Determinants of Adherence to a "GRADIOR" Computer-Based Cognitive Training Program in People with Mild Cognitive Impairment (MCI) and Mild Dementia

Pilot randomized study of adaptive cognitive training's effect on breast cancer survivors assessed through eye tracking

PURPOSE

Cancer-related cognitive impairment (CRCI) is a prevalent comorbidity among breast cancer survivors, yet evidence supporting the efficacy of adaptive cognitive training remains limited. This pilot study seeks to examine participants' adherence and preliminary effect of tablet-based cognitive training as an intervention for CRCI and apply eye tracking technology as an innovative approach to evaluate cognitive training outcomes.

METHODS

Fifty-two eligible participants were randomly assigned to either the biofeedback therapy group (BF) or the combined biofeedback therapy and cognitive training group (BF + COG). Participants completed a 30-session intervention lasting 6 weeks and eye tracking assessments at two timepoints: baseline and immediately after the intervention completion.

RESULTS

Retention rates were 68% in the BF group and 70.4% in the BF + COG group. At the 6-week follow-up, the BF + COG group demonstrated significantly improved fixation stability. Under non-interfering conditions, they maintained fixation 307.76 ms longer (p = 0.022, Cohen's d = 0.307) and had a 32.4% reduction in saccadic distance (p = 0.019, Cohen's d = -0.677) compared to BF. This advantage persisted under interference conditions with a 28.2% shorter saccadic distance (p = 0.034, Cohen's d = -0.579). While within-group changes were not significant, the BF+COG group consistently showed reduced saccade distances across conditions, whereas the BF group exhibited increases.

CONCLUSION

Adaptive cognitive training may enhance attentional engagement and inhibitory control in breast cancer survivors. Large-scale study is needed to confirm these effects and refine eye-tracking applications for CRCI assessment.

IMPLICATIONS FOR CANCER SURVIVORS

Tablet-based cognitive training targeting cognitive control with adaptive difficulty levels may ameliorate CRCI among breast cancer survivors.

Effective engagement in computerized cognitive training for older adults

Computerized cognitive training (CCT) is a frontline therapy to prevent or slow age-related cognitive decline. A prerequisite for CCT research to provide clinically relevant improvements in cognition is to understand effective engagement, i.e., the pattern of energy investment that ensures CCT effectiveness. Even though previous studies have assessed whether particular variables (e.g., gamification) predict engagement and/or CCT effectiveness, the field lacks a systematic approach to understanding effective engagement. Here, by comprehensively reviewing and evaluating engagement and adjacent literature, we propose a standardized measurement and operational framework to promote effective engagement with CCT targeting cognitive decline in older adults. We suggest that promoting effective engagement with CCT has two key steps: 1) comprehensively measuring engagement with CCT and 2) identifying which aspects of engagement are essential to achieve the pre-specified outcome of clinically relevant improvements in cognition. The proposed measurement and operational framework of effective engagement will allow future research to maximize older adults' engagement with CCT to slow/prevent age-related cognitive decline.

Development of an Evidence-Based Cognitive Training Application for Elderly Individuals with Cognitive Dysfunction

BACKGROUND

Early cognitive training is important to prevent cognitive decline in patients with mild cognitive impairment (MCI) or dementia. Therefore, developing an application that can provide evidence-based cognitive training is necessary for patients with MCI or dementia.

METHOD

This study aimed to develop and evaluate Smart Brain, an evidence-based application that provides comprehensive cognitive training tailored to this population. The application was developed using an ADDIE (analysis, design, development, implementation, and evaluation) model. A systematic review of databases, including Ovid-MEDLINE, Ovid-EMBASE, Cochrane Library, and CINAHL, was conducted up to April 15, 2021, to identify key content areas. Additionally, a survey of 100 participants highlighted the need for features such as cognitive games, health notes, social networking services, and goal achievement.

RESULT

The application was developed with distinct user and administrator interfaces to support engagement and monitoring. Usability testing involved 7 experts and 11 elderly individuals with MCI or dementia from a daycare center. Based on usability feedback, features such as the time limits for cognitive games were refined. The final application integrates cognitive games, physical exercises, emotional support, and health management tools to address user needs comprehensively.

CONCLUSION

Smart Brain holds significant potential to improve the quality of life and cognitive health of elderly individuals with MCI or dementia. Its usability and functionality make it a promising tool for community-based interventions.

Feasibility and acceptability of a remote computerized cognitive training employing telehealth in older adults with subjective cognitive complaints

Introduction

Computerized cognitive training (CCT) represents promising solutions for remote training of cognitive abilities in older people with cognitive decline. In the present article, we tested the feasibility and acceptability of a CCT performed at home via a telehealth platform, with participants connected remotely to a clinician, in comparison to an in-person CCT.

Methods

Thirty participants took part in the study. Twelve participants opted for classical in-person training and met a neuropsychologist twice a week for 12 weeks, for a total of 24 30-minute sessions. Eighteen participants opted for the remote home-based training and met with the clinician virtually via a telehealth system at the same frequency and duration. The intervention consisted of a serious-game platform training memory, spatial abilities, and executive functions. All participants underwent a neuropsychological and clinical assessment before and after the training.

