Computer-based Cognitive Training Research Articles

Methodological Designs Applied in the Development of Computer-Based Training Programs for the Cognitive Rehabilitation in People with Mild Cognitive Impairment (MCI) and Mild Dementia. Systematic Review.

In recent years, different computer-based cognitive training (CT) programs for people with dementia (PwD) have been developed following a psychosocial approach. Aim: This systematic review aims to identify the methodological designs applied in the development of computer-based training (CCT) programs for the rehabilitation of cognitive functioning in people with mild cognitive impairment (MCI) or mild dementia. Methods: A systematic review was conducted using the databases PubMed and PsycINFO. The search period was between 2000–2019. The study selection and data extraction processes were carried out by two independent reviewers. The protocol was registered in International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42020159027. Results: Thirteen studies met the inclusion criteria. The most frequently used methodological design in the development of CCT programs for people with MCI or mild dementia was the user-centered design (UCD). This design involves an interactive system characterized by the inclusion of end users from the initial stages of its development, throughout the establishment of functional requirements, and in the evaluation of the program’s usability and user-experience (UX). Conclusion: UCD was the most used methodological design for the development of CCT programs although there was quite some variation in how this design was applied. Recommendations for future studies about the development of CCT programs for people with MCI and mild dementia are given. Central focus should be the inclusion and active participation of end users from the initial stages of development.

The impact of computer-based cognitive training intervention on the quality of life among elderly people: a randomized clinical trial

BackgroundThrough the process of normal aging, cognitive decline would cause a lower level of functioning in real life. This flow might interfere with health-related quality of life (QoL). The purpose of this study is to investigate the effect of computer-based cognitive intervention on increasing QoL of elderly people.MethodsA total number of 52 community-dwelling older adults participated in this study. This community scored ≥ 21 in the Mini-Mental State Examination (MMSE) and a clock drawing test score ≥ 4 from health centers in Tehran, Iran. This study is a parallel group stratified randomized clinical trial. The intervention group received a 45-min cognitive training session twice a week for 10 sessions, using Attentive Rehabilitation of Attention and Memory (ARAM) software focusing on selective attention and working memory. QoL was evaluated as a primary outcome. The control group participated in educational workshops.ResultsFrom fifty-two persons, only one participant was excluded from the study in the intervention group during follow-up. Results revealed by increasing cognitive function, improvement occurred in QoL (F = 13.417, p value < 0.001, partial eta-squared = 0.324) as a primary outcome in the intervention group. Among eight domains of QoL, there was significant increasing in domain of role limitations due to emotional problems (F = 4.007, p value = 0.021, partial eta-squared = 0.059), social functioning (F = 2.423, p value = 0.044, partial eta-squared = 0.004), and role limitations due to physical health (F = 10.749, p value < 0.001, partial eta-squared = 0.026).ConclusionsBased on the results, ARAM showed transition and long-term effects on QoL in elderly people by improving cognitive functions such as selective attention and working memory.Trial registrationIranian Registry of Clinical Trials IRCT2016122731602N1. Registered on June 21, 2017

Meta-Analysis on the Effectiveness of Virtual Reality Cognitive Training (VRCT) and Computer-Based Cognitive Training (CBCT) for Individuals with Mild Cognitive Impairment (MCI)

This meta-analysis aims to assess the effectiveness of virtual reality cognitive training (VRCT) and conventional computer-based cognitive training (CBCT) in five specific cognitive domains (i.e., global cognitive function (GCF), memory (Mem), executive function (EF), language (Lang) and visuospatial skills (VS)) of individuals with mild cognitive impairment. A total of 320 studies were yielded from five electronic databases. Eighteen randomized controlled trials met the PRISMA criteria, with 10 related to VRCT and 8 related to CBCT. A random-effect model was used in determining the main effect of cognitive training in five specific cognitive domains. VRCT provided the largest effect size on VS and Lang while the smallest on EF. CBCT provided the largest effect size on Mem and Lang while the smallest on EF. VRCT and CBCT generate an opposite effect on VS. VRCT outweighs CBCT in treatment effectiveness of GCF, EF, Lang and VS. More immersive and interactive experiences in VRCT may help individuals with MCI better engage in real-life experiences, which supports skill generalization and reduces external distractions. CBCT tends to improve Mem but no definite conclusions can be made. Further investigation with more stringent research design and specific protocol are required to reach consensus about the optimum intervention regime.

