Multi-domain training in healthy old age: Hotel Plastisse as an iPad-based serious game to systematically compare multi-domain and single-domain training

Randomized clinical trial on the effects of a computerized cognitive training for pediatric patients with acquired brain injury or congenital malformation

Both acquired injuries and congenital malformations often cause lifelong disabilities in children, with a significant impact on cognitive abilities. Remote computerized cognitive training (CCT) may be delivered in ecological settings to favour rehabilitation continuity. This randomized clinical trial (RCT) evaluated the efficacy of an 8-week multi-domain, home-based CCT in a sample of patients aged 11-16 years with non-progressive acquired brain injury (ABI), brain tumor (BT) and congenital brain malformation (CBM). Following a stepped-wedge research design, patients were randomized into two groups: Training-first group, which started the CCT immediately after baseline assessment and Waiting-first group, which started the CCT after a period of time comparable to that required by the training (8 weeks). Post-training and long-term (6 months) changes were assessed. Both groups improved on visual-spatial working memory after the CCT, with benefits maintained after 6 months, while no other changes in cognitive or psychological measures were found. These findings suggest that a multi-domain CCT can generate benefits in visual-spatial working memory, in accordance with data from extant literature reporting that computer games heavily engage visuo-spatial abilities. We speculate that is tapping on the same cognitive ability with a prolonged training that may generate the greatest change after a CCT.

Combined anodal transcranial direct current stimulation and behavioural naming treatment improves language performance in patients with post-stroke aphasia

PRIMARY OBJECTIVE

During the last decade, studies using anodal transcranial Direct Current Stimulation (atDCS) have yielded promising results in patients with aphasia. The main aim of the present pilot study was to assess the effects of combined atDCS over the left posterior perisylvian region and behavioral naming training on the behavioral outcomes of language comprehension and production of patients with post-stroke aphasia.

RESEARCH DESIGN

A 2 × 2 quasi-experimental design was conducted, optimal to compare changes after treatment in experimental versus control group.

METHODS AND PROCEDURES

Ten patients with post-stroke aphasia were enrolled in this study: half received atDCS on the left posterior perisylvian region while they underwent a 2-week behavioral naming training. The other half received sham stimulation. The outcomes were measured using the abbreviated form of the Boston Diagnostic Aphasia Examination and analyzed using ANOVAs.

MAIN OUTCOMES AND RESULTS

Both groups improved their performance in Oral comprehension, Narrative writing and Language Competence Index, but only those that received anodal tDCS presented better results in the Naming category after the treatment.

CONCLUSIONS

AtDCS on the left posterior perisylvian area seems to be a promising tool for boosting the outcomes of behavioral naming therapy in patients with post-stroke aphasia.

The NESTORE e-Coach: Designing a Multi-Domain Pathway to Well-Being in Older Age

This article describes the coaching strategies of the NESTORE e-coach, a virtual coach for promoting healthier lifestyles in older age. The novelty of the NESTORE project is the definition of a multi-domain personalized pathway where the e-coach accompanies the user throughout different structured and non-structured coaching activities and recommendations. The article also presents the design process of the coaching strategies, carried out including older adults from four European countries and experts from the different health domains, and the results of the tests carried out with 60 older adults in Italy, Spain and The Netherlands.

"Hi This Is NESTORE, Your Personal Assistant": Design of an Integrated IoT System for a Personalized Coach for Healthy Aging

In the context of the fourth revolution in healthcare technologies, leveraging monitoring and personalization across different domains becomes a key factor for providing useful services to maintain and promote well-being. This is even more crucial for older people, with aging being a complex multi-dimensional and multi-factorial process which can lead to frailty. The NESTORE project was recently funded by the EU Commission with the aim of supporting healthy older people to sustain their well-being and capacity to live independently. It is based on a multi-dimensional model of the healthy aging process that covers physical activity, nutrition, cognition, and social activity. NESTORE is based on the paradigm of the human-in-the-loop cyber-physical system that, exploiting the availability of Internet of Things technologies combined with analytics in the cloud, provides a virtual coaching system to support healthy aging. This work describes the design of the NESTORE methodology and its IoT architecture. We first model the end-user under several domains, then we present the NESTORE system that, analyzing relevant key-markers, provides coaching activities and personalized feedback to the user. Finally, we describe the validation strategy to assess the effectiveness of NESTORE as a coaching platform for healthy aging.

Prognostic Factors and Models for Changes in Cognitive Performance After Multi-Domain Cognitive Training in Healthy Older Adults: A Systematic Review

Background: Cognitive Training (CT) may contribute to the maintenance and even enhancement of cognitive functions in healthy older adults. However, the question who benefits most from multi-domain CTs is still highly under-investigated.

