Computerized and virtual reality cognitive training for individuals at high risk of cognitive decline: systematic review of the literature

Nonpharmacological Multimodal Interventions for Cognitive Functions in Older Adults With Mild Cognitive Impairment: Scoping Review

BACKGROUND

As the global population ages, the prevalence of dementia is expected to rise significantly. To alleviate the burden on health care systems and the economy, it is essential to develop effective strategies to enhance cognitive function in older adults. Previous studies have shown that combined nonpharmacological interventions can improve cognition across various domains in older individuals. However, there is no established gold standard for the exact combination and duration of these interventions, which makes it challenging to assess their overall effectiveness.

OBJECTIVE

Given the diversity of nonpharmacological multimodal interventions aimed at preventing cognitive decline in older adults with mild cognitive impairment (MCI), this scoping review sought to identify and summarize the characteristics and outcomes of these interventions.

METHODS

We adhered to the Arksey and O'Malley methodological framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and searched 4 electronic databases (MEDLINE, PsycINFO, CINAHL, and Web of Science) systematically on July 6, 2023, and updated the search on April 17, 2024, using specific terms and keywords.

RESULTS

This review included 45 studies from 18 countries with 4705 participants from 2014 to 2024 encompassing different combinations of physical training (PT), cognitive training (CT), nutrition intervention, psychosocial intervention, social activities, and electrical stimulation. There is a growing numbers of studies combining PT and CT for MCI treatment, with additional modalities often added to address various aspects of the condition. Compared to single-modal interventions and usual care, multimodal approaches demonstrated significantly better improvements in cognition domains such as attention, global cognition, executive function, memory, processing speed, and verbal fluency. Technology has been instrumental in delivering these interventions and enhancing the effects of PT and CT. Multimodal interventions also show promise in terms of acceptability and user experience, which can improve treatment adherence.

CONCLUSIONS

Research is limited regarding the cost-effectiveness and optimal dosage of these interventions, making it difficult to assess the additional benefits of incorporating more modalities. Future research should examine the long-term effects of incorporating multiple modalities, using standardized MCI criteria and outcome measures.

Effects of virtual reality-based interventions on cognitive function, emotional state, and quality of life in patients with mild cognitive impairment: a meta-analysis

Objectives

This meta-analysis aims to systematically evaluate the effects of virtual reality (VR)-based interventions on cognitive function, emotional state, and quality of life in patients with mild cognitive impairment (MCI).

Methods

A comprehensive literature search was conducted using five databases from their inception to June 2024. The inclusion criteria focused on randomized controlled trials (RCTs) that examined VR-based interventions in adults aged 60 or older diagnosed with MCI. The primary outcome was cognitive function, while secondary outcomes included emotional state, quality of life, and dynamic balance. To investigate potential sources of heterogeneity, subgroup analyses and meta-regression were conducted. Subgroup analyses were stratified by VR parameters (immersion level, duration, session, and frequency) and demographic factors (geographic region, education level, and male proportion). Publication bias was assessed using funnel plots and Egger's regression test. A "trim and fill" method was employed to adjust for any detected publication bias. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework with the GRADEpro GDT software.

Results

A total of 30 RCTs involving 1,365 participants from 9 countries across 4 continents were included. The meta-analysis revealed that VR-based interventions significantly improved global cognition, as assessed by the Montreal Cognitive Assessment (MoCA; SMD = 0.82, 95% CI: 0.27 to 1.38, p = 0.003, GRADE: moderate) and the Mini-Mental State Examination (MMSE; SMD = 0.83, 95% CI: 0.40 to 1.26, p = 0.0001, GRADE: low). Additionally, VR interventions enhanced attention, as measured by the Digit Span Backward (DSB; SMD = 0.61, 95% CI: 0.21 to 1.02, p = 0.003, GRADE: low) and Digit Span Forward (DSF; SMD = 0.89, 95% CI: 0.34 to 1.45, p = 0.002, GRADE: low). Improvements were also observed in quality of life, as indicated by scores on the Instrumental Activities of Daily Living (IADL; SMD = 0.22, 95% CI: 0.00 to 0.45, p = 0.049, GRADE: moderate). However, no significant effects were found for executive function, memory, verbal fluency, visual abilities, emotional status, or dynamic balance (p > 0.05). Subgroup analysis revealed that VR interventions were more effective when using semi-immersive VR, with session durations of ≤60 min and a frequency of more than twice per week. Participants from Asia and Europe demonstrated better outcomes, and a lower proportion of male participants (≤ 40%) was also associated with improvements in targeted cognitive domains.

Conclusion

The findings indicate that VR interventions can significantly improve global cognition, attention, and quality of life in individuals with MCI. Subgroup analyses further revealed that optimal cognitive outcomes were associated with semi-immersive VR, session durations of ≤60 min, intervention frequencies exceeding twice per week, studies conducted in Asia and Europe, and participant groups with a male proportion of ≤40%. Moreover, the study provides valuable insights into secondary outcomes, suggesting that VR interventions may positively impact emotional state and dynamic balance when appropriately tailored to factors such as immersion level, duration, frequency, and other relevant parameters.

