Computerized Cognitive Training Research Articles

Effects and mechanisms of computerized cognitive training in Huntington's disease: protocol for a pilot study

Huntington's disease (HD) causes progressive cognitive decline, with no available treatments. Computerized cognitive training (CCT) has shown efficacy in other populations, but its effects in HD are largely unknown. This pilot study will explore the effects and neural mechanisms of CCT in HD. The intervention group participants will complete 12 weeks of multidomain CCT. Control group participants will receive lifestyle education and access to CCT after the study. The primary outcome is change in processing speed. Secondary outcomes include – change in other cognitive domains, functional brain network connectivity (derived from MRI) and psychosocial function. Feasibility outcomes include rates of recruitment, adherence and retention. This study may provide insights into the effects of CCT in HD and guide future trials. Clinical Trial Registration: ACTRN12622000908730 ( ClinicalTrials.gov )

Efficacy and Concurrent Validity of Computerized Brain Training Based on Everyday Living (BTEL) Based on Instrumental Activities of Living for Cognitively Healthy Old Individuals: A Preliminary Study

Background: Interventions to prevent or attenuate cognitive decline and dementia in older adults are becoming increasingly important. Recently, cognitive training exercise can be via computer or mobile technology for independent or home use. Recent meta-analysis has reported that Computerized Cognitive Training (CCT) is effective at enhancing cognitive function in healthy older and Alzheimer’s disease adults, although little is known about individual characteristics of each computerized program. Objective: We developed a new CCT named Brain Training Based on Everyday Living (BTEL) to enhance cognitive capacity for Instrumental Activities of Daily Living (IADL). We aim to evaluate the efficacy of the BTEL among cognitively healthy old individuals and to explore its concurrent validity and construct concept. Methods: We conducted a double-blind study where 106 individuals aged 65 years and older (intervened = 53, control = 53) worked on the active and placebo tasks three times a week over three months (clinical trial: UMIN000048730). The main results were examined using ANCOVA and calculating correlation coefficients. Results: We found no effect on total score of the three tests; however, there was significant effect for the BTEL on: recognition in MMSE, and immediate recall in HDSR. The tasks are associated with prefrontal cortex. In addition, correlations indicated that each BTEL domain had some validity as a cognitive assessment tool. Different from previous CCT, we determined the neuropsychological characteristics of specific cognitive tasks of the BTEL to a certain degree. Conclusions: We found modest efficacy of the BTEL in cognitively healthy old individuals and confirmed its concurrent validity and the conceptual construct.

Effectiveness of Computerized Cognitive Training on Working Memory in Pediatric Cancer Survivors: A Systematic Review and Meta-analysis.

Interactive features of computerized cognitive training (CCT) may enhance adherence to training, providing a relatively low-cost intervention. A robust systematic review on the effectiveness of CCT for improving working memory (WM) among pediatric survivors with cancer is lacking. To summarize the available evidence and determine the effectiveness of CCT for WM among pediatric survivors with cancer. Five databases were searched. The Effective Public Health Practice Project was used to assess the study quality. ReviewerManager was used. The primary outcome was WM performance. Secondary outcomes included processing speed, attention, intervention adherence, and number of adverse events. Six studies were included. Regarding overall quality, 1 study was weak, and 5 studies were moderate. Five studies reported a significant improvement of WM postintervention (P < .05). The meta-analysis of Cogmed interventions on symbolic WM revealed a significant difference between groups (vs placebo), with an overall pooled effect size of 0.71 (95% confidence interval, 0.02-1.41; P = .04). Two and 4 studies investigated the effects of CCT on processing speed and attention, respectively, with conflicting results. Four studies reported adherence of 80% or greater. Two studies reported no adverse events. Computerized cognitive training using Cogmed has a significant positive effect on WM. The effects of CCT on processing speed and attention remain inconclusive. More rigorous trials should be conducted to elucidate the cognitive effects of CCT, particularly processing speed and attention, in the pediatric population with cancer. Further studies should consider combining CCT with other existing interventions to strengthen their effectiveness.

