Cognitive Training Games Research Articles

Negative global metacognitive biases are associated with depressive and posttraumatic stress disorder symptoms and improve with targeted or game-based cognitive training.

Metacognition is disrupted in several clinical populations. One aspect of metacognition, global metacognitive bias (difference between objective and self-reported abilities), has shown to be particularly relevant to clinical functioning. However, previous studies of global metacognitive biases in populations with elevated depressive/posttraumatic stress disorder (PTSD) symptoms have not measured objective and self-reported abilities relative to normative samples, limiting the quantification of biases. Additionally, few studies have examined whether cognitive interventions can improve metacognitive biases or how this relates to depressive/PTSD symptom severity. A total of 84 participants with mild traumatic brain injury (77% veterans) performed PTSD and depression assessments along with self-reported and objective measures of global cognition. Age-adjusted norm-based z scores were used for self-reported and objective cognition, and bias was calculated by subtracting objective minus self-report scores. Participants then received 13 weeks of targeted cognitive training or entertainment games training (both providing performance feedback). Participants were assessed at baseline, immediately posttraining, and 3 months posttraining. We found large negative metacognitive biases in those with clinically significant severity of depressive symptoms (z score difference = -1.77), PTSD symptoms (-1.47), and depressive + PTSD symptoms (-2.29). Metacognitive biases improved after both targeted and entertainment training and was associated with reductions in depressive/PTSD symptom severity (r = -.41/-.42, respectively), led by the entertainment training group (r = -.54/-.46, respectively). These findings show that clinically significant severity of depressive/PTSD symptoms is associated with substantial negative global metacognitive biases and preliminarily suggests that cognitive training may improve these biases and depressive/PTSD symptom severity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Association between a combination of cognitively stimulating leisure activities and long-chain polyunsaturated fatty acid intake on cognitive decline among community-dwelling older Japanese individuals.

Multifactorial lifestyle approaches could be more effective than a single factor for maintaining cognitive function. This study investigated the association of combining cognitively stimulating leisure activities (CSLAs), including puzzles, quizzes, and cognitive training games, with intake of long-chain polyunsaturated fatty acids (LCPUFAs), including docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and arachidonic acid (ARA), on cognitive function in the older Japanese individuals without dementia. Participants were community-dwelling Japanese individuals without a self-reported history of dementia (n = 906, aged 60-88 years) from datasets of a 2-year longitudinal study (baseline: 2006-2008 and follow-up: 2008-2010). CSLA engagement and LCPUFA intake were divided into high and low groups according to frequency (≥once/week and <once/week) for CSLA engagement and median intake level for LCPUFA intake according to sex, then categorized into four groups. The associations of multivariate-adjusted odds ratio (OR) for a cognitive decline, shown as a decrease in the Mini-Mental State Examination score by 2 or more points, and the combination of CSLA engagement with LCPUFA intake were assessed using a multiple logistic regression model. Subgroup analysis involved participants with low DHA and EPA intakes (n = 303; median intake, 325 mg/day), mirroring those in North America. The HIGH-CSLA/HIGH-ARA group cumulatively yielded a lower OR for cognitive decline (0.41; 95% confidence interval, 0.25-0.70) than did the LOW-CSLA/LOW-ARA group (p for trend = 0.001). In the subgroup analysis, the OR for the HIGH-CSLA/HIGH-DHA group was notably reduced (0.31; 95% confidence interval, 0.11-0.87; p for trend = 0.025) compared with the LOW-CSLA/LOW-DHA group. High CSLA engagement frequency combined with high ARA intake may cumulatively reduce the risk of cognitive decline among older Japanese individuals. Furthermore, combining CSLA engagement frequency with DHA intake could have a positive association with maintaining cognitive function among older individuals, particularly those with low DHA and EPA intakes.