Computer-based cognitive stimulation for posttraumatic cognitive impairment: a clinical case

The paper describes a clinical case of applying a set of computer-based stimulation programs for cognitive impairment arising from severe open traumatic brain injury (TBI). It demonstrates the rehabilitation capabilities of a set of «Neurotechnology+» stimulation programs for correction of cognitive deficits in patients with dysregulated moderate cognitive impairment resulting from experienced severe open TBI. It is noted that the use of a set of the programs contributed to the improvement of impaired regulatory and neurodynamic functions, the expansion of phonemic and semantic speech activity, and the improvement of memory processes. The described case suggests that computer-based cognitive training has a positive impact on cognitive recovery after post-traumatic brain injury.

Cognitive training for robotic surgery: a chance to optimize surgical training? A pilot study

The rapid rise of robotic-assisted surgery (RAS) has necessitated an efficient and standardized training curriculum. Cognitive training (CT) can significantly improve skills, such as attention, working memory and problem solving, and can enhance surgical capacity and support RAS training. This pilot study was carried out between 02/2019 and 04/2019. The participants included 33 student volunteers, randomized into 3 groups: group 1 received training using the da Vinci training simulator, group 2 received computer-based cognitive training, and group 3 was the control group without training. Before (T1) and after-training (T2), performance was measured. Additionally, expert ratings and self-evaluations were collected. Subjective evaluations of performance were supplemented by evaluations based on three scales from the revised NEO Personality Inventory (NEO PI-R). In total, 25 probands remained with complete data for further analyses: n = 8 (group 1), n = 7 (group 2) and n = 10 (group 3). There were no significant differences in T1 and T2 among all three groups. The average training gain of group 1 and 2 was 15.87% and 24.6%, respectively, (a restricting condition is the loss of the last training session in group 2). Analyses of semi-structured psychological interviews (SPIs) revealed no significant differences for T1, but in T2, significance occurred at ‘self-reflection’ for group 2 (F(2.22) = 8.56; p < .005). The efficacy of CT in training highly complex and difficult procedures, such as RAS, is a proven and accepted fact. Further investigation involving higher numbers of training trials (while also being cost effective) should be performed.

400 - Effects of Computerized Cognitive Training with an Elderly Community Sample

Community-focused programs that promote active and healthy aging can help preserve cognitive capacities, prevent or reverse cognitive deficits. Computer-based cognitive training (CCT) is a promising non-pharmacological, cost -effective and accessible intervention to face the effects of age-related cognitive decline. Previous studies proved CCT to have equal or better efficacy compared to traditional interventions. This comparative multifactorial study aims to test the efficacy of a CCT in a non-randomized community sample of 74 older adults: G1-CCT Experimental group (n=43) (Mean age M=72.21, SD=12.65) and G2- Paper-Pencil Control group (n=31; M=77.94, SD=10.51). Pensioners (97.3%), mostly women (83.8 %) with basic education (51.4%) and without dementia diagnosis, completed a cognitive training program of 17 or 34 group sessions (twice a week). G2 undertook a classic cognitive paper-pencil stimuli tasks. G1, performed, additionally, individual CCT with COGWEB® in a multimodal format (intensive training of attention, calculation, memory, gnosis, praxis, executive functions). Both groups completed Portuguese versions of Mini -Mental State Examination (MMSE),Montreal Cognitive Assessment (MOCA); Geriatric Depressive Scale (GDS); Mini Dependence Assessment (MDA); WHOOQL 5 and Social Support Satisfaction Scale (ESSS) before and after participating in the program. Both groups reported better post-test scores on basic cognitive functions (MMSE, MOCA), Depression symptoms (GDS-30), subjective well-being and quality of life (WHOOQL-5). G1 presented higher MOCA and lower GDS scores before and after CCT, although, group differences become less expressive when interaction effects are considered. Results are in line with findings from past studies, CCT supported by the new technologies, is as a relevant cost-effective therapeutic tool for health professionals working with older adults. Particularly for preventive purposes of neuro-cognitive disorders.