Development of a Cognitive Training Support Programme for prevention of dementia and cognitive decline in at-risk older adults

BackgroundEvidence for the beneficial effects of cognitive training on cognitive function and daily living activities is inconclusive. Variable study quality and design does not allow for robust comparisons/meta-analyses of different cognitive training programmes. Fairly low adherence to extended cognitive training interventions in clinical trials has been reported.AimsThe aim of further developing a Cognitive Training Support Programme (CTSP) is to supplement the Computerised Cognitive Training (CCT) intervention component of the multimodal Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), which is adapted to different cultural, regional and economic settings within the Word-Wide FINGERS (WW-FINGERS) Network. The main objectives are to improve adherence to cognitive training through a behaviour change framework and provide information about cognitive stimulation, social engagement and lifestyle risk factors for dementia.MethodsSix CTSP sessions were re-designed covering topics including (1) CCT instructions and tasks, (2) Cognitive domains: episodic memory, executive function and processing speed, (3) Successful ageing and compensatory strategies, (4) Cognitive stimulation and engagement, (5) Wellbeing factors affecting cognition (e.g., sleep and mood), (6) Sensory factors. Session content will be related to everyday life, with participant reflection and behaviour change techniques incorporated, e.g., strategies, goal-setting, active planning to enhance motivation, and adherence to the CCT and in relevant lifestyle changes.ConclusionsThrough interactive presentations promoting brain health, the programme provides for personal reflection that may enhance capability, opportunity and motivation for behaviour change. This will support adherence to the CCT within multidomain intervention trials. Efficacy of the programme will be evaluated through participant feedback and adherence metrics.

Improvements in performance based measures of functional capacity and cognition after computerized functional skills training in older people with mild cognitive impairment and healthy comparators

With no pharmacological treatments for Mild Cognitive impairment (MCI), computerized training strategies have been attempted. A computerized skills training intervention, FUNSAT, previously produced training-related gains in cognition in MCI and in comparators with normal cognition (NC). A new remotely delivered version of FUNSAT was administered to a new sample of participants with NC and MCI. Outcomes measures included cognition (BAC) and functional capacity (VRFCAT) to examine training transfer. Participants with MCI (n = 92) and NC (n = 72) trained for up to 12 weeks on FUNSAT. Half the MCI participants started with 3 weeks of computerized cognitive training (CCT). Baseline, post-training, and 30-day follow-up scores on cognition and functional capacity were compared. Participants improved on both cognition (d = 0.80) and functional capacity (d = 0.64), with no differences in training gains across MCI and NC, although treatment with CCT in MCI was associated with similar gains with fewer FUNSAT training sessions. This is the first treatment study in MCI to demonstrate transfer to untrained measures of functional capacity. NC improved in cognition and functional capacity with skills training alone. These findings have implications for other conditions, such as schizophrenia, where functional capacity is a treatment target.

White Matter Plasticity Underpins Cognitive Gains After Multidomain Adaptive Computerized Cognitive Training.

This study aims to evaluate the effectiveness of computerized cognitive training (CCT) on white matter (WM) neuroplasticity and neuropsychological performance. A total of 128 community older adults (64.36 ± 6.14 years) were recruited and randomly assigned to the intervention or control group. Participants in the intervention group received a home-based, multidomain, and adaptive CCT for 30 minutes, 2 days per week for 1 year. Neuropsychological assessments, diffusion magnetic resonance imaging (MRI), and T1-weighted structural MRI were performed at the pre- and post-intervention visits. Eighty-one of 128 participants (41 in the intervention group and 40 in the control group) completed the 1-year intervention, and 61 of them (27 in the intervention group and 34 in the control group) underwent MRI scans twice. After excluding attrition bias, a significant time-by-group interaction on the Stroop Color-Word Test (SCWT; F = 51.85, p < .001) was found, showing improvement in the intervention group and a decline in the control group. At the brain level, the intervention group exhibited increased axial diffusivity in the left posterior thalamic radiation, and this increase was significantly correlated with reduced SCWT reaction time (r = ‒0.42, p = .029). No significant time-by-group interactions were found for gray matter volume. Our findings suggest that conducting multidomain adaptive CCT is an effective and feasible method to counteract cognitive decline in older adults, with WM neuroplasticity underpinning cognitive improvements. This study contributes to the understanding of the neural basis for the beneficial effect of CCT for older adults.