Usability and Tolerability of Virtual Reality-Based Cognitive Stimulation in Healthy Elderly Volunteers-A Feasibility Clinical Trial

Background: The aim of the current pilot study was to evaluate the usability, acceptability, and tolerability of virtual reality (VR)-based cognitive stimulation exercises (CSEs) in healthy young versus old populations before health care integration. A secondary aim was to assess the accuracy of VR games as a proxy for cognitive stimulation, specifically for attention. VR-based CSEs promise to improve attention and brain function through varied learning systems. Methods: This is a Phase 1 feasibility clinical trial at a single center. It involves 30 healthy volunteers randomly selected using the American Society of Anesthesiologists (ASA) physical status classification system. Participants fall into ASA 1 (age >18-35 years, n = 15) or ASA 2 (age >60 years, n = 15) categories. All participants tested the ReCognitionVR-based CSEs. Feasibility criterion: Participants in each group were monitored for completion of 20 minutes of VR-based CSEs. Acceptability criterion: Proportion of participants with system usability scale (SUS) >35 or SUS score of 87.5. Safety (tolerability) monitoring: Sessions were monitored for neurological, cardiovascular, or pulmonary adverse events (AEs). Safety criterion: No more than 10% of sessions stopped due to neurological, cardiovascular, or pulmonary AEs. Results: The primary outcome (feasibility) of ReCognitionVR-based CSEs was 100%. For the secondary outcome (acceptability), there was no group difference in SUS scores (ASA 1 = 88.17 ± 12.83 vs. ASA 2 = 88.39 ± 10.22, P = 0.81). For the tertiary outcome (safety), mild transient uneasiness was reported by two (13.4%) ASA 1 participants (resolved in 2 minutes), and one (6.67%) ASA 1 participant experienced a temporary >20% increase in blood pressure from baseline. No ASA 2 participants had AEs. Conclusion: The feasibility, acceptability, and safety of ReCognitionVR-based CSEs in healthy elderly volunteers are acceptable, indicating that the evaluation of the ReCognitionVR-based CSEs in hospitalized patients is reasonable.

Effectiveness of Virtual Reality Intervention in Enhancing Motor and Cognitive Functions in Down Syndrome: A Systematic Review

Down syndrome (DS) is a chromosomal disorder and is most commonly associated with cognitive impairments, motor dysfunction, and developmental delays. Various therapeutic interventions have been implemented to improve developmental milestones and enhance the quality of life in DS patients. Hence, this systematic review was performed to evaluate the impact of virtual reality (VR) based physical and cognitive rehabilitation in individuals with DS. The databases involved in the literature search consisted of PubMed, Science Direct, and Google Scholar. Studies were included if they assessed or evaluated VR-based therapeutic interventions in individuals with DS of any age. Moreover, randomized controlled trials (RCTs) with full-text availability in English were incorporated. Furthermore, a mixed-method appraisal tool was utilized to assess the quality of the studies. A total of seven RCTs that met the inclusion criteria were included. The included studies demonstrated that VR-based interventions significantly improved motor function, postural control, physical fitness, and independent skills. However, compliance with clinical guidelines and healthcare transition planning for DS patients remain areas of concern. Additionally, future research should focus on conducting large, high-quality RCTs with standardized assessment tools and long-term follow-ups to establish evidence-based guidelines associated with VR therapy for individuals with DS.

Engagement in computerized cognitive training instructions by older people. A within-subject design to evaluate comprehension and acceptability of serious games instructions

This article emphasizes the advantages of using a within-subject experimental design to assess the impact of salient visual cues on the comprehension and acceptability of computerized cognitive training (CCT) instructions among older adults. The study would involve participants aged 65 and above, who will engage in an online experiment presenting two sets of instructions for serious games: one with salient visual cues and one without. This within-subject design eliminates the need for random assignment, improves internal consistency, and enhances statistical power. Participants serve as their own controls, providing a more robust comparison of how visual cues affect instruction comprehension and software acceptance. The primary objective is to identify indicators of acceptability for CCT serious games and to evaluate how well participants comprehend the instructions, influencing their intention to use the software. The hypothesis suggests that salient visual cues will improve instruction comprehension and foster greater software acceptability. By focusing on this design method, the study aims to enhance the engagement of older adults in cognitive training programs, reducing dropout rates. This research offers valuable insights into methodological strengths that can be applied in future studies to improve the usability and acceptance of CCT tools for older adults without cognitive impairments.

Effects of Virtual Reality-Based Activities of Daily Living Rehabilitation Training in Older Adults With Cognitive Frailty and Activities of Daily Living Impairments: A Randomized Controlled Trial

OBJECTIVES

Cognitive frailty, which is notably prevalent in nursing homes, correlates with a range of adverse health outcomes; however, interventions targeting this population are scarce, particularly those addressing activities of daily living (ADLs). The objective of this study was to evaluate the effects of virtual reality-based ADL rehabilitation training on older adults with cognitive frailty and ADL impairments.

DESIGN

A 2-arm randomized controlled trial.

SETTING AND PARTICIPANTS

Older adults with cognitive frailty and mild ADL impairments in a nursing home.

METHODS

Sixty-six eligible participants were equally randomized into intervention and control groups. The intervention involved 45-minute sessions conducted twice weekly for 12 weeks. Outcomes evaluated included ADL performance, cognition, frailty, depression, and quality of life. Assessments were performed at baseline, 6 weeks (T1), and 12 weeks (T2).

RESULTS

There was no statistically significant difference between the 2 groups at baseline. The mean age of the participants was 80.20 ± 9.14 years, and most were women (54.55%). Compared with the control group, the intervention group showed significant improvements in ADLs (T1: β = 6.33, T2: β = 12.79), basic ADLs (T1: β = 4.09, T2: β = 6.97), instrumental ADLs (T1: β = 2.24, T2: β = 4.12), cognition (T1: β = 3.67, T2: β = 4.42), frailty (T1: β = -0.76, T2: β = -1.27), and mental component summary of quality of life (T1: β = 8.49, T2: β = 16.44) at T1 and T2. By T2, significant improvements were observed in depression (T2: β = -2.06) and physical component summary of quality of life (T2: β = 8.52).