Evaluating the effect of action-like video game play and of casual video game play on anxiety in adolescents with elevated anxiety: protocol for a multi-center, parallel group, assessor-blind, randomized controlled trial

BackgroundAdolescence is a critical period for the onset and maintenance of anxiety disorders, which raises the importance of intervening early; one possibility of doing so is via digital interventions. Within that research field, at least two important research paths have been explored in the past years. On the one hand, the anxiolytic effect of casual video games has been tested as such gaming activity may distract away from anxious thoughts through the induction of flow and redirection of attention toward the game and thus away of anxious thoughts. On the other hand, the bidirectional link between weak attentional control and higher anxiety has led to the design of interventions aiming at improving attentional control such as working memory training studies. Taking stock that another genre of gaming, action video games, improves attentional control, game-based interventions that combines cognitive training and action-like game features would seem relevant. This three-arm randomized controlled trial aims to evaluate the feasibility and the efficacy of two video game interventions to document how each may potentially alleviate adolescent anxiety-related symptoms when deployed fully on-line.MethodsThe study aims to recruit 150 individuals, 12 to 14 years of age, with high levels of anxiety as reported by the parents’ online form of the Screen for Child Anxiety Related Disorders questionnaire. This trial contrasts a child-friendly, “action-like” video game designed to improve attentional control abilities in a progressive and stepwise manner (Eco-Rescue), a casual puzzle video game selected to act as a positive distraction tool (Bejeweled) and finally a control group with no assigned training intervention to control for possible test-retest effects (No-training). Participants will be assigned randomly to one of the three study arms. They will be assessed for main (anxiety) and secondary outcomes (attentional control, affective working memory) at three time points, before training (T1), one week after the 6-week training (T2) and four months after completing the training (T3).DiscussionThe results will provide evidence for the feasibility and the efficacy of two online video game interventions at improving mental health and emotional well-being in adolescents with high levels of anxiety. This project will contribute unique knowledge to the field, as few studies have examined the effects of video game play in the context of digital mental health interventions for adolescents.Trial registrationThe trial is registered on ClinicalTrials.gov (NCT05923944, June 20, 2023).

An OMICS‐based analytical framework to identify metabolic predictors of the cognitive response to a multimodal intervention: preliminary findings from the PENSA Study

AbstractBackgroundNot all individuals may respond to a cognitive decline preventive intervention. However, the low frequency of cognitive assessments during short‐lasting interventions hampers the study of the heterogeneity of treatment effects (HTE). We have recently developed and validated an innovative method for remote monthly monitoring of executive functions, which leverages the performance indicators from cognitive training games (CTG) (Figure 1). Here, we aimed to examine the HTE to a multimodal intervention using this CTG measure and to identify which baseline glycaemic, lipidic, and inflammatory factors are associated with the cognitive response profiles.MethodsWe included N = 98 individuals (65.3% females; 67.2 ±4.6 years) APOE‐ɛ4 carriers with Subjective Cognitive Decline who had completed eight months of the PENSA Study multimodal intervention on January 2023. We analysed P = 62 baseline exposures that included: anthropometric factors, biochemical parameters, endocannabinoids, and plasma metabolites of the tryptophan and glutamine metabolism. First, we examined the HTE with the CTG measure as the outcome (6 repeated measures/subject) using growth mixture models. Second, we assessed the partial correlations between exposures using graphical LASSO with stability selection. Finally, we identified the most contributing predictors to the cognitive response profiles using stability selection‐based LASSO multinomial regression, fit on 500 random 80% subsamples of the data using the R package ‘sharp’.ResultsWe identified and labelled three different cognitive response trajectories: ‘average respondents’ (75.6%), ‘super respondents’ (16.3%), and ‘non‐respondents’ (8.2%) (Figure 2A). The network of exposures showed higher intra‐family than inter‐family correlations (Figure 2B). Finally, four out of 62 exposures were identified as stable predictors of the cognitive response profiles (Figure 2C). Compared to ‘average respondents’ the ‘super‐respondents’ and ‘non‐respondents’ presented higher carnitine and serotonin concentrations. However, fasting plasma glucose and total cholesterol were lower in ‘super‐respondents’ (OR = 0.63 and OR = 0.69) and higher in ‘non‐respondents’ (OR = 6.07 and OR = 2.40).ConclusionsThis study shows that not all individuals at high risk of Alzheimer’s disease respond to an intensive lifestyle‐based multimodal intervention, and that baseline cholesterol and glycaemic homeostasis could determine the success of preventive interventions for cognitive decline. Further cholesterol‐ and glycaemic‐related metabolites should be analysed to better understand the underlying mechanisms of these findings.

