An Alpha and Theta Intensive and Short Neurofeedback Protocol for Healthy Aging Working-Memory Training

Effects of one session of theta or high alpha neurofeedback on EEG activity and working memory

Neurofeedback techniques provide participants immediate feedback on neuronal signals, enabling them to modulate their brain activity. This technique holds promise to unveil brain-behavior relationship and offers opportunities for neuroenhancement. Establishing causal relationships between modulated brain activity and behavioral improvements requires rigorous experimental designs, including appropriate control groups and large samples. Our primary objective was to examine whether a single neurofeedback session, designed to enhance working memory through the modulation of theta or high-alpha frequencies, elicits specific changes in electrophysiological and cognitive outcomes. Additionally, we explored predictors of successful neuromodulation. A total of 101 healthy adults were assigned to groups trained to increase frontal theta, parietal high alpha, or random frequencies (active control group). We measured resting-state EEG, working memory performance, and self-reported psychological states before and after one neurofeedback session. Although our analyses revealed improvements in electrophysiological and behavioral outcomes, these gains were not specific to the experimental groups. An increase in the frequency targeted by the training has been observed for the theta and high alpha groups, but training designed to increase randomly selected frequencies appears to induce more generalized neuromodulation compared with targeting a specific frequency. Among all the predictors of neuromodulation examined, resting theta and high alpha amplitudes predicted specifically the increase of those frequencies during the training. These results highlight the challenge of integrating a control group based on enhancing randomly selected frequency bands and suggest potential avenues for optimizing interventions (e.g., by including a control group trained in both up- and down-regulation).

Modulation of human frontal midline theta by neurofeedback: A systematic review and quantitative meta-analysis

Human brain activity consists of different frequency bands associated with varying functions. Oscillatory activity of frontal brain regions in the theta range (4-8 Hz) is linked to cognitive processing and can be modulated by neurofeedback - a technique where participants receive real-time feedback about their brain activity and learn to modulate it. However, criticism of this technique evolved, and high heterogeneity of study designs complicates a valid evaluation of its effectiveness. This meta-analysis provides the first systematic overview over studies attempting to modulate frontal midline theta with neurofeedback in healthy human participants. Out of 1261 articles screened, 14 studies were eligible for systematic review and 11 for quantitative meta-analyses. Studies were evaluated following the DIAD model and the PRISMA guidelines. A significant across-study effect of medium size (Hedges' g = .66; 95%-CI [-0.62, 1.73]) with substantial between-study heterogeneity (Q(16) = 167.43, p < .001) was observed and subanalysis revealed effective frontal midline theta upregulation. We discuss moderators of effect sizes and provide guidelines for future research in this dynamic field.

Alpha neurofeedback training improves visual working memory in healthy individuals

Neurofeedback (NF) training is a closed-loop brain training in which participants learn to regulate their neural activation. NF training of alpha (8-12 Hz) activity has been reported to enhance working memory capacity, but whether it affects the precision in working memory has not yet been explored. Moreover, whether NF training distinctively influences performance in different types of working memory tasks remains unclear. Therefore, the present study conducted a randomized, single-blind, sham-controlled experiment to investigate how alpha NF training affected the capacity and precision of working memory, as well as the related neural change. Forty participants were randomly and equally assigned to the NF group and the sham control group. Both groups received NF training (about 30 min daily) for five consecutive days. The NF group received alpha (8-12 Hz) training, while the sham control group received sham NF training. We found a significant alpha increase within sessions but no significant difference across sessions. However, the behavioral performance and neural activity in the modified Sternberg task did not show significant change after alpha NF training. On the contrary, the alpha NF training group significantly increased visual working memory capacity measured by the Corsi-block tapping task and improved visual working memory precision in the interference condition in a color-recall task. These results suggest that alpha NF training influences performance in working memory tasks involved in the visuospatial sketchpad. Notably, we demonstrated that alpha NF training improves the quantity and quality of visual working memory.

Effectiveness of Electroencephalography Neurofeedback for Improving Working Memory and Episodic Memory in the Elderly: A Meta-Analysis

Background and Objective: Existing evidence indicates the potential benefits of electroencephalography neurofeedback (NFB) training for cognitive function. This study aims to comprehensively review all available evidence investigating the effectiveness of NFB on working memory (WM) and episodic memory (EM) in the elderly population. Material and Methods: A systematic search was conducted across five databases to identify clinical trials examining the impact of NFB on memory function in healthy elderly individuals or those with mild cognitive impairment (MCI). The co-primary outcomes focused on changes in WM and EM. Data synthesis was performed using a random-effects meta-analysis. Results: Fourteen clinical trials (n = 284) were included in the analysis. The findings revealed that NFB was associated with improved WM (k = 11, reported as Hedges' g = 0.665, 95% confidence [CI] = 0.473 to 0.858, p < 0.001) and EM (k = 12, 0.595, 0.333 to 0.856, p < 0.001) in the elderly, with moderate effect sizes. Subgroup analyses demonstrated that NFB had a positive impact on both WM and EM, not only in the healthy population (WM: k = 7, 0.495, 0.213 to 0.778, p = 0.001; EM: k = 6, 0.729, 0.483 to 0.976, p < 0.001) but also in those with MCI (WM: k = 6, 0.812, 0.549 to 1.074, p < 0.001; EM: k = 6, 0.503, 0.088 to 0.919, p = 0.018). Additionally, sufficient training time (totaling more than 300 min) was associated with a significant improvement in WM (k = 6, 0.743, 0.510 to 0.976, p < 0.001) and EM (k = 7, 0.516, 0.156 to 0.876, p = 0.005); however, such benefits were not observed in groups with inadequate training time. Conclusions: The results suggest that NFB is associated with enhancement of both WM and EM in both healthy and MCI elderly individuals, particularly when adequate training time (exceeding 300 min) is provided. These findings underscore the potential of NFB in dementia prevention or rehabilitation.

