Combined Cognitive Training Research Articles

Effects of Serious Games in Older Adults With Mild Cognitive Impairment.

The rising prevalence of mild cognitive impairment (MCI) has spurred interest in innovative cognitive rehabilitation approaches, including serious games. This review summarizes randomized clinical trials (RCTs) exploring the impact of serious games on MCI patients. We conducted a comprehensive data search using key terms such as "gamification," "digital therapy," "cognition," "mild cognitive impairment," and "Alzheimer's disease." We exclusively considered published RCTs, excluding animal studies and basic research. We identified eight RCTs. Four RCTs examined the effects of serious games using cognitive training for MCI patients. Notably, one study found that non-specific training (Nintendo Wii) significantly enhanced cognitive function and quality of life compared to cognition-specific computer training (CoTras). Among the remaining three RCTs, one specifically demonstrated that personalized serious game-based cognitive training yielded superior cognitive outcomes and reduced depressive symptoms. One RCT focused on serious games incorporating physical exercise, highlighting the effectiveness of kinetic-based exergaming in enhancing overall cognition. Three RCT focused on combined cognitive training and physical exercise. A double-blind RCT revealed that progressive resistance training or standalone physical exercise outperformed the combined approach in improving executive function and global cognition. Two additional RCTs reported positive outcomes, including improvements in cognitive function and electroencephalogram patterns associated with game-based interventions. Serious games, whether focusing on cognitive training, physical exercise, or a combination of both, have potential to improve cognitive and functional outcomes in individuals with MCI. Further research and standardization of protocols are needed to better understand the full potential of serious games in MCI.

EVALUATION OF THE EFFECTIVENESS OF A COMPREHENSIVE PROGRAM OF REHABILITATION OFFERED ACCORDING TO DIFFERENT THERAPEUTIC PROTOCOLS IN REDUCING CHRONIC FRONTAL SYNDROME IN PATIENTS 10-YEARS FOLLOWING NEUROSURGERY FOR POST-TRAUMATIC INTRACEREBRAL HEMATOMA

The aim of the study was to evaluate the effectiveness of a Comprehensive Program of Rehabilitation (CPReh) offered according to different therapeutic protocols in reducing chronic frontal syndrome in patients 10 years following neurosurgery for post-traumatic intracerebral hematoma.Out of 568 adult car accident patients who underwent neurosurgery for post-traumatic intracerebral hematoma between 2004 and 2010 at the Department of Neurosurgery and Neurotraumatology of the Jagiellonian University's Collegium Medicum in Krakow, 90 patients with OFC injury and Chronic Frontal Syndrome were selected for the study. Patients were divided into three groups A, B and C of 30 each, matched for age, gender and injury severity. The Comprehensive Rehabilitation Program (CPReh) (cf. Pąchalska 2008) was applied in all groups ten years after hospitalization and surgery for intracerebral hematoma and was conducted according to three therapeutic Protocols:- Protocol 1 administered in group A, combained cognitive training (CT) and the "Life Academy" program administered twice a week. The activities were continued as long as the patient was able and willing to continue (average 24 months 1.18).- Protocol 2 administered in group B, included CT and the "Academy of Life" program also administered twice a week but lasting for the standard period of about a year (average 12 months 1.03).- Protocol 3 administered in group C, included CT and the "Community Base Treatment" program similarly administered twice a week and also lasting about a year as standard (average 12 months 1.27).Evaluation of the effects of rehabilitation using the Frontal Behavioral Inventory (FBInv) was conducted 2 times: Study I (baseline, 10 years follow up after operation)-before the start of rehabilitation, Study II (follow up) after the end of rehabilitation according to all protocols.all or most of the positive or negative symptoms tested by FBInv, including neurological, cognitive, emotional and behavioral ones. A modified CPReh program administered with Protocol 1. in which combined cognitive training (CT) and the "Academy of Life" program is provided twice a week, but which continues as long as the patient was able and willing to continue, is more effective in reducing these symptoms, like the standard CPReh program administered with Protocol 2 or 3 administered only up to a year as a standard. It was also found that the "Academy of Life " program has also been shown to be a more effective component of CPReh than the Community Base Treatment.The improvement achieved by group A, in which a modified CPReh administered with Protocol 1. that provided the patient the opportunity to continue rehabilitation as long as the patient was able and willing to continue was more effective in the reduction of Chronic Frontal Syndrome than the standard CPReh administered with Protocols 2. and 3. for the patients in groups B and C.

