. No unexpected problems or adverse events were observed. CONCLUSIONS Long-term (eg, 24 weeks) computerized cognitive training using Constant Therapy is feasible in patients with AD in the mild cognitive impairment and mild dementia stages. Patients adhered more to Constant Therapy than to the paper-and-pencil training over 24 weeks and improved their performance over time. These findings support the development of future randomized controlled trials that will investigate the efficacy of Constant Therapy to sustain cognitive function in patients with AD. TRIAL REGISTRATION ClinicalTrials.gov NCT02521558; https://clinicaltrials.gov/ct2/show/NCT02521558.
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Affiliation(s)
- Anna Marin
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Renée DeCaro
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Kylie Schiloski
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - Ala'a Elshaar
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - Brigid Dwyer
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Ana Vives-Rodriguez
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - Rocco Palumbo
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - Katherine Turk
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
- Alzheimer's Disease Research Center, Boston University School of Medicine, Boston, MA, United States
| | - Andrew Budson
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
- Alzheimer's Disease Research Center, Boston University School of Medicine, Boston, MA, United States
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Curcic J, Vallejo V, Sorinas J, Sverdlov O, Praestgaard J, Piksa M, Deurinck M, Erdemli G, Bügler M, Tarnanas I, Taptiklis N, Cormack F, Anker R, Massé F, Souillard-Mandar W, Intrator N, Molcho L, Madero E, Bott N, Chambers M, Tamory J, Shulz M, Fernandez G, Simpson W, Robin J, Snædal JG, Cha JH, Hannesdottir K. Description of the Method for Evaluating Digital Endpoints in Alzheimer Disease Study: Protocol for an Exploratory, Cross-sectional Study. JMIR Res Protoc 2022; 11:e35442. [PMID: 35947423 PMCID: PMC9403829 DOI: 10.2196/35442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background More sensitive and less burdensome efficacy end points are urgently needed to improve the effectiveness of clinical drug development for Alzheimer disease (AD). Although conventional end points lack sensitivity, digital technologies hold promise for amplifying the detection of treatment signals and capturing cognitive anomalies at earlier disease stages. Using digital technologies and combining several test modalities allow for the collection of richer information about cognitive and functional status, which is not ascertainable via conventional paper-and-pencil tests. Objective This study aimed to assess the psychometric properties, operational feasibility, and patient acceptance of 10 promising technologies that are to be used as efficacy end points to measure cognition in future clinical drug trials. Methods The Method for Evaluating Digital Endpoints in Alzheimer Disease study is an exploratory, cross-sectional, noninterventional study that will evaluate 10 digital technologies’ ability to accurately classify participants into 4 cohorts according to the severity of cognitive impairment and dementia. Moreover, this study will assess the psychometric properties of each of the tested digital technologies, including the acceptable range to assess ceiling and floor effects, concurrent validity to correlate digital outcome measures to traditional paper-and-pencil tests in AD, reliability to compare test and retest, and responsiveness to evaluate the sensitivity to change in a mild cognitive challenge model. This study included 50 eligible male and female participants (aged between 60 and 80 years), of whom 13 (26%) were amyloid-negative, cognitively healthy participants (controls); 12 (24%) were amyloid-positive, cognitively healthy participants (presymptomatic); 13 (26%) had mild cognitive impairment (predementia); and 12 (24%) had mild AD (mild dementia). This study involved 4 in-clinic visits. During the initial visit, all participants completed all conventional paper-and-pencil assessments. During the following 3 visits, the participants underwent a series of novel digital assessments. Results Participant recruitment and data collection began in June 2020 and continued until June 2021. Hence, the data collection occurred during the COVID-19 pandemic (SARS-CoV-2 virus pandemic). Data were successfully collected from all digital technologies to evaluate statistical and operational performance and patient acceptance. This paper reports the baseline demographics and characteristics of the population studied as well as the study's progress during the pandemic. Conclusions This study was designed to generate feasibility insights and validation data to help advance novel digital technologies in clinical drug development. The learnings from this study will help guide future methods for assessing novel digital technologies and inform clinical drug trials in early AD, aiming to enhance clinical end point strategies with digital technologies. International Registered Report Identifier (IRRID) DERR1-10.2196/35442
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Affiliation(s)
- Jelena Curcic
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Vanessa Vallejo
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | | | | | - Jens Praestgaard
- Novartis Institutes for Biomedical Research, Cambridge, MA, United States
| | - Mateusz Piksa
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Mark Deurinck
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Gul Erdemli
- Novartis Institutes for Biomedical Research, Cambridge, MA, United States
| | | | - Ioannis Tarnanas
- Altoida Inc, Washington, DC, United States.,Global Brain Health Institute, Trinity College, Dublin, Ireland
| | | | | | | | | | - William Souillard-Mandar
- Linus Health, Boston, MA, United States.,Massachusetts Institute of Technology, Cambridge, MA, United States
| | | | | | - Erica Madero
- Neurotrack Technologies Inc, Redwood City, CA, United States
| | - Nicholas Bott
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | | | - Josef Tamory
- Neurovision Imaging Inc, Sacramento, CA, United States
| | | | | | | | | | | | - Jang-Ho Cha
- Novartis Institutes for Biomedical Research, Cambridge, MA, United States
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21
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Mendes L, Oliveira J, Barbosa F, Castelo-Branco M. A Conceptual View of Cognitive Intervention in Older Adults With and Without Cognitive Decline-A Systemic Review. FRONTIERS IN AGING 2022; 3:844725. [PMID: 35821828 PMCID: PMC9261456 DOI: 10.3389/fragi.2022.844725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/28/2022] [Indexed: 11/17/2022]
Abstract
Background: Dementia is the one of the most common and prominent disease in the elderly person that results in the Cognitive interventions. In this study, we aim to conceptualize the cognitive intervention for older adults with and without cognitive dysfunction and to clarify the heterogeneity existing in this literature field by determining the main variables implicated. Methods: We conducted a study analysis using previous literature highlighting the significant data reporting empirical results from cognitive intervention for healthy older adults and other seniors with different types of dementia. Each paper was reviewed in terms of compensatory cognitive training, cognitive remediation, enrichment, cognitive activation, brain training, cognitive stimulation, cognitive training, and cognitive rehabilitation. The research analysis was performed following rigorous inclusion and exclusion criteria with the purpose of collecting relevant answers to our research questions. Results: We included a total of 168 studies in our review. Our findings indicated heterogeneity regarding methods, concepts, and procedures. Additionally, the values were integrated using different information existing in this field. Conclusion: In conclusion, we highlighted that this is the first review that clarify the discrepancy of various existing definitions, methods, and procedures, as well as the overlapping information in the cognitive interventions.
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Affiliation(s)
- Liliana Mendes
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Joana Oliveira
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Fernando Barbosa
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Miguel Castelo-Branco
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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22
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Liu W, Li J, Li L, Zhang Y, Yang M, Liang S, Li L, Dai Y, Chen L, Jia W, He X, Lin H, Tao J. Enhanced Medial Prefrontal Cortex and Hippocampal Activity Improves Memory Generalization in APP/PS1 Mice: A Multimodal Animal MRI Study. Front Cell Neurosci 2022; 16:848967. [PMID: 35386301 PMCID: PMC8977524 DOI: 10.3389/fncel.2022.848967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/08/2022] [Indexed: 02/03/2023] Open
Abstract
Memory generalization allows individuals to extend previously learned movement patterns to similar environments, contributing to cognitive flexibility. In Alzheimer’s disease (AD), the disturbance of generalization is responsible for the deficits of episodic memory, causing patients with AD to forget or misplace things, even lose track of the way home. Cognitive training can effectively improve the cognition of patients with AD through changing thinking mode and memory flexibility. In this study, a T-shaped maze was utilized to simulate cognitive training in APP/PS1 mice to elucidate the potential mechanisms of beneficial effects after cognitive training. We found that cognitive training conducted by a T-shaped maze for 4 weeks can improve the memory generalization ability of APP/PS1 mice. The results of functional magnetic resonance imaging (fMRI) showed that the functional activity of the medial prefrontal cortex (mPFC) and hippocampus was enhanced after cognitive training, and the results of magnetic resonance spectroscopy (MRS) showed that the neurochemical metabolism of N-acetyl aspartate (NAA) and glutamic acid (Glu) in mPFC, hippocampus and reuniens (Re) thalamic nucleus were escalated. Furthermore, the functional activity of mPFC and hippocampus was negatively correlated with the escape latency in memory generalization test. Therefore, these results suggested that cognitive training might improve memory generalization through enhancing the functional activity of mPFC and hippocampus and increasing the metabolism of NAA and Glu in the brain regions of mPFC, hippocampus and Re nucleus.
