Effects of Virtual Reality Motor-Cognitive Training for Older People With Cognitive Frailty: Multicentered Randomized Controlled Trial

Cognitive frailty: A comprehensive clinical paradigm beyond cognitive decline

Cognitive frailty is an emerging concept in research and clinical practice that incorporates both physical frailty and mild cognitive impairment (MCI) or subjective cognitive decline (SCD). Unlike traditional approaches that separate physical frailty and dementia, cognitive frailty treats these domains as interrelated and coexisting, with significant implications for clinical outcomes and predicting cognitive decline. Despite growing recognition of this interrelationship, a dualistic view of physical and cognitive processes persists. The paradigm of cognitive frailty holds promise as a biomarker- like amyloid plaques or neurofibrillary tangles- but with the advantage of identifying risk at a prefrail stage, before clinical signs of MCI or dementia emerge. This review examines the pathophysiological and clinical dimensions of cognitive frailty and promotes for its integration into routine assessments in memory clinics.

Efficacy of Virtual Reality-Based Interventions on Cognitive Function in Patients With Neuropsychiatric Disorders: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background

Virtual reality (VR) technology has emerged as a promising tool for cognitive rehabilitation in patients with neuropsychiatric disorders. These patients often endure significant cognitive impairments, which are associated with decreased quality of life and increased disease burden. Traditional treatments are limited in improving cognitive functions, making VR-based interventions an area of growing interest.

Objective

This meta-analysis aims to evaluate the efficacy of VR-based interventions on cognitive function in patients with neuropsychiatric disorders by synthesizing data from randomized controlled trials (RCTs).

Methods

Following PRISMA guidelines, we conducted a comprehensive search across PubMed, Web of Science, MEDLINE, EMBASE, and Cochrane Library for RCTs from January 2010 to December 2024. Studies were included if they evaluated the impact of VR-based interventions on cognitive outcomes in patients with neuropsychiatric disorders. Data extraction and risk of bias assessment were performed independently by 2 researchers. Meta-analyses were conducted using random-effects models, and standardized mean differences (SMDs) as effect size.

Results

A total of 21 RCTs involving 1051 participants were included. Overall, VR-based interventions significantly improved cognitive functions of patients with neuropsychiatric disorders (SMD 0.67, 95% CI 0.33-1.01, z=3.85; P<.001). Subgroup analyses revealed significant benefits for cognitive rehabilitation training (SMD 0.75, 95% CI 0.33-1.17, z=3.53; P<.001), exergame-based training (SMD 1.09, 95% CI 0.26-1.91, z=2.57; P=.01), and telerehabilitation and social functioning training (SMD 2.21, 95% CI 1.11-3.32, z=3.92; P<.001). Conversely, immersive cognitive training, music attention training, and vocational and problem-solving skills training did not yield significant improvements (z=1.86, P=.06; z=0.35, P=.72; z=0.88, P=.38; respectively). Disease-type subgroup analyses indicated significant improvements in schizophrenia (SMD 0.92, 95% CI 0.22-1.62, z=2.58; P=.01), and mild cognitive impairment (SMD 0.75, 95% CI 0.16-1.35, z=2.47; P=.01), but not in brain injuries, Parkinson disease, or stroke (z=0.34, P=.73; z=1.26, P=.21; z=1.16, P=.24; respectively).

Conclusions

This meta-analysis revealed that VR-based interventions can improve cognitive functions among individuals with neuropsychiatric disorders, with notable improvements observed in cognitive rehabilitation training, exergame-based training, and tele-rehabilitation and social functioning training. These results offer valuable evidence supporting the use of VR technology in rehabilitation for neuropsychiatric conditions and inform the optimization of future intervention approaches.

Effectiveness of Exercise Intervention on Mobility, Postural Control, and Falls for Older Adults With Mild Cognitive Impairment: A Systematic Review and Network Meta-analysis

OBJECTIVE

To review and synthesize the effectiveness of exercise interventions on mobility, postural control, and falls in older adults with mild cognitive impairment (MCI).

DATA SOURCES

This review was registered with PROSPERO (CRD42023453320) and adhered to the PRISMA guidelines. The PubMed, Embase, APA PsycInfo, Cochrane Library, Web of Science, CINAHL, and SPORTDiscus were searched from inception until September 2024.