Effect of cognitive training on cognitive function in community-dwelling older people with mild-to-moderate dementia: A single-blind randomised controlled trial.

The purpose of this assessor-blinded, randomised controlled trial was to determine the effect of computerised cognitive training (CT) on executive function, processing speed and working memory in 61 people with mild-to-moderate dementia. The primary outcomes were forward Digit Span and Trail Making Tests (TMT) at the completion of the 6-month intervention. Secondary outcomes included cognitive and physical performance, rate of falls, participant and caregiver's quality of life and usability and adherence to the CT program. The study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12617000364370). Intervention group (n = 31) participants averaged 81 min of CT per week, and system usability scores were acceptable (participants: 68.8 ± 22.1; caregivers: 79.4 ± 23.5). There were no statistically significant differences in cognitive or physical performance outcomes between the intervention and control groups at 6- or 12-months (between-group differences [95% CI] for primary outcomes at 6-months: Forward Digit Span -0.3 [-0.8, 0.3]; TMT-A 2.7 s [-14.1, 19.5]; TMT-B -17.1 s [-79.3, 45.2]). At the 12-month follow-up reassessment, the intervention group reported significantly more depressive symptoms and had lower caregiver-rated participant quality of life and higher caregiver quality of life compared to control. This study showed no benefit of the CT program on working memory, processing speed and executive function. Future studies are required to better understand how CT can be used to improve cognitive and physical functioning in older people with mild-moderate dementia.

Exploring the associations between physical activity level, cognitive performance, and response to computerized cognitive training among chronic stroke patients

AbstractBackgroundPost‐stroke attentional and working memory deficits are common and represent relevant predictors of long‐term functional recovery and outcome. The individual responses to cognitive rehabilitation and interventions vary between patients and are influenced by multiple factors. Recently, a link between the level of engagement in physical activities and cognitive rehabilitation has been suggested. However, few previous studies have tested the predictive value of physical activity on cognitive performance and response to cognitive training among chronic stroke patients. There is also a lack of knowledge concerning the prognostic value of index stroke characteristics on physical activity in chronic phase.MethodIn this cross‐sectional and longitudinal study, including stroke survivors suffering mild‐to‐moderate strokes (n = 52, mean age = 70 years), we used Bayesian regression to test the association between cognitive performance and response to a 3‐week intervention with a commonly used computerized cognitive training (CCT) system and baseline physical activity level measured with International Physical Activity Questionnaire. We also tested the association between physical activity level in chronic phase and stroke characteristics, including stroke severity (National Institutes of Health Stroke Scale), ischemic stroke etiology (Trial of Org 10172 in Acute Stroke Treatment), and stroke location (n = 66, mean age = 68 years). For descriptive purposes, we included 104 sex‐ and age‐matched healthy controls (mean age = 69 years).ResultsThe analyses revealed anecdotal evidence of a positive association between overall cognitive performance and daily minutes of sedentary behavior, indicating that better cognitive performance was associated with more daily hours of sitting still. We found no support for an association between cognitive performance and response to CCT with activity level. In addition, the analysis showed group differences in sedentary behavior between patients with small‐vessel disease (n = 20) and cardioembolism (n = 7), indicating more sedentary behavior in patients with small‐vessel disease. There was no further support for a predictive value of index stroke characteristics on physical activity level.ConclusionThe results do not support that baseline physical activity level is a relevant predictor of the overall performance or response to CCT in this sample of chronic stroke patients. Similarly, the analyses revealed little evidence for an association between index stroke characteristics and future activity level in patients surviving mild‐to‐moderate stroke.