The Relationship Between Cognitive Resource Consumption During Gameplay and Postgame Aggressive Behaviors: Between-Subjects Experiment.

The question of how video games can shape aggressive behaviors has been a focus for many researchers. Previous research has focused on how violent video game content leads to postgame aggressive behaviors. However, video games not only convey violence or prosocial content to players but also require cognitive effort from individuals. Since human cognitive resources are limited, consuming more cognitive resources in a game leads to less cognitive resources to suppress aggressive impulses. Therefore, the depletion of cognitive resources from playing video games may also lead to changes in postgame aggressive behaviors. This study aimed to examine the relationship between cognitive resources consumed in video games and postgame aggressive behaviors. A total of 60 participants (age: mean 20.22; range 18-24 y) were randomly assigned to either the high-load group or the low-load group. Participants from both groups played a video game centered around college life. In the low-load group, participants followed the gameplay instructions to complete it. In the high-load group, participants were given an extra digital memory task to complete while playing the game. Participants in both groups played the video game for about 25 minutes. A maze selection task was then conducted to measure the participants' helping and hurting behaviors. The independent samples 2-tailed t tests showed that the high-load group had significantly higher hurting scores (mean 3.13, SD 2.47) than the low-load group (mean 1.90, SD 2.12; t58=-2.07, P=.04; Cohen d=-0.535), whereas helping behaviors were not significantly affected (t58=1.52, P=.13; Cohen d=0.393). As more cognitive resources are consumed in a video game, more hurting behaviors are exhibited after the game. This finding proposes an alternative route by which video games impact aggressive behaviors, adding to previous theories and raising concerns about the popularity of cognitive training games.

Computer-based cognitive training for cognitive development of alcohol-exposed children in South Africa: a feasibility randomised control trial

Children exposed to alcohol in utero may suffer from cognitive and physical sequelae. The most impactful damage in terms of daily functioning is to higher order cognitive functions involved in planning and goal-directed behaviour, referred to as executive functions. Cognitive training interventions are used as a remedial tool for executive function deficits but require implementation by professionals. For the South African context, where resources are limited, a tablet computer-based cognitive training game was developed. This study aimed to establish the feasibility of implementing and evaluating this intervention in South Africa for children exposed to alcohol prenatally. This was a three-arm feasibility randomised control trial comparing an alcohol exposed intervention arm, to an alcohol exposed control arm, and a non-exposed normative arm. Arm allocation was based on self-reported maternal alcohol use during a structured interview. To assess feasibility, we evaluated participant recruitment and barriers to implementation. Executive functions were measured at baseline and following intervention to evaluate the preliminary impact of the intervention. No significant differences were found between the three arms on the post-intervention assessments. The retention rate was acceptable for a randomised control trial; however, there was significant variance in the length of time spent playing the game overall. The majority of participants learned to play the game quickly and progressed through the difficulty levels. In conclusion, a full randomised control trial using the recruitment, randomisation and implementation method would be suitable in the South African context. The statistical outcomes of this trial do not support a full-scale randomised control trial of this intervention.

Feasibility and Effects of Cognitive Training with the COGNIPLAT Game Platform in Elderly with Mild Cognitive Impairment: Pilot Randomized Controlled Trial.