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Affiliation(s)
- Weilin Liu
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jianhong Li
- TCM Rehabilitation Research Center of SATCM, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Le Li
- TCM Rehabilitation Research Center of SATCM, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yuhao Zhang
- TCM Rehabilitation Research Center of SATCM, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Minguang Yang
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Shengxiang Liang
- TCM Rehabilitation Research Center of SATCM, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Long Li
- TCM Rehabilitation Research Center of SATCM, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yaling Dai
- TCM Rehabilitation Research Center of SATCM, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lewen Chen
- TCM Rehabilitation Research Center of SATCM, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Weiwei Jia
- TCM Rehabilitation Research Center of SATCM, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiaojun He
- TCM Rehabilitation Research Center of SATCM, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Huawei Lin
- TCM Rehabilitation Research Center of SATCM, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jing Tao
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- *Correspondence: Jing Tao,
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Klaming L, Robbemond L, Lemmens P, Hart de Ruijter E. Digital Compensatory Cognitive Training for Older Adults with Memory Complaints. ACTIVITIES, ADAPTATION & AGING 2022. [DOI: 10.1080/01924788.2022.2044989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Laura Klaming
- Philips Research Brain, Behavior & Cognition High Tech Campus 34, Eindhoven, Netherlands
| | - Lisanne Robbemond
- University of Groningen, University Center of Psychiatry, Groningen, The Netherlands
| | - Paul Lemmens
- Philips Research Brain, Behavior & Cognition High Tech Campus 34, Eindhoven, Netherlands
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Roschina I, Kalantarova M, Shvedovskaya A, Hromov A. Prevention of Cognitive Decline in Elderly: Programs "Memory Clinic" and "Cognitive Stimulation Therapy". КЛИНИЧЕСКАЯ И СПЕЦИАЛЬНАЯ ПСИХОЛОГИЯ 2022. [DOI: 10.17759/cpse.2022110302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The problem of preventing factors associated with the risks of cognitive decline and hindering active longevity in old age is becoming increasingly important. According to the United Nations in 2019, about 10% of the total population in the world is over the age of 65, and by 2050 this figure will already be 20%. The syndrome of mild cognitive decline is considered as a transitional state between normal physiological aging and dementia. The two modern approaches to the prevention of cognitive impairment during aging are presented. Methods for the prevention of cognitive impairments are proposed to be considered according to the level of organization of mental activity, to which they mainly appeal: based on the semantic level (training) and the level of personal meanings (stimulation programs). The experience of preventing cognitive decline in the elderly within the framework of the program of psychosocial therapy and neurocognitive rehabilitation at the “Memory Clinic” (Russia) and the “Cognitive Stimulation Therapy” (CST) program (Great Britain) is described.
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Affiliation(s)
| | | | | | - A. Hromov
- Moscow State University of Psychology & Education
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Abd-Alrazaq A, Alhuwail D, Al-Jafar E, Ahmed A, Shuweihdi F, Reagu SM, Househ M. The effectiveness of serious games in improving memory among the elderly with cognitive impairment: A systematic review and meta-analysis (Preprint). JMIR Serious Games 2021; 10:e35202. [PMID: 35943792 PMCID: PMC9399845 DOI: 10.2196/35202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/10/2022] [Accepted: 05/13/2022] [Indexed: 12/17/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Alaa Abd-Alrazaq
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Dari Alhuwail
- Information Science Department, 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
| | - Farag Shuweihdi
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | | | - 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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26
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Abd-alrazaq A, Alhuwail D, Al-jafar E, Ahmed A, Reagu SM, Househ M. The effectiveness of serious games in improving memory among elderly people with cognitive impairment: A systematic review and meta-analysis (Preprint).. [DOI: 10.2196/preprints.35202] [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
Memory, one of the main cognitive functions, is known to decline by age. Serious games have been used for improving memory among the elderly. The effectiveness of serious games in improving memory has been investigated by several systematic reviews; however, they are limited by design and methodological weaknesses.
OBJECTIVE
This study aims to assess the effectiveness of serious games in improving memory among the elderly with cognitive impairment.
METHODS
A systematic review of randomized controlled trials (RCTs) was carried out. The search sources included searching 8 databases, screening reference lists of the included studies and relevant reviews, and checking studies that cited the included studies. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Extracted data were synthesized using a narrative approach and a statistical approach (i.e., meta-analysis), as appropriate.
RESULTS
Out of 466 citations retrieved, 18 studies met the eligibility criteria of this review. Of those, 15 RCTs were eventually included in 10 meta-analyses. We found that serious games are more effective than no or passive interventions in improving non-verbal memory (P=0.002) and working memory (P=0.02), but not verbal memory (P=0.13). The review also showed that serious games are more effective than conventional exercises in improving verbal memory (P=0.004), but not for non-verbal memory (P=0.12) and working memory (P=0.49). Serious games were as effective as conventional cognitive activities in improving verbal memory (P=0.07), non-verbal memory (P=0.94), and working memory (P=0.08) among the elderly with cognitive impairment. Lastly, the effect of adaptive serious games on working memory was comparable to non-adaptive serious games (P=0.08).
CONCLUSIONS
Serious games have the potential to improve verbal, non-verbal, and working memory among elderly people with cognitive impairment. However, our findings should be interpreted cautiously given that most meta-analyses were based on a few studies (≤3) and judged to have a low quality of evidence. Therefore, serious games should be offered as supplemental to existing proven and safe interventions, rather than a complete substitute until further, more robust evidence is available. Future studies should investigate the short and long-term effects of serious games on memory and other cognitive abilities among people from different age groups with or without cognitive impairment.
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Tawfik HM, Tsatali M, Hassanin HI. Pilot feasibility study of cognitive training exercises for Egyptian adults: Proof of concept. Int J Geriatr Psychiatry 2021; 37. [PMID: 34569644 DOI: 10.1002/gps.5624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/06/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Cognitive training exercises (CTE) are promising and effective interventions to enhance cognitive reserve and slowdown cognitive deterioration in people with subjective memory impairment (SCI) and mild cognitive impairment (MCI). In this pilot study, we aimed to assess the feasibility of CTE among Egyptian adults. METHODS Eighteen participants above 40 years old were recruited. They underwent baseline neuropsychological assessment and functional assessment. However, after receiving a 6 weeks' cognitive training, eight participants (seven with MCI and one was cognitively intact) dropped out from the study. Finally, 10 participants (8 participants with MCI, 1 with SCI and 1 was cognitively intact) completed 12 weeks of CTE and undergone the post-assessment afterward. CTE included visual, verbal, memory, executive function, visuospatial, attention, and psychokinetic exercises through onsite and home-based sessions. RESULTS For the 10 participants who completed 12 weeks of CTE, the Wilcoxon signed-rank test showed a statistically significant change in the scores of mini-mental state examination (Z = -2.546, p = 0.011), semantic fluency test (Z = -2.913, p = 0.004), subjective memory complaint questionnaire (Z = -2.913, p = 0.004), Consortium to Establish a Registry for Alzheimer's Disease Word List (first trial: Z = -2.641, p = 0.008; Word list recall: Z = -2.825, p = 0.005), construction abilities (immediate: Z = -2.121, p = 0.034; delayed recall: Z = -2.414, p = 0.016), and Digit span test (forward: Z = -2.724, p = 0.006; backward: Z = -2.724, p = 0.006). CONCLUSIONS The results of this study suggested that CTE are feasible among Egyptian adults, especially those with MCI, and potentially effective in enhancing global cognition and after 12 weeks of training. Future research should shed light on the efficacy of longitudinal CTE implementation in Arab adults' populations.