Objective: The goal is to investigate prognostic factors and models for changes in cognitive test performance in healthy older adults after a multi-domain CT.

Methods: The data bases MEDLINE, Web of Science Core Collection, CENTRAL, and PsycInfo were searched up to July 2019. Studies investigating prognostic factors and/or models on cognitive outcomes (global cognition, memory, attention, executive functions, language, visuo-spatial abilities) after conducting a multi-domain CT in healthy older adults were included. Risk of Bias was assessed using the QUIPS and the PROBAST tool.

Results: 23 prognostic factor and model studies were included. Results indicate a high heterogeneity regarding the conducted multi-domain CTs, the investigated prognostic factors, the investigated outcomes, and the used statistical approaches. Age and neuropsychological performance at study entry were the most investigated predictors, yet they show inconsistent results.

Conclusion: Data on prognostic factors and models of changes after multi-domain CT are still too rare and inconsistent to draw clear conclusions due to statistical shortcomings and low reporting quality. Approaches for future research are outlined.

Registration:https://www.crd.york.ac.uk/prospero/, ID: CRD42020147531

Do Older and Young Adults Learn to Integrate Geometry While Navigating in an Environment of a Serious Game?

We evaluated the outcomes of an intervention using a serious game designed to be played on iPads for improving spatial reorientation by training users to integrate geometry of the environment, instead of relying solely on featural cues. Using data logged online through a clinical study of using this game, the effect of training among 16 older adults (69.3 ± 6.4 years, 4 males), who played the game repeatedly (self-administered) over a period of 8 weeks, was investigated. The game contains a hexagonal room with 3 objects, textured walls, and grids on the floor, which are removed one by one as the participant played the game. In each level, the room also rotates such that the viewpoint of the user is different from that of the previous level. Participants cannot play a higher level unless they make no mistake during the trials of the lower test level. In addition to data of older adults available from that clinical trial, we recruited 16 young adults (27.3 ± 5.6 years, 4 males) to play the game for 5 sessions and compared their results with those of the older adults. We evaluated the error type made in each test level and the scores for each session among older adults. Further, we compared the frequency of each error type between young and older adults during the test levels that a landmark adjacent to the target was removed over the first 5 sessions. The results of older adults’ performance suggest they learned to make fewer mistakes over the sessions. Also, both young and older adults learned to integrate the geometrical cues rather than relying on the landmark cue adjacent to the target to find the target. Overall, the results indicate the designed hexagonal room game can enhance spatial cognition among all age groups of adults.

Preventing dementia? Interventional approaches in mild cognitive impairment

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.

Training and Transfer of Cue Updating in Older Adults Is Limited: Evidence From Behavioral and Neuronal Data

Cognitive control processes, such as updating task-relevant information while switching between multiple tasks, are substantially impaired in older adults. However, it has also been shown that these cognitive control processes can be improved by training interventions, e.g., by training in task switching. Here, we applied an event-related potential (ERP) approach to identify whether a cognitive training improves task-preparatory processes such as updating of relevant task goals. To do so, we applied a pretest-training-posttest design with eight training sessions. Two groups of older adults were either trained in task switching (treatment group) or in performing single tasks (control group) and we compared their performance to a group of untrained younger adults. To foster cue updating in the treatment group, we applied a cue-based switching task in which the two task cues were randomly selected prior to target presentation so that participants had time to prepare for the upcoming task. In contrast, the control group also received task cues but those were redundant as only one task had to be performed. We also examined whether training in cue updating during task switching can be transferred to a similar cognitive control task measuring updating of context information, namely a modified version of the AX-Continuous Performance Task (AX-CPT). The results revealed training-specific improvements in task switching, that is, a larger improvement in blocks requiring switching in comparison to single tasks at the behavioral level. In addition, training specific-effects were also found at the neuronal level. Older adults trained in cue updating while switching showed a reduction in mixing costs in the cue-related P3, indicating an improvement in preparatory updating processes. Additionally, P3 topography changed with training from a very broad to a parietally focused scalp distribution similar to the one found in younger adults. However, we did not obtain training-specific improvements in context updating in the AX-CPT neither at the behavioral level nor at the neuronal level. Results are discussed in the context of the ongoing debate on whether transfer of cognitive training improvements is possible.

Reflective and Reflexive Stress Responses of Older Adults to Three Gaming Experiences In Relation to Their Cognitive Abilities: Mixed Methods Crossover Study

BACKGROUND

The gamification of digital health provisions for older adults (eg, for rehabilitation) is a growing trend; however, many older adults are not familiar with digital games. This lack of experience could cause stress and thus impede participants' motivations to adopt these technologies.