This study examines the effectiveness of a new multi-domain multimodal cognitive training game platform, COGNIPLAT, in improving cognitive performance in elderly with mild cognitive impairment (MCI). The platform combines standard serious games and cognitive stimulation leveraging virtual and augmented reality technologies. A double-arm, evaluator-blinded randomized controlled trial was conducted with 21 elderly participants in the MCI spectrum, with 11 in the intervention group (INT) and 10 in the control group (CTL). Feasibility was assessed in terms of adherence, effective learning, and perceived usefulness. The INT attended 24 training sessions, 60 minutes long, twice a week, whereas the CTL engaged in normal daily activities and usual care. Results showed that the INT had a statistically significant change in the Montreal Cognitive Assessment score, stages List B Recall, Short-term delayed Recall, and Long-term delayed Recall of the Rey Auditory Verbal Learning Test (RAVLT), Trail Making Test-A and B test scores, Digit Span Test (DST) Forward Span, and Functional Activities Questionnaire score. A trend level difference was also found for the RAVLT Recognition and the DST Backward Span. No significant differences were found for the CTL in any of the metrics. The completion rate of the INT was 91%, and the attendance rate was 100% for participants who completed the follow-up segment of the study. The engagement level was high, and effective learning was observed between the participants. The perceived usability and usefulness of the game platform was assessed as high. This study provides evidence of a positive effect of a multi-domain multimodal-based cognitive training program in elderly with MCI, with broader benefits on cognition by inducing more cooperative transfer effects over different domains.

Intensive assessment of executive functions derived from performance in cognitive training games

Traditional neuropsychological tests accurately describe the current cognitive state but fall short to characterize cognitive change over multiple short time periods. We present an innovative approach to remote monitoring of executive functions on a monthly basis, which leverages the performance indicators from self-administered computerized cognitive training games (NUP-EXE). We evaluated the measurement properties of NUP-EXE in N= 56 individuals (59% women, 60-80 years) at increased risk of Alzheimer's disease (APOE-ϵ4 carriers with subjective cognitive decline) who completed a 12-month multimodal intervention for preventing cognitive decline. NUP-EXE presented good psychometric properties and greater sensitivity to change than traditional tests. Improvements in NUP-EXE correlated with improvements in functionality and were affected by participants' age and gender. This novel data collection methodology is expected to allow a more accurate characterization of an individual's response to a cognitive decline preventive intervention and to inform development of outcome measures for a new generation of intervention trials.

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.

Acute Effects of Cognitive Training Game on Functional Brain Asymmetry and Motor Performance in Golf Putting: A Pilot Study

ABSTRACT Neural and behavioral evidence has indicated that video games and mental training can enhance motor skills and attentional stability. The purpose of this study is to investigate the acute effect of a single session of cognitive game training on electroencephalography (EEG) activity and golf putting performance (10, 12 ft putts). A total of twelve participants (10 males, 2 females, aged 22–59) participated in this study. Seven participants were assigned to an experimental group. This group putted before and after a 10-min of cognitive game training; five additional participants were assigned to a control group, sitting quietly with limited physical movements. Measures of EEG signals (i.e., frontal alpha asymmetry, temporal alpha asymmetry) and performance outcomes (i.e., accuracy, quality of feel) were recorded before and after the intervention. The experimental group demonstrated a significantly increased quality of putting feel compared to the control group. Although functional brain asymmetry did not approach a significant level, it was speculated that this single session of cognitive game training might stimulate approaching attention to the target (i.e., hole) and reduce mental exertions which could explain why the experimental group showed a high quality of feel in their performance. Future work is still needed with larger sample size and controlled variables (e.g., eye-dominance, handedness) to examine the long-term effects of cognitive game training on motor performance in skilled and novice golfers, respectively.

The Effectiveness of Serious Games on Cognitive Processing Speed Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis

BackgroundHuman cognitive processing speed is known to decline with age. Human cognitive processing speed refers to the time that an individual takes from receiving a stimulus to reacting to it. Serious games, which are video games used for training and educational purposes, have the potential to improve processing speed. Numerous systematic reviews have summarized the evidence regarding the effectiveness of serious games in improving processing speed, but they are undermined by some limitations.ObjectiveThis study aimed to examine the effectiveness of serious games on the cognitive processing speed of an older adult population living with cognitive impairment.MethodsA systematic review of randomized controlled trials (RCTs) was conducted. Two search sources were used in this review: 8 electronic databases and backward and forward reference list checking. A total of 2 reviewers independently checked the eligibility of the studies, extracted data from the included studies, and appraised the risk of bias and quality of the evidence. Evidence from the included studies was synthesized using a narrative and statistical approach (ie, meta-analysis), as appropriate.ResultsOf the 548 publications identified, 16 (2.9%) RCTs eventually met all eligibility criteria. Very-low-quality evidence from 50% (8/16) and 38% (6/16) of the RCTs showed no statistically significant effect of serious games on processing speed compared with no or passive intervention groups (P=.77) and conventional exercises (P=.58), respectively. A subgroup analysis showed that both types of serious games (cognitive training games: P=.26; exergames: P=.88) were as effective as conventional exercises in improving processing speed.ConclusionsThere is no superiority of serious games over no or passive interventions and conventional exercises in improving processing speed among older adults with cognitive impairment. However, our findings remain inconclusive because of the low quality of the evidence, the small sample size in most of the included studies, and the paucity of studies included in the meta-analyses. Therefore, until more robust evidence is published, serious games should be offered or used as an adjunct to existing interventions. Further trials should be undertaken to investigate the effect of serious games that specifically target processing speed rather than cognitive abilities in general.Trial RegistrationPROSPERO CRD42022301667; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=301667