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Affiliation(s)
- Heba M Tawfik
- Geriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Ain Shams Ageing Research Center, Ain Shams Cognitive Training Lab, Cairo, Egypt
| | - Marianna Tsatali
- Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
- City College, University of York Europe campus, Thessaloniki, Greece
| | - Hany I Hassanin
- Geriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Ain Shams Ageing Research Center, Ain Shams Cognitive Training Lab, Cairo, Egypt
- Global Brain Health Institute, Trinity College Dublin, Ireland and University of California San Francisco, San Francisco, California, USA
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Griffiths J, Thaikruea L, Wongpakaran N, Munkhetvit P, Kittisares A, Varnado P. Effects of Combined Physical Movement Activity and Multifaceted Cognitive Training in Older People with Mild Neurocognitive Disorder in a Rural Community: A Randomized Control Trial. Dement Geriatr Cogn Disord 2021; 49:194-201. [PMID: 32535601 DOI: 10.1159/000507922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/14/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Cognitive deterioration in older people with mild neurocognitive disorders (mNCD) increases the risk of progress to major NCD. Health professionals worldwide are trying to find strategies for prevention. There is a limited number of studies that deal with cultural conditions in northern Thailand. OBJECTIVES This study aimed to investigate the effects of a combination of physical movement activity and multifaceted cognitive training on cognitive function in older people with mNCD. METHODS A randomized control trial involving 70 mNCD people, according to DSM-5 criteria, was conducted on an intervention group and a control group (n = 35 each). The program for the intervention group included 24 sessions (twice a week). The outcome measures on cognitive function were assessed before and after the intervention by means of composite cognitive measures for older people, i.e., the Trail-Making Test (TMT), Digit Span (DS), Verbal Fluency (VF), Word-List Learning (WLL), and Block Design (BD). RESULTS The combined intervention enhanced cognitive function. TMT-A was significantly improved in the intervention group. There were significant improvements in DS sequence scores, letter verbal fluency (LVF), and category verbal fluency (CVF). Comparing the groups, there were significant differences in LVF including immediate and delayed recall. BD improved significantly in the intervention group. CONCLUSIONS The combined intervention appeared to be effective in delaying/preventing cognitive deterioration and cognitive functional decline in people with mNCD. Further studies on a variation of treatments suited to cultural conditions and their effects are needed. Trials in other communities are also recommended.
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Affiliation(s)
- Jiranan Griffiths
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Lakkana Thaikruea
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,
| | - Nahathai Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Peeraya Munkhetvit
- Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Adisak Kittisares
- Sriphat Medical Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pairada Varnado
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Reynolds GO, Willment K, Gale SA. Mindfulness and Cognitive Training Interventions in Mild Cognitive Impairment: Impact on Cognition and Mood. Am J Med 2021; 134:444-455. [PMID: 33385339 DOI: 10.1016/j.amjmed.2020.10.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 12/29/2022]
Abstract
With the lack of disease-modifying pharmacologic treatments for mild cognitive impairment and dementia, there has been an increasing clinical and research focus on nonpharmacological interventions for these disorders. Many treatment approaches, such as mindfulness and cognitive training, aim to mitigate or delay cognitive decline, particularly in early disease stages, while also offering potential benefits for mood and quality of life. In this review, we highlight the potential of mindfulness and cognitive training to improve cognition and mood in mild cognitive impairment. Emerging research suggests that these approaches are feasible and safe in this population, with preliminary evidence of positive effects on aspects of cognition (attention, psychomotor function, memory, executive function), depression, and anxiety, though some findings have been unclear or limited by methodological weaknesses. Even so, mindfulness and cognitive training warrant inclusion as current treatments for adults with mild cognitive impairment, even if there is need for additional research to clarify treatment outcomes and questions related to dose, mechanisms, and transfer and longevity of treatment effects.
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Affiliation(s)
| | - Kim Willment
- Department of Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Seth A Gale
- Department of Neurology, Brigham and Women's Hospital, Boston, Mass
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Preventing dementia? Interventional approaches in mild cognitive impairment. Neurosci Biobehav Rev 2021; 122:143-164. [PMID: 33440197 DOI: 10.1016/j.neubiorev.2020.12.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/13/2020] [Accepted: 12/19/2020] [Indexed: 12/19/2022]
Abstract
Mild cognitive impairment (MCI) is defined as an intermediate state between normal cognitive aging and dementia. It describes a status of the subjective impression of cognitive decline and objectively detectible memory impairment beyond normal age-related changes. Activities of daily living are not affected. As the population ages, there is a growing need for early, proactive programs that can delay the consequences of dementia and improve the well-being of people with MCI and their caregivers. Various forms and approaches of intervention for older people with MCI have been suggested to delay cognitive decline. Pharmacological as well as non-pharmacological approaches (cognitive, physiological, nutritional supplementation, electric stimulation, psychosocial therapeutic) and multicomponent interventions have been proposed. Interventional approaches in MCI from 2009 to April 2019 concerning the cognitive performance are presented in this review.
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Meta-Analysis on the Effectiveness of Virtual Reality Cognitive Training (VRCT) and Computer-Based Cognitive Training (CBCT) for Individuals with Mild Cognitive Impairment (MCI). ELECTRONICS 2020. [DOI: 10.3390/electronics9122185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This meta-analysis aims to assess the effectiveness of virtual reality cognitive training (VRCT) and conventional computer-based cognitive training (CBCT) in five specific cognitive domains (i.e., global cognitive function (GCF), memory (Mem), executive function (EF), language (Lang) and visuospatial skills (VS)) of individuals with mild cognitive impairment. A total of 320 studies were yielded from five electronic databases. Eighteen randomized controlled trials met the PRISMA criteria, with 10 related to VRCT and 8 related to CBCT. A random-effect model was used in determining the main effect of cognitive training in five specific cognitive domains. VRCT provided the largest effect size on VS and Lang while the smallest on EF. CBCT provided the largest effect size on Mem and Lang while the smallest on EF. VRCT and CBCT generate an opposite effect on VS. VRCT outweighs CBCT in treatment effectiveness of GCF, EF, Lang and VS. More immersive and interactive experiences in VRCT may help individuals with MCI better engage in real-life experiences, which supports skill generalization and reduces external distractions. CBCT tends to improve Mem but no definite conclusions can be made. Further investigation with more stringent research design and specific protocol are required to reach consensus about the optimum intervention regime.
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Pang SH, Lim SF, Siah CJ. Online memory training intervention for early-stage dementia: A systematic review and meta-analysis. J Adv Nurs 2020; 77:1141-1154. [PMID: 33259701 DOI: 10.1111/jan.14664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/01/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of online memory training interventions in improving memory of patients diagnosed with early-stage dementia. The secondary outcomes comprised cognitive and psychological outcomes. DESIGN This review was conducted for accordance to the Cochrane Handbook for Systematic Reviews of Interventions. DATA SOURCE A comprehensive search from six electronic databases: PubMed, Embassy, The Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature, Scopus and Web of Science was conducted (2000-2020). REVIEW METHODS The populations included in this review comprised adults who had been clinically diagnosed with early-stage dementia and involved in online memory training interventions. Two reviewers appraised the risks of bias through the Cochrane Collaboration's tool and performed the meta-analysis, including the assessment of heterogeneity. RESULTS Eleven randomized controlled trials retrieved from six databases demonstrated low to moderate levels of quality of evidence according to the GRADE approach. The meta-analysis revealed that online memory training interventions have demonstrated a moderate effect size in improving memory outcomes (d = 0.57; 95% confidence interval 0.28-0.85; p = 0.0001). Additionally, such interventions have shown improvements in secondary outcomes of cognition and psychological with small to medium effects. Duration of each online memory training session and its frequencies did not affect the memory outcome. As opposed to the conventional face-to-face interventions conducted for a group, it is more effective to be conducted for an individual setting. CONCLUSIONS Online memory training intervention was effective in improving the memory for adults with dementia. IMPACT Memory interventions have the prospect of reducing everyday problems caused by lapses in memory and improving well-being. With factors such as limited resources and restriction of social gathering due to pandemic, this review could offer relevant information for clinical decision-makers when planning online memory training interventions for adults with dementia.
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Affiliation(s)
- Shi-Hui Pang
- National University of Singapore, Singapore, Singapore
| | - Su-Fee Lim
- Singapore General Hospital, Singapore, Singapore
| | - Chiew-Jiat Siah
- National University of Singapore, Yong Loo Lin School ore frf Medicine - Alice Lee Centre for Nursing Studies, Singapore, Singapore
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Franco-Martín MA, Diaz-Baquero AA, Bueno-Aguado Y, Cid-Bartolomé MT, Parra Vidales E, Perea Bartolomé MV, de la Torre Díez I, van der Roest HG. Computer-based cognitive rehabilitation program GRADIOR for mild dementia and mild cognitive impairment: new features. BMC Med Inform Decis Mak 2020; 20:274. [PMID: 33092577 PMCID: PMC7584078 DOI: 10.1186/s12911-020-01293-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 10/14/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The growing number of older people and, with it, the increase of neurological impairments such as dementia has led to the implementation of the use of computer programs for cognitive rehabilitation in people with dementia. For 20 years, we have been developing the GRADIOR cognitive rehabilitation program and conducted several studies associated with its usability and effectiveness. This paper describes the development of the latest version of the GRADIOR computer-based cognitive rehabilitation program for people with different neurological etiologies, especially mild cognitive impairment and mild dementia. RESULTS GRADIOR is a program that allows cognitive evaluation and rehabilitation of people affected by cognitive impairment. The new version of GRADIOR is characterized by a structure that is dynamic and flexible for both user and therapist, consisting of: Clinical Manager, Clinical History Manager, Treatment Manager and Report Manager. As a structure based on specific requirements, GRADIOR includes a series of modalities and sub-modalities, each modality comprising a series of exercises with different difficulty levels. DISCUSSION Previous studies associated with earlier versions of GRADIOR have allowed the development of a new version of GRADIOR. Taking into account aspects associated with user experience, usability and effectiveness. Aspects that have made it possible to achieve a program that can meet the needs of older people with dementia.