A review: effects of neurofeedback on patients with mild cognitive impairment (MCI), and Alzheimer's disease (AD)

Neurofeedback training (NFT) is a non-invasive method and has been shown to be effective for attention deficit/hyperactivity disorder (ADHD) and various psychiatric disorders. The aim of this paper is to evaluate the effectiveness of NFT for patients with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) or Vascular Diseases (VD), so that we searched research articles from four databases, using the keywords neurofeedback, elderly, MCI, AD, VD, and dementia. As a result, 13 articles were identified regarding the effectiveness of NFT in patients with MCI and AD. Although each study differed in study design, training protocol, electroencephalogram (EEG) electrode placement, and reward and inhibition frequency bands, all were shown to enhance memory, attention, and other cognitive abilities. Additional well-designed, randomized studies with sufficient power are needed to further confirm the effectiveness of NFT.

Paving the Way for Memory Enhancement: Development and Examination of a Neurofeedback System Targeting the Medial Temporal Lobe

Neurofeedback (NF) shows promise in enhancing memory, but its application to the medial temporal lobe (MTL) still needs to be studied. Therefore, we aimed to develop an NF system for the memory function of the MTL and examine neural activity changes and memory task score changes through NF training. We created a memory NF system using intracranial electrodes to acquire and visualise the neural activity of the MTL during memory encoding. Twenty trials of a tug-of-war game per session were employed for NF and designed to control neural activity bidirectionally (Up/Down condition). NF training was conducted with three patients with drug-resistant epilepsy, and we observed an increasing difference in NF signal between conditions (Up-Down) as NF training progressed. Similarities and negative correlation tendencies between the transition of neural activity and the transition of memory function were also observed. Our findings demonstrate NF's potential to modulate MTL activity and memory encoding. Future research needs further improvements to the NF system to validate its effects on memory functions. Nonetheless, this study represents a crucial step in understanding NF's application to memory and provides valuable insights into developing more efficient memory enhancement strategies.

Working memory impairment in children orphaned by parental HIV/AIDS: An event-related potentials study

A large body of literature has established that children orphaned by HIV/AIDS ('AIDS orphans') face numerous challenges, such as parental death, poverty, disrupted school attendance and stigma. All of these early life adversities can have long-lasting effects on brain function, especially the executive functions. Working memory, as one of the most studied aspects of executive functions, is also reported to be impaired in children with early adversity. However, limited data are available regarding how early life adverse events affect the neural dynamic associated with working memory processing in AIDS orphans. This study applied the electroencephalogram (EEG) technique to investigate the working memory process in 81 AIDS orphans and 62 non-orphan controls with n-back tasks. Results from EEG analysis and time-frequency analysis showed that AIDS orphans displayed smaller N2 and larger P2, P3 activation as well as enhanced theta and attenuated alpha band oscillations compared to the controls. The present findings indicated a deficit in working memory process in AIDS orphans and suggested that this deficit might be due to the impairments in attention allocation, detection and classification of stimuli and updating process in working memory.

Nicotinic acetylcholine receptors and learning and memory deficits in Neuroinflammatory diseases

Animal survival depends on cognitive abilities such as learning and memory to adapt to environmental changes. Memory functions require an enhanced activity and connectivity of a particular arrangement of engram neurons, supported by the concerted action of neurons, glia, and vascular cells. The deterioration of the cholinergic system is a common occurrence in neurological conditions exacerbated by aging such as traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), Alzheimer's disease (AD), and Parkinson's disease (PD). Cotinine is a cholinergic modulator with neuroprotective, antidepressant, anti-inflammatory, antioxidant, and memory-enhancing effects. Current evidence suggests Cotinine's beneficial effects on cognition results from the positive modulation of the α7-nicotinic acetylcholine receptors (nAChRs) and the inhibition of the toll-like receptors (TLRs). The α7nAChR affects brain functions by modulating the function of neurons, glia, endothelial, immune, and dendritic cells and regulates inhibitory and excitatory neurotransmission throughout the GABA interneurons. In addition, Cotinine acting on the α7 nAChRs and TLR reduces neuroinflammation by inhibiting the release of pro-inflammatory cytokines by the immune cells. Also, α7nAChRs stimulate signaling pathways supporting structural, biochemical, electrochemical, and cellular changes in the Central nervous system during the cognitive processes, including Neurogenesis. Here, the mechanisms of memory formation as well as potential mechanisms of action of Cotinine on memory preservation in aging and neurological diseases are discussed.

Exploring the Effects of EEG-Based Alpha Neurofeedback on Working Memory Capacity in Healthy Participants

Neurofeedback, an operant conditioning neuromodulation technique, uses information from brain activities in real-time via brain-computer interface (BCI) technology. This technique has been utilized to enhance the cognitive abilities, including working memory performance, of human beings. The aims of this study are to investigate how alpha neurofeedback can improve working memory performance in healthy participants and to explore the underlying neural mechanisms in a working memory task before and after neurofeedback. Thirty-six participants divided into the NFT group and the control group participated in this study. This study was not blinded, and both the participants and the researcher were aware of their group assignments. Increasing power in the alpha EEG band was used as a neurofeedback in the eyes-open condition only in the NFT group. The data were collected before and after neurofeedback while they were performing the N-back memory task (N = 1 and N = 2). Both groups showed improvement in their working memory performance. There was an enhancement in the power of their frontal alpha and beta activities with increased working memory load (i.e., 2-back). The experimental group showed improvements in their functional connections between different brain regions at the theta level. This effect was absent in the control group. Furthermore, brain hemispheric lateralization was found during the N-back task, and there were more intra-hemisphere connections than inter-hemisphere connections of the brain. These results suggest that healthy participants can benefit from neurofeedback and from having their brain networks changed after the training.