CONCLUSIONS AND IMPLICATIONS

For older adults with cognitive frailty and mild ADL impairments residing in a nursing home, the virtual reality-based ADL rehabilitation program was safe and effective. Following the 12-week intervention, significant improvements were observed in ADL performance, cognition, frailty, depression, and quality of life.

Virtual reality interventions and their effects on the cognition of individuals with Alzheimer's disease: A systematic review and meta-analysis

BACKGROUND

Dementia due to Alzheimer's disease (AD) is the most prevalent neurocognitive disorder in the world and impacts the individual's cognitive functions and functionality in the early stages of the condition. Virtual reality (VR) interventions can assist in non-pharmacological treatment in a more ecological way, positively impacting cognitive abilities. However, there are few studies on VR exclusively involving people with AD in randomized controlled trials.

OBJECTIVE

To evaluate the effects of VR intervention on the cognitive functions of people with AD.

METHODS

A systematically conducted search was carried out in MEDLINE, EMBASE, BVS, Web of Science, and Scopus. Eligible studies were randomized controlled trials comparing the efficacy of VR and traditional cognitive interventions in people with AD. Methodologic quality was assessed with the Cochrane risk of bias tool, and outcomes were calculated as risk ratios (for dichotomous outcomes) and mean differences (for continuous outcomes) with 95% confidence interval.

RESULTS

A total of three randomized controlled trials with 75 participants were included. An improvement in the performance of the VR group was observed in memory, especially when comparing the usual treatment [MD = 0.99; CI95%: 0.33; 1.66; I2 = 0%]. VR has little or no effect on participants' executive function [MD = 1.36; 95%CI: -1.12; 3.85; I2 = 0%] compared to the usual treatment.

CONCLUSIONS

Our study results cautiously suggest, despite the small number of participants, that VR intervention may be a suitable memory treatment for individuals diagnosed with AD.

Efficacy and safety of Neurocognitive Adaptive Training for Depression combined with SSRIs for treating cognitive impairment among patients with late-life depression: a 12-week, randomized controlled study

BACKGROUND

This randomized, open-label study examined the therapeutic effects of Neurocognitive Adaptive Training for Depression (NCAT-D) combined with selective serotonin reuptake inhibitors (SSRIs) on cognitive impairment among patients with late-life depression (LLD).

METHOD

Study data were collected from May 5, 2021, to April 21, 2023. Outpatients who met the diagnostic criteria for major depressive disorder according to the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (i.e., a total score on the 17-item Hamilton Depression Rating Scale (HAMD-17) ≥ 18 and a total score on the Montreal Cognitive Assessment scale (MOCA) < 26) were recruited at Beijing Anding Hospital. These participants were randomly assigned to receive up to 12 weeks of NCAT-D and SSRIs treatment (n = 57) or SSRIs with a control treatment (n = 61). Primary outcomes included changes in Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) scores from baseline to week 12 between the two groups. Assessments were conducted at baseline, after 2 weeks, 4 weeks, 8 weeks, and at 12 weeks. Mixed model repeated measures (MMRM) analysis was performed on modified intention-to-treat (mITT) and completer populations.

RESULTS

The full analysis set (FAS) included 118 patients (NCAT-D and SSRIs group, n = 57; SSRIs and Control group, n = 61). During the 12-week study period, MMRM analysis revealed a significantly greater reduction in cognitive function (as indicated by ADAS-cog total scores) from baseline to post-treatment in the NCAT-D and SSRIs group compared to the SSRIs and Control groups [(F (1,115) = 13.65, least-squares mean difference [95% CI]: -2.77 [- 3.73, - 1.81], p < 0.001)]. The intervention group showed a significantly greater reduction in HAMD-17 scores compared to the control group [MMRM, estimated mean difference (SE) between groups: -3.59 [- 5.02, - 2.15], p < 0.001]. There was no significant difference in the incidence of adverse events between the two groups.

CONCLUSIONS

NCAT-D combined with SSRIs was efficacious and well tolerated in LLD patients with cognitive impairment.

TRIAL REGISTRATION

Registered on October 18, 2022, at ClinicalTrials.gov Identifier: (#NCT05588102).

Effects of virtual reality-based cognitive training for adolescents with depressive episodes: A pilot randomized controlled study

Cognitive impairment is a common symptom in depression, yet few intervention strategies target adolescents. This study investigated the effects of an attention and working memory cognitive training system based on virtual reality (VRCT) in adolescents with mild to moderate depressive episodes. Adolescents with depression were randomized into a VR training group (VRG, n = 47) or a waitlist control group (WT, n = 46). The VR training consisted of three 10-min tasks per session, conducted three sessions per week for 20 sessions over 7 weeks. Forty-four healthy adolescents participated as a comparison group for baseline cognitive assessment. Cognitive functions and depressive symptoms were assessed using the Das-Naglieri cognitive assessment system, driven by the Planning, Attention, Simultaneous, and Successive (PASS) processing theory, and the Hamilton Depression Rating Scale-24 at pre- and post-intervention. Baseline results indicated significantly lower cognitive scores in patients compared to healthy adolescents. Post-intervention, the VRG demonstrated significant improvements in all four cognitive scales (effect sizes 0.56 to 0.76) and a significant reduction in depressive symptoms compared to the WT. These findings suggest that VRCT holds potential for improving cognitive impairments and alleviating depressive symptoms in adolescents with depression. Further large-scale and follow-up studies are necessary to confirm long-term benefits.