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Affiliation(s)
- Manuel A Franco-Martín
- Psychiatric Department, Rio Hortega University Hospital, Valladolid, Spain
- Zamora Hospital, Zamora, Spain
- Institute of Biomedical Research of Salamanca, University of Salamanca, Salamanca, Spain
- Department of Research and Development, Iberian Research Psycho-Sciences Institute, INTRAS Foundation, Zamora, Spain
| | - Angie A Diaz-Baquero
- Institute of Biomedical Research of Salamanca, University of Salamanca, Salamanca, Spain.
- Department of Research and Development, Iberian Research Psycho-Sciences Institute, INTRAS Foundation, Zamora, Spain.
| | | | | | - Esther Parra Vidales
- IBIP Center for Clinical Care in Mental Health and Aging, INTRAS Foundation, Zamora, Spain
| | - María V Perea Bartolomé
- Basic Psychology, Psychobiology and Methodology Department, Salamanca University, Salamanca, Spain
| | | | - Henriëtte G van der Roest
- Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos-Institute), Utrecht, The Netherlands
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Brei NG, Raicu AM, Lee HJ, Klein-Tasman BP. Feasibility and acceptability of an online response inhibition cognitive training program for youth with Williams syndrome. INTERNATIONAL REVIEW OF RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 59:107-134. [PMID: 33083211 PMCID: PMC7560495 DOI: 10.1016/bs.irrdd.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Williams syndrome (WS) is a genetic neurodevelopmental disorder often accompanied by inhibitory difficulties. Online cognitive training programs show promise for improving cognitive functions. No such interventions have been developed for individuals with WS, but to explore the practicality of large-scale online cognitive training for this population, we must first investigate whether families of those with WS find these programs feasible and acceptable. Twenty individuals aged 10-17 years with WS, along with parents, participated in a pilot online cognitive training program supervised in real time using videoconference software. We evaluated the feasibility and acceptability of this response inhibition training using three parent questionnaires. Descriptive data are reported for the measures of feasibility and acceptability. Overall, the online procedures received a positive reaction from families. Parents were likely to recommend the study to others. They indicated training was ethical and acceptable despite feeling neutral about effectiveness. The frequency and duration of sessions were acceptable to families (two 20-to-30-min sessions per week; 10 sessions total). Families provided feedback and offered suggestions for improvement, such as more flexibility in scheduling and decreasing time spent in review of procedures.
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Affiliation(s)
- Natalie G Brei
- Catholic Social Services of Southern Nebraska, Lincoln, NE, United States
| | | | - Han Joo Lee
- University of Wisconsin-Milwaukee, Milwaukee, WI, United States
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Koller EJ, Chakrabarty P. Tau-Mediated Dysregulation of Neuroplasticity and Glial Plasticity. Front Mol Neurosci 2020; 13:151. [PMID: 32973446 PMCID: PMC7472665 DOI: 10.3389/fnmol.2020.00151] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/20/2020] [Indexed: 01/14/2023] Open
Abstract
The inability of individual neurons to compensate for aging-related damage leads to a gradual loss of functional plasticity in the brain accompanied by progressive impairment in learning and memory. Whereas this loss in neuroplasticity is gradual during normal aging, in neurodegenerative diseases such as Alzheimer’s disease (AD), this loss is accelerated dramatically, leading to the incapacitation of patients within a decade of onset of cognitive symptoms. The mechanisms that underlie this accelerated loss of neuroplasticity in AD are still not completely understood. While the progressively increasing proteinopathy burden, such as amyloid β (Aβ) plaques and tau tangles, definitely contribute directly to a neuron’s functional demise, the role of non-neuronal cells in controlling neuroplasticity is slowly being recognized as another major factor. These non-neuronal cells include astrocytes, microglia, and oligodendrocytes, which through regulating brain homeostasis, structural stability, and trophic support, play a key role in maintaining normal functioning and resilience of the neuronal network. It is believed that chronic signaling from these cells affects the homeostatic network of neuronal and non-neuronal cells to an extent to destabilize this harmonious milieu in neurodegenerative diseases like AD. Here, we will examine the experimental evidence regarding the direct and indirect pathways through which astrocytes and microglia can alter brain plasticity in AD, specifically as they relate to the development and progression of tauopathy. In this review article, we describe the concepts of neuroplasticity and glial plasticity in healthy aging, delineate possible mechanisms underlying tau-induced plasticity dysfunction, and discuss current clinical trials as well as future disease-modifying approaches.
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Affiliation(s)
- Emily J Koller
- Department of Neuroscience, University of Florida, Gainesville, FL, United States.,Center for Translational Research in Neurodegenerative Disease, University of Florida, Gainesville, FL, United States
| | - Paramita Chakrabarty
- Department of Neuroscience, University of Florida, Gainesville, FL, United States.,Center for Translational Research in Neurodegenerative Disease, University of Florida, Gainesville, FL, United States.,McKnight Brain Institute, University of Florida, Gainesville, FL, United States
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Martin DM, Mohan A, Alonzo A, Gates N, Gbadeyan O, Meinzer M, Sachdev P, Brodaty H, Loo C. A Pilot Double-Blind Randomized Controlled Trial of Cognitive Training Combined with Transcranial Direct Current Stimulation for Amnestic Mild Cognitive Impairment. J Alzheimers Dis 2020; 71:503-512. [PMID: 31424410 DOI: 10.3233/jad-190306] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is currently no effective intervention for improving memory in people at increased risk for dementia. Cognitive training (CT) has been promising, though effects are modest, particularly at follow-up. OBJECTIVE To investigate whether adjunctive non-invasive brain stimulation (transcranial direct current stimulation, tDCS) could enhance the memory benefits of CT in amnestic mild cognitive impairment (aMCI). METHODS Participants with aMCI were randomized to receive CT with either Active tDCS (2 mA for 30 min and 0.016 mA for 30 min) or Sham tDCS (0.016 mA for 60 min) for 15 sessions over a period of 5 weeks in a double-blind, sham-controlled, parallel group clinical trial. The primary outcome measure was the California Verbal Learning Task 2nd Edition. RESULTS 68 participants commenced the intervention. Intention-to-treat (ITT) analysis showed that the CT+Active tDCS group significantly improved at post treatment (p = 0.033), and the CT+Sham tDCS group did not (p = 0.050), but there was no difference between groups. At the 3-month follow-up, both groups showed large-sized memory improvements compared to pre-treatment (CT+Active tDCS: p < 0.01, d = 0.99; CT+Sham tDCS: p < 0.01, d = 0.74), although there was no significant difference between groups. CONCLUSION This study found that CT+Active tDCS did not produce greater memory improvement compared to CT+Sham tDCS. Large-sized memory improvements occurred in both conditions at follow-up. One possible interpretation, based on recent novel findings, is that low intensity tDCS (used as 'sham') may have contributed biological effects. Further work should use a completely inert tDCS sham condition.
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Affiliation(s)
- Donel M Martin
- Black Dog Institute, Sydney, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Adith Mohan
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Angelo Alonzo
- Black Dog Institute, Sydney, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Nicola Gates
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Oyetunde Gbadeyan
- University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Marcus Meinzer
- University of Queensland Centre for Clinical Research, Brisbane, Australia.,Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Perminder Sachdev
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Henry Brodaty
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Colleen Loo
- Black Dog Institute, Sydney, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia.,St George Hospital, South Eastern Sydney Health, Sydney, Australia
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Computerized Cognitive Rehabilitation Training for Ugandan Seniors Living with HIV: A Validation Study. J Clin Med 2020; 9:jcm9072137. [PMID: 32645896 PMCID: PMC7408686 DOI: 10.3390/jcm9072137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 11/17/2022] Open
Abstract
The feasibility, acceptability and preliminary efficacy of computerized cognitive rehabilitation therapy (CCRT) for mitigating neurocognitive decline was evaluated in African adults ≥50 years old. Eighty-one Ugandans with (n = 40) and without (n = 41) chronic human immunodeficiency viruses (HIV) were allocated CCRT—i.e., 20–45-min cognitive training sessions with culturally adapted video games delivered via Captain’s Log Software, or standard of care (SOC). Pre and post (i.e., 8-weeks later) intervention performance based neurocognitive tests, quality of life (QOL) and frailty related phenotype (FRP) were determined in all respondents. Multivariable linear regression estimated CCRT- vs. SOC-related differences (β) in neurocognitive batteries, QOL and FRP. Effect sizes (ES) for estimated β were calculated. CCRT protocol was completed by 92.8% of persons allocated to it. Regardless of HIV status, CCRT was associated with higher performance in learning tests than SOC—interference list (β = 1.00, 95%CI: (0.02, 1.98); ES = 0.43) and delayed recall (β = 1.04, 95%CI: (0.06, 2.02); ES = 0.47). CCRT effect on verbal fluency was clinically important (ES = 0.38), but statistical significance was not reached (β = 1.25, 95%CI: (−0.09, 2.58)). Among HIV-positive adults, clinically important post-CCRT improvements were noted for immediate recall (ES = 0.69), working memory (ES = 0.51), verbal fluency (ES = 0.51), and timed gait (ES = −0.44) tasks. Among HIV-negative adults, CCRT resulted in moderate post-intervention improvement in learning tests (ES = 0.45) and large decline in FRP (ES = −0.71), without a positive effect on simple attention and visuomotor coordination tasks. CCRT intervention is feasible among older Ugandan adults with potential benefit for learning and verbal fluency tests regardless of HIV status and lowering FRP in HIV-negative older adults.