Systematic Review and Meta-Analysis on the Effects of Neurofeedback Training of Theta Activity on Working Memory and Episodic Memory in Healthy Population

The main purpose of this study was to investigate the effects of neurofeedback training (NFT) of theta activity on working memory (WM) and episodic memory (EM) in healthy participants via a systematic review and meta-analysis. A total of 337 articles obtained from electronic databases were assessed; however, only 11 articles met the criteria for meta-analysis after manually screening and eliminating unnecessary studies. A meta-analysis calculating the Hedges' g effect size metric with 95% confidence intervals using random effects models was employed. Heterogeneity was estimated using I2 statistics. Theta NFT is effective in improving memory outcomes, including WM with a Hedges' g of 0.56 [0.10; 1.02] (I2 = 62.9% and p = 0.02), and EM with a Hedges' g of 0.62 [0.13; 1.10] (I2 = 42.04% and p = 0.01). Overall, the results suggest that theta NFT seems to be useful as nonpharmacological/adjunct training to improve WM and EM in healthy participants.

The modulatory effect of adaptive task-switching training on resting-state neural network dynamics in younger and older adults

With increasing life expectancy and active aging, it becomes crucial to investigate methods which could compensate for generally detected cognitive aging processes. A promising candidate is adaptive cognitive training, during which task difficulty is adjusted to the participants' performance level to enhance the training and potential transfer effects. Measuring intrinsic brain activity is suitable for detecting possible distributed training-effects since resting-state dynamics are linked to the brain's functional flexibility and the effectiveness of different cognitive processes. Therefore, we investigated if adaptive task-switching training could modulate resting-state neural dynamics in younger (18-25 years) and older (60-75 years) adults (79 people altogether). We examined spectral power density on resting-state EEG data for measuring oscillatory activity, and multiscale entropy for detecting intrinsic neural complexity. Decreased coarse timescale entropy and lower frequency band power as well as increased fine timescale entropy and higher frequency band power revealed a shift from more global to local information processing with aging before training. However, cognitive training modulated these age-group differences, as coarse timescale entropy and lower frequency band power increased from pre- to post-training in the old-training group. Overall, our results suggest that cognitive training can modulate neural dynamics even when measured outside of the trained task.

Neurofeedback Training of Alpha Relative Power Improves the Performance of Motor Imagery Brain-Computer Interface

Significant variation in performance in motor imagery (MI) tasks impedes their wide adoption for brain-computer interface (BCI) applications. Previous researchers have found that resting-state alpha-band power is positively correlated with MI-BCI performance. In this study, we designed a neurofeedback training (NFT) protocol based on the up-regulation of the alpha band relative power (RP) to investigate its effect on MI-BCI performance. The principal finding of this study is that alpha NFT could successfully help subjects increase alpha-rhythm power and improve their MI-BCI performance. An individual difference was also found in this study in that subjects who increased alpha power more had a better performance improvement. Additionally, the functional connectivity (FC) of the frontal-parietal (FP) network was found to be enhanced after alpha NFT. However, the enhancement failed to reach a significant level after multiple comparisons correction. These findings contribute to a better understanding of the neurophysiological mechanism of cognitive control through alpha regulation.

Sharpening Working Memory With Real-Time Electrophysiological Brain Signals: Which Neurofeedback Paradigms Work?

Growing evidence supports the idea that the ultimate biofeedback is to reward sensory pleasure (e.g., enhanced visual clarity) in real-time to neural circuits that are associated with a desired performance, such as excellent memory retrieval. Neurofeedback is biofeedback that uses real-time sensory reward to brain activity associated with a certain performance (e.g., accurate and fast recall). Working memory is a key component of human intelligence. The challenges are in our current limited understanding of neurocognitive dysfunctions as well as in technical difficulties for closed-loop feedback in true real-time. Here we review recent advancements of real time neurofeedback to improve memory training in healthy young and older adults. With new advancements in neuromarkers of specific neurophysiological functions, neurofeedback training should be better targeted beyond a single frequency approach to include frequency interactions and event-related potentials. Our review confirms the positive trend that neurofeedback training mostly works to improve memory and cognition to some extent in most studies. Yet, the training typically takes multiple weeks with 2-3 sessions per week. We review various neurofeedback reward strategies and outcome measures. A well-known issue in such training is that some people simply do not respond to neurofeedback. Thus, we also review the literature of individual differences in psychological factors e.g., placebo effects and so-called "BCI illiteracy" (Brain Computer Interface illiteracy). We recommend the use of Neural modulation sensitivity or BCI insensitivity in the neurofeedback literature. Future directions include much needed research in mild cognitive impairment, in non-Alzheimer's dementia populations, and neurofeedback using EEG features during resting and sleep for memory enhancement and as sensitive outcome measures.

One-Year Follow-Up of Healthy Older Adults with Electroencephalographic Risk for Neurocognitive Disorder After Neurofeedback Training

Background:

In healthy older adults, excess theta activity is an electroencephalographic (EEG) predictor of cognitive impairment. In a previous study, neurofeedback (NFB) treatment reinforcing reductions theta activity resulted in EEG reorganization and cognitive improvement.