Digital computerised cognitive training for preventing cognitive decline among hypertensive patients: a study protocol for a multicentre randomised controlled trial (DELIGHT trial)

IntroductionMild cognitive impairment (MCI) is an important intervenable stage for the prevention of dementia. Hypertension is associated with impaired cognition, and when combined with MCI, it may lead to a...

Does Including Facebook Training Improve the Effectiveness of Computerized Cognitive Training? A Randomized Controlled Trial.

To determine whether implementing a Facebook training program improves the effectiveness of computerized cognitive training (CCT) in older adults. Randomized, controlled, double single-blind trial with parallel groups. Community centers. Eighty-six adults between 60 and 90 years old. Nine face-to-face 60-min sessions of CCT with VIRTRAEL for all participants. The experimental group received an additional 30 min of Facebook training per session. Attention (d2 Test of Attention); learning and verbal memory (Hopkins Verbal Learning Test-Revised); working memory (Letter-Number Sequencing test), semantic and abstract reasoning (Similarities and Matrix Reasoning tests); and planning (Key Search test). There was a significant Group*Time interaction in the Hopkins Verbal Learning Test-Revised-Trial 3, Letter-Number sequencing, and Matrix tests. Between groups, post-hoc analyses showed a difference in Matrix reasoning (p < .001; d  =  0.893) at post-intervention in favor of the experimental group. Significant main effects of time were found in the CCT group between baseline and 3-month follow-up for Concentration (F  =  26.431, p ≤ .001), Letters and Numbers (F  =  30.549, p ≤ .001), Learning (F  =  38.678, p ≤ .001), Similarities (F  =  69.885, p ≤ .001), Matrix (F  =  90.342, p ≤ .001), and Key Search (F  =  7.904, p  =  .006) tests. The utilization of CCT with VIRTRAEL, a freely accessible tool with broad applicability, resulted in enhanced attention, verbal learning, working memory, abstract and semantic reasoning, and planning among older adults. These improvements were sustained for at least three months post-training. Additional training in Facebook did not enhance the effectiveness of CCT.

Supporting Learning Differences: Effects of Cognitive Training on Cognitive Abilities in a School-Based Sample

A growing body of research demonstrates the effectiveness of computerized cognitive training (CCT) in building specific abilities (e.g., working memory) among school-age children. As a result, CCT is increasingly cited as a means to enhance and support students’ academic performance and school experience. However, many studies exploring CCT as an intervention have done so outside of the school setting, limiting its potential impact with regard to students who may benefit from it but cannot access such supports. This project examined the efficacy of a CCT program implemented within the academic day for all students attending a private school. The findings showed that two CCT programs resulted in improvements in working memory, cognitive flexibility, and/or processing speed among third graders through sixth graders (N = 95). Furthermore, this project demonstrates a model for the effective integration of CCT into a school day without interrupting the academic curriculum. The present results have important implications for the current ideological shift in education that focuses on how to more broadly address students’ learning differences.

Cognitive and Exercise Training Improves Intraindividual Variability in Cognitive Performance in Older Adults: Secondary Findings of A Randomized Controlled Trial