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Sherman DS, Durbin KA, Ross DM. Meta-Analysis of Memory-Focused Training and Multidomain Interventions in Mild Cognitive Impairment. J Alzheimers Dis 2020; 76:399-421. [PMID: 32508325 DOI: 10.3233/jad-200261] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Meta-analysis examining the efficacy of cognitive interventions on neuropsychological outcomes have suggested interventions that focus on memory may actually provide greater benefit against the cognitive declines associated with mild cognitive impairment (MCI). However, it remains unclear if memory-based training would be more effective at addressing the cognitive deficits associated with MCI than multidomain forms of intervention. OBJECTIVE A meta-analytic review and subgroup analysis was conducted to examine the effects of cognitive training in individuals diagnosed with MCI and to compare the efficacy of memory-based training with multidomain interventions. METHODS A total of 32 randomized controlled trials met inclusion criteria for the meta-analysis, which included 9 studies on memory-focused training and 17 studies on multidomain interventions. RESULTS We found significant, large effects for memory-focused training (Hedges' g observed = 0.947; 95% CI [-1.668, 3.562]; Z = 2.517; p = 0.012) and significant, moderate effects for multidomain interventions (Hedges' g observed = 0.420; 95% CI [-0.4491, 1.2891]; Z = 3.525; p < 0.001). A subgroup analysis found significant point estimates for memory-based forms of training and multidomain interventions, with memory-based forms of content yielding significantly greater summary effects than multidomain interventions (SMD Z = 2.162; p = 0.031, two-tailed; all outcomes). There was no difference between effect sizes when comparing outcomes limited to its respective domain. CONCLUSION Overall, these findings suggest that, while both interventions were beneficial, treatment interventions that were strictly memory-based were more effective at improving cognition in individuals diagnosed with MCI than interventions that targeted multiple cognitive domains.
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Affiliation(s)
- Dale S Sherman
- Department of Physical Medicine & Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Rossier School of Education, University of Southern California, Los Angeles, CA, USA
| | - Kelly A Durbin
- Department of Physical Medicine & Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - David M Ross
- Department of Physical Medicine & Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Psychology, Loma Linda University, Loma Linda, CA, USA
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Yang HL, Chu H, Kao CC, Miao NF, Chang PC, Tseng P, O'Brien AP, Chou KR. Construction and evaluation of multidomain attention training to improve alertness attention, sustained attention, and visual-spatial attention in older adults with mild cognitive impairment: A randomized controlled trial. Int J Geriatr Psychiatry 2020; 35:537-546. [PMID: 31994767 DOI: 10.1002/gps.5269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 01/20/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We aimed to analyze the effects of multidomain attention training on alertness, sustained attention, and visual-spatial attention in older adults with mild cognitive impairment (MCI). DESIGN The design used in this study was a two-arm, parallel group, double-blind randomized controlled trial. SETTING AND PARTICIPANTS The participants of the study were seventy-eight older adults with MCI (mean age: 79.5 ± 7.9 years) from retirement centers and community housing for the elderly. INTERVENTION The participants were randomly assigned to an experimental group (multidomain attention training, n = 39) or an active control group (n = 39). Both groups underwent training sessions for 45 minutes three times per week for 6 weeks (18 sessions in total). MEASURES The main efficacy indicator was alertness (Trail Making Test Part B), sustained attention (Digit Vigilance Test), and visual-spatial attention (Trail Making Test Part A). The secondary outcome indicators were other cognitive functions (Mini-Mental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA] subscales). Measurements were obtained at pretest, posttest, and 3 and 6 months after training. RESULTS The results were analyzed by a generalized estimating equation (GEE), which indicated that attention outcomes (alertness, sustained attention, and visual-spatial attention) of the experimental group did not improve after training. However, the experimental group displayed a significant improvement in the attention, memory, and orientation of MMSE and MoCA subscales over a period of 6 months and also showed superior results compared with the control group. CONCLUSIONS Multidomain attention training demonstrated improved alertness and visual-spatial attention for posttest after 6 months. We also outline potential future advances in attention training for improving attention in older adults with MCI.
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Affiliation(s)
- Hui-Ling Yang
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China.,School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Ching-Chiu Kao
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China.,Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Nae-Fang Miao
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Pi-Chen Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Philip Tseng
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China.,Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan, Republic of China.,Brain and Consciousness Research Center, TMU-Shuang Ho Hospital, New Taipei City, Taiwan, Republic of China
| | - Anthony Paul O'Brien
- School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle (UoN), Newcastle, New South Wales, Australia
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China.,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan, Republic of China.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan, Republic of China
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Oh MW, Ki YJ, Jeon BH, Kim SY, Oh Y, Yoo S, Cho A, Seo JH, Lee GJ. Nurse-Led Computerized Cognitive Training for Mild Cognitive Impairment: A Preliminary Study. Rehabil Nurs 2020; 46:00006939-202105000-00006. [PMID: 32304482 DOI: 10.1097/rnj.0000000000000264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This preliminary study aimed to compare the outcomes of an occupational therapist-led and a nurse-led computerized cognitive training (CCT) for mild cognitive impairment (MCI) in older adults. DESIGN A single-blind randomized controlled trial was performed. METHODS Participants 65 years of age and older with MCI were randomly assigned to a group led by an occupational therapist or by a nurse. Both groups received CCT for 4 weeks. FINDINGS Six participants in the occupational therapist-led group and nine in the nurse-led group completed CCT. The nurse-led group showed significant improvement in scores on the Seoul Verbal Learning Test-Elderly's version immediate recall scores (p = .030) and the Korean-Boston Naming Test (p = .012). CONCLUSIONS Nurse-led CCT demonstrated improvement in some language and memory areas in older adults with MCI. CLINICAL RELEVANCE This study supports the idea of educating nurses to use a CCT program for treating older adults with MCI to improve their cognitive function.