Objective:

To explore the clinical applicability of this NFB treatment, the present study performed a 1-year follow-up to determine its lasting effects.

Methods:

Twenty seniors with excessive theta activity in their EEG were randomly assigned to the experimental or control group. The experimental group received an auditory reward when the theta absolute power (AP) was reduced. The control group received the reward randomly.

Results:

Both groups showed a significant decrease in theta activity at the training electrode. However, the EEG results showed that only the experimental group underwent global changes after treatment. These changes consisted of delta and theta decreases and beta increases. Although no changes were found in any group during the period between the posttreatment evaluation and follow-up, more pronounced theta decreases and beta increases were observed in the experimental group when the follow-up and pretreatment measures were compared. Executive functions showed a tendency to improve two months after treatment which became significant one year later.

Conclusion:

These results suggest that the EEG and behavioral benefits of this NFB treatment persist for at least one year, which adds up to the available evidence contributing to identifying factors that increase its efficacy level. The relevance of this study lies in its prophylactic features of addressing a clinically healthy population with EEG risk of cognitive decline.

Working Memory Training and Cortical Arousal in Healthy Older Adults: A Resting-State EEG Pilot Study

The current pilot study aimed to test the gains of working memory (WM) training, both at the short- and long-term, at a behavioral level, and by examining the electrophysiological changes induced by training in resting-state EEG activity among older adults. The study group included 24 older adults (from 64 to 75 years old) who were randomly assigned to a training group (TG) or an active control group (ACG) in a double-blind, repeated-measures experimental design in which open eyes, resting-state EEG recording, followed by a WM task, i.e., the Categorization Working Memory Span (CWMS) task, were collected before and after training, as well as at a 6-month follow-up session. At the behavioral level, medium to large Cohen's d effect sizes was found for the TG in immediate and long-term gains in the WM criterion task, as compared with small gains for the ACG. Regarding intrusion errors committed in the CWMS, an index of inhibitory control representing a transfer effect, results showed that medium to large effect sizes for immediate and long-term gains emerged for the TG, as compared to small effect sizes for the ACG. Spontaneous high-beta/alpha ratio analyses in four regions of interest (ROIs) revealed no pre-training group differences. Significantly greater TG anterior rates, particularly in the left ROI, were found after training, with frontal oscillatory responses being correlated with better post-training CWMS performance in only the TG. The follow-up analysis showed similar results, with greater anterior left high-beta/alpha rates among TG participants. Follow-up frontal high-beta/alpha rates in the right ROI were correlated with lower CWMS follow-up intrusion errors in only the TG. The present findings are further evidence of the efficacy of WM training in enhancing the cognitive functioning of older adults and their frontal oscillatory activity. Overall, these results suggested that WM training also can be a promising approach toward fostering the so-called functional cortical plasticity in aging.

EEG-neurofeedback and executive function enhancement in healthy adults: A systematic review

Electroencephalographic (EEG)-neurofeedback training (NFT) is a promising technique that supports individuals in learning to modulate their brain activity to obtain cognitive and behavioral improvements. EEG-NFT is gaining increasing attention for its potential "peak performance" applications on healthy individuals. However, evidence for clear cognitive performance enhancements with healthy adults is still lacking. In particular, whether EEG-NFT represents an effective technique for enhancing healthy adults' executive functions is still controversial. Therefore, the main objective of this systematic review is to assess whether the existing EEG-NFT studies targeting executive functions have provided reliable evidence for NFT effectiveness. To this end, we conducted a qualitative analysis of the literature since the limited number of retrieved studies did not allow us meta-analytical comparisons. Moreover, a second aim was to identify optimal frequencies as NFT targets for specifically improving executive functions. Overall, our systematic review provides promising evidence for NFT effectiveness in boosting healthy adults' executive functions. However, more rigorous NFT studies are required in order to overcome the methodological weaknesses that we encountered in our qualitative analysis.

Mindfulness Training Improves Cognition and Strengthens Intrinsic Connectivity Between the Hippocampus and Posteromedial Cortex in Healthy Older Adults

Maintaining optimal cognitive functioning throughout the lifespan is a public health priority. Evaluation of cognitive outcomes following interventions to promote and preserve brain structure and function in older adults, and associated neural mechanisms, are therefore of critical importance. In this randomized controlled trial, we examined the behavioral and neural outcomes following mindfulness training (n = 72), compared to a cognitive fitness program (n = 74) in healthy, cognitively normal, older adults (65-80 years old). To assess cognitive functioning, we used the Preclinical Alzheimer Cognitive Composite (PACC), which combines measures of episodic memory, executive function, and global cognition. We hypothesized that mindfulness training would enhance cognition, increase intrinsic functional connectivity measured with magnetic resonance imaging (MRI) between the hippocampus and posteromedial cortex, as well as promote increased gray matter volume within those regions. Following the 8-week intervention, the mindfulness training group showed improved performance on the PACC, while the control group did not. Furthermore, following mindfulness training, greater improvement on the PACC was associated with a larger increase in intrinsic connectivity within the default mode network, particularly between the right hippocampus and posteromedial cortex and between the left hippocampus and lateral parietal cortex. The cognitive fitness training group did not show such effects. These findings demonstrate that mindfulness training improves cognitive performance in cognitively intact older individuals and strengthens connectivity within the default mode network, which is particularly vulnerable to aging affects. Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT02628548], identifier [NCT02628548].