A double-blind randomized controlled trial of the efficacy of cognitive training delivered using two different methods in mild cognitive impairment in Parkinson's disease: preliminary report of benefits associated with the use of a computerized tool.

The effectiveness of computer-based cognitive training (CCT) remains controversial, especially in older adults with neurodegenerative diseases. To evaluate the efficacy of CCT in patients with Parkinson's disease and mild cognitive impairment (PD-MCI). In this randomized controlled trial, 53 patients were randomized to receive CCT delivered by means of CoRe software, traditional paper-and-pencil cognitive training (PCT), or an unstructured activity intervention (CG). In each group, the intervention lasted 3 consecutive weeks (4 individual face-to-face sessions/week). Neuropsychological assessment was administered at baseline (T0) and post-intervention (T1). Outcome measures at T0 and T1 were compared within and between groups. The Montreal Overall Cognitive Assessment (MoCA) was taken as the primary outcome measure. Unlike the PCT group and the CG, the patients receiving CCT showed significant medium/large effect size improvements in MoCA performance, global cognition, executive functions, and attention/processing speed. No baseline individual/demographic variables were associated with greater gains from the intervention, although a negative correlation with baseline MoCA performance was found. CCT proved effective in PD-MCI patients when compared with traditional PCT. Further follow-up assessments are being conducted to verify the retention of the gains and the potential ability of the tool to delay conversion to PD-dementia. Trial registration number (ClinicalTrials.gov): NCT04111640 (30th September 2019).

Corrigendum to: The Beneficial Effects of Computer-Based Cognitive Training in Parkinson's Disease: A Systematic Review.

Corrigendum to: The Beneficial Effects of Computer-Based Cognitive Training in Parkinson's Disease: A Systematic Review.

Management of Cognitive Impairment After Stroke

In this review, we present the reader with the latest diagnostic and therapeutic approaches in the management of patients with post-stroke cognitive impairment (PSCI). We discuss the most commonly utilized and validated neuropsychological assessments and neuroimaging diagnostic assessment tools. We also provide a critical appraisal of the pharmacological treatment approaches of PSCI, in addition to highlighting the latest emerging non-pharmacological and technological advances in cognitive rehabilitation techniques. Advanced MRI techniques and newer PET tracers are being utilized heavily in research into cognitive impairment. Non-invasive brain stimulation (NIBS), computer-based cognitive training (CBCT), and virtual reality (VR)–based rehabilitation are playing an increasing role in recent trials of cognitive rehabilitation techniques of PSCI patients. In approaching patients with PSCI, neuropsychological assessment and neuroimaging should be undertaken to aid in the diagnosis and classification of underlying pathological processes. Aggressive vascular risk factor modification, in addition to the use of cholinesterase inhibitors, is the recommended pharmacological treatment approach in these patients. This should be accompanied by encouraging exercise and prescribing conventional cognitive rehabilitation, while attempting to incorporate newer technological treatment modalities such as NIBS, CBCT, and VR. We identified a significant need for future research into treatment modalities aimed at PSCI and vascular dementia (VaD).

Time course of cognitive training in Parkinson disease.

People with Parkinson disease (PD) have difficulty initiating internally generated movements. We have shown that computer-based cognitive training can improve movement initiation. However, little is known about the optimal duration of training. To determine the optimal training duration for computer-based neurorehabilitation of internally represented movement initiation in people with PD. Nineteen PD and twenty-one age-matched control participants, ages 50-85 years, were included in analysis of pre- and post-training evaluation and 30 training sessions. Computer training consisted of cued and un-cued movement trials. The presentation of a cue (a combination of numbers on either the right, left or both sides of the screen) indicated that participants should respond by typing the numbers. Successful cued trials were followed by un-cued trials consisting of a green filled circle. Participants re-enter the cued sequence, thus producing an internally represented (IR) movement. The training was adaptive. Outcome measures were reaction time and error rate, and cumulative sum (CUSUM) analysis was used to identify peak training improvement. Participants with PD were divided into impaired (IPD) and unimpaired (UPD) groups, based on mean control group pre-training performance. All three groups showed improved RT and error rates for IR trials; however, the IPD group demonstrated significantly greater improvement in reaction time. Training was most effective in participants with greater disease severity and duration. Peak day of training improvement for the IPD group was 8 days. Optimal training duration was relatively short and the IPD group demonstrated the most gain, indicating that cognitive training should be tailored to individual needs.