OBJECTIVE

This crossover longitudinal multifactorial study aimed to examine the interactions between game difficulty, appraisal, cognitive ability, and physiological and cognitive responses that indicate game stress using the Affective Game Planning for Health Applications framework.

METHODS

A total of 18 volunteers (mean age 71 years, SD 4.5; 12 women) completed a three-session study to evaluate different genres of games in increasing order of difficulty (S₁-BrainGame, S₂-CarRace, and S₃-Exergame). Each session included an identical sequence of activities (t₁-Baseline, t₂-Picture encode, t₃-Play, t₄-Stroop test, t₅-Play, and t₆-Picture recall), a repeated sampling of salivary cortisol, and time-tagged ambulatory data from a wrist-worn device. Generalized estimating equations were used to investigate the effect of session×activity or session×activity×cognitive ability on physiology and cognitive performance. Scores derived from the Montreal Cognitive Assessment (MoCA) test were used to define cognitive ability (MoCA-high: MoCA>27, n=11/18). Kruskal-Wallis tests were used to test session or session×group effects on the scores of the postgame appraisal questionnaire.

RESULTS

Session×activity effects were significant on all ambulatory measures (χ²₁₀>20; P<.001) other than cortisol (P=.37). Compared with S₁ and S₂, S₃ was associated with approximately 10 bpm higher heart rate (P<.001) and approximately 5 muS higher electrodermal activity (P<.001), which were both independent of the movement caused by the exergame. Compared with S₁, we measured a moderate but statistically significant drop in the rate of hits in immediate recall and rate of delayed recall in S₃. The low-MoCA group did not differ from the high-MoCA group in general characteristics (age, general self-efficacy, and perceived stress) but was more likely to agree with statements such as digital games are too hard to learn. In addition, the low-MoCA group was more likely to dislike the gaming experience and find it useless, uninteresting, and visually more intense (χ²₁>4; P<.04). Group differences in ambulatory signals did not reach statistical significance; however, the rate of cortisol decline with respect to the baseline was significantly larger in the low-MoCA group.

CONCLUSIONS

Our results show that the experience of playing digital games was not stressful for our participants. Comparatively, the neurophysiological effects of exergame were more pronounced in the low-MoCA group, suggesting greater potential of this genre of games for cognitive and physical stimulation by gamified interventions; however, the need for enjoyment of this type of challenging game must be addressed.

[Smartphone-based health promotion in old age : An explorative multi-component approach to improving health in old age]

BACKGROUND

As age-related health problems are often related to a combination of physiological, psychological and social aspects, it has been proposed that multi-component interventions might be particularly effective to improve older peoples' health. The present study used a smartphone-based approach to promote health through activities including physical as well as cognitive components performed in a daily life context.

METHODS

This study investigated the effects of different health-related variables (e.g. gait and cognition) as well as the individual motivation for physical activity. The study included 34 community-dwelling older adults (mean age 75.0 ± 3.7 years, 15 women) who took part either in smartphone-based activities (intervention group) or attended lectures (control group). The smartphone-based interventions were undertaken semiweekly.

RESULTS

Baseline tests showed that participants in both groups already had a high motivation for physical activities. Analyses indicated that the smartphone application was considered to be user-friendly.

CONCLUSION

There were no substantial health-related benefits from the activities, probably due to moderate to good health status and activity levels at baseline and too little additional activity intensity during the intervention. Hence, it is recommended that for future research the subjects included should be less active or have health restrictions.

Home-based cognitive training in pediatric patients with acquired brain injury: preliminary results on efficacy of a randomized clinical trial

Cognitive rehabilitation may compensate for cognitive deficits of children with acquired brain injury (ABI), capitalizing on the use-dependent plasticity of a developing brain. Remote computerized cognitive training (CCT) may be delivered to patients in ecological settings, ensuring rehabilitation continuity. This work evaluated cognitive and psychological adjustment outcomes of an 8-week multi-domain, home-based CCT (Lumosity Cognitive Training) in a sample of patients with ABI aged 11–16 years. Two groups of patients were engaged in five CCT sessions per week for eight weeks (40 sessions). According to a stepped-wedge research design, one group (Training-first Group) started the CCT immediately, whereas the other group (Waiting-first Group) started the CCT after a comparable time of waiting list. Changes after the training and after the waiting period were compared in the two groups. Both groups improved in visual-spatial working memory more after the training than after the waiting-list period. The Training-first group improved also in arithmetic calculation speed. Findings indicate that a multi-domain CCT can produce benefits in visual-spatial working memory, probably because, in accordance with previous research, computer games heavily tax visuo-spatial abilities. This suggests that the prolonged stimulation of the same cognitive ability may generate the greatest benefits in children with ABI.