Speech Processing as a Far-Transfer Gauge of Serious Games for Cognitive Training in Aging: Randomized Controlled Trial of Web-Based Effectivate Training.

BackgroundThe number of serious games for cognitive training in aging (SGCTAs) is proliferating in the market and attempting to combat one of the most feared aspects of aging—cognitive decline. However, the efficacy of many SGCTAs is still questionable. Even the measures used to validate SGCTAs are up for debate, with most studies using cognitive measures that gauge improvement in trained tasks, also known as near transfer. This study takes a different approach, testing the efficacy of the SGCTA—Effectivate—in generating tangible far-transfer improvements in a nontrained task—the Eye tracking of Word Identification in Noise Under Memory Increased Load (E-WINDMIL)—which tests speech processing in adverse conditions.ObjectiveThis study aimed to validate the use of a real-time measure of speech processing as a gauge of the far-transfer efficacy of an SGCTA designed to train executive functions.MethodsIn a randomized controlled trial that included 40 participants, we tested 20 (50%) older adults before and after self-administering the SGCTA Effectivate training and compared their performance with that of the control group of 20 (50%) older adults. The E-WINDMIL eye-tracking task was administered to all participants by blinded experimenters in 2 sessions separated by 2 to 8 weeks.ResultsSpecifically, we tested the change between sessions in the efficiency of segregating the spoken target word from its sound-sharing alternative, as the word unfolds in time. We found that training with the SGCTA Effectivate improved both early and late speech processing in adverse conditions, with higher discrimination scores in the training group than in the control group (early processing: F1,38=7.371; P=.01; ηp2=0.162 and late processing: F1,38=9.003; P=.005; ηp2=0.192).ConclusionsThis study found the E-WINDMIL measure of speech processing to be a valid gauge for the far-transfer effects of executive function training. As the SGCTA Effectivate does not train any auditory task or language processing, our results provide preliminary support for the ability of Effectivate to create a generalized cognitive improvement. Given the crucial role of speech processing in healthy and successful aging, we encourage researchers and developers to use speech processing measures, the E-WINDMIL in particular, to gauge the efficacy of SGCTAs. We advocate for increased industry-wide adoption of far-transfer metrics to gauge SGCTAs.

Effectiveness of Serious Games for Improving Executive Functions Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis.