Community based complex interventions to sustain independence in older people: systematic review and network meta-analysis

ObjectiveTo synthesise evidence of the effectiveness of community based complex interventions, grouped according to their intervention components, to sustain independence for older people.DesignSystematic review and network meta-analysis.Data sourcesMedline, Embase, CINAHL,...

Computerized serious game‐based cognitive training combined with tDCS for apathy treatment in Mild Neurocognitive Disorders

AbstractBackgroundApathy is a clinical syndrome, associated with numerous adverse outcomes, which is pervasive in neurocognitive disorders. Neural bases of apathy rest on dysfunctions of brain structures involved in initiation, execution and control of goal directed behavior, and notably implicate dysfunction of cognitive functions which are required to generate plan of actions. Cognitive training has shown efficacious effects in mild cognitive disorders, and non‐invasive brain stimulation seems to be a promising intervention for cognition and neuropsychiatric symptoms, as suggested by the benefit effects found on depression. The aim of this study is to assess the effectiveness of repeated sessions of computerized serious game‐based cognitive training combined with transcranial direct current stimulation (tDCS) on apathy among older adults with neurocognitive disorders.MethodThe study is an ongoing double‐blind randomized controlled trial. Patients are randomized into a 4‐week intervention of computerized “MeMo” serious game‐based cognitive training combined with either sham or active tDCS. The 4‐week intervention comprise 3 sessions per week, with 20 minutes of cognitive training plus simultaneously sham or active tDCS targeting the left dorsolateral prefrontal cortex with a 2mA of current intensity. The main outcome was the apathy, assessed using the Apathy Diagnostic Criteria, the Apathy Inventory and the self‐reported Apathy Motivation Index questionnaire. Secondary outcomes are cognitive performances, fatigue and daily motor activity.ResultPreliminary results of the ongoing study will be presented during the AAIC.ConclusionThese results will provide new evidence about the interest to use combined cognitive training and tDCS as neurorehabilitation intervention, for cognition and apathy treatment in mild neurocognitive disorders.

The moderating effects of sex, age, and education on the outcome of combined cognitive training and transcranial electrical stimulation in older adults.

ClinicalTrials.gov, identifier NCT03475446.

Rehafox – A therapeutical approach developing a serious game to support rehabilitation of stroke patients using a leap motion controller

The consequences of stroke are often severe and result in the need for rehabilitation of different regions in the body for a defined period. Rehabilitation exercises are often monotonous and quickly become boring, therefore serious games try to include gaming aspects into the rehabilitation process, which was previously shown can support the overall process. To support wrist and hand rehabilitation, the authors propose a new and innovative serious game, which relies only on the Leap Motion Controller together with a PC combining cognitive and physical rehabilitation. The development was based on a user-centred design approach divided into 3 consecutive phases focusing on the therapeutical point of view. In Phase 1, requirements for such a solution were identified and validated in cooperation with one therapist. Phases 2 and 3 pose additional changes gathered from interviews together with four more therapists and one stroke patient to develop a highly sophisticated and flexible prototype. Different and easily adaptable levels were developed in which the patient needs to perform specific movements with one or two hands and wrists to control the avatar throughout a jump-and-run game. Additionally, it includes memory aspects for additional and combined cognitive training. In the end, overall 44 requirements were identified and the gathered feedback during the iterations showed a positive acceptance and massive potential of the proposed solution. These requirements should also pose a good starting point for the development and research of new serious games in that domain as well.

