Abstract
BackgroundCognitive and behavioral symptoms are the clinical hallmarks of neurocognitive disorders. Cognitive training may be offered to reduce the risks of cognitive decline and dementia and to reduce behavioral symptoms, such as apathy. Information and communication technology approaches, including serious games, can be useful in improving the playful aspect of computerized cognitive training and providing motivating solutions in elderly patients.ObjectiveThe objective of this study was to assess the effectiveness of employing the MeMo (Memory Motivation) Web app with regard to cognitive and behavioral symptoms in patients with neurocognitive disorders.MethodsMeMo is a Web app that can be used on any Web browser (computer or tablet). The training activities proposed in MeMo are divided into the following two parts: memory and mental flexibility/attention. The study included 46 individuals (mean age 79.4 years) with a diagnosis of neurocognitive disorders at the Institut Claude Pompidou Memory Center in Nice. This randomized controlled study compared the evolution of cognition and behavior between patients not using MeMo (control group) and patients using MeMo (MeMo group) for 12 weeks (four sessions per week). Patients underwent memory and attention tests, as well as an apathy assessment at baseline, week 12 (end of the training period), and week 24 (12 weeks after the end of the training sessions). In addition, to assess the impact of high and low game uses, the MeMo group was divided into patients who used MeMo according to the instructions (about once every 2 days; active MeMo group) and those who used it less (nonactive MeMo group).ResultsWhen comparing cognitive and behavioral scores among baseline, week 12, and week 24, mixed model analysis for each cognitive and behavioral score indicated no significant interaction between testing time and group. On comparing the active MeMo group (n=9) and nonactive MeMo group (n=13), there were significant differences in two attention tests (Trial Making Test A [P=.045] and correct Digit Symbol Substitution Test items [P=.045]) and in the Apathy Inventory (AI) (P=.02). Mixed analysis (time: baseline, week 12, and week 24 × number of active days) indicated only one significant interaction for the AI score (P=.01), with a significant increase in apathy in the nonactive MeMo group.ConclusionsThis study indicates that the cognitive and behavioral efficacies of MeMo, a Web-based training app, can be observed only with regular use of the app. Improvements were observed in attention and motivation.Trial RegistrationClinicalTrials.gov NCT04142801; https://clinicaltrials.gov/ct2/show/NCT04142801
Highlights
Attention, and behavioral symptoms are the clinical hallmarks of neurocognitive disorders (NCDs), such as Alzheimer disease and related disorders [1]
The World Health Organization guidelines for risk reduction of cognitive decline and dementia indicate that cognitive training may be offered to older adults with normal cognition and with mild cognitive impairment to reduce the risks of cognitive decline and dementia [6]
Evidence on the efficacy of cognitive training in people with cognitive decline is still scarce, and there is a lack of randomized controlled trials (RCTs) [5,7,8]
Summary
Attention, and behavioral symptoms are the clinical hallmarks of neurocognitive disorders (NCDs), such as Alzheimer disease and related disorders [1]. Cognitive training, which refers to the guided practice of specific standardized tasks designed to enhance particular cognitive functions [4], appears to be a promising option to improve cognitive performance in older adults [5]. Apathy is a multidimensional syndrome characterized by a significant reduction in goal-directed activity [10,11] It represents the most common behavioral and psychological symptoms in people with Alzheimer disease and is often observed in Parkinson disease and other dementia-related disorders, such as vascular dementia and frontotemporal dementia [12]. Information and communication technology approaches, including serious games, can be useful in improving the playful aspect of computerized cognitive training and providing motivating solutions in elderly patients
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