BackgroundExecutive functions are one of the known cognitive abilities that decline with age. They are the high-order cognitive processes that enable an individual to concentrate, plan, and take action. Serious games, which are games developed for specific purposes other than entertainment, could play a positive role in improving executive functions. Several systematic reviews have pooled the evidence about the effectiveness of serious games in improving executive functions; however, they are limited by some weaknesses.ObjectiveThis study aims to investigate the effectiveness of serious games for improving executive functions among older adults with cognitive impairment.MethodsA systematic review of randomized controlled trials (RCTs) was conducted. To retrieve relevant studies, 8 electronic databases were searched. Further, reference lists of the included studies and relevant reviews were screened, and we checked studies that cited our included studies. Two reviewers independently checked the eligibility of the studies, extracted data from the included studies, assessed the risk of bias, and appraised the quality of the evidence. We used a narrative and statistical approach, as appropriate, to synthesize results of the included studies.ResultsOf 548 publications identified, 16 RCTs were eventually included in this review. Of the 16 studies, 14 studies were included in 6 meta-analyses. Our meta-analyses showed that serious games are as effective as no or passive interventions at improving executive functions (P=.29). Surprisingly, conventional exercises were more effective than serious games at improving executive functions (P=.03). Our subgroup analysis showed that both types of serious games (cognitive training games, P=.08; exergames, P=.16) are as effective as conventional exercises at improving executive functions. No difference was found between adaptive serious games and nonadaptive serious games for improving executive functions (P=.59).ConclusionsSerious games are not superior to no or passive interventions and conventional exercises at improving executive functions among older adults with cognitive impairment. However, our findings remain inconclusive due to the low quality of the evidence, the small sample size in most included studies, and the paucity of studies included in the meta-analyses. Accordingly, until more robust evidence is available, serious games should not be offered by health care providers nor used by patients for improving executive functions among older adults with cognitive impairment. Further reviews are needed to assess the long-term effect of serious games on specific executive functions or other cognitive abilities among people from different age groups with or without cognitive impairment.Trial RegistrationPROSPERO CRD42021272757; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=272757

Virtual reality-based targeted cognitive training program for Chinese older adults: A feasibility study

ObjectiveTo investigate the acceptance and tolerance of a targeted cognitive training program with virtual reality (VR) in Chinese older adults. MethodsWe developed a VR-based program consisting of five games for cognitive training. Fourteen older adults voluntarily participated in the VR training program from January 1 to 22, 2022. The tolerance of the participants and acceptance of the video-based training were assessed after training. ResultsOf the participants, 8 (57.1%) had normal cognitive function, and 6 (42.9%) had cognitive impairment. The participants tolerated the program well with a total SSQ (simulated sickness questionnaire) score of 10.42±12.97. Regarding acceptance, 97.6% of subjects found VR equipment to be easy to use, 76.2% said it was a positive experience, and 57.1% thought VR devices were attractive. ConclusionThis study shows that VR-based cognitive training was well tolerated by Chinese older adults, without major or severe adverse events.

Comparison of Feasibility of Touch-Based Cognitive Training Games in Community Elderly and Elderly with Minor Dementia

Comparison of Feasibility of Touch-Based Cognitive Training Games in Community Elderly and Elderly with Minor Dementia

Effectiveness of Serious Games for Language Processing Amongst Elderly Population with Cognitive Impairment: A Systematic Review and Meta-Analysis.

This article intended to carry out a systematic review on the effectiveness of serious games for language processing among older adults with cognitive impairment. Out of 548 retrieved records, six randomized controlled trials (RCTs) eventually met the eligibility criteria. A meta-analysis of four studies showed that serious games are more effective than no/passive interventions in enhancing language processing among older adults with cognitive impairment (p=0.008). Further, a statistically significant effect of serious games on language processing when compared with conventional cognitive activities and conventional exercises was reported in two RCTs. Other RCTs found that exergames are as effective as computerized cognitive training games in improving language processing. Serious games should be offered or used as complementary (i.e., not a substitute) to the current interventions. For there to be definitive conclusions about the efficacy of serious games on language processing more trials are needed.

Perceptions of Cognitive Training Games and Assessment Technologies for Dementia: Acceptability Study With Patient and Public Involvement Workshops.