N°343 – Effect of combined cognitive training and neuronavigated magnetic stimulation in Alzheimer[StQuote]s disease treatment: A graph analysis study

N°343 – Effect of combined cognitive training and neuronavigated magnetic stimulation in Alzheimer[StQuote]s disease treatment: A graph analysis study

The Effect of Cognitive Training with Neurofeedback on Cognitive Function in Healthy Adults: A Systematic Review and Meta-Analysis

Cognitive training aims to improve cognitive function through cognitive tasks or training games. Neurofeedback is a technique to monitor brain signals with either visual or auditory feedback. Previous studies suggest that a combination of cognitive training and neurofeedback has a superior effect on cognitive functions compared with cognitive training alone. However, no systematic reviews and meta-analyses of the benefits of cognitive training with neurofeedback (CTNF) exist. The purpose of this study was to examine the beneficial effects of CTNF in healthy adults using a systematic review and multilevel meta-analysis. PubMed, Scopus, PsychoINFO, and MEDLINE were searched for research papers reporting the results of interventions using CTNF. After an initial screening of 234 records, three studies using near-infrared spectroscopy (NIRS) and one study using electroencephalography were extracted from the database. We performed a multi-level meta-analysis with three NIRS studies including 166 participants (mean ages ranged from 21.43 to 65.96 years). A multi-level meta-analysis revealed that CTNF has a beneficial effect on the episodic, long-term, and working memory domains. Although three studies were included in the systematic review and meta-analysis, our results indicate that CTNF using NIRS would lead to improvements in memory functioning.

Cognitive Retraining and Functional Treatment (CRAFT) for adults with cancer related cognitive impairment: a preliminary efficacy study.

To examine the preliminary efficacy of Cognitive Retraining and Functional Treatment (CRAFT) combining remote computerized cognitive training (CCT) and occupation-based treatment in adults with cancer-related cognitive impairment (CRCI). Three-armed randomized controlled trial including 74 individuals with CRCI, randomized into 12weeks of either CRAFT, CCT alone, or treatment-as-usual. Assessments evaluating participation in daily life, perceived cognition, cognitive performance, quality-of-life, and treatment satisfaction were administered at baseline, post-intervention, and 3-month follow-up. Significant time × group interactions in favor of the CRAFT and CCT groups were found for participation in daily life (F2,34 = 5.31, p = .01, eta = .238), perceived cognition (F2,34 = 4.897, p = .014, eta = .224), and cognitive performance on speed of processing test (F = 5.678, p = .009, eta = .289). The CRAFT group demonstrated significantly larger clinically meaningful gains on participation in daily life (chi-square = 6.91, p = .032) and significantly higher treatment satisfaction. All treatment gains were maintained at a 3-month follow-up (n = 32). CCT and CRAFT were found to have a positive impact on participation and cognitive outcomes among individuals with CRCI. The CRAFT showed an additional advantage in improving self-chosen occupation-based goals suggesting that a combination of cognitive training with occupation-based intervention has a positive synergistic effect resulting in "real world" health benefits. A combination of cognitive training with occupation-based intervention has a positive effect resulting in clinically meaningful improvements in participation in daily life, objective cognitive performance, and subjective cognitive impairment. ClinicalTrials.gov NCT04210778, December 26, 2019, retrospectively registered.

Moderating effects of gender, age and cognitive reserve on combined cognitive training and transcranial electrical stimulation

Moderating effects of gender, age and cognitive reserve on combined cognitive training and transcranial electrical stimulation

The effectiveness of anodal tDCS and cognitive training on cognitive functions in multiple sclerosis; a randomized, double-blind, parallel-group study