The Beneficial Effects of Computer-Based Cognitive Training in Parkinson's Disease: A Systematic Review.

Cognitive dysfunction is one of the most prevalent non-motor aspects of Parkinson's disease (PD). The present review focuses on published studies investigating the effect of computer-based cognitive training (CT) on neuropsychological performance in PD. A systematic search of the PubMed database and Google Scholar was carried out. Randomized controlled studies published before September 2019, investigating the effect of computer-based CT (regardless of the comparator, active or placebo) on PD patients were included. Literature search, data extraction, and Risk of Bias (RoB) evaluation (based on the RoB Cochrane tool for Randomized Trials) were performed by two authors (A.N. and M.M), independently. Among 31 full-texts assessed for eligibility, eight articles fulfilled the inclusion criteria and were involved in the qualitative analysis. The main outcomes of the retrieved studies (all studies used similar cognitive rehabilitation methodologies) were indicative of cognitive improvement in most cognitive domains, particularly memory, executive function, processing speed, and attention, that is, the domains primarily impaired in the disease. Multidomain CT, which is exclusively based on computer software, leads to measurable improvements in most cognitive domains affected in patients with PD. The present review is the first to include studies assessing the effect of computer-based CT techniques without deploying CT with paper-pencil techniques. Limitations originate mainly due to the heterogeneity among included studies (differences in CT softwares, PD stages, number, and duration of training sessions.

Effects of Combined Aerobic Exercise and Cognitive Training on Verbal Fluency in Older Adults.

We have previously shown that aerobic exercise improves measures of verbal fluency in older adults, and such an improvement is correlated with improved cardiovascular reserve (i.e., estimates of VO2). Due to increasing popularity in computer-based cognitive training, we explored whether the addition of cognitive training to aerobic exercise would further enhance the beneficial cognitive impact of exercise. Therefore, this study sought to test the hypothesis that a cognitive training regimen alone would directly improve executive function and that this effect would be potentiated with the addition of aerobic exercise. The interventions lasted 12 weeks, and cognitive assessments were taken immediately prior to and after the interventions. We found that only the groups employing aerobic exercise showed improvements in verbal fluency (semantic and letter) and cardiovascular fitness with no other executive functions being significantly impacted. Cognitive training alone was associated with decreased verbal fluency. These data replicate previous findings which indicate that aerobic exercise may have a remedial or mitigating effect of cognitive decline. In addition, they provide evidence that the addition of concurrent cognitive training to an aerobic exercise program does not provide synergistic improvement in executive functions.

Can computer-based cognitive training improve cognition in patients with mild cognitive impairment or dementia? A review

Can computer-based cognitive training improve cognition in patients with mild cognitive impairment or dementia? A review

Development of tablet personal computer-based cognitive training programs for children with developmental disabilities whose cognitive age is less than 4 years.

This study was to develop tablet personal computer-based cognitive training programs for children with developmental disabilities whose cognitive age is less than 4 years. Twelve cognitive training programs (named Injini) were designed comprising cognitive domains that included attention, visual and auditory perception, memory, executive function, language, and reasoning. In addition, programs related to learning experiences, such as self-regulation, role play, learning of number, and letter/shape concepts, comparison, classification, and pattern matching, were included. Six of 12 programs comprised approximately 10 levels for each program, with different difficulty levels. Other programs consisted of universal tasks that did not have a difficulty level. To ensure that the difficulty level was appropriate, we pre-tested the pilot version of Injini among 80 children with typical development aged 18 to 41 months. After modifying the pilot version, we developed the final version and tested it among 80 children with cognitive impairment whose cognitive age was 18 to 41 months. All children were assessed using the Bayley Scales of Infant and Toddler Development to determine their development and cognitive age. The difficulty level analyses in children with typical development revealed several inappropriate results wherein the success rate did not decrease with increase in level in some programs. After adjusting the difficulty level, the analyses in children with cognitive impairment demonstrated that the success rate gradually decreased with increasing level in all programs. Cognitive training programs for children with developmental disabilities were successfully developed.