Neurofeedback training improves episodic and semantic long-term memory performance

Understanding and improving memory are vital to enhance human life. Theta rhythm is associated with memory consolidation and coding, but the trainability and effects on long-term memory of theta rhythm are unknown. This study investigated the ability to improve long-term memory using a neurofeedback (NFB) technique reflecting the theta/low-beta power ratio on an electroencephalogram (EEG). Our study consisted of three stages. First, the long-term memory of participants was measured. In the second stage, the participants in the NFB group received 3 days of theta/low-beta NFB training. In the third stage, the long-term memory was measured again. The NFB group had better episodic and semantic long-term memory than the control group and significant differences in brain activity between episodic and semantic memory during the recall tests were revealed. These findings suggest that it is possible to improve episodic and semantic long-term memory abilities through theta/low-beta NFB training.

Improving cognitive control: Is theta neurofeedback training associated with proactive rather than reactive control enhancement?

Frontal-midline (FM) theta activity (4-8 Hz) is proposed to reflect a mechanism for cognitive control that is needed for working memory retention, manipulation, and interference resolution. Modulation of FM theta activity via neurofeedback training (NFT) demonstrated transfer to some but not all types of cognitive control. Therefore, the present study investigated whether FM theta NFT enhances performance and modulates underlying EEG characteristics in a delayed match to sample (DMTS) task requiring mainly proactive control and a color Stroop task requiring mainly reactive control. Moreover, temporal characteristics of transfer were explored over two posttests. Across seven 30-min NFT sessions, an FM theta training group exhibited a larger FM theta increase compared to an active control group who upregulated randomly chosen frequency bands. In a posttest performed 13 days after the last training session, the training group showed better retention performance in the DMTS task. Furthermore, manipulation performance was associated with NFT theta increase for the training but not the control group. Contrarily, behavioral group differences and their relation to FM theta change were not significant in the Stroop task, suggesting that NFT is associated with proactive but not reactive control enhancement. Transfer to both tasks at a posttest one day after training was not significant. Behavioral improvements were not accompanied by changes in FM theta activity, indicating no training-induced modulation of EEG characteristics. Together, these findings suggest that NFT supports transfer to cognitive control that manifests late after training but that other training-unspecific factors may also contribute to performance enhancement.

Brain Exercising Games With Consumer-Grade Single-Channel Electroencephalogram Neurofeedback: Pre-Post Intervention Study

Background

The aging population is one of the major challenges affecting societies worldwide. As the proportion of older people grows dramatically, so does the number of age-related illnesses such as dementia-related illnesses. Preventive care should be emphasized as an effective tool to combat and manage this situation.

Objective

The aim of this pilot project was to study the benefits of using neurofeedback-based brain training games for enhancing cognitive performance in the elderly population. In particular, aiming for practicality, the training games were designed to operate with a low-cost consumer-grade single-channel electroencephalogram (EEG) headset that should make the service scalable and more accessible for wider adoption such as for home use.

Methods

Our training system, which consisted of five brain exercise games using neurofeedback, was serviced at 5 hospitals in Thailand. Participants were screened for cognitive levels using the Thai Mental State Examination and Montreal Cognitive Assessment. Those who passed the criteria were further assessed with the Cambridge Neuropsychological Test Automated Battery (CANTAB) computerized cognitive assessment battery. The physiological state of the brain was also assessed using 16-channel EEG. After 20 sessions of training, cognitive performance and EEG were assessed again to compare pretraining and posttraining results.

Results

Thirty-five participants completed the training. CANTAB results showed positive and significant effects in the visual memory (delayed matching to sample [percent correct] P=.04), attention (median latency P=.009), and visual recognition (spatial working memory [between errors] P=.03) domains. EEG also showed improvement in upper alpha activity in a resting state (open-eyed) measured from the occipital area (P=.04), which similarly indicated improvement in the cognitive domain (attention).

Conclusions

Outcomes of this study show the potential use of practical neurofeedback-based training games for brain exercise to enhance cognitive performance in the elderly population.

Neurofeedback and the Aging Brain: A Systematic Review of Training Protocols for Dementia and Mild Cognitive Impairment

Dementia describes a set of symptoms that occur in neurodegenerative disorders and that is characterized by gradual loss of cognitive and behavioral functions. Recently, non-invasive neurofeedback training has been explored as a potential complementary treatment for patients suffering from dementia or mild cognitive impairment. Here we systematically reviewed studies that explored neurofeedback training protocols based on electroencephalography or functional magnetic resonance imaging for these groups of patients. From a total of 1,912 screened studies, 10 were included in our final sample (N = 208 independent participants in experimental and N = 81 in the control groups completing the primary endpoint). We compared the clinical efficacy across studies, and evaluated their experimental designs and reporting quality. In most studies, patients showed improved scores in different cognitive tests. However, data from randomized controlled trials remains scarce, and clinical evidence based on standardized metrics is still inconclusive. In light of recent meta-research developments in the neurofeedback field and beyond, quality and reporting practices of individual studies are reviewed. We conclude with recommendations on best practices for future studies that investigate the effects of neurofeedback training in dementia and cognitive impairment.