Introducing virtual reality to older adults: A qualitative analysis of a co-design innovation with care staff

Previous studies of Virtual Reality (VR) in aged care settings have demonstrated that the benefits can be multiple, including improved social connection and engagement and reduced social isolation in later life. However, there remains a lack of widespread uptake of VR in aged care facilities. This prompts an important question: Given the potential benefits, why is there such poor engagement in VR by aged care facilities? The aim of this qualitative study is to investigate the experience of introducing VR into an aged care facility. Our innovative approach supported care staff to introduce VR into aged care facilities. Fieldwork diaries and focus group discussions were used to document experiences of introducing VR, including the obstacles, challenges and benefits and the adaptations to aged care environments that were required to accommodate new VR activities. Thematic analysis of the data revealed that VR can be an important medium to support the wellbeing of older residents. However, our findings also indicate that there are significant challenges associated with introducing VR, including substantial costs in time, money and institutional resources and attention. This study concludes that, to be successful, VR requires substantive care and relational resources from both staff and residents that are only visible when paying attention to the contextual adjustments required to introduce the technology to a new setting. This suggests that other research on gerontechnologies would likely also benefit from further attention to the role of the broader social context - including care and relational resources - in ensuring their successful design and implementation.

Immersive Virtual Reality Cognitive Training for Improving Cognition and Depressive Symptoms Among Older Adults. Current Evidence and Future Recommendations. A Systematic Review

Older adults, particularly impacted by the pandemic, are anticipated to face considerable challenges to their cognitive and psychological health. Various cognitive training methods have been proposed to improve their cognitive decline through regular practice. Immersive virtual reality (IVR) offers a promising avenue to bolster cognitive and mental health care accessibility for older adults and has shown potential in augmenting traditional cognitive training methods. This systematic review aims to assess the efficacy of IVR-based cognitive training on improving cognitive impairments and depressive symptoms among older adults, irrespective of their level of cognitive decline. Systematic searches were conducted across MEDLINE-PubMed, EMBASE, and Web of Science databases from inception to December 2022. Only peer-reviewed articles reporting results from randomized controlled trials and pilot studies, focusing on the effects of VR-based cognitive training on adults aged 55 or older, were deemed eligible. Using the Cochrane Handbook for Systematic Reviews of Interventions, the risk of bias was appraised for each selected study. Out of 3,835 studies identified, 9 met the inclusion criteria. The qualitative analyses concluded that IVR cognitive training interventions enhanced certain cognitive functions and well-being among older adults, notably those with mild cognitive impairments. These interventions were particularly effective in boosting memory, visuospatial abilities, and measures related to depressive symptoms and overall well-being. However, enhancements were less pronounced for executive functions, attention, and global cognition. Based on these findings, we propose a set of tailored, inclusive, and evidence-based recommendations to adapt emerging technologies to better accommodate the needs of older adults.

DigiDOP: A framework for applying digital technology to the Differential Outcomes Procedure (DOP) for cognitive interventions in persons with neurocognitive disorders

We present a framework -Digi-DOP- that includes a series of evidence-based recommendations to design and apply cognitive interventions for people with Neurocognitive Disorders (NCDs) using a relatively new approach, the Differential Outcomes Procedure (DOP). To do so, we critically review the substantial experimental research conducted with relevant clinical and non-clinical populations, and the theoretical underpinnings of this procedure. We further discuss how existing digital technologies that have been used for cognitive interventions could be applied to overcome some of the limitations of DOP-based interventions and further enhance DOP benefits. Specifically, we present three digital DOP developments that are currently being designed, investigated and/or tested. Finally, we discuss constraints, ethical and legal considerations that need to be taken into account to ensure that the use of technology in DOP-based interventions proposed here does not widen disparities and inequalities. We hope that this framework will inform and guide digital health leaders and developers, researchers and healthcare professionals to design and apply DOP-based interventions for people with NCDs.

Exploring transfer effects on memory and its neural mechanisms through a computerized cognitive training in mild cognitive impairment: randomized controlled trial

BACKGROUND

Computerized cognitive training (CCT) has been proposed as a potential therapy for cognitive decline. One of the benefits of CCT is a transfer effect, but its mechanism on the memory domain is unclear. This study aimed to investigate the transfer effect of non-memory multidomain CCT on the memory domain and its neural basis in patients with mild cognitive impairment (MCI) through a randomized controlled trial.

METHODS

Patients with MCI recruited from memory clinics were randomly assigned to either the CCT or the control group. The CCT group received multidomain CCT training excluding memory training, while the control group read educational books with learning-based quizzes twice a week for 8 weeks. Participants underwent memory tests yielding a composite score, other cognitive domain tests, non-cognitive scales, and resting-state functional magnetic resonance imaging (rsfMRI), at baseline and after intervention. Within- and between-group comparisons, group × time interactions, and seed-to-voxel analyses in memory-involving brain networks were performed.

RESULTS

The CCT group showed improvement over the control group in memory domain (Group × time, F = 5.87, P = 0.03, η2 = 0.31), which was related with the increased connectivity in the hippocampal-frontal and fusiform-occipital network. No other cognitive and non-cognitive symptoms differed between groups after adjusting for covariates.

CONCLUSION

Eight weeks of multidomain CCT without memory training improved memory function and restored functional network in the hippocampal and medial temporal region in MCI patients. These results can provide evidence for the transferring ability of CCT on memory functioning with its neural basis.

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.