BackgroundForty to 70% of patients with multiple sclerosis (MS) suffer from cognitive impairment during their illness. Only a few studies have examined the effects of anodal transcranial direct current stimulation (a-tDCS) along with cognitive training on cognitive performance in MS patients. This study aims to determine whether multi-session a-tDCS with or without cognitive training impacts cognitive performance in MS. MethodsEighty MS patients received a-tDCS, cognitive training, a-tDCS plus cognitive training, and sham for ten consecutive daily sessions. Cognitive function (including episodic memory, attention, and inhibitory control, working memory, and visuospatial skill) was measured at baseline, week 4, and week 12 after the intervention. ResultsAll cognitive functions significantly improved after the intervention compared to the sham condition. This effect also showed persistence during follow-up for some cognitive tasks in the a-tDCS and a-tDCS combined cognitive training groups. Although the cognitive training group experienced an immediate improvement in attention and inhibitory control, the difference was not significant at follow-up. Also, there were no significant differences between these three groups in cognitive scores after the intervention. Conclusiona-tDCS alone and a-tDCS paired with or without cognitive training as compared to sham appears to be a promising therapeutic option for cognitive performance in MS patients.

Combined Cognitive Training and Transcranial Direct Current Stimulation in Neuropsychiatric Disorders: A Systematic Review and Meta-analysis

BackgroundTreatments for cognitive dysfunction in neuropsychiatric conditions are urgently needed. Cognitive training and transcranial direct current stimulation (tDCS) hold promise, and there is growing interest in combined or multimodal treatments, though studies to date have had small samples and inconsistent results. MethodsA systematic review and meta-analysis was completed. Retained studies included cognitive training combined with active or sham tDCS in a neuropsychiatric population and reported a posttreatment cognitive outcome. Meta-analyses included effect sizes comparing cognitive training plus active tDCS and cognitive training plus sham tDCS in 5 cognitive domains. Risk of bias in included studies and across studies was explored. ResultsFifteen studies were included: 10 in neurodegenerative disorders and 5 in psychiatric disorders (n = 629). There were several tDCS montages, though two-thirds of studies placed the anode over the left dorsolateral prefrontal cortex. A wide variety of cognitive training types and outcome measures were reported. There was a small, statistically significant effect of combined treatment on measures of attention/working memory, as well as small and non–statistically significant effects favoring combined treatment on global cognition and language. There was no evidence of bias in individual studies but some evidence of nonreporting or small-study bias across studies. ConclusionsThese results may provide preliminary support for the efficacy of combined cognitive training and tDCS on measures of attention/working memory. More data are needed, particularly via studies that explicitly align the cognitive ability of interest, stimulation target, training type, and outcome measures.

Older adults with lower working memory capacity benefit from transcranial direct current stimulation when combined with working memory training: A preliminary study.

Aging is a very diverse process: successful agers retain most cognitive functioning, while others experience mild to severe cognitive decline. This decline may eventually negatively impact one’s everyday activities. Therefore, scientists must develop approaches to counteract or, at least, slow down the negative change in cognitive performance of aging individuals. Combining cognitive training and transcranial direct current stimulation (tDCS) is a promising approach that capitalizes on the plasticity of brain networks. However, the efficacy of combined methods depends on individual characteristics, such as the cognitive and emotional state of the individual entering the training program. In this report, we explored the effectiveness of working memory training, combined with tDCS to the right dorsolateral prefrontal cortex (DLPFC), to manipulate working memory performance in older individuals. We hypothesized that individuals with lower working memory capacity would benefit the most from the combined regimen. Thirty older adults took part in a 5-day combined regimen. Before and after the training, we evaluated participants’ working memory performance with five working memory tasks. We found that individual characteristics influenced the outcome of combined cognitive training and tDCS regimens, with the intervention selectively benefiting old-old adults with lower working memory capacity. Future work should consider developing individualized treatments by considering individual differences in cognitive profiles.

Cognitive Improvement Following Physical Exercise and Cognitive Training Intervention for Older Adults With MCI.