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Affiliation(s)
- Min Woo Oh
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju-si, Republic of Korea
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Cheongju-si, Republic of Korea
| | - Young Jin Ki
- CNC Yullyang Hospital, Cheongju-si, Republic of Korea
| | | | - Si Yeon Kim
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju-si, Republic of Korea
| | - Youngmin Oh
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju-si, Republic of Korea
| | - Suwon Yoo
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju-si, Republic of Korea
| | - Aeri Cho
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju-si, Republic of Korea
| | - Joo Han Seo
- M3 Solution Co., Ltd, Daegu-si, Republic of Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju-si, Republic of Korea
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Cheongju-si, Republic of Korea
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Gates NJ, Rutjes AWS, Di Nisio M, Karim S, Chong L, March E, Martínez G, Vernooij RWM. Computerised cognitive training for 12 or more weeks for maintaining cognitive function in cognitively healthy people in late life. Cochrane Database Syst Rev 2020; 2:CD012277. [PMID: 32104914 PMCID: PMC7045394 DOI: 10.1002/14651858.cd012277.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Increasing age is associated with a natural decline in cognitive function and is the greatest risk factor for dementia. Cognitive decline and dementia are significant threats to independence and quality of life in older adults. Therefore, identifying interventions that help to maintain cognitive function in older adults or that reduce the risk of dementia is a research priority. Cognitive training uses repeated practice on standardised exercises targeting one or more cognitive domains and may be intended to improve or maintain optimal cognitive function. This review examines the effects of computerised cognitive training interventions lasting at least 12 weeks on the cognitive function of healthy adults aged 65 or older and has formed part of a wider project about modifying lifestyle to maintain cognitive function. We chose a minimum 12 weeks duration as a trade-off between adequate exposure to a sustainable intervention and feasibility in a trial setting. OBJECTIVES To evaluate the effects of computerised cognitive training interventions lasting at least 12 weeks on cognitive function in cognitively healthy people in late life. SEARCH METHODS We searched to 31 March 2018 in ALOIS (www.medicine.ox.ac.uk/alois), and we performed additional searches of MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov, and the WHO Portal/ICTRP (www.apps.who.int/trialsearch), to ensure that the search was as comprehensive and as up-to-date as possible to identify published, unpublished, and ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs, published or unpublished, reported in any language. Participants were cognitively healthy people, and at least 80% of the study population had to be aged 65 or older. Experimental interventions adhered to the following criteria: intervention was any form of interactive computerised cognitive intervention - including computer exercises, computer games, mobile devices, gaming console, and virtual reality - that involved repeated practice on standardised exercises of specified cognitive domain(s) for the purpose of enhancing cognitive function; the duration of the intervention was at least 12 weeks; cognitive outcomes were measured; and cognitive training interventions were compared with active or inactive control interventions. DATA COLLECTION AND ANALYSIS We performed preliminary screening of search results using a 'crowdsourcing' method to identify RCTs. At least two review authors working independently screened the remaining citations against inclusion criteria. At least two review authors also independently extracted data and assessed the risk of bias of included RCTs. Where appropriate, we synthesised data in random-effects meta-analyses, comparing computerised cognitive training (CCT) separately with active and inactive controls. We expressed treatment effects as standardised mean differences (SMDs) with 95% confidence intervals (CIs). We used GRADE methods to describe the overall quality of the evidence for each outcome. MAIN RESULTS We identified eight RCTs with a total of 1183 participants. The duration of the interventions ranged from 12 to 26 weeks; in five trials, the duration of intervention was 12 or 13 weeks. The included studies had moderate risk of bias, and the overall quality of evidence was low or very low for all outcomes. We compared CCT first against active control interventions, such as watching educational videos. Negative SMDs favour CCT over control. Trial results suggest slight improvement in global cognitive function at the end of the intervention period (12 weeks) (standardised mean difference (SMD) -0.31, 95% confidence interval (CI) -0.57 to -0.05; 232 participants; 2 studies; low-quality evidence). One of these trials also assessed global cognitive function 12 months after the end of the intervention; this trial provided no clear evidence of a persistent effect (SMD -0.21, 95% CI -0.66 to 0.24; 77 participants; 1 study; low-quality evidence). CCT may result in little or no difference at the end of the intervention period in episodic memory (12 to 17 weeks) (SMD 0.06, 95% CI -0.14 to 0.26; 439 participants; 4 studies; low-quality evidence) or working memory (12 to 16 weeks) (SMD -0.17, 95% CI -0.36 to 0.02; 392 participants; 3 studies; low-quality evidence). Because of the very low quality of the evidence, we are very uncertain about the effects of CCT on speed of processing and executive function. We also compared CCT to inactive control (no interventions). We found no data on our primary outcome of global cognitive function. At the end of the intervention, CCT may lead to slight improvement in episodic memory (6 months) (mean difference (MD) in Rivermead Behavioural Memory Test (RBMT) -0.90 points, 95% confidence interval (CI) -1.73 to -0.07; 150 participants; 1 study; low-quality evidence) but can have little or no effect on executive function (12 weeks to 6 months) (SMD -0.08, 95% CI -0.31 to 0.15; 292 participants; 2 studies; low-quality evidence), working memory (16 weeks) (MD -0.08, 95% CI -0.43 to 0.27; 60 participants; 1 study; low-quality evidence), or verbal fluency (6 months) (MD -0.11, 95% CI -1.58 to 1.36; 150 participants; 1 study; low-quality evidence). We could not determine any effects on speed of processing because the evidence was of very low quality. We found no evidence on quality of life, activities of daily living, or adverse effects in either comparison. AUTHORS' CONCLUSIONS We found low-quality evidence suggesting that immediately after completion of the intervention, small benefits of CCT may be seen for global cognitive function when compared with active controls, and for episodic memory when compared with an inactive control. These benefits are of uncertain clinical importance. We found no evidence that the effect on global cognitive function persisted 12 months later. Our confidence in the results was low, reflecting the overall quality of the evidence. In five of the eight trials, the duration of the intervention was just three months. The possibility that more extensive training could yield larger benefit remains to be more fully explored. We found substantial literature on cognitive training, and collating all available scientific information posed problems. Duration of treatment may not be the best way to categorise interventions for inclusion. As the primary interest of older people and of guideline writers and policymakers involves sustained cognitive benefit, an alternative would be to categorise by length of follow-up after selecting studies that assess longer-term effects.
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Affiliation(s)
- Nicola J Gates
- University of New South WalesCentre for Healthy Brain Ageing (CHeBA)Suite 407 185 Elizabeth StreetSydneyNSWAustralia2000
| | - Anne WS Rutjes
- University of BernInstitute of Social and Preventive Medicine (ISPM)Mittelstrasse 43BernBernSwitzerland3012
- University of BernInstitute of Primary Health Care (BIHAM)Mittelstrasse 43BernBernSwitzerland3012
| | - Marcello Di Nisio
- University "G. D'Annunzio" of Chieti‐PescaraDepartment of Medicine and Ageing SciencesVia dei Vestini 31Chieti ScaloItaly66013
| | - Salman Karim
- Lancashire Care NHS Foundation TrustPsychiatrySceptre Point, Sceptre WayPrestonUKPR5 6AW
| | | | - Evrim March
- St Vincent's Hospital (Melbourne)St Vincent's Adult Mental Health46 Nicholson StreetFitzroyVICAustralia3065
| | - Gabriel Martínez
- Universidad de AntofagastaFaculty of Medicine and DentistryAvenida Argentina 2000AntofagastaChile127001
| | - Robin WM Vernooij
- University Medical Center UtrechtDepartment of Nephrology and Hypertension and Julius Center for Health Sciences and Primary CareHeidelberglaan 100UtrechtNetherlands3584 CX
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Patnode CD, Perdue LA, Rossom RC, Rushkin MC, Redmond N, Thomas RG, Lin JS. Screening for Cognitive Impairment in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2020; 323:764-785. [PMID: 32096857 DOI: 10.1001/jama.2019.22258] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Early identification of cognitive impairment may improve patient and caregiver health outcomes. OBJECTIVE To systematically review the test accuracy of cognitive screening instruments and benefits and harms of interventions to treat cognitive impairment in older adults (≥65 years) to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials through January 2019, with literature surveillance through November 22, 2019. STUDY SELECTION Fair- to good-quality English-language studies of cognitive impairment screening instruments, and pharmacologic and nonpharmacologic treatments aimed at persons with mild cognitive impairment (MCI), mild to moderate dementia, or their caregivers. DATA EXTRACTION AND SYNTHESIS Independent critical appraisal and data abstraction; random-effects meta-analyses and qualitative synthesis. MAIN OUTCOMES AND MEASURES Sensitivity, specificity; patient, caregiver, and clinician decision-making; patient function, quality of life, and neuropsychiatric symptoms; caregiver burden and well-being. RESULTS The review included 287 studies with more than 280 000 older adults. One randomized clinical trial (RCT) (n = 4005) examined the direct effect of screening for cognitive impairment on patient outcomes, including potential harms, finding no significant differences in health-related quality of life at 12 months (effect size, 0.009 [95% CI, -0.063 to 0.080]). Fifty-nine studies (n = 38 531) addressed the accuracy of 49 screening instruments to detect cognitive impairment. The Mini-Mental State Examination was the most-studied instrument, with a pooled sensitivity of 0.89 (95% CI, 0.85 to 0.92) and specificity of 0.89 (95% CI, 0.85 to 0.93) to detect dementia using a cutoff of 23 or less or 24 or less (15 studies, n = 12 796). Two hundred twenty-four RCTs and 3 observational studies including more than 240 000 patients or caregivers addressed the treatment of MCI or mild to moderate dementia. None of the treatment trials were linked with a screening program; in all cases, participants were persons with known cognitive impairment. Medications approved to treat Alzheimer disease (donepezil, galantamine, rivastigmine, and memantine) improved scores on the ADAS-Cog 11 by 1 to 2.5 points over 3 months to 3 years. Psychoeducation interventions for caregivers resulted in a small benefit for caregiver burden (standardized mean difference, -0.24 [95% CI, -0.36 to -0.13) over 3 to 12 months. Intervention benefits were small and of uncertain clinical importance. CONCLUSIONS AND RELEVANCE Screening instruments can adequately detect cognitive impairment. There is no empirical evidence, however, that screening for cognitive impairment improves patient or caregiver outcomes or causes harm. It remains unclear whether interventions for patients or caregivers provide clinically important benefits for older adults with earlier detected cognitive impairment or their caregivers.