AbstractBackgroundIncreased intraindividual variability of cognitive performance is a marker of cognitive decline. Whether computerized cognitive training (CCT) and aerobic exercise counteracts cognitive decline by reducing intraindividual variability is unknown. We investigated the effects of CCT with or without aerobic exercise on reaction time intraindividual variability in older adults.MethodThis was a secondary analysis of an 8‐week randomized controlled trial. Older adults (aged 65‐85 years) were randomized to CCT alone (n = 41), CCT with aerobic exercise (n = 41), or an active control group (n = 42). The CCT group trained using the Fit Brains® platform 3×/week for 1 hour (plus 3×/week of home‐based training). The CCT with aerobic exercise group received 15 min of walking plus 45 min of Fit Brains® 3×/week (plus 3×/week of home‐based training). The control group received sham exercise and cognitive training (3×/week for 1 hour). We extracted reaction times from the Dimensional Change Card Sort Test, Flanker Inhibitory Control and Attention Test (Flanker), and Pattern Comparison Processing Speed Test (PACPS). Intraindividual variability was measured as residual intraindividual standard deviation (residual ISD) of raw reaction time latencies. Residual ISD is an unbiased measure of variability that accounts for within and between participant source of variation that could influence reaction time latencies. We also calculated reaction time intraindividual SD (raw‐score ISD) and intraindividual coefficient of variation (ICV).ResultCompared with the control group, residual ISD improved in a processing speed task (PACPS) following CCT alone (mean difference [95% confidence interval]: ‐0.147 [‐0.230 to ‐0.065], p&lt;0.001) and CCT with aerobic exercise (‐0.111 [‐0.195 to ‐0.027], p&lt;0.01). Also, for processing speed, both CCT (‐0.173 [‐0.261 to ‐0.084], p&lt;0.001) and CCT with aerobic exercise (‐0.122 [‐0.213 to ‐0.032], p&lt;0.01) showed greater reduction in raw‐score ISD compared with controls, while only CCT reduced ICV for this task (‐0.108 [‐0.176 to ‐0.040], p&lt;0.001). Inhibitory attention (Flanker) improved only after CCT with aerobic exercise (congruent = ‐0.128 [‐0.250 to ‐0.006], incongruent = ‐0.121 [‐0.237 to ‐0.005], both p&lt;0.05).ConclusionA CCT program promoted cognitive health via reductions in intraindividual variability of cognitive performance and combining it with aerobic exercise resulted in broader benefits.

An 8‐week program of computerized cognitive training with exercise impacts cortical grey matter in older adults: Secondary findings of a randomized controlled trial

AbstractBackgroundThe world’s population is aging and thus, it is important that we find strategies to reduce the rate of age‐related cognitive decline. Lifestyle interventions can play an important role in delaying the onset of cognitive decline. Evidence shows both computerized cognitive training (CCT) or exercise can improve cognitive function. However, the effect of CCT on cortical structure is not well understood. This study examines the effect of 8‐weeks of CCT, with or without a preceding exercise bout, on cortical structure in community‐dwelling older adults.MethodStructural magnetic resonance imaging (MRI) data acquired from an 8‐week, 3‐arm, proof of concept randomized controlled trial was used. Participants (N = 125) aged 65 – 85 were randomized (1:1:1) to either 8 weeks of 3x/week: 1) Balance and Toned (BAT; active control); 2) CCT; or 3) Exercise + CCT (Ex‐CCT). Measurement occurred at baseline and trial completion (i.e., 8‐weeks). Fifty‐three participants with baseline and trial completion MRI data were included in this analysis. Freesurfer was used to assess BAT vs. CCT, BAT vs. Ex‐CCT, and CCT vs. Ex‐CCT differences in cortical thickness and volume at trial completion, adjusting for age, sex, and Montreal Cognitive Assessment (MoCA) score.ResultAt trial completion, CCT vs. BAT decreased left rostral middle frontal gyrus volume (cluster size = 553.51 mm2, cluster‐wise p = .027) and left superior temporal gyrus thickness (cluster size = 525.58 mm2, cluster‐wise p = .039). Ex‐CCT vs. BAT increased cortical thickness in the left (cluster size = 900.23 mm2, cluster‐wise p = .001) and right (cluster size = 681.95 mm2, cluster‐wise p = .020) superior parietal gyri. Finally, Ex‐CCT vs. CCT increased left cuneus thickness (cluster size = 1062.12 mm2, cluster‐wise p &lt; .001) as well as right post central gyrus thickness (cluster size = 714.85 mm2, cluster‐wise p = .005) and volume (cluster size = 1030.08 mm2, cluster‐wise p &lt; .001).ConclusionEight weeks of CCT with exercise is of sufficient duration to induce structural change in the brain. Moreover, exercise may enhance the effect of CCT on cortical grey matter structure vs. CCT alone.