EAST MEETS WEST: IMPROVING HEALTH AND LONG-TERM CARE FOR OLDER ADULTS IN THE U.S. AND CHINA

As the number of older adults in the U.S. and China continues to increase, promoting healthy aging is essential for individuals, family, and society. Both countries face many similar issues due to their aging populations, including prolonging healthy life expectancy and providing quality of care. However, the change in demographics brings with it unique challenges for both the U.S and China. This forum invites scholars and researchers from these two countries to share their knowledge and insights on promoting healthy aging and improving care for older adults. This forum includes five presentations and one-panel discussion. Two presentations will focus on long-term care (LTC) in China, one is to forecast the needs of LTC in the next five decades, and the other is to evaluate the current LTC needs and discuss LTC policy. Using the data from the Health and Retirement Study, the third presentation aims to re-conceptualize spousal caregiving as a dyad-level phenomenon and provides a dynamic view of the spousal caregiving experiences. The last two presentations will focus on promoting healthy aging through clinical interventions. The fourth one is to evaluate the effectiveness of adaptive computer-based cognitive training among community-dwelling older adults in China. The last presentation provides some examples of using pragmatic clinical trials to improve the care of older adults in skilled nursing facilities in the U.S. After the five presentations, the three panelists will provide feedback to the presentations and share their views on healthy aging with the audience.

EFFECTS OF ADAPTIVE COMPUTER-BASED COGNITIVE TRAINING ON COMMUNITY-DWELLING ELDERS

This quasi-experimental designed study analyzed the effects of adaptive computer-based cognitive training among community-dwelling older adults. A 6-week (5 times/week) program was implemented with an intervention group (Difficulty Adaptive Training) and control group (Difficulty Fixed Training). General cognitive, memory, executive and attention functions were evaluated before (T1), completion (T2), and one month after intervention (T3). Sixty-one participants completed data collection. (1) General cognitive function: improved in both groups at T2, and T3, intervention group had better effect; (2) Memory function: improved in both groups in immediate, short and long-delayed recalls at T2 and T3, and recognition at T2. (3) Executive function: improved in both groups. Time of simple information processing was shortened at T2 and T3 in intervention group, at T3 in control group; TMT response inhibition was shortened at T2 and T3 in both groups. (4) Attention function: digit span forward was improved at T2 in intervention group.

Computer-Based Cognitive Training Improves Brain Functional Connectivity in the Attentional Networks: A Study With Primary School-Aged Children.

We have shown that a computer-based program that trains schoolchildren in cognitive tasks that mainly tap working memory (WM), implemented by teachers and integrated into school routine, improved cognitive and academic skills compared with an active control group. Concretely, improvements were observed in inhibition skills, non-verbal IQ, mathematics and reading skills. Here, we focus on a subsample from the overarching study who volunteered to be scanned using a resting state fMRI protocol before and 6-month after training. This sample reproduced the aforementioned behavioral effects, and brain functional connectivity changes were observed within the attentional networks (ATN), linked to improvements in inhibitory control. Findings showed stronger relationships between inhibitory control scores and functional connectivity in a right middle frontal gyrus (MFG) cluster in trained children compared to children from the control group. Seed-based analyses revealed that connectivity between the r-MFG and homolateral parietal and superior temporal areas were more strongly related to inhibitory control in trained children compared to the control group. These findings highlight the relevance of computer-based cognitive training, integrated in real-life school environments, in boosting cognitive/academic performance and brain functional connectivity.

Evaluation of a Custom-Developed Computer Game to Improve Executive Functioning in 4- to 6-Year-Old Children Exposed to Alcohol in Utero: Protocol for a Feasibility Randomized Controlled Trial.