A multimodal group-based immersive virtual reality intervention for improving cognition and mental health in patients with post-covid-19 condition. A quasi-experimental design study

Introduction

Adults with Post-COVID-19 Condition (PCC) may show cognitive impairments in attention, processing speed, memory, and executive function. Multimodal programs that combine cognitive training, physical activity and emotional tasks, such as mindfulness-based interventions (MBIs), may offer a suitable alternative for improving PCC treatments. Immersive Virtual Reality (IVR) is a promising technology that can enhance traditional cognitive training, physical activity, and MBIs. The use of IVR technology may increase engagement with these interventions and potentially enhance the individual benefits of cognitive training, exercise and MBIs. The current study evaluated the impact of a multimodal IVR intervention, comparing this with a usual care intervention (control group), in order to assess changes in cognition and mental health in adults with PCC. We also aimed to assess user experience factors such as enjoyment, perceived improvement, and fatigue following each multimodal IVR session within the experimental group.

Method

Thirty-one participants with PCC symptoms were assigned to either the experimental group (IVR, n = 15) or the control group (usual care intervention, n = 16) in a quasi-experimental design study. The multimodal IVR intervention consisted of MBI, cognitive training and physical exercise and was delivered in a 60-min group session with 5 participants, twice a week, for 8 weeks (16 sessions in total). Measures of global cognition, attention, processing speed, verbal episodic memory and subjective memory complaints (primary measures), and depressive and anxiety symptoms and fatigue (secondary measures) were assessed at baseline and also after 8 weeks (post-intervention).

Results

Mixed between-group (group) and within-group (pre-post assessments) ANOVAs revealed significant group*time interactions in global cognition, simple attention, processing speed, memory and depressive symptoms, with large effect sizes (p < 0.05; partial η2 > 0.14). There was also a marginally significant group*time interaction for executive function (p = 0.05). Follow-up analyses comparing pre-and post-intervention outcomes for each group separately showed that the experimental group significantly improved in global cognition, processing speed, memory and depressive symptoms, while the control group showed no significant pre-post changes. Friedman tests showed a significant main effect of time (χ2(2) = 6.609, p = 0.04), with a gradual increase in enjoyment from the first, to the mid, and then to the final session. In addition, perceived improvement scores remained high throughout the intervention, and patient-reported fatigue levels did not fluctuate significantly throughout the intervention.

Conclusion

To our knowledge, no previous research has combined cognitive training, physical exercise and MBI using an IVR paradigm in adults with PCC. Despite their inherent limitations, our findings mark a pioneering step toward improving cognition and mental health outcomes in PCC through the innovative use of new technology and multimodal approaches. This first study should be accompanied by more extensive, randomized clinical trials aimed at further exploring and refining these interventions.

Intervention of computer-assisted cognitive training combined with occupational therapy in people with mild cognitive impairment: a randomized controlled trial

Objective

Investigate the impact of combined computerized cognitive training and occupational therapy on individuals with mild cognitive impairment (MCI).

Methods

We randomly assigned 118 MCI patients into two groups: a combined intervention group (n = 37) and a control group (n = 81), the latter receiving standard nursing care. The intervention group additionally underwent 12 weeks of computerized cognitive training and occupational therapy. Blind assessors evaluated cognitive performance, anxiety, depression, and daily living activities before the intervention, post-intervention, and at a 3-month follow-up.

Results

Repeated-measures analysis of variance showed that the sMoCA scores, HAMA scores, and ADL scores of the experimental group at T2 (post-intervention) and T3 (3-month follow-up) were higher than those of the control group, and the difference was statistically significant (p < 0.001, p < 0.001, p = 0.026).

Conclusion

Computerized cognitive training combined with occupational therapy can improve patients' cognitive status, enhance their compliance with continuing care, and maintain their anxiety and self-care ability at a stable level.

Clinical trial registration

https://www.chictr.org.cn/index.html, identifier ChiCTR2200065014.

A Pilot Study to Improve Cognitive Performance and Pupil Responses in Mild Cognitive Impaired Patients Using Gaze-Controlled Gaming

Mild cognitive impairment (MCI) may progress to severe forms of dementia, so therapy is needed to maintain cognitive abilities. The neural circuitry for oculomotor control is closely linked to that which controls cognitive behavior. In this study, we tested whether training the oculomotor system with gaze-controlled video games could improve cognitive behavior in MCI patients. Patients played a simple game for 2-3 weeks while a control group played the same game using a mouse. Cognitive improvement was assessed using the MoCA screening test and CANTAB. We also measured eye pupil and vergence responses in an oddball paradigm. The results showed an increased score on the MoCA test specifically for the visuospatial domain and on the Rapid Visual Information Processing test of the CANTAB battery. Pupil responses also increased to target stimuli. Patients in the control group did not show significant improvements. This pilot study provides evidence for the potential cognitive benefits of gaze-controlled gaming in MCI patients.

Immersive experiences in museums for elderly with cognitive disorders: a user-centered design approach

In the context of global aging, to explore the design needs of elderly with dementia in museum environments, to establish a user cognitive psychological model based on immersion theory, and to enhance the satisfaction of cognitively impaired dementia with the museum service experience. Using literature research, surveys, questionnaires, interviews, and focus groups, we analyze the experience design from the psychological demands of elderly with dementia, build a method of mining user needs by combining the KANO model with the analytic hierarchy process (AHP) method, and establish a model for evaluating the excellence of the experience of the museum environment. The conclusion shows that displaying museum virtual scenes or old objects can effectively increase the subjective well-being of people suffering from various health conditions. The method can accurately tap the attributes of the needs of elderly with dementia, break through the drawbacks of the traditional museum experience design which is dominated by the designer's subjective consciousness, and allow the audience to better experience the museum immersive experience, which provides a new idea and method for the effectiveness of cognitive interventions for elderly with cognitive disorders.