The Effects of Computerized Cognitive Training on Memory Performance in Adults with Mild Cognitive Impairment or Dementia. A Systematic Review and Meta‐analysis

AbstractBackgroundMemory impairment is a predominant symptom in people with mild cognitive impairment (MCI) and dementia. Computerized cognitive training (CCT) has been proposed as a promising non‐pharmaceutical intervention to slow down the deterioration of cognitive functions. While previous studies have reported the benefits of CCT on global cognition, few have focused specifically on memory outcomes. Therefore, the aim of this study is to investigate the benefits of CCT on memory outcomes in adults with MCI or dementia.MethodA literature search was conducted via the PubMed, Medline, Embase and PsycINFO databases from inception to Sept 2022. Inclusion criteria included: (1) participants with MCI or dementia, (2) CCT as one of the interventions, (3) randomized trials with a non‐CCT comparison group, and (4) studies that reported changes in memory‐related neuropsychological scores before and after the intervention. The outcomes were measures of verbal memory, visual memory and working memory. With the heterogeneous definitions of CCT, the standardized mean differences (SMD) were pooled using a random‐effects model.ResultThirty‐nine clinical trials with 2,010 participants with MCI or dementia were included. The mean age ranged from 44 to 83, and the percentage of males ranged from 21% to 73%. Participants with MCI that received CCT demonstrated significantly better performance in verbal memory (SMD = 0.69, 95% CI = 0.41 to 0.90), visual memory (SMD = 0.49, 95% CI = 0.14 to 0.84) and working memory (SMD = 0.42, 95% CI = 0.12 to 0.72) than the control groups. In the sub‐group analyses of different control groups, those MCI patients who received CCT demonstrated better verbal memory performance than the usual care and the active control groups, but comparable results as the paper‐and‐pencil cognitive training group. For the studies that include dementia participants, CCT effects were not significantly better than the control groups.ConclusionComputerized cognitive training conferred significant benefits in preserving memory function in people with MCI, while the benefits were not statistically significant in patients with dementia. This study also supports that computerized cognitive training can be enhanced by using mobile devices, gamification and immersive technologies.

The effect of computerized cognitive training and exercise on white matter integrity: a secondary analysis of a randomized controlled trial

AbstractBackgroundAs a consequence of aging, the structure of the brain can be negatively impacted, and consequently, cognitive function. Although aerobic exercise and computerized cognitive training (CCT) are promising lifestyle interventions to prevent or delay cognitive decline, the underlying mechanisms of the effect of CCT, with or without exercise, on cognitive function remain poorly understood. Diffusion tensor imaging (DTI) is a neuroimaging technique for detecting changes in white matter (WM) tissue. Common DTI metrics such as fractional anisotropy (FA) can be summarized as a measure of overall WM integrity. The aim of this analysis was to explore the effect of CCT, with or without exercise, on WM integrity in healthy older adults.MethodsThis sub‐analysis included 65 community‐dwelling older adults aged 65‐85 years. Participants were enrolled in an 8‐week proof‐of‐concept randomized controlled trial and were assigned to either: 1) Group‐based CTT (Fit Brains; FBT; n = 19) 3x/week for 1hr plus 3x/week home‐based training; 2) Group‐based CCT preceded by exercise (ExFBT; n = 22) 3x/week for 1hr plus 3x/week home‐based training or; 3) Group‐based balanced‐and‐toned (BAT; n = 24) classes 3x/week for 1hr (control). DTI scans were acquired at baseline and at trial completion. Analysis of covariance (ANCOVA) evaluated treatment effects on FA at trial completion controlling for baseline age, MoCA, BMI, and FA. We conducted planned contrasts of FBT vs. BAT and ExFBT vs. BAT. In addition, we included an exploratory comparison between ExFBT vs. FBT.ResultsWe found significant group differences in fornix and superior longitudinal fasciculus (SLF) FA at trial completion. Planned contrasts revealed significantly greater fornix FA in BAT vs. FBT (mean difference = 0.015, 95%CI = 0.002‐0.029). Also, fornix FA was significantly greater in ExFBT vs. FBT (mean difference = 0.017, 95%CI = 0.003‐0.031). In addition, SLF FA was significantly greater in ExFBT vs. FBT (mean difference = 0.008, 95%CI = 0.001‐0.014) at trial completion.ConclusionThese findings suggest CCT alone may be detrimental to WM integrity, potentially due to its sedentary nature.