Results

Results showed a high adherence to training and a strong acceptability in both the remote and the in-person groups. A significant improvement in mental flexibility and planning abilities was observed in both groups (as measured by the Zoo planning test), but no other neuropsychological tests showed improvement.

Discussion

This non-randomized study suggests the feasibility and acceptability of the telehealth CCT intervention. When participants are able to select their preferred intervention modality, training adherence and efficacy are comparable between remote and in-person delivery. Future studies should be performed to verify which are the most effective intervention parameters, such as training frequency and duration.

Usability and user experience impressions of older adults with cognitive impairment and people with schizophrenia towards GRADIOR, a cognitive rehabilitation program: A cross-sectional study

OBJECTIVE

The aim of this study was to evaluate and compare the impressions of older adults with mild dementia/MCI (mild cognitive impairment) and people with schizophrenia towards the usability of GRADIOR (version 4.5) and their user experience (UX) with this computerized cognitive rehabilitation program.

METHODS

The impressions towards the usability of GRADIOR and the UX of 41 older adults with mild dementia/MCI and 41 people with schizophrenia were obtained using the User Experience Questionnaire.

RESULTS

Older adults with dementia/MCI had more positive impressions than people with schizophrenia. Both agreed that its quality was lower in Dependability.

CONCLUSION

GRADIOR meets users' needs and preferences but needs improvements to ensure they feel more in control when interacting with it. For people with schizophrenia, other aspects of usability and UX need improvement. Usability and UX evaluation allow the verification of technological acceptability and functionality, and to identifying specific improvements for each user group.

A systematic review about the importance of neuropsychological features in heart failure: is at heart the only failure?

Heart failure can lead to cognitive impairment that is estimated to be present in over a quarter of patients. It is important to intervene at a cognitive level to promote brain plasticity through cognitive training programs. Interventions transformed by technology offer the promise of improved cognitive health for heart failure patients. This review was conducted on studies evaluating the role of cognitive rehabilitation in patients with heart failure. We examined clinical trials involving patients with heart failure. Our search was performed on Pubmed, Web of Science and Cochrane library databases. Of the initial 256 studies, 10 studies met the inclusion criteria. Cognitive rehabilitation training has important implications for the treatment and prevention of cognitive decline in heart failure patients with significant recovery for delayed recall memory and a significant time effect for total recall memory and delayed, psychomotor speed and IADL performance. It is important to include the assessment of cognitive functioning in the routine clinical examinations of patients with heart failure, discover the relationship between cognitive function and heart failure, and target cognitive rehabilitation programs that promote brain plasticity.

Adherence to a lifestyle intervention - just a question of self-efficacy? Analysis of the AgeWell.de-intervention against cognitive decline

BACKGROUND

Aim of this study was to detect predictors of better adherence to the AgeWell.de-intervention, a two-year randomized multi-domain lifestyle intervention against cognitive decline.

METHODS

Data of 317 intervention group-participants comprising a risk group for dementia (Cardiovascular Risk Factors, Ageing and Dementia (CAIDE) score of  ≥ 9; mean age 68.9 years, 49.5% women) from the AgeWell.de intervention study were analysed. Regression models with four blocks of predictors (sociodemographic, cognitive and psychosocial, lifestyle factors and chronic conditions) were run on adherence to the components of nutrition, enhancement of social and physical activity and cognitive training. Adherence to each component was operationalised by assessing the degree of goal achievement per component at up to seven time points during the intervention period, measured using a 5-point Likert scale (mean score of goal achievement).

RESULTS

Increasing age was negatively associated with adherence, while higher education positively predicted adherence. Participants with better mental state (Montreal Cognitive Assessment (MoCA)-score > 25) at baseline and higher self-efficacy adhered better. Diabetes and cardiovascular conditions were not associated with adherence, whereas smoking negatively affected adherence. Highest education and quitting smoking in the past were the only predictors associated with all four intervention components.

CONCLUSION

Results identified predictors for better and worse adherence. Particularly self-efficacy seems to be of considerable influence on adherence. This should be considered when designing future intervention trials.

TRIAL REGISTRATION

German Clinical Trials Register (ref. number: DRKS00013555).

Impact of AI-Powered Solutions in Rehabilitation Process: Recent Improvements and Future Trends