Use of Virtual Reality to Improve Spatial Orientation in Alzheimer's Disease and Mild Cognitive Impairment: A Systematic Review

BACKGROUND

Alzheimer's disease is a chronic, neurodegenerative condition that leads to a significant cognitive decline. One of the symptoms that greatly reduces the quality of daily functioning is the deterioration of spatial orientation abilities. A non-pharmacological treatment option for Alzheimer's disease, which is also employed to improve the cognitive functioning of individuals with mild cognitive impairment, is virtual reality training.

OBJECTIVE

To the best of the authors' knowledge, there is no existing systematic review on the use of virtual reality training to enhance spatial orientation in individuals with Alzheimer's disease or mild cognitive impairment. The review was therefore conducted to fill this gap. The findings of this review may support the efficacy of virtual reality in enhancing spatial orientation.

METHODS

Five databases were searched. The primary inclusion criteria were study participants aged over 60 years with a diagnosis of Alzheimer's disease or mild cognitive impairment and the use of virtual reality for improving spatial orientation. Six studies meeting these criteria were ultimately included in the review.

RESULTS

All included studies demonstrated an improvement in the spatial orientation of individuals with Alzheimer's disease or mild cognitive impairment following virtual reality training. This indicates the effectiveness of virtual reality technology in cognitive rehabilitation.

CONCLUSION

As virtual reality cognitive training has proven effective, its use should be more widely adopted. Further research on the application of virtual reality for enhancing spatial orientation in individuals with dementia is recommended.

Effects of Virtual Reality Physical and Cognitive Training Intervention On Cognitive Abilities of Elders with Mild Cognitive Impairment

Background

Virtual reality (VR) technology has become increasingly used for assessment and intervention in the neuroscience field.

Objective

We aimed to investigate the effects of a VR Training System, named VRADA (VR Exercise App for Dementia and Alzheimer's Patients), on the cognitive functioning of older people with mild cognitive impairment (MCI).

Methods

In this intervention study, 122 older adults with MCI were randomly assigned to five groups (the VRADA group (n = 28), a bike group (n = 11), a physical exercise group (n = 24), a mixed group (physical and cognitive exercise) (n = 31), and a non-contact control group (n = 28). The VRADA group underwent 32 physical and cognitive training sessions, performed 2 or 3 times weekly for 12 weeks in the VR environment. All participants had detailed neuropsychological assessments before and after intervention.

Results

A series of linear regression models revealed that the VRADA group showed improvement or no deterioration in cognitive decline in global cognitive function (MMSE), verbal memory (Rey Auditory Verbal Learning Test and WAIS forward test), and executive functions, mental flexibility (Trail Making Test B).

Conclusions

This interventionstudy indicates that the VRADA system improves the cognitive function of elders with MCI.

Virtual reality applications based on instrumental activities of daily living (iADLs) for cognitive intervention in older adults: a systematic review

BACKGROUND

In recent years, the use of virtual reality (VR) as a complementary intervention in treating cognitive impairment has significantly increased. VR applications based on instrumental activities of daily living (iADL-VR) could offer a promising approach with greater ecological validity for intervention in groups with cognitive impairments. However, the effectiveness of this approach is still debated.

OBJECTIVE

This systematic review aims to synthesize the effects of iADL-VR interventions to rehabilitate, train, or stimulate cognitive functions in healthy adults and people with mild cognitive impairment (MCI) and different types of dementia.

METHODS

A systematic search was performed in the Scopus, PubMed, IEEE Xplore, Web of Science, and APA PsycNet databases until September 2022 and repeated in April 2023. The selected studies met the search terms, were peer-reviewed, included an iADL-VR intervention, and were written in English. Descriptive, qualitative studies, reviews, cognitive assessment, non-intervention studies, those unrelated to VR or iADL, those focused on motor aspects, and non-degenerative disorders were excluded. The PEDro scale was used to assess the methodological quality of the controlled studies. To present and synthesize the results, we organized the extracted data into three tables, including PEDro scores, participant characteristics, and study characteristics.

RESULTS

Nineteen studies that met the inclusion and exclusion criteria were included. The total sample reached 590 participants, mostly women (72.67%). Approximately 30% were diagnosed with Alzheimer's disease or dementia, and 20% had mild cognitive impairment. Variables such as authors and year of publication, study design, type of intervention and VR applied, duration of the intervention, main findings, and conclusions were extracted. Regarding demographic characteristics, the sample size, age, sex, years of education, neurological diagnosis, dropouts, and the city and country where the intervention took place were recorded. Almost all studies showed improvements in some or all the outcomes after the intervention, generally greater in the iADL-VR group than in the control group.

CONCLUSION

iADL-VR interventions could be beneficial in improving the performance of cognitive functions in older adults and people with MCI and different types of dementia. The ecological component of these tasks makes them very suitable for transferring what has been learned to the real world. However, such transfer needs to be confirmed by further studies with larger and more homogeneous samples and longer follow-up periods. This review had no primary funding source and was registered with PROSPERO under registration ID: 375166.

The attention atlas virtual reality platform maps three-dimensional (3D) attention in unilateral spatial neglect patients: a protocol

BACKGROUND

Deficits in visuospatial attention, known as neglect, are common following brain injury, but underdiagnosed and poorly treated, resulting in long-term cognitive disability. In clinical settings, neglect is often assessed using simple pen-and-paper tests. While convenient, these cannot characterise the full spectrum of neglect. This protocol reports a research programme that compares traditional neglect assessments with a novel virtual reality attention assessment platform: The Attention Atlas (AA).

METHODS/DESIGN

The AA was codesigned by researchers and clinicians to meet the clinical need for improved neglect assessment. The AA uses a visual search paradigm to map the attended space in three dimensions and seeks to identify the optimal parameters that best distinguish neglect from non-neglect, and the spectrum of neglect, by providing near-time feedback to clinicians on system-level behavioural performance. A series of experiments will address procedural, scientific, patient, and clinical feasibility domains.