Interaction Modalities Used on Serious Games for Upper Limb Rehabilitation: A Systematic Review

This systematic review aims to analyze the state-of-the-art regarding interaction modalities used on serious games for upper limb rehabilitation. A systematic search was performed in IEEE Xplore and Web of Science databases. PRISMA and QualSyst protocols were used to filter and assess the articles. Articles must meet the following inclusion criteria: they must be written in English; be at least four pages in length; use or develop serious games; focus on upper limb rehabilitation; and be published between 2007 and 2017. Of 121 articles initially retrieved, 33 articles met the inclusion criteria. Three interaction modalities were found: vision systems (42.4%), complementary vision systems (30.3%), and no-vision systems (27.2%). Vision systems and no-vision systems obtained a similar mean QualSyst (86%) followed by complementary vision systems (85.7%). Almost half of the studies used vision systems as the interaction modality (42.4%) and used the Kinect sensor to collect the body movements (48.48%). The shoulder was the most treated body part in the studies (19%). A key limitation of vision systems and complementary vision systems is that their device performances might be affected by lighting conditions. A main limitation of the no-vision systems is that the range-of-motion in angles of the body movement might not be measured accurately. Due to a limited number of studies, fruitful areas for further research could be the following: serious games focused on finger rehabilitation and trauma injuries, game difficulty adaptation based on user's muscle strength and posture, and multisensor data fusion on interaction modalities.

Let's Play Cards: Multi-Component Cognitive Training With Social Engagement Enhances Executive Control in Older Adults

Cognitive training and social engagement are two of the routes that potentially improve cognitive functions in older adults. The former targets specific functions so that an intervention can trigger the plasticity and efficiency of the underpinning neural systems, and the latter also provides an environment supportive of social and emotional needs. We investigated whether an integration of the two routes could enhance cognitive functions related to executive control, because no prior research has adopted a theory-driven approach to design a group-based cognitive training program for executive control. Forty-six healthy and active older adults living in community settings were randomly assigned to a group-based training program or a group-based active control program. Twenty-three volunteers in a community center were recruited for the waitlist control group. A battery of card games was designed for the cognitive training program based on three theoretical models of executive functions. A set of commercial board games were run in the active control program. Using untrained tests as the outcome measures, we found significant improvement on executive control in the cognitive training group compared with the active and waitlist control groups while the two control groups did not differ in performance. The cognitive training group did not outperform the two groups on a test of reasoning or on a test of delayed episodic memory. The results support the idea that cognitive training with social interaction can improve performance on untrained tests that share overlapping cognitive processes. Despite the inability to adapt to each person’s performance, integrating the two routes is beneficial for improving cognitive functions in older adults.

Can Driving-Simulator Training Enhance Visual Attention, Cognition, and Physical Functioning in Older Adults?

Virtual reality offers a good possibility for the implementation of real-life tasks in a laboratory-based training or testing scenario. Thus, a computerized training in a driving simulator offers an ecological valid training approach. Visual attention had an influence on driving performance, so we used the reverse approach to test the influence of a driving training on visual attention and executive functions. Thirty-seven healthy older participants (mean age: 71.46 ± 4.09; gender: 17 men and 20 women) took part in our controlled experimental study. We examined transfer effects from a four-week driving training (three times per week) on visual attention, executive function, and motor skill. Effects were analyzed using an analysis of variance with repeated measurements. Therefore, main factors were group and time to show training-related benefits of our intervention. Results revealed improvements for the intervention group in divided visual attention; however, there were benefits neither in the other cognitive domains nor in the additional motor task. Thus, there are no broad training-induced transfer effects from such an ecologically valid training regime. This lack of findings could be addressed to insufficient training intensities or a participant-induced bias following the cancelled randomization process.

Development and Evaluation of a Cognitive Training Game for Older People: A Design-based Approach