Neurofeedback of Alpha Activity on Memory in Healthy Participants: A Systematic Review and Meta-Analysis

Background: Neurofeedback training (NFT) has recently been proposed as a valuable technique for cognitive enhancement and psychiatric amelioration. However, effect of NFT of alpha activity on memory is controversial. The current study analyzed previous works in terms of randomized and blinded analyses, training paradigms, and participant characteristics to validate the efficacy of alpha NFT on memory in a healthy population. Objectives: A systematic meta-analysis of studies with randomized controlled trials was performed to explore the effect of alpha NFT on working memory (WM) and episodic memory (EM) in a healthy population. Methods: We searched PubMed, Embase, and Cochrane Library from January 1, 1999, to November 30, 2019. Previous studies were evaluated with the Cochrane risk of bias (RoB). A meta-analysis calculating absolute weighted standardized mean difference (SMD) using random-effects models was employed. Heterogeneity was estimated using I 2 statistics. Funnel plots and Egger's test were performed to evaluate the quality of evidence. Results: Sixteen studies with 217 healthy participants in the control group and 210 participants in the alpha group met the eligibility criteria. Alpha NFT studies with WM measures presented little publication bias (P = 0.116), and 5 of 7 domains in the Cochrane RoB exhibited a low risk of bias. The overall effect size from 14 WM studies was 0.56 (95% CI 0.31-0.81, P < 0.0001; I 2 = 28%). Six EM studies exhibited an effect size of 0.77 (95% CI 0.06-1.49, P = 0.03; I 2 = 77%). Conclusion: Meta-analysis results suggest that alpha NFT seems to have a positive effect on the WM and EM of healthy participants. Future efforts should focus on the neurophysiological mechanisms of alpha NFT in memory.

Comparison of Biofeedback and Combined Interventions on Athlete's Performance

The aim of this study was the comparison of neurofeedback and biofeedback as a combination, against biofeedback intervention alone on athletic performance. 45 novice basketball players were allocated into three groups and assigned accordingly, two experimental and one control group. The experimental group 1 received 24 biofeedback sessions only, experimental group 2 received 24 biofeedback and neurofeedback sessions combined, whereas the control group didn't receive any form of intervention. Athletic performance scales were used before and after each intervention and multivariate analysis of covariance was used to compare the two groups. Results showed that in comparison to the control group, the athletic performance scales scores in both experimental groups were significantly increased. Furthermore, in experimental group 2 (combined method), we noticed a significantly greater improvement in performance levels than experimental group 1. We concluded that neurofeedback and biofeedback interventions combined, can be used as an effective method to enhance athletic performance.

The Effects of Neurofeedback on Aging-Associated Cognitive Decline: A Systematic Review

For more than a decade, neurofeedback interventions have been applied with the goal of improving cognitive functions in older adults. Some of these studies have been reviewed, but only in combination with experiments conducted in young adults or with studies seeking to modify functions not related to cognition. The purpose of the present review is to assess whether neurofeedback interventions benefit cognition in elderly adults. We included all neurofeedback studies conducted in older adults, whether healthy or affected by a clinical condition, that attempted to ameliorate any domain of cognition, with no restrictions by publication date. Fourteen studies were eligible for this review. Neurofeedback improved memory in healthy and unhealthy participants mainly when the theta and sensorimotor rhythm (SMR) frequencies were trained. In addition, other cognitive domains benefited from this intervention. Conversely, neurofeedback had no effect on attention processes. Although different studies used markedly different methods, almost all of them reported positive effects of neurofeedback in at least one cognitive domain. New interventions under consideration should be tested using placebo-controlled, double-blind experimental designs with follow-up evaluations.

Z-score neurofeedback, heart rate variability biofeedback, and brain coaching for older adults with memory concerns

BACKGROUND

The three-month, multi-domain Memory Boot Camp program incorporates z-score neurofeedback (NFB), heart rate variability (HRV) biofeedback, and one-on-one coaching to teach memory skills and encourage behavior change in diet, sleep, physical fitness, and stress reduction.

OBJECTIVE

This prospective trial evaluates the Memory Boot Camp program for adults ages 55 to 85 with symptoms of Mild Cognitive Impairment (MCI) and subjective memory complaints.

METHODS

Participants were evaluated via the Montreal Cognitive Assessment (MoCA), NeuroTrax Global Cognitive Score, measures of anxiety, depression, sleep, quality of life, quantitative electroencephalography (QEEG), and HRV parameters at four timepoints: baseline, pre-program, post-program, and follow-up. The trial included a three-month waiting period between baseline and pre-program, such that each participant acted as their own control, and follow-up took place six months after completion of the program.

RESULTS

Participants' MoCA scores and self-reported measures of anxiety, depression, sleep quality, and quality of life improved after treatment, and these changes were maintained at follow-up. Physiological changes in HRV parameters after treatment were not significant, however, breathing rate and QEEG parameters were improved at post-program and maintained at follow-up. Finally, participants' improvement in MoCA score over the treatment period was correlated with their improvement in two brain oscillation parameters targeted by the z-score NFB protocol: relative power of delta and relative power of theta.

CONCLUSIONS

Trial results suggest that the Memory Boot Camp program is a promising treatment strategy for older adults with symptoms of MCI and subjective memory complaints.

Enhancing Working Memory Based on Mismatch Negativity Neurofeedback in Subjective Cognitive Decline Patients: A Preliminary Study

Mismatch negativity (MMN) is suitable for studies of preattentive auditory discriminability and the auditory memory trace. Subjective cognitive decline (SCD) is an ideal target for early therapeutic intervention because SCD occurs at preclinical stages many years before the onset of Alzheimer’s disease (AD). According to a novel lifespan-based model of dementia risk, hearing loss is considered the greatest potentially modifiable risk factor of dementia among nine health and lifestyle factors, and hearing impairment is associated with cognitive decline. Therefore, we propose a neurofeedback training based on MMN, which is an objective index of auditory discriminability, to regulate sensory ability and memory as a non-pharmacological intervention (NPI) in SCD patients. Seventeen subjects meeting the standardized clinical evaluations for SCD received neurofeedback training. The auditory frequency discrimination test, the visual digital N-back (1-, 2-, and 3-back), auditory digital N-back (1-, 2-, and 3-back), and auditory tone N-back (1-, 2-, and 3-back) tasks were used pre- and post-training in all SCD patients. The intervention schedule comprised five 60-min training sessions over 2 weeks. The results indicate that the subjects who received neurofeedback training had successfully improved the amplitude of MMN at the parietal electrode (Pz). A slight decrease in the threshold of auditory frequency discrimination was observed after neurofeedback training. Notably, after neurofeedback training, the working memory (WM) performance was significantly enhanced in the auditory tone 3-back test. Moreover, improvements in the accuracy of all WM tests relative to the baseline were observed, although the changes were not significant. To the best of our knowledge, our preliminary study is the first to investigate the effects of MMN neurofeedback training on WM in SCD patients, and our results suggest that MMN neurofeedback may represent an effective treatment for intervention in SCD patients and the elderly with aging memory decline.