RESULTS

Analyses focuses on descriptive measures of reaction time, accuracy data for target localisation, and histogram-based raycast attentional mapping analysis; which measures the individual's orientation in space, and inter- and intra-individual variation of visuospatial attention. We will compare neglect and control data using parametric between-subjects analyses. We present example individual-level results produced in near-time during visual search.

CONCLUSIONS

The development and validation of the AA is part of a new generation of translational neuroscience that exploits the latest advances in technology and brain science, including technology repurposed from the consumer gaming market. This approach to rehabilitation has the potential for highly accurate, highly engaging, personalised care.

Internet usage and the prospective risk of dementia: A population-based cohort study

BACKGROUND

Little is known about the long-term cognitive impact of internet usage among older adults. This research characterized the association between various measures of internet usage and dementia.

METHODS

We followed dementia-free adults aged 50-64.9 for a maximum of 17.1 (median = 7.9) years using the Health and Retirement Study. The association between time-to-dementia and baseline internet usage was examined using cause-specific Cox models, adjusting for delayed entry and covariates. We also examined the interaction between internet usage and education, race-ethnicity, sex, and generation. Furthermore, we examined whether the risk of dementia varies by the cumulative period of regular internet usage to see if starting or continuing usage in old age modulates subsequent risk. Finally, we examined the association between the risk of dementia and daily hours of usage. Analyses were conducted from September 2021 to November 2022.

RESULTS

In 18,154 adults, regular internet usage was associated with approximately half the risk of dementia compared to non-regular usage, CHR (cause-specific hazard ratio) = 0.57, 95% CI = 0.46-0.71. The association was maintained after adjustments for self-selection into baseline usage (CHR = 0.54, 95% CI = 0.41-0.72) and signs of cognitive decline at the baseline (CHR = 0.62, 95% CI = 0.46-0.85). The difference in risk between regular and non-regular users did not vary by educational attainment, race-ethnicity, sex, and generation. In addition, additional periods of regular usage were associated with significantly reduced dementia risk, CHR = 0.80, 95% CI = 0.68-0.95. However, estimates for daily hours of usage suggested a U-shaped relationship with dementia incidence. The lowest risk was observed among adults with 0.1-2 h of usage, though estimates were non-significant due to small sample sizes.

CONCLUSIONS

Regular internet users experienced approximately half the risk of dementia than non-regular users. Being a regular internet user for longer periods in late adulthood was associated with delayed cognitive impairment, although further evidence is needed on potential adverse effects of excessive usage.

A systematic review: Virtual-reality-based techniques for human exercises and health improvement

Virtual Reality (VR) has emerged as a new safe and efficient tool for the rehabilitation of many childhood and adulthood illnesses. VR-based therapies have the potential to improve both motor and functional skills in a wide range of age groups through cortical reorganization and the activation of various neuronal connections. Recently, the potential for using serious VR-based games that combine perceptual learning and dichoptic stimulation has been explored for the rehabilitation of ophthalmological and neurological disorders. In ophthalmology, several clinical studies have demonstrated the ability to use VR training to enhance stereopsis, contrast sensitivity, and visual acuity. The use of VR technology provides a significant advantage in training each eye individually without requiring occlusion or penalty. In neurological disorders, the majority of patients undergo recurrent episodes (relapses) of neurological impairment, however, in a few cases (60-80%), the illness progresses over time and becomes chronic, consequential in cumulated motor disability and cognitive deficits. Current research on memory restoration has been spurred by theories about brain plasticity and findings concerning the nervous system's capacity to reconstruct cellular synapses as a result of interaction with enriched environments. Therefore, the use of VR training can play an important role in the improvement of cognitive function and motor disability. Although there are several reviews in the community employing relevant Artificial Intelligence in healthcare, VR has not yet been thoroughly examined in this regard. In this systematic review, we examine the key ideas of VR-based training for prevention and control measurements in ocular diseases such as Myopia, Amblyopia, Presbyopia, and Age-related Macular Degeneration (AMD), and neurological disorders such as Alzheimer, Multiple Sclerosis (MS) Epilepsy and Autism spectrum disorder. This review highlights the fundamentals of VR technologies regarding their clinical research in healthcare. Moreover, these findings will raise community awareness of using VR training and help researchers to learn new techniques to prevent and cure different diseases. We further discuss the current challenges of using VR devices, as well as the future prospects of human training.

Digital Intervention For The Management Of Alzheimer's Disease

Alzheimer's disease (AD) is a progressive, multifactorial, chronic, neurodegenerative disease with high prevalence and limited therapeutic options, making it a global health crisis. Being the most common cause of dementia, AD erodes the cognitive, functional, and social abilities of the individual and causes escalating medical and psychosocial needs. As yet, this disorder has no cure and current treatment options are palliative in nature. There is an urgent need for novel therapy to address this pressing challenge. Digital therapeutics (Dtx) is one such novel therapy that is gaining popularity globally. Dtx provides evidence based therapeutic interventions driven by internet and software, employing tools such as mobile devices, computers, videogames, apps, sensors, virtual reality aiding in the prevention, management, and treatment of ailments like neurological abnormalities and chronic diseases. Dtx acts as a supportive tool for the optimization of patient care, individualized treatment and improved health outcomes. Dtx uses visual, sound and other non-invasive approaches for instance-consistent therapy, reminiscence therapy, computerised cognitive training, semantic and phonological assistance devices, wearables and computer-assisted rehabilitation environment to find applications in Alzheimer's disease for improving memory, cognition, functional abilities and managing motor symptom. A few of the Dtx-based tools employed in AD include "Memory Matters", "AlzSense", "Alzheimer Assistant", "smart robotic dog", "Immersive virtual reality (iVR)" and the most current gamma stimulation. The purpose of this review is to summarize the current trends in digital health in AD and explore the benefits, challenges, and impediments of using Dtx as an adjunctive therapy for the management of AD.