The diagnosis of mild cognitive impairment (MCI) presents a critical period for intervention. Although exercise and cognitive training (CT) interventions have reported independent success in improving cognition, some meta-analyses have suggested that combined interventions provide maximal benefits. Much previous research has studied land-based as opposed to water-based exercise, which places potential barriers on older adults. The purpose of the current study was to examine the impact of combined exercise (water- or land-based) and CT treatment on cognition for older adults with MCI. Participants were 67 adults ages 54-86 years classified with MCI who engaged in 6 months of land or aquatic-based exercise with subsequent CT over 4 weeks. Primary outcome variables were performance measures of several cognitive domains across 3-time points (baseline, following exercise intervention, and following CT intervention). Linear mixed effects modeling examined exercise group differences across time periods in an intention-to-treat analysis. Both aquatic- and land-based exercise with CT interventions resulted in significant improvement in learning and memory outcomes, though improvement in executive functioning, processing speed, language, and visuospatial abilities was limited to water-based and CT treatment groups. Differences in linear growth patterns between groups were nonsignificant. Results suggest that for older adults with MCI to obtain global cognitive benefits (ie, learning and memory, executive functioning, processing speed, language, and visuospatial abilities) using combined exercise and CT interventions, they must be able to fully engage in exercise, and aquatic-based activities should be further considered.

Feasibility of Cognitive Training in Combination With Transcranial Direct Current Stimulation in a Home-Based Context (TrainStim-Home): study protocol for a randomised controlled trial

IntroductionWith the worldwide increase of life expectancy leading to a higher proportion of older adults experiencing age-associated deterioration of cognitive abilities, the development of effective and widely accessible prevention and...

Virtual Reality simulation streamlines medical training for healthcare professionals

According to World Health Organization, our planet will need more than 40 million new doctors, nurses, frontline healthcare workers, and other healthcare professionals by the year 2030, which is double the current medical workforce (1). The existing training model (a master teaching a limited number of apprentices over the course of several years) is unable to meet the level of healthcare professionals needed. Empirical evidence from other industries demonstrates virtual reality (VR) technology is an effective and efficient way of improving training. VR technology allows users to interact with a computer-simulated environment. VR implementation in medicine focuses on the rapid acceleration of human learning in medical training. It aims to provide technology for medical staff to reskill and upskill more effectively, without a large time investment. The combination of cognitive training in an experience-based learning virtual environment enabled by advanced VR software and hardware provides several advantages: (1) unrestricted training time, increased training access during COVID-19 restrictions; (2) remote training access: growing demand for health professionals in countries with less developed infrastructure; (3) modernizing standards: during simulated training competency evaluations for residents are performed. (1) Increased trainee engagement and knowledge retention (70%) compared to videos (10%) or lecturing (5%) (2) Decreased training time, 29% less OR training time due to skill transfer from VR to OR (3) Decreased training costs. An intelligent VR training simulation for dental healthcare professionals results in a proven skills transfer and embodied cognition in a fail-safe environment, in scalable training with low-cost and on-demand VR software, as well as in progress achieved through learning curricula faster, at lower cost and with the highest fidelity.

A Multimodal Intervention to Improve Cognition in Community-dwelling Older Adults

To examine the effects of a multimodal intervention composed of cognitive training, physical exercise, and group counseling on cognitive function in community-dwelling older adults. A four-armed, quasi-experimental intervention study. Community-dwelling adults aged 60 years and older (n=153). Participants were allocated into multimodal intervention, cognitive training plus Taichi exercise, cognitive training, or control group. The multimodal intervention included 18 sessions of cognitive training, 18 sessions of Taichi, and 6 sessions of group reminiscence over six weeks. Cognitive function, depressive symptoms, and psychological well-being were assessed at the baseline, postintervention, and three-month follow-up. The primary outcome was the change in overall cognition measured by the Montreal Cognitive Assessment (MoCA) and a composite cognitive score derived from a battery of neuropsychological tests. For MoCA, there was no significant difference between any of the three intervention groups and controls. For composite cognition, all three intervention groups showed improvements at the three-month follow-up, with a large effect size in the cognitive training plus Taichi group (change difference 0.37, 95% CI 0.18-0.56, Hedge's g=0.92), and medium effect sizes in the multimodal intervention group (change difference 0.23, 95% CI 0.0 -0.42, g=0.58) and cognitive training group (change difference 0.22, 95% CI 0.03-0.42, g=0.55). Multimodal intervention, cognitive training plus Taichi, and cognitive training could foster cognitive function in community-dwelling older adults. The combination of cognitive training and Taichi showed greater efficacy than the other two interventions.