STUDY SELECTION

Randomized controlled trials (RCTs) examining the effectiveness of exercise interventions on mobility, postural control, and falls in older adults with MCI.

DATA EXTRACTION

Data extraction included author names, publication years, participant characteristics, intervention details, outcomes, key results, and attrition rates. Data accuracy was verified by 2 reviewers, with discrepancies resolved through consultation with a third reviewer.

DATA SYNTHESIS

Thirty-two RCTs met the criteria for qualitative systematic review, with 22 RCTs included in the pairwise meta-analysis and network meta-analysis. Aerobic exercise (AE) (SMD 1.07 [95% CI, 0.62-1.52]), multicomponent exercise (SMD 0.46 [95% CI, 0.18-0.74]), and simultaneous cognitive-motor training (SMD 0.56 [95% CI, 0.23-0.89]) significantly improved gait speed during single task (P<.05). AE was the most effective intervention for single-task walking performance (99.3%), whereas Exergaming was the most effective for timed Up and Go performance (100.0%) according to the surface under the cumulative ranking. Paddling exercise (SMD 0.42 [95% CI, 0.16-0.68]) effectively increased handgrip strength (P<.05). However, network meta-analyses revealed no intervention demonstrating significant effects on postural control performance (Berg Balance Scale and Functional Reach Test scores). The effect of exercise on falls remained inconclusive because of the limited number of studies.

CONCLUSIONS

AE, multicomponent exercise, and combined cognitive-motor training significantly enhance gait speed and functional performance in older adults with MCI. However, the effect of exercise on fall risk remains unclear. These findings underscore the potential of tailored exercise interventions to improve physical function in this vulnerable population.

Self-adaptive over progressive non-adaptive immersive virtual reality serious game to promote motor learning in older adults - A double blind randomized controlled trial

Older adults often experience cognitive and functional decline, which can be mitigated by innovative interventions like immersive virtual reality (iVR). Self-adaptive serious games, which dynamically adjust task difficulty, may provide additional benefits by tailoring challenges to individual performance. However, the comparative effectiveness of self-adaptive versus progressive non-adaptive iVR interventions on motor learning in older adults remains underexplored. This randomized controlled trial primarily aimed to compare the effects of self-adaptive and progressive non-adaptive iVR interventions on motor learning in older adults. A total of 33 older adults were randomly assigned to either a self-adaptive (n = 17) or progressive non-adaptive (n = 16) iVR group. Both interventions involved an iVR serious game requiring unimanual reaching, target selection, and distractor inhibition under increasing difficulty over three days. Performance was evaluated pre- and post-intervention using a standardized iVR task, consisting of hitting a virtual target while ignoring distractors. This task features five levels of difficulty (level 0: no distractors; level 4: 17 low-saliency distractors). Primary outcomes, assessed during the standardized task, included changes in speed-accuracy trade-offs (SAT) and relative response time (RT, compared to level 0). Both participants and assessors were blinded to the intervention. After the intervention, both groups exhibited significant SAT improvements at level 1, 3 and 4 (P < 0.05) and RT gains at level 3 and 4 (P < 0.05). The self-adaptive group demonstrated significantly greater SAT (P = 0.049) and relative RT (P = 0.004) improvements at level 4. Findings suggest that older adults can achieve motor learning in iVR, particularly with self-adaptive serious games, highlighting potential for self-rehabilitation. Clinical trial NCT06141642 approved the 21th November 2023.

Combined Physical-Cognitive Therapies for the Health of Older Adults with Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