Rehabilitation is an important and necessary part of local and global healthcare services along with treatment and palliative care, prevention of disease, and promotion of good health. The rehabilitation process helps older and young adults even children to become as independent as possible in activities of daily life and enables participation in useful living activities, recreation, work, and education. The technology of Artificial Intelligence (AI) has evolved significantly in recent years. Many activities related to rehabilitation have been getting benefits from using AI techniques. The objective of this review study is to explore the advantages of AI for rehabilitation and how AI is impacting the rehabilitation process. This study aims at the most critical aspects of the rehabilitation process that could potentially take advantage of AI techniques including personalized rehabilitation apps, rehabilitation through assistance, rehabilitation for neurological disorders, rehabilitation for developmental disorders, virtual reality rehabilitation, rehabilitation of neurodegenerative diseases and Telerehabilitation of Cardiovascular. We presented a survey on the newest empirical studies available in the literature including the AI-based technology helpful in the Rehabilitation process. The novelty feature included but was not limited to an overview of the technological solutions useful in rehabilitation. Seven different categories were identified. Illustrative examples of practical applications were detailed. Implications of the findings for both research and practice were critically discussed. Most of the AI applications in these rehabilitation types are in their infancy and continue to grow while exploring new opportunities. Therefore, we investigate the role of AI technology in rehabilitation processes. In addition, we do statistical analysis of the selected studies to highlight the significance of this review work. In the end, we also present a discussion on some challenges, and future research directions.

Effects of engagement, persistence and adherence on cognitive training outcomes in older adults with and without cognitive impairment: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Limited understanding exists regarding the influences of engagement, persistence and adherence on the efficacy of cognitive training for age-related cognitive decline and neurodegenerative cognitive impairment.

METHODS

This study conducted a meta-analysis of randomised controlled trials (RCTs). We systematically searched MEDLINE, PubMed, Web of Science, Embase and CINAHL databases from 1 January 2012 to 13 June 2023, and included RCTs assessing the effects of cognitive training in older adults, both with and without cognitive impairment. Hedges' g with a 95% confidence interval (CI) was used to synthesise cognitive training effect sizes on various neuropsychological tests. Subgroup analyses were conducted based on variables including engagement, persistence, adherence and cognitive conditions of normal cognition, mild cognitive impairment (MCI) or neurodegenerative dementia.

RESULTS

This meta-analysis included 55 RCTs with 4,455 participants with cognitive conditions spanning normal cognition, MCI and neurodegenerative dementia. The mean age of participants was 73.9 (range: 65.7-84.5) years. Overall, cognitive training showed a significant cross-domain effect (Hedges' g = 0.286, 95% CI: 0.224-0.348). Training effects are significant when engagement or persistence rates exceed 60% or when adherence rates exceed 80%. Higher levels of persistence are required to achieve significant training effects in memory, visuospatial ability and reasoning than in executive function and attention and language. Higher persistence is also required for older adults with normal cognition to achieve significant training gains compared to those with cognitive impairment.

CONCLUSIONS

This systematic review highlights the critical roles of engagement, persistence and adherence in augmenting the efficacy of cognitive training.

Computer-assisted cognitive rehabilitation in neurological patients: state-of-art and future perspectives

Background and aim

Advances in computing technology enabled researchers and clinicians to exploit technological devices for cognitive training and rehabilitation interventions. This expert review aims to describe the available software and device used for cognitive training or rehabilitation interventions of patients with neurological disorders.

Methods

A scoping review was carried out to analyze commercial devices/software for computerized cognitive training (CCT) in terms of feasibility and efficacy in both clinical and home settings. Several cognitive domains responding to the different patients' needs are covered.

Results

This review showed that cognitive training for patients with neurological diseases is largely covered by several devices that are widely used and validated in the hospital setting but with few translations to remote/home applications. It has been demonstrated that technology and software-based devices are potential and valuable tools to administer remotely cognitive rehabilitation with accessible costs.

Conclusion

According to our results, CCT entails the possibility to continue cognitive training also in different settings, such as home, which is a significant breakthrough for the improvement of community care. Other possible areas of use should be the increase in the amount of cognitive therapy in the free time during the hospital stay.

FindMyApps eHealth intervention improves quality, not quantity, of home tablet use by people with dementia

Introduction

FindMyApps is a tablet-based eHealth intervention, designed to improve social health in people with mild dementia or mild cognitive impairment.

Methods

FindMyApps has been subject to a randomized controlled trial (RCT), Netherlands Trial Register NL8157. Following UK Medical Research Council guidance, a mixed methods process evaluation was conducted. The goal was to investigate the quantity and quality of tablet use during the RCT, and which context, implementation, and mechanisms of impact (usability, learnability and adoption) factors might have influenced this. For the RCT, 150 community dwelling people with dementia and their caregivers were recruited in the Netherlands. For the process evaluation, tablet-use data were collected by proxy-report instrument from all participants' caregivers, FindMyApps app-use data were registered using analytics software among all experimental arm participants, and semi-structured interviews (SSIs) were conducted with a purposively selected sample of participant-caregiver dyads. Quantitative data were summarized and between group differences were analyzed, and qualitative data underwent thematic analysis.

Results

There was a trend for experimental arm participants to download more apps, but there were no statistically significant differences between experimental and control arm participants regarding quantity of tablet use. Qualitative data revealed that experimental arm participants experienced the intervention as easier to use and learn, and more useful and fun than control arm participants. Adoption of tablet app use was lower than anticipated in both arms.

Conclusions

A number of context, implementation and mechanism of impact factors were identified, which might explain these results and may inform interpretation of the pending RCT main effect results. FindMyApps seems to have had more impact on the quality than quantity of home tablet use.