BackgroundFetal alcohol spectrum disorder (FASD) is one of the most common causes of preventable intellectual disability, and the key associated deficits are in executive function (EF). Aspects of EF can be improved using cognitive training interventions. The highest prevalence of FASD globally (at a rate of 135.1 per 1000) has been found in a South African population in the Western Cape province. There is a shortage of specialized health service personnel, and there are limited remedial services. Computer-based cognitive training, if age and culturally appropriate, could be an effective way to provide the interventions with minimal need for skilled personnel and other resources. The Foundation for Alcohol Related Research has developed such a program for the South African context.ObjectiveThis protocol aimed to evaluate whether it is feasible to use computerized cognitive training in a resource-poor context to improve cognitive function in children exposed to alcohol in utero.MethodsWe are conducting a randomized controlled trial in the Saldanha Bay Municipal area, evaluating a custom-developed cognitive training program to improve the cognitive function of children aged between 4 and 6 years who were exposed to alcohol in the prenatal stage. Participants will be recruited from local Early Childhood Development centers. Community workers will interview biological mothers to identify alcohol-exposed pregnancies. Alcohol-exposed children will be randomized into an intervention or a control group of 40 participants each using block randomization. A group of 40 children not exposed to alcohol will be included in a normative group using individual randomization. The intervention group will play the game for 6 months (40 sessions). Normative and control groups will receive no intervention. Neurodevelopmental assessments will be done at baseline and upon completion of the study with all participants.ResultsThe intervention has started, and all baseline assessments have been done at the time of submission.ConclusionsThis study will provide insight into whether computerized cognitive training is viable and effective in the South African context. It has the potential to provide a means of intervention globally and in other resource-poor context and expand the knowledge base regarding executive functioning and FASD. This paper presents the research protocol and intervention design of the study.Trial RegistrationISRCTN Registry ISRCTN17244156; http://www.isrctn.com/ISRCTN17244156.International Registered Report Identifier (IRRID)DERR1-10.2196/14489

A computer-based cognitive training in Mild Cognitive Impairment in Parkinson’s Disease

There is no successful pharmacological treatment for cognitive impairment in Parkinson's Disease, therefore treatments capable of slowing down the progression of cognitive dysfunction are needed. To evaluate the effectiveness of a cognitive training, supported by the CoRe computerized tool, in patients with Parkinson's Disease Mild Cognitive Impairment. This is a prospective, open-unblinded, randomized, controlled study. After baseline cognitive assessment (T0), enrolled patients were randomized to receive motor rehabilitation plus cognitive intervention (G1) or motor rehabilitation only (G2). Follow-up assessments were scheduled 4 weeks (T1) and 6 months after (T2). Global cognitive functioning scores (MOCA and MMSE) were considered as primary outcome. Outcome measures at T0, T1 and T2 were compared within- and between-groups. A percentage change score between T0 and next assessments was calculated to identify patients who improved, remain stable or worsened. Differently from G2, G1 showed a medium/large effect size improvement in primary (MoCA) and secondary outcome, both between T0 and T1 and T0 and T2. Moreover, within G1, most patients improved their cognitive state compared to the baseline. Patients trained with CoRe showed a better evolution of cognitive decline, while untreated patients tended to get worse over time.

Computer-based cognitive training for older adults: Determinants of adherence.

The possibilities of computer-based cognitive training (CCT) in postponing the onset of dementia are currently unclear, but promising. Our aim is to investigate older adults´ adherence to a long-term CCT program, and which participant characteristics are associated with adherence to the CCT. This study was part of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). Participants were 60-77-year-old individuals with increased dementia risk, recruited from previous population-based studies. The participants included in this study (n = 631) had been randomized to receive a multi-domain lifestyle intervention, including CCT. The measure of adherence was the number of completed CCT sessions (max = 144) as continuous measure. Due to a substantial proportion of participants with 0 sessions, the zero inflated negative binomial regression analyses were used to enable assessment of both predictors of starting the training and predictors of completing a higher number of training sessions. Several cognitive, demographic, lifestyle, and health-related variables were examined as potential predictors of adherence to CCT. Altogether, 63% of the participants participated in the CCT at least once, 20% completed at least half of the training, and 12% completed all sessions. Previous experience with computers, being married or cohabiting, better memory performance, and positive expectations toward the study predicted greater odds for starting CCT. Previous computer use was the only factor associated with a greater number of training sessions completed. Our study shows that there is a large variation in adherence to a long-lasting CCT among older adults with an increased risk of dementia. The results indicate that encouraging computer use, and taking into account the level of cognitive functioning, may help boost adherence to CCT.