Odor Identification Moderates Relationship Between Cognitive Training and Cognitive Decline

AbstractBackgroundOlfactory deficits have been shown to predict cognitive decline. Recent findings suggest that computerized cognitive training may reduce the risk of cognitive decline and dementia. However, the impact of olfaction deficits on cognitive training outcomes is unclear. In this study, we investigate how lower odor identification may moderate the relationship between treatment assignment (cognitive games versus crossword puzzles) and cognitive outcomes in older adults diagnosed with mild cognitive impairment (MCI).MethodData were drawn from the Cognitive Training and Neuroplasticity in Mild Cognitive Impairment (COG‐IT) Trial (NCT03205709). In this two‐site, single‐blinded, 78‐week trial, participants with MCI — stratified by age, severity (early/late MCI), and site — were randomly assigned to 12 weeks of intensive, home‐based, Computerized Cognitive Training (CCT) or computerized Crossword Puzzle Training (CPT), followed by six booster sessions. 106 patients received neuropsychological and olfactory assessments through the 11‐item Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS‐Cog) and the 40‐item University of Pennsylvania Smell Identification Test (UPSIT). In linear mixed‐model analyses, the effect of baseline UPSIT score on change in the ADAS‐Cog score from baseline over 78 weeks by treatment group, adjusted for age and baseline ADAS‐Cog, was assessed.ResultAmong 106 older adults (n = 50 [games]; n = 56 [crosswords]), higher baseline UPSIT scores predicted improved ADAS‐Cog performance at week 78 for all patients randomized to CPT (beta coefficient, 0.15, 95% confidence interval [CI], 0.02 to 0.27; P = 0.02). Greater baseline UPSIT score predicted improved ADAS‐Cog performance at weeks 12, 52, and 78 for early MCI patients randomized to CPT (Week 12: beta coef. 0.26, 95% CI 0.09 to 0.43; Week 52: beta coef. 0.23, 95% CI 0.05 to 0.40; Week 78: beta coef. 0.22, 95% CI 0.05 to 0.39). This was not shown in early MCI patients randomized to CCT. Higher baseline UPSIT predicted significant improvement in ADAS‐Cog for late MCI patients randomized to CCT at week 78 (beta coefficient, 0.24, 95% CI 0.05 to 0.42; P = 0.01).ConclusionOur results are consistent with literature, suggesting that impaired olfaction moderates memory decline. Our preliminary results show that individuals with less impaired olfaction may experience greater cognitive improvement following cognitive training.

Feasibility of a Non‐pharmacological Intervention for Impaired Financial Capacity in Mild Cognitive Impairment

AbstractBackgroundA pilot trial of financial literacy training (FL) and computerized cognitive training (CCT) was conducted to assess tolerability, feasibility, and the effect on financial capacity (FC) in participants with normal cognition and MCI.MethodsCognitively normal and MCI participants were randomized to receive either targeted FL content (N = 4) (Savvy Saving Seniors (“SSS”) workshop) narrated and presented online or the active control CCT (N = 3) (BrainHQ, ©Posit Science) over 6‐weeks. “SSS” participants were instructed to complete 25‐minute sessions twice per week and BrainHQ participants were instructed to complete 60‐minute sessions three times per week.ResultsNo significant differences were found between baseline and follow‐up in either group. Table 1. Two out of 3 BrainHQ participants reported that their processing speed had improved and they felt challenged and experienced positive cognitive benefits. Three out of 4 “SSS” participants reported that they felt stimulated and challenged and that the activities were a good use of their time. All “SSS” participants agreed their financial literacy had improved. The most common reported benefits were accomplishment, enjoyment, and increased alertness. The most common reported discomforts were frustration, boredom and one participant complained of eye strain.Discussion/ConclusionsWe demonstrated good efficacy, tolerability, and adherence in delivering FL education and CCT interventions in cognitively normal and MCI participants.