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Affiliation(s)
- Carrie D Patnode
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Leslie A Perdue
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | | | - Megan C Rushkin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Rachel G Thomas
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Basak C, Qin S, O'Connell MA. Differential effects of cognitive training modules in healthy aging and mild cognitive impairment: A comprehensive meta-analysis of randomized controlled trials. Psychol Aging 2020; 35:220-249. [PMID: 32011155 DOI: 10.1037/pag0000442] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This meta-analysis was designed to compare the effectiveness of 2 cognitive training modules, single-component training, which targets 1 specific cognitive ability, versus multicomponent training, which trains multiple cognitive abilities, on both trained abilities (near transfer) and untrained abilities (far transfer) in older adults. The meta-analysis also assessed whether individual differences in mental status interacted with the extent of transfer. Eligible randomized controlled trials (215 training studies) examined the immediate effects of cognitive training in either healthy aging (HA) or mild cognitive impairment (MCI). Results yielded an overall net-gain effect size (g) for the cognitive training of 0.28 (p < .001). These effects were similar across mental status and training modules, and were significant for both near (g = 0.37) and far (g = 0.22) transfer. Although all training modules yielded significant near transfer, only a few yielded significant far transfer. Single-component training of executive functions was most effective on near and far transfer, with processing speed training improving everyday functioning. All modules of multicomponent training (specific and nonspecific) yielded significant near and far transfer, including everyday functioning. Training effects on cognition were moderated by educational attainment and number of cognitive outcomes, but only in HA. These findings suggest that, in older adults, all modules of multicomponent training are more effective in engendering near and far transfer, including everyday functioning, when compared with single-component training modules. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Four-Week, Home-Based, Robot Cognitive Intervention for Patients with Mild Cognitive Impairment: a Pilot Randomized Controlled Trial. Dement Neurocogn Disord 2020; 19:96-107. [PMID: 32985149 PMCID: PMC7521954 DOI: 10.12779/dnd.2020.19.3.96] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 12/16/2022] Open
Abstract
Background and Purpose Previous studies suggest that cognitive intervention can mitigate the development of dementia in patients with mild cognitive impairment (MCI). However, the previous cognitive intervention was mostly provided as a group session, in which MCI patients sometimes had difficulty in regularly attending sessions or were reluctant to participate in group-based classes. Additionally, experienced instructors for traditional cognitive intervention may be unavailable in some chronic-care facilities or community centers. Considering these reasons, we have developed 5 programs for home-based cognitive intervention using a personal robot for MCI patients. In this preliminary study, we aimed to demonstrate the effects of our newly developed home-based cognitive intervention with robots on cognitive function in MCI patients. Methods We conducted a single-blind randomized controlled trial enrolling 46 MCI patients. Participants were randomized into 2 groups: the robot cognitive intervention (robot) (n=24) group and without cognitive intervention (control) (n=22) group. The interventions comprised 60-min sessions per day for 4 weeks. The primary outcome was the change in cognitive function measured using the Cambridge Neuropsychological Test Automated Battery. Results There were no significant baseline demographic or clinical differences between the robot and control groups. After the 4-week cognitive intervention, the robot group showed greater improvement in working memory than did the control group. Conclusions Our home-based cognitive intervention with a personal robot improved the working memory in MCI patients. Further studies with larger samples and longer study periods are required to demonstrate the effects of these programs in other cognitive domains in MCI patients.
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Nousia A, Martzoukou M, Siokas V, Aretouli E, Aloizou AM, Folia V, Peristeri E, Messinis L, Nasios G, Dardiotis E. Beneficial effect of computer-based multidomain cognitive training in patients with mild cognitive impairment. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:717-726. [DOI: 10.1080/23279095.2019.1692842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Anastasia Nousia
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Maria Martzoukou
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Eleni Aretouli
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece
| | - Athina-Maria Aloizou
- Department of Neurology, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Vasiliki Folia
- Department of Neurology, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Eleni Peristeri
- Department of Neurology, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Lambros Messinis
- Neuropsychology Section, Department of Neurology, University of Patras Medical School, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Alnajjar F, Khalid S, Vogan AA, Shimoda S, Nouchi R, Kawashima R. Emerging Cognitive Intervention Technologies to Meet the Needs of an Aging Population: A Systematic Review. Front Aging Neurosci 2019; 11:291. [PMID: 31798439 PMCID: PMC6821684 DOI: 10.3389/fnagi.2019.00291] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/09/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Cognitive training helps to promote healthy aging and ease activities of daily living for older adults. Recently, experiments have been conducted using robots to perform this cognitive training. Methods: A review was conducted to examine the effects of computer-based cognitive interventions for older adults who were either healthy or experiencing mild cognitive impairment (MCI). A second study also examined the evolution of socially assistive robots (SAR) and their effectiveness at administering cognitive training for older adults. Results: Eighty-one studies published between 2009 and 2019 were identified for review, 56 of which focused on computerized cognitive training (CCT) while 25 examined the use of robotics. Twenty-four of the 56 CCT studies met the inclusion criteria. These were further classified into two groups: studies which used self-designed programs, and studies using commercially available ones. Of the 25 studies examining the use of robotics in cognitive intervention 7 met the inclusion criteria. Review shows that CCT improves cognitive function but that robots are more effective tools for improving cognition. Conclusion: It can be concluded that CCT is beneficial for older adults and though there are drawbacks to this approach they are overcome by the introduction of robots into the training process. Culture, language, and socio-economic considerations vis-a-vis robot design and training methodology should be included in future research.
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Affiliation(s)
- Fady Alnajjar
- College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates.,Intelligent Behavior Control Unit, CBS-TOYOTA Collaboration Center, RIKEN, Nagoya, Japan
| | - Sumayya Khalid
- College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Alistair A Vogan
- College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Shingo Shimoda
- Intelligent Behavior Control Unit, CBS-TOYOTA Collaboration Center, RIKEN, Nagoya, Japan
| | - Rui Nouchi
- Institute of Development, Aging and Cancer (IDAC), Tohoku University, Sendai, Japan
| | - Ryuta Kawashima
- Institute of Development, Aging and Cancer (IDAC), Tohoku University, Sendai, Japan
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Gauthier K, Morand A, Dutheil F, Alescio-Lautier B, Boucraut J, Clarys D, Eustache F, Girard N, Guedj E, Mazerolle M, Paccalin M, de la Sayette V, Zaréa A, Huguet P, Michel BF, Desgranges B, Régner I. Ageing stereotypes and prodromal Alzheimer's disease (AGING): study protocol for an ongoing randomised clinical study. BMJ Open 2019; 9:e032265. [PMID: 31594904 PMCID: PMC6797355 DOI: 10.1136/bmjopen-2019-032265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The number of older people diagnosed with amnestic mild cognitive impairment (aMCI), the prodromal state of Alzheimer's disease (AD), is increasing worldwide. However, some patients with aMCI never convert to the AD type of dementia, with some remaining stable and others reverting to normal. This overdiagnosis bias has been largely overlooked and gone unexplained. There is ample evidence in the laboratory that negative ageing stereotypes (eg, the culturally shared belief that ageing inescapably causes severe cognitive decline) contribute to the deteriorating cognitive performances of healthy older adults, leading them to perform below their true abilities. The study described here is intended to test for the first time whether such stereotypes also impair patients' cognitive performances during neuropsychological examinations in memory clinics, resulting in overdiagnosis of aMCI. METHODS AND ANALYSIS The ongoing study is a 4-year randomised clinical trial comparing patients' physiological stress and cognitive performances during neuropsychological testing in memory clinics. A total of 260 patients attending their first cognitive evaluation will be randomised to either a standard condition of test administration, assumed here to implicitly activate negative ageing stereotypes or a reduced-threat instruction condition designed to alleviate the anxiety arising from these stereotypes. Both groups will be tested with the same test battery and stress biomarkers. For 30 patients diagnosed with aMCI in each group (n=60), biomarkers of neurodegeneration and amyloidopathy will be used to distinguish between aMCI with normal versus abnormal AD biomarkers. A 9-month follow-up will be performed on all patients to identify those whose cognitive performances remain stable, deteriorate or improve. ETHICS AND DISSEMINATION This protocol has been approved by the French National Agency for Medicines and Health Products Safety and the Sud-Est I French Ethics Committee (2017-A00946-47). Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03138018.