Beta Neurofeedback Training Improves Attentional Control in the Elderly

One of the well-documented behavioral changes that occur with advancing age is a decline in executive functioning, for example, attentional control. Age-related executive deficits are said to be associated with a deterioration of the frontal lobes. Neurofeedback is a training method which aims at acquiring self-control over certain brain activity patterns. It is considered as an effective approach to help improve attentional and self-management capabilities. However, studies evaluating the efficacy of neurofeedback training to boost executive functioning in an elderly population are still relatively rare and controversial. The aim of our study was to contribute to the assessment of the efficacy of neurofeedback as a method for enhancing executive functioning in the elderly. We provided a group of seniors with beta up-training (12-22 Hz), consisting of 20 sessions (30 minutes each), on the Cz site and tested its possible beneficiary influence on attentional control assessed by means of the Stroop and Simon tasks. The analysis of the subjects' mean reaction times during consecutive tasks in the test and the retest, after implementation of neurofeedback training, showed a significant improvement. In contrast, the difference in reaction times between the test and the retest in the control group who had not been submitted to neurofeedback training was not significant.

Neurofeedback training with a low-priced EEG device leads to faster alpha enhancement but shows no effect on cognitive performance: A single-blind, sham-feedback study

INTRODUCTION

Findings of recent studies indicate that it is possible to enhance cognitive capacities of healthy individuals by means of individual upper alpha neurofeedback training (NFT). Although these results are promising, most of this research was conducted based on high-priced EEG systems developed for clinical and research purposes. This study addresses the question whether such effects can also be shown with an easy to use and comparably low-priced Emotiv Epoc EEG headset available for the average consumer. In addition, critical voices were raised regarding the control group designs of studies addressing the link between neurofeedback training and cognitive performance. Based on an extensive literature review revealing considerable methodological issues in an important part of the existing research, the present study addressed the question whether individual upper alpha neurofeedback has a positive effect on alpha amplitudes (i.e. increases alpha amplitudes) and short-term memory performance focussing on a methodologically sound, single-blinded, sham controlled design.

METHOD

Participants (N = 33) took part in four test sessions over four consecutive days of either neurofeedback training (NFT group) or sham feedback (SF group). In the NFT group, five three-minute periods of visual neurofeedback training were administered each day whereas in the SF group (control group), the same amount of sham feedback was presented. Performance on eight digit-span tests as well as participants' affective states were assessed before and after each of the daily training sessions.

RESULTS

NFT did not show an effect on individual upper alpha and cognitive performance. While performance increased in both groups over the course of time, this effect could not be explained by changes in individual upper alpha. Additional analyses however revealed that participants in the NFT group showed faster and larger increase in alpha compared to the SF group. Surprisingly, exploratory analyses showed a significant correlation between the initial alpha level and the alpha improvement during the course of the study. This finding suggests that participants with high initial alpha levels benefit more from alpha NFT interventions. In the discussion, the appearance of the alpha enhancement in the SF group and possible reasons for the absence of a connection between NFT and short-term memory are addressed.

Comparison of effects between SMR/delta-ratio and beta1/theta-ratio neurofeedback training for older adults with Mild Cognitive Impairment: a protocol for a randomized controlled trial

Background

Older adults with Mild Cognitive Impairment (MCI) are at high risk of progressing to Alzheimer’s disease (AD). Slowing down the effect of dementia by enhancing brain plasticity represents one of the most prominent challenges. Neurofeedback (NF) has shown promising results in improving working memory but has never been evaluated in people with MCI. We aim to examine whether NF training can decrease cognitive disorders, targeting memory, attention functions and brain electrical activity in elderly patients with MCI.

Methods

In this single-blind, randomized controlled trial (RCT) protocol, we will investigate the effects of two NF training protocols on cognitive performances and on brain electrical activity. Sixty MCI patients will be assigned either to an intervention program or to psycho-pedagogical care as a control condition. Participants in the intervention group will attend 30 sessions of sensorimotor/delta-ratio NF training or beta1/theta-ratio NF training. Neuropsychological assessment, questionnaires and electroencephalography (EEG) assessment parameters will be used as dependent variables in three periods: at baseline (T0), immediately after the last NF training session at 4 months (T1) and at 3-month follow-up (T2). The primary outcome will be the change in attention measured with the Trail Making Test B. Secondary outcome will be the changes in cognitive performance and in EEG activities.

Discussion

If the results of our study show improvement in cognitive performances of older adults with MCI, this non-invasive, low-cost technique may deserve better consideration as a therapeutic intervention to delay cognitive decline and dementia. Consequently, research in NF will need to review and develop the rigor of its application in gerontology.

Trial registration

ClinicalTrials.gov, ID: NCT03526692. Registered on 16 May 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-3170-x) contains supplementary material, which is available to authorized users.