BackgroundCognitive training and assessment technologies offer the promise of dementia risk reduction and a more timely diagnosis of dementia, respectively. Cognitive training games may help reduce the lifetime risk of dementia by helping to build cognitive reserve, whereas cognitive assessment technologies offer the opportunity for a more convenient approach to early detection or screening.ObjectiveThis study aims to elicit perspectives of potential end users on factors related to the acceptability of cognitive training games and assessment technologies, including their opinions on the meaningfulness of measurement of cognition, barriers to and facilitators of adoption, motivations to use games, and interrelationships with existing health care infrastructure.MethodsFour linked workshops were conducted with the same group, each focusing on a specific topic: meaningful improvement, learning and motivation, trust in digital diagnosis, and barriers to technology adoption. Participants in the workshops included local involvement team members acting as facilitators and those recruited via Join Dementia Research through a purposive selection and volunteer sampling method. Group activities were recorded, and transcripts were analyzed using thematic analysis with a combination of a priori and data-driven themes. Using a mixed methods approach, we investigated the relationships between the categories of the Capability, Opportunity, and Motivation–Behavior change model along with data-driven themes by measuring the φ coefficient between coded excerpts and ensuring the reliability of our coding scheme by using independent reviewers and assessing interrater reliability. Finally, we explored these themes and their relationships to address our research objectives.ResultsIn addition to discussions around the capability, motivation, and opportunity categories, several important themes emerged during the workshops: family and friends, cognition and mood, work and hobbies, and technology. Group participants mentioned the importance of functional and objective measures of cognitive change, the social aspect of activities as a motivating factor, and the opportunities and potential shortcomings of digital health care provision. Our quantitative results indicated at least moderate agreement on all but one of the coding schemes and good independence of our coding categories. Positive and statistically significant φ coefficients were observed between several coding themes between categories, including a relatively strong positive φ coefficient between capability and cognition (0.468; P<.001).ConclusionsThe implications for researchers and technology developers include assessing how cognitive training and screening pathways would integrate into existing health care systems; however, further work needs to be undertaken to address barriers to adoption and the potential real-world impact of cognitive training and screening technologies.International Registered Report Identifier (IRRID)RR2-10.1007/978-3-030-49065-2_4

Temporally and functionally distinct large-scale brain network dynamics supporting task switching

ObjectiveOur daily activities require frequent switches among competing responses at the millisecond time scale. We determined the spatiotemporal characteristics and functional significance of rapid, large-scale brain network dynamics during task switching. MethodsThis cross-sectional study investigated patients with drug-resistant focal epilepsy who played a Lumosity cognitive flexibility training game during intracranial electroencephalography (iEEG) recording. According to a given task rule, unpredictably switching across trials, participants had to swipe the screen in the direction the stimulus was pointing or moving. Using this data, we described the spatiotemporal characteristics of iEEG high-gamma augmentation occurring more intensely during switch than repeat trials, unattributable to the effect of task rule (pointing or moving), within-stimulus congruence (the direction of stimulus pointing and moving was same or different in a given trial), or accuracy of an immediately preceding response. Diffusion-weighted imaging (DWI) tractography determined whether distant cortical regions showing enhanced activation during task switch trials were directly connected by white matter tracts. Trial-by-trial iEEG analysis deduced whether the intensity of task switch-related high-gamma augmentation was altered through practice and whether high-gamma amplitude predicted the accuracy of an upcoming response among switch trials. ResultsThe average number of completed trials during five-minute gameplay was 221.4 per patient (range: 171–285). Task switch trials increased the response times, whereas later trials reduced them. Analysis of iEEG signals sampled from 860 brain sites effectively elucidated the distinct spatiotemporal characteristics of task switch, task rule, and post-error-specific high-gamma modulations. Post-cue, task switch-related high-gamma augmentation was initiated in the right calcarine cortex after 260 ms, right precuneus after 330 ms, right entorhinal after 420 ms, and bilateral anterior middle-frontal gyri after 450 ms. DWI tractography successfully showed the presence of direct white matter tracts connecting the right visual areas to the precuneus and anterior middle-frontal regions but not between the right precuneus and anterior middle-frontal regions. Task-related high-gamma amplitudes in later trials were reduced in the calcarine, entorhinal and anterior middle-frontal regions, but increased in the precuneus. Functionally, enhanced post-cue precuneus high-gamma augmentation improved the accuracy of subsequent responses among switch trials. ConclusionsOur multimodal analysis uncovered two temporally and functionally distinct network dynamics supporting task switching. High-gamma augmentation in the visual-precuneus pathway may reflect the neural process facilitating an attentional shift to a given updated task rule. High-gamma activity in the visual-dorsolateral prefrontal pathway, rapidly reduced through practice, may reflect the cost of executing appropriate stimulus-response translation.

The Effectiveness and Safety of Serious Games for Improving Cognitive Abilities Among Elderly People With Cognitive Impairment: Systematic Review and Meta-Analysis.