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Affiliation(s)
- Kim Gauthier
- Aix Marseille Univ, CNRS, LPC, Marseille, France
| | - Alexandrine Morand
- Normandie Université, UNICAEN, PSL Universités Paris, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Frederic Dutheil
- Université Clermont Auvergne, CNRS, LAPSCO, Clermont-Ferrand, France
- Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, Clermont-Ferrand, France
| | | | - José Boucraut
- Immunology Laboratory, Assistance Publique-Hôpitaux de Marseille, Conception Hospital, Marseille, France
- Timone Neuroscience Institute, Aix-Marseille Univ, Marseille, France
| | - David Clarys
- Centre de Recherches sur la Cognition et l'Apprentissage, CNRS, Université de Poitiers, Université de Tours, Poitiers, France
| | - Francis Eustache
- Normandie Université, UNICAEN, PSL Universités Paris, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Nadine Girard
- Aix Marseille Univ, CRMBM UMR CNRS 7339, APHM Timone Neuroradiologie, Marseille, France
| | - Eric Guedj
- Aix Marseille Univ, CNRS, Ecole Centrale Marseille, UMR 7249, Institut Fresnel, & Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Marseille, Timone University Hospital, Marseille, France
| | - Marie Mazerolle
- Department and Laboratory of Psychology, MSHE, Université Bourgogne Franche-Comté, Besançon, France
| | - Marc Paccalin
- Centre d'Investigation Clinique CIC 1402, INSERM, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Vincent de la Sayette
- Normandie Université, UNICAEN, PSL Universités Paris, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Aline Zaréa
- Department of Neurology, Rouen University Hospital and University of Rouen, Rouen, France
| | - Pascal Huguet
- Université Clermont Auvergne, CNRS, LAPSCO, Clermont-Ferrand, France
| | - Bernard F Michel
- Departement of Neurological Behavior, Assistance Publique-Hôpitaux de Marseille, Sainte-Marguerite University Hospital, Marseille, France
| | - Béatrice Desgranges
- Normandie Université, UNICAEN, PSL Universités Paris, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
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D'Antonio J, Simon-Pearson L, Goldberg T, Sneed JR, Rushia S, Kerner N, Andrews H, Hellegers C, Tolbert S, Perea E, Petrella J, Doraiswamy PM, Devanand D. Cognitive training and neuroplasticity in mild cognitive impairment (COG-IT): protocol for a two-site, blinded, randomised, controlled treatment trial. BMJ Open 2019; 9:e028536. [PMID: 31471436 PMCID: PMC6720324 DOI: 10.1136/bmjopen-2018-028536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/17/2019] [Accepted: 07/10/2019] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Mild cognitive impairment (MCI) is common in older adults and represents a high-risk group for progression to Alzheimer's disease (AD). Medication trials in MCI have generally failed, but new discoveries with brain plasticity in ageing have led to the study of cognitive training as a potential treatment to improve cognitive abilities. Computerised cognitive training (CCT) involves computerised cognitive exercises that target specific cognitive abilities and neural networks to potentially improve cognitive functioning through neuroplasticity. METHODS AND ANALYSIS In a two-site study (New York State Psychiatric Institute/Columbia University Medical Center and Duke University Medical Center), we will randomise 100 patients with MCI (Wechsler Memory Scale-III Logical Memory II score 0-11; Folstein Mini Mental State Examination ≥23) to home-based CCT (suite of exercises: memory, matching, spatial recognition, processing speed) or a home-based active control condition (computerised crossword puzzle training (CPT)) with 12 weeks of intensive training followed by regular booster sessions up to 78 weeks. All patients will receive standard neuropsychological and functional assessments in clinic as well as structural/functional brain MRI scans at study entry and endpoint. We will test if CCT, versus CPT, leads to improved cognitive functioning, transfers to functional ability and tasks of everyday life and impacts hippocampal volume changes and changes in the default mode network of the brain measured by resting-state functional MRI. ETHICS AND DISSEMINATION The study will be conducted following ethics approval and written informed consent will be obtained from all subjects. Study results will be disseminated via publication, clinicaltrials.gov, media and conference presentations. This will be the first controlled long-term trial to evaluate the effects of home-based CCT versus computerised CPT on cognitive abilities and functional measures and neural outcomes as determined by MRI indices in patients with MCI. Positive results from trial may support further development of home-based CCT. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier (NCT03205709).
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Affiliation(s)
- Jessica D'Antonio
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Laura Simon-Pearson
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Terry Goldberg
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Joel R Sneed
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
- Department of Psychology, Queens College, City University of New York, Flushing, New York, USA
| | - Sara Rushia
- Department of Psychology, Queens College, City University of New York, Flushing, New York, USA
- Department of Psychology, The Graduate Center, City University of New York, New York, New York, USA
| | - Nancy Kerner
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA
| | - Caroline Hellegers
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA
| | - Sierra Tolbert
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA
| | - Elena Perea
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeffrey Petrella
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - P Murali Doraiswamy
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA
| | - Davangere Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
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Zhang H, Huntley J, Bhome R, Holmes B, Cahill J, Gould RL, Wang H, Yu X, Howard R. Effect of computerised cognitive training on cognitive outcomes in mild cognitive impairment: a systematic review and meta-analysis. BMJ Open 2019; 9:e027062. [PMID: 31427316 PMCID: PMC6701629 DOI: 10.1136/bmjopen-2018-027062] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 04/03/2019] [Accepted: 06/06/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To determine the effect of computerised cognitive training (CCT) on improving cognitive function for older adults with mild cognitive impairment (MCI). DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, Web of Science and the Cochrane Library were searched through January 2018. ELIGIBILITY CRITERIA Randomised controlled trials comparing CCT with control conditions in those with MCI aged 55+ were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed the risk of bias. Effect sizes (Hedges' g and 95% CIs) were calculated and random-effects meta-analyses were performed where three or more studies investigated a comparable intervention and outcome. Heterogeneity was quantified using the I2 statistic. RESULTS 18 studies met the inclusion criteria and were included in the analyses, involving 690 participants. Meta-analysis revealed small to moderate positive treatment effects compared with control interventions in four domains as follows: global cognitive function (g=0.23, 95% CI 0.03 to 0.44), memory (g=0.30, 95% CI 0.11 to 0.50), working memory (g=0.39, 95% CI 0.12 to 0.66) and executive function (g=0.20, 95% CI -0.03 to 0.43). Statistical significance was reached in all domains apart from executive function. CONCLUSIONS This meta-analysis provides evidence that CCT improves cognitive function in older people with MCI. However, the long-term transfer of these improvements and the potential to reduce dementia prevalence remains unknown. Various methodological issues such as heterogeneity in outcome measures, interventions and MCI symptoms and lack of intention-to-treat analyses limit the quality of the literature and represent areas for future research.
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Affiliation(s)
- Haifeng Zhang
- Division of Psychiatry, University College London, London, UK
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing Dementia Key Lab, Beijing, China
| | | | - Rohan Bhome
- Division of Psychiatry, University College London, London, UK
| | - Benjamin Holmes
- Division of Psychiatry, University College London, London, UK
| | - Jack Cahill
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Rebecca L Gould
- Division of Psychiatry, University College London, London, UK
| | - Huali Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing Dementia Key Lab, Beijing, China
| | - Xin Yu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing Dementia Key Lab, Beijing, China
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
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Poptsi E, Lazarou I, Markou N, Vassiloglou M, Nikolaidou E, Diamantidou A, Siatra V, Karathanassi E, Karakostas A, Zafeiropoulou FK, Tsiatsos T, Tsolaki M. A Comparative Single-Blind Randomized Controlled Trial With Language Training in People With Mild Cognitive Impairment. Am J Alzheimers Dis Other Demen 2019; 34:176-187. [PMID: 30518237 PMCID: PMC10852481 DOI: 10.1177/1533317518813554] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
BACKGROUND Although cognitive training is effective for people with mild cognitive impairment (MCI), it is not clear which format is more effective. OBJECTIVE To compare the effectiveness of the same language programs when carried out via computer, paper/pencil and orally in people with MCI. METHODS Seventy-one participants with MCI were randomly classified in 3 experimental and 2 control groups. The experimental groups attended 48 sessions of language training for 6 months. The control groups attended either unstructured sessions or they were on waiting list. RESULTS Mixed measures analysis of variance, at the follow-up, showed a significant cognitive abilities improvement among the experimental versus control groups. At the end of the language training, the 3 groups presented improvement in cognitive abilities and daily function, while the control groups remained at the same performance level. CONCLUSION All 3 cognitive language training methods were equally significantly effective.
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Affiliation(s)
- Eleni Poptsi
- Greek Alzheimer Association, Thessaloniki, Greece
| | - Ioulietta Lazarou
- Greek Alzheimer Association, Thessaloniki, Greece
- 1st Department of Neurology, Medical School, Aristotle University of Thessaloniki, Greece
| | | | | | | | | | | | | | | | | | | | - Magda Tsolaki
- Greek Alzheimer Association, Thessaloniki, Greece
- 1st Department of Neurology, Medical School, Aristotle University of Thessaloniki, Greece
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