How to engage patients in computerized cognitive training: a cognitive rehabilitation expert’s perspective

Purpose The relationship between a patient and their therapist plays a crucial role in patient engagement. While Computerized Cognitive Training (CCT) may assist in preserving cognitive skills in cases of aging, dementia or acquired brain injuries, its effectiveness has not been definitively proven. Improving user engagement, acceptance, and software usability could aid in addressing this issue. The present study aims to identify potential obstacles and facilitators by examining the perspectives of rehabilitation professionals on the current usage of CCT software. Methods Semi-structured interviews were conducted with 16 rehabilitation professionals, familiar with a CCT software. The data were transcribed and followed by an independent iterative thematic analysis. Results Two major themes were identified: (1) facilitating factors and (2) difficulties related to use. The main obstacles were difficulties related to the computerized nature of the exercises, technology use, understanding the software and general learning difficulties. The main facilitators were the ecological and novel nature of the exercises, and the adaptability of the difficulty levels. Conclusion The complexity of the CCT presents challenges for its usage by rehabilitation professionals, which in turn can impede patient utilization as well. To address this issue and promote sustainable use of the software, providing instruction delivery to facilitate learning and understanding of the CCT is essential. Additionally, creating a standardized foundation that therapists can refer to for guidance may also aid in optimizing the software’s usage. It is recommended to utilize a model for CCT acceptability and acceptance in developing these solutions to enhance patient engagement.

Validation of a Computerized Cognitive Training Tool to Assess Cognitive Impairment and Enable Differentiation Between Mild Cognitive Impairment and Dementia.

Age-related cognitive decline is a chronic, progressive process that requires active clinical management as cognitive status changes. Computerized cognitive training (CCT) provides cognitive exercises targeting specific cognitive domains delivered by computer or tablet. Meanwhile, CCT can be used to regularly monitor the cognitive status of patients, but it is not clear whether CCT can reliably assess cognitive ability or be used to diagnose different stages of cognitive impairment. To investigate whether CCT can accurately monitor the cognitive status of patients with cognitive impairment as well as distinguish patients with dementia from patients with mild cognitive impairment (MCI). We included 116 patients (42 dementia and 74 MCI) in final analysis. Cognitive ability was assessed by averaging the patient performance on the CCT to determine the Cognitive Index. The validity of the Cognitive Index was evaluated by its correlation with neuropsychological tests, and internal consistency was measured to assess the reliability. Additionally, we determined the diagnostic ability of the Cognitive Index to detect dementia using receiver operating characteristic (ROC) analysis. The Cognitive Index was highly correlated with the Montreal Cognitive Assessment (r = 0.812) and the Mini-Mental State Examination (r = 0.694), indicating good convergent validity, and the Cronbach's alpha coefficient was 0.936, indicating excellent internal consistency. The area under the ROC curve, sensitivity, and specificity of the Cognitive Index to diagnose dementia were 0.943, 83.3%, and 91.9%, respectively. CCT can be used to assess cognitive status and detect dementia in patients with cognitive impairment.

Intrinsic functional brain connectivity changes following aerobic exercise, computerized cognitive training, and their combination in physically inactive healthy late-middle-aged adults: the Projecte Moviment

Lifestyle interventions have positive neuroprotective effects in aging. However, there are still open questions about how changes in resting-state functional connectivity (rsFC) contribute to cognitive improvements. The Projecte Moviment is a 12-week randomized controlled trial of a multimodal data acquisition protocol that investigated the effects of aerobic exercise (AE), computerized cognitive training (CCT), and their combination (COMB). An initial list of 109 participants was recruited from which a total of 82 participants (62% female; age = 58.38 ± 5.47) finished the intervention with a level of adherence > 80%. Only in the COMB group, we revealed an extended network of 33 connections that involved an increased and decreased rsFC within and between the aDMN/pDMN and a reduced rsFC between the bilateral supplementary motor areas and the right thalamus. No global and especially local rsFC changes due to any intervention mediated the cognitive benefits detected in the AE and COMB groups. Projecte Moviment provides evidence of the clinical relevance of lifestyle interventions and the potential benefits when combining them.