In the research field of cognitive aging, games have gained attention as training interventions to remediate age-related deficits. Cognitive training games on computer, video and mobile platforms have shown ample and positive support. However, the generalized effects are not agreed upon unanimously, and the game tasks are usually simple and decontextualized due to the limitations of measurements. This study adopted a qualitative approach of design-based research (DBR) to systematically review and pragmatically examine the regime, presentation and feedback design of a cognitive training game for older adults. An overview of the literature of cognitive aging and training games was conducted to form the theoretical conjectures of the design, and an iterative cycle and process were employed to develop a mobile game for older adults who are homebound or receiving care in a nursing home. Stakeholders, i.e., elderly users and institutional administrators, were invited to participate in the design process. Using two cycles of design and evaluation, a working prototype of an iPad-based app that accounted for the needs of elderly adults in terms of form, appearance and working function was developed and tested in the actual contexts of the participants' homes and an assisted living facility. The results showed that the cognitive training game developed in this study was accepted by the participants, and a high degree of satisfaction was noted. Moreover, the elements of the interface, including its size, layout and control flow, were tested and found to be suitable for use. This study contributes to the literature by providing design suggestions for such games, including the designs of the cognitive training structure, interface, interaction, instructions and feedback, based on empirical evidence collected in natural settings. This study further suggests that the effectiveness of cognitive training in mobile games be evaluated through field and physical testing on a larger scale in the future.

Expertise-related functional brain network efficiency in healthy older adults

Background

In view of age-related brain changes, identifying factors that are associated with healthy aging are of great interest. In the present study, we compared the functional brain network characteristics of three groups of healthy older participants aged 61–75 years who had a different cognitive and motor training history (multi-domain group: participants who had participated in a multi-domain training; visuomotor group: participants who had participated in a visuomotor training; control group: participants with no specific training history). The study’s basic idea was to examine whether these different training histories are associated with differences in behavioral performance as well as with task-related functional brain network characteristics. Based on a high-density electroencephalographic measurement one year after training, we calculated graph-theoretical measures representing the efficiency of functional brain networks.

Results

Behaviorally, the multi-domain group performed significantly better than the visuomotor and the control groups on a multi-domain task including an inhibition domain, a visuomotor domain, and a spatial navigation domain. In terms of the functional brain network features, the multi-domain group showed significantly higher functional connectivity in a network encompassing visual, motor, executive, and memory-associated brain areas in the theta frequency band compared to the visuomotor group. These brain areas corresponded to the multi-domain task demands. Furthermore, mean connectivity of this network correlated positively with performance across both the multi-domain and the visuomotor group. In addition, the multi-domain group showed significantly enhanced processing efficiency reflected by a higher mean weighted node degree (strength) of the network as compared to the visuomotor group.

Conclusions

Taken together, our study shows expertise-dependent differences in task-related functional brain networks. These network differences were evident even a year after the acquisition of the different expertise levels. Hence, the current findings can foster understanding of how expertise is positively associated with brain functioning during aging.

Cortical Thickness Changes Correlate with Cognition Changes after Cognitive Training: Evidence from a Chinese Community Study

The aim of this study was to investigate whether changes in cortical thickness correlated with cognitive function changes in healthy older adults after receiving cognitive training interventions. Moreover, it also aimed to examine the differential impacts of a multi-domain and a single-domain cognitive training interventions. Longitudinal magnetic resonance imaging (MRI) scanning was performed on participants 65–75 years of age using the Siemens 3.0 T Trio Tim with the Magnetization Prepared Rapid Gradient Echo (MPRAGE) sequence. The cortical thickness was determined using FreeSurfer Software. Cognitive functioning was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). There were significant group × time interaction effects on the left supramarginal, the left frontal pole cortical regions; and a marginal significant group × time interaction effects on visuospatial/constructional and delayed memory scores. In a multi-domain cognitive training group, a number of cortical region changes were significantly positively correlated with changes in attention, delayed memory, and the total score, but significantly negatively correlated with changes in immediate memory and language scores. In the single-domain cognitive training group, some cortical region changes were significantly positively associated with changes in immediate memory, delayed memory, and the total score, while they were significantly negatively associated with changes in visuospatial/constructional, language, and attention scores. Overall, multi-domain cognitive training offered more advantages in visuospatial/constructional, attention, and delayed memory abilities, while single-domain cognitive training benefited immediate memory ability more effectively. These findings suggest that healthy older adults benefit more from the multi-domain cognitive training than single-domain cognitive training. Cognitive training has impacted on cortical thickness changes in healthy elderly.

Drugs, games, and devices for enhancing cognition: implications for work and society

As work environments change, the demands on working people change. Cognitive abilities in particular are becoming progressively more important for work performance and successful competition in a global environment. However, work-related stress, performance over long hours, lack of sleep, shift work, and jet lag affect cognitive functions. Therefore, an increasing number of healthy people are reported to use cognitive-enhancing drugs, as well as other interventions, such as noninvasive brain stimulation, to maintain or improve work performance. This review summarizes research on pharmacological and technical methods as well as cognitive training, including game apps for the brain, in healthy people. In neuropsychiatric disorders, impairments in cognitive functions can drastically reduce the chances of returning to work; therefore, this review also summarizes findings from pharmacological and cognitive-training studies in neuropsychiatric disorders.