Cognitive Rehabilitation Programs for Survivors of Breast Cancer Treated With Chemotherapy: A Systematic Review

Background: Chemotherapy-related cognitive impairment (CRCI) is a condition experienced by many survivors of breast cancer. At present, there are a limited number of rehabilitation programs tailored to improve the cognitive performance of these survivors. Purpose: This systematic review aims to evaluate the existing evidence-based cognitive rehabilitation programs designed for survivors of breast cancer with CRCI. Methods: Electronic databases, including PubMed and CINAHL Plus, were used to identify the relevant articles. The search was restricted to studies published in the English language from inception to March 2020. The methodological quality of the studies included here was examined using the Quality Criteria for Rating Studies of Cognitive Rehabilitation. Results: The search strategy identified 1557 studies, 10 of which met the inclusion criteria. The studies included randomized controlled trial (n = 6), quasi-randomized controlled trial (n = 1), and single-arm trial (n = 3). Discussion and Limitations: Seven of the 10 studies were considered high-quality cognitive rehabilitation research. Cognitive training (n = 4), compensatory strategies (n = 5), and a combination of cognitive training and compensatory strategies (n = 1) were shown to improve executive function, working and verbal memory, processing speed, and attention. Conclusion: Cognitive rehabilitation programs demonstrated positive outcomes for survivors of breast cancer with cognitive impairment. However, because of methodological concerns and the diversity in the programs' parameters and outcome measures, an explicit recommendation could not be established. The findings may guide future research, policies, and practices related to cognitive rehabilitation programs for survivors of breast cancer.

The effects of combined cognitive training on prospective memory in older adults with mild cognitive impairment

This study aimed to assess the effects of combined cognitive training on prospective memory ability of older adults with mild cognitive impairment (MCI). A total of 113 participants were divided into a control group and three intervention groups. Over three months, the control group received only community education without any training, whereas for the first six weeks, an executive function training group received executive function training, a memory strategy training group received semantic encoding strategy training, and the combined cognitive training group received executive function training twice a week for the first six weeks, and semantic encoding strategy training twice a week for the next six weeks. The combined cognitive training group showed improvement on the objective neuropsychological testing (Montreal Cognitive Assessment scale). The memory strategy training group showed improvement on the self-evaluation scales (PRMQ-PM). Combined cognitive training improved the prospective memory and cognitive function of older adults with MCI.

Effects of a Combined Motor Imagery and Action Observation Intervention on Vascular Cognitive Impairment: A Randomized Pilot Study.

The aim of the study was to identify the effects of combined motor imagery and action observation therapy on vascular cognitive impairment. Thirty vascular cognitive impairment patients were randomly assigned into three groups. Cognitive training group was given conventional cognitive training, motor imagery + action observation group was treated with motor imagery and action observation therapy, and mixed therapy group was given conventional cognitive training and motor imagery + action observation therapy, for 8 wks continuously. The Montreal Cognitive Assessment Scale, Rivermead Behavioral Memory Test, and event-related potential were used to evaluate the cognitive function at baseline, 4- and 8-wk posttreatment, and 1-mo follow-up. There were significant time × group interactions in Montreal Cognitive Assessment Scale (F6,4.20 = 8.38, P < 0.001), event-related potential latent period (F6,294.24 = 5.10, P < 0.001), event-related potential amplitude (F6,1.68 = 23.08, P < 0.001), and Rivermead Behavioral Memory Test (F6,312.61 = 5.42, P < 0.001). Intragroup comparisons showed that Montreal Cognitive Assessment Scale and Rivermead Behavioral Memory Test scores and event-related potential amplitude increased significantly (P < 0.05), and event-related potential latency decreased significantly (P < 0.05) in all groups. Intergroup comparisons showed that the changes of all outcomes in mixed therapy group were greater than those in cognitive training and motor imagery + action observation group (P < 0.05) after treatment. These results suggest that the combination of cognitive training with motor imagery and action observation therapy is an effective treatment on cognitive function in people with vascular cognitive impairment.