Background: Mild cognitive impairment (MCI) represents an early stage of cognitive loss that significantly increases the risk of dementia. The aim of this study was to comprehensively synthesize the current evidence on the effect of combined physical and cognitive therapies in older adults with MCI. Methods: A systematic review with meta-analysis was conducted by searching for specific keywords in the PubMed, Scopus, Cinhal, and Web of Science databases. This meta-analysis included a total of 2256 participants distributed across 21 studies that evaluated the benefits of combining physical exercise with cognitive stimulation. Results: This review revealed that these types of therapies present a significant improvement in memory, attention, and executive functions. Participants showed notable improvements in these cognitive areas, highlighting the synergistic effects of physical exercise and cognitive stimulation, which exceeded the benefits of each therapy separately. These results contribute to the understanding of how these combined therapies can improve cognitive health in this population, offering robust evidence supporting their application in clinical practice. Conclusions: This meta-analysis shows that combined physical exercise and cognitive stimulation interventions may be an effective strategy for improving cognitive health in older adults with MCI. The findings of this study offer a valuable contribution to the field, highlighting the potential of these combined therapies to prevent cognitive decline and improve the quality of life of this population. The results may be of interest to health professionals and guide future research and clinical applications.

A Self-Adaptive Serious Game to Improve Motor Learning Among Older Adults in Immersive Virtual Reality: Short-Term Longitudinal Pre-Post Study on Retention and Transfer

BACKGROUND

Despite their potential, the use of serious games within immersive virtual reality (iVR) for enhancing motor skills in older adults remains relatively unexplored. In this study, we developed a self-adaptive serious game in iVR called REAsmash-iVR. This game involves swiftly locating and striking a digital mole presented with various distractors.

OBJECTIVE

This short-term longitudinal pre-post study aims to evaluate REAsmash-iVR's efficacy in promoting motor learning in older adults. Specifically, we seek to determine the transfer and retention of motor learning achieved through REAsmash-iVR to other iVR tasks.

METHODS

A total of 20 older adults participated in the study, engaging with REAsmash-iVR over 7 consecutive days. The evaluation included iVR tests such as KinematicsVR and a VR adaptation of the Box and Block Test (BBT-VR). KinematicsVR tasks included drawing straight lines and circles as fast and as accurately as possible, while BBT-VR required participants to move digital cubes as quickly as possible within 60 seconds. Assessments were conducted before and after the intervention, with a follow-up at 1 week post intervention. The primary outcome focused on evaluating the impact of REAsmash-iVR on speed-accuracy trade-off during KinematicsVR tasks. Secondary outcomes included analyzing movement smoothness, measured by spectral arc length, and BBT-VR scores.

RESULTS

Results revealed significant improvements in speed-accuracy trade-off post intervention compared to that before the intervention, with notable retention of skills for straight lines (t19=5.46; P<.001; Cohen d=1.13) and circle drawing (t19=3.84; P=.001; Cohen d=0.787). Likewise, there was a significant enhancement in spectral arc length, particularly for circle drawing (χ²2=11.2; P=.004; ε2=0.23), but not for straight-line drawing (χ²2=2.1; P=.35; ε2=0.003). Additionally, participants demonstrated transfer with significant improvement (q=5.26; P<.001; Cohen r=0.678) and retention (q=6.82; P<.001; Cohen r=0.880) in BBT-VR skills.

CONCLUSIONS

These findings provide perspectives for the use of iVR to improve motor learning in older adults through delivering self-adaptive serious games targeting motor and cognitive functions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04694833; https://clinicaltrials.gov/study/NCT04694833.

Integrating frailty interventions into existing care models: a comprehensive approach to enhancing patient outcomes in chronic disease management

Frailty syndrome (FS) is a complex and multifaceted condition commonly observed in old adults patients with chronic diseases, often accompanied by cognitive impairments. This review explores the integration of frailty interventions into existing care models to improve patient outcomes, focusing on four key areas. First, it emphasizes the importance of comprehensive assessment tools to identify frailty and cognitive impairments early, facilitating targeted care planning. Second, it highlights the value of personalized interventions, such as dietary modifications, exercise programs, and cognitive training, tailored to individual patient needs and preferences. Third, the review underscores the critical role of multidisciplinary care teams in providing holistic and coordinated care, leveraging the expertise of diverse healthcare professionals. Finally, it examines the potential of technological innovations and caregiver support systems in enhancing frailty management and addressing the challenges posed by cognitive impairments. By integrating these approaches, this review presents a patient-centered framework aimed at mitigating the impact of frailty and improving long-term outcomes. The findings emphasize the need for a unified strategy that combines personalized care, interdisciplinary collaboration, and technological advancements to address the multifaceted challenges of frailty in chronic disease management.