BackgroundCognitive impairment is a mental disorder that commonly affects elderly people. Serious games, which are games that have a purpose other than entertainment, have been used as a nonpharmacological intervention for improving cognitive abilities. The effectiveness and safety of serious games for improving cognitive abilities have been investigated by several systematic reviews; however, they are limited by design and methodological weaknesses.ObjectiveThis study aims to assess the effectiveness and safety of serious games for improving cognitive abilities among elderly people with cognitive impairment.MethodsA systematic review of randomized controlled trials (RCTs) was conducted. The following 8 electronic databases were searched: MEDLINE, Embase, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also screened reference lists of the included studies and relevant reviews, as well as checked studies citing our included studies. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies.ResultsFifteen studies met the eligibility criteria among 466 citations retrieved. Of those, 14 RCTs were eventually included in the meta-analysis. We found that, regardless of their type, serious games were more effective than no intervention (P=.04) and conventional exercises (P=.002) for improving global cognition among elderly people with cognitive impairment. Further, a subgroup analysis showed that cognitive training games were more effective than no intervention (P=.05) and conventional exercises (P<.001) for improving global cognition among elderly people with cognitive impairment. Another subgroup analysis demonstrated that exergames (a category of serious games that includes physical exercises) are as effective as no intervention and conventional exercises (P=.38) for improving global cognition among elderly people with cognitive impairment. Although some studies found adverse events from using serious games, the number of adverse events (ie, falls and exacerbations of pre-existing arthritis symptoms) was comparable between the serious game and control groups.ConclusionsSerious games and specifically cognitive training games have the potential to improve global cognition among elderly people with cognitive impairment. However, our findings remain inconclusive because the quality of evidence in all meta-analyses was very low, mainly due to the risk of bias raised in the majority of the included studies, high heterogeneity of the evidence, and imprecision of total effect sizes. Therefore, psychologists, psychiatrists, and patients should consider offering serious games as a complement and not a substitute to existing interventions until further more robust evidence is available. Further studies are needed to assess the effect of exergames, the safety of serious games, and their long-term effects.

Development of a computer-based cognitive training game and usage feasibility with Thai stroke patients

Background: Cognitive impairments are common sequelae found in patients after a stroke event, leading them to necessitate long-term care. Currently, there are two common cognitive approaches, namely conventional intervention, and technology-based intervention, with the latter having become extensively used, especially in developed countries. In a developing country like Thailand, there is still a clear lack of usage of computer-based cognitive training and there is still a lack of research focus on investigating the feasibility of its usage with Thai stroke patients. Objectives: This study aimed to develop a computer-based cognitive training game and investigate its feasibility for being used with Thai stroke patients Materials and methods: This study was a developmental research design consisting of two phases. Phase one involved the development, content validity, and pilot use of our computer-based cognitive training game. The game contents were examined by three experts, who are occupational therapists with more than 5 years of experience with cognitive rehabilitation for stroke patients, to assure content validity. Phase two instead, involved the process of investigating the feasibility of using the newly developed computer-based cognitive training games with Thai stroke patients. Participants in this study were stroke patients with cognitive impairments identified with the Mental State Examination (MSET10) and who were familiar with the technology. Fourteen participants were asked to rate their overall experience with the newly developed game, the design, the convenience aspects, and the portability of the training material, by using The Test of Satisfaction on Computer-based Cognitive Game. Demographic characteristics and user experiences were analyzed by descriptive statistics. Results: The newly developed computer-based cognitive training game, called CoWMeG, is a game-like training using simulated real-life activities whose design is based on the Thai ecosystem, and it consists of ten games. The game's contents involve working memory tasks, such as verbal, visuospatial, executive, and process speed skills-related tasks. Each game was designed to have different difficulty levels with each level consisting of three subsequential screen pages (i.e., instruction, playing, and scoring screen pages). Most of the participants rated their user experiences with CoWMeG as very satisfied, corresponding to 84.2 percent of the total answers on satisfaction. Conclusion: In accordance with the obtained results, the newly developed computer-based cognitive training game, named CoWMeG, may represent a feasible tool to be used with Thai stroke patients who have cognitive impairments.