SMR Neurofeedback Training Facilitates Working Memory Performance in Healthy Older Adults: A Behavioral and EEG Study

Cognitive aging has become a major concern because life expectancy has increased and elderly populations are socially and economically active. Neurofeedback is a technique of neuromodulation through operant conditioning paradigm that uses a computer interface to provide real-time information about brain activity to increase individual self-perception and assist in modulation. The sensorimotor rhythm (SMR) training protocol is known to enhance attention and has been applied to improve cognitive performance, primarily for attention and memory gains. The aim of this study is to test if the SMR protocol can improve working memory performance in an aging population and consequently favor cognitive reserve. Seventeen older adults (12 females) took part in a randomized placebo-controlled study. They completed a visual working memory test, Delayed Matching to Sample Task (DMTS), before and after the SMR neurofeedback protocol in order to compare their visual working memory performance. Moreover, a 19-channels EEG was collected while they perform the DMTS pre- and post-training. The experimental group showed an improvement in their working memory performance after the training with similar activation power, mainly in theta and beta frequency band at frontal and alpha at temporal regions. The sham group showed some variations in the score of working memory after the training, but were not statistically significant and their power spectrum demonstrate enhancement in alpha and beta band frontal and temporal. The group that did not receive neurofeedback training did not show a change in their working memory performance, neither in their EEG spectrum. The results suggest that neurofeedback can benefit brain reserve in an aging population because individuals enhanced their working memory performance after training and have their EEG activation changed according to expected in working memory tasks.

Effects of an Integrated Neurofeedback System with Dry Electrodes: EEG Acquisition and Cognition Assessment

Electroencephalogram (EEG) neurofeedback improves cognitive capacity and behaviors by regulating brain activity, which can lead to cognitive enhancement in healthy people and better rehabilitation in patients. The increased use of EEG neurofeedback highlights the urgent need to reduce the discomfort and preparation time and increase the stability and simplicity of the system’s operation. Based on brain-computer interface technology and a multithreading design, we describe a neurofeedback system with an integrated design that incorporates wearable, multichannel, dry electrode EEG acquisition equipment and cognitive function assessment. Then, we evaluated the effectiveness of the system in a single-blind control experiment in healthy people, who increased the alpha frequency band power in a neurofeedback protocol. We found that upregulation of the alpha power density improved working memory following short-term training (only five training sessions in a week), while the attention network regulation may be related to other frequency band activities, such as theta and beta. Our integrated system will be an effective neurofeedback training and cognitive function assessment system for personal and clinical use.

Brain-Computer Interface for Clinical Purposes: Cognitive Assessment and Rehabilitation

Alongside the best-known applications of brain-computer interface (BCI) technology for restoring communication abilities and controlling external devices, we present the state of the art of BCI use for cognitive assessment and training purposes. We first describe some preliminary attempts to develop verbal-motor free BCI-based tests for evaluating specific or multiple cognitive domains in patients with Amyotrophic Lateral Sclerosis, disorders of consciousness, and other neurological diseases. Then we present the more heterogeneous and advanced field of BCI-based cognitive training, which has its roots in the context of neurofeedback therapy and addresses patients with neurological developmental disorders (autism spectrum disorder and attention-deficit/hyperactivity disorder), stroke patients, and elderly subjects. We discuss some advantages of BCI for both assessment and training purposes, the former concerning the possibility of longitudinally and reliably evaluating cognitive functions in patients with severe motor disabilities, the latter regarding the possibility of enhancing patients' motivation and engagement for improving neural plasticity. Finally, we discuss some present and future challenges in the BCI use for the described purposes.

Electroencephalographic Neurofeedback to up-regulate frontal Theta rhythms: Preliminary results

Retrieval of positive Autobiographical Memory (AM) has been reported to increase positive emotions in healthy population. Evidence suggests that positive AM retrieval tasks are correlated with synchronisation of frontal Theta rhythms (4-8Hz). The present study has developed the Electroencephalography (EEG) based Neurofeedback (NF) protocols to promote voluntary elevation or up-regulation of positive AM retrieval related Theta rhythms over F3, Fz, F4 electrode sites (10-20 System). The protocols were evaluated with a human participant in 10-day NF training. It observed that the average amplitude of observed Theta rhythms in each NF regulation block gradually increased over days of training and most was prominent at Fz electrode site. Furthermore, a larger peak at 6Hz was present in the spectrum of the observed Theta with later trial day suggesting up-regulation of Frontal Midline Theta (FmT) rhythms.

Tuning Up the Old Brain with New Tricks: Attention Training via Neurofeedback

Neurofeedback (NF) is a form of biofeedback that uses real-time (RT) modulation of brain activity to enhance brain function and behavioral performance. Recent advances in Brain-Computer Interfaces (BCI) and cognitive training (CT) have provided new tools and evidence that NF improves cognitive functions, such as attention and working memory (WM), beyond what is provided by traditional CT. More published studies have demonstrated the efficacy of NF, particularly for treating attention deficit hyperactivity disorder (ADHD) in children. In contrast, there have been fewer studies done in older adults with or without cognitive impairment, with some notable exceptions. The focus of this review is to summarize current success in RT NF training of older brains aiming to match those of younger brains during attention/WM tasks. We also outline potential future advances in RT brainwave-based NF for improving attention training in older populations. The rapid growth in wireless recording of brain activity, machine learning classification and brain network analysis provides new tools for combating cognitive decline and brain aging in older adults. We optimistically conclude that NF, combined with new neuro-markers (event-related potentials and connectivity) and traditional features, promises to provide new hope for brain and CT in the growing older population.