Inclusion of hearing and vision impairments in cognitive training interventions

Introduction

Cognitive training can potentially reduce risk of cognitive decline and dementia in older adults. To support implementation of cognitive training in the broader population of older adults, it is critical to evaluate intervention implementation and efficacy among representative samples, particularly those at highest risk of cognitive decline. Hearing and vision impairments are highly prevalent among older adults and confer increased risk of cognitive decline/dementia. Whether cognitive training interventions enroll and are designed to include this important subgroup is unknown.

Methods

A scoping review of PubMed and PsycINFO was conducted to examine the inclusion of older adults with hearing and vision impairment in cognitive training interventions. Two independent reviewers completed a full-text review of eligible articles. Eligible articles included cognitive training and multimodal randomized controlled trials and a study population that was cognitively unimpaired, aged ≥55-years, and community dwelling. Articles were primary outcome papers published in English.

Results

Among the 130 articles included in the review, 103 were cognitive training interventions (79%) and 27 were multimodal interventions (21%). More than half the trials systematically excluded participants with hearing and/or vision impairment (n = 60, 58%). Few studies reported hearing and vision measurement (cognitive: n = 16, 16%; multimodal: n = 3, 11%) or incorporated universal design and accessibility into intervention design (cognitive: n = 7, 7%; multimodal: n = 0, 0%).

Discussion

Older adults with hearing and vision impairment are underrepresented in cognitive training interventions. Reporting of hearing and vision measurement, proper justification of exclusions, and inclusion of accessibility and universal intervention design are also lacking. These findings raise concerns about whether current trial findings apply to those with hearing and vision impairment and generalize to the broader population of older adults. It is critical to include more diverse study populations and integrate accessibility into intervention design to include and better represent older adults with hearing and vision impairment.

Highlights

Cognitive training interventions underrepresent hearing and vision impairment.Sensory measurement and proper justification of exclusions are rarely reported.Interventions lack inclusion of accessibility and universal intervention design.More diverse study populations are needed in cognitive training interventions.Integration of accessibility into cognitive training intervention design is needed.

Treadmill training with virtual reality to enhance gait and cognitive function among people with multiple sclerosis: a randomized controlled trial

BACKGROUND

Motor and cognitive impairments impact the everyday functioning of people with MS (pwMS). The present randomized controlled trial (RCT) evaluated the benefits of a combined motor-cognitive virtual reality training program on key motor and cognitive symptoms and related outcomes in pwMS.

METHODS

In a single-blinded, two-arm RCT, 124 pwMS were randomized into a treadmill training with virtual reality (TT + VR) group or a treadmill training alone (TT) (active-control) group. Both groups received three training sessions per week for 6 weeks. Dual-tasking gait speed and cognitive processing speed (Symbol Digit Modalities Test, SDMT, score) were the primary outcomes. Secondary outcomes included additional tests of cognitive function, mobility, and patient-reported questionnaires. These were measured before, after, and 3 months after training.

RESULTS

Gait speed improved (p < 0.005) in both groups, similarly, by about 10 cm/s. The TT + VR group (n = 53 analyzed per-protocol) showed a clinically meaningful improvement of 4.4 points (95% CI 1.9-6.8, p = 0.001) in SDMT, compared to an improvement of only 0.8 points in the TT (n = 51 analyzed per-protocol) group (95% CI 0.9-2.5 points, p = 0.358) (group X time interaction effect p = 0.027). Furthermore, TT + VR group-specific improvements were seen in depressive symptoms (lowered by 31%, p = 0.003), attention (17%, p < 0.001), and verbal fluency (11.6% increase, p = 0.002).

DISCUSSION

These findings suggest that both TT and TT + VR improve usual and dual-task gait in pwMS. Nonetheless, a multi-modal approach based on VR positively impacts multiple aspects of cognitive function and mental health, more than seen after treadmill-treading alone. Trial registered at ClinicalTrials.Gov NCT02427997.

Functional improvement in chronic stroke patients when following a supervised home-based computerized cognitive training

BACKGROUND

Computerized Cognitive Training (CCT) is an effective treatment for cognitive impairment in the post-acute stage of stroke. However, it is still not clear if it is suitable for chronic stage.

OBJECTIVES

To explore if patients with cognitive deficit following stroke may benefit from CCT.

METHODS

Thirty patients post-stroke between 24 and 62 years old were randomized into two groups (A and B) to receive two different types of CCT. All patients were tested with a neuropsychological battery and functional questionnaires, before and after each CCT and also 6 months after the end of the study. In phase I, Group A received a customized CCT and Group B received a non-customized CCT, over 6 weeks. Three months after, each group received the other intervention (phase II).

RESULTS

After phase I, between-group analyses revealed that Group A showed a relative decrease in subjective complaints. In contrast, Group B showed improvement in performance-based measures. After phase II, the decrease in subjective complaints continued in Group A, and both groups showed improvement in performance-based measures.

CONCLUSIONS

Patients with chronic stroke improved cognitive functioning after performing supervised home-based multi-domain computerized cognitive training.

Therapeutic Application of Virtual Reality in the Rehabilitation of Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

This review aimed to quantify the effect of therapeutic application of virtual reality (VR) on cognitive function in individuals with mild cognitive impairment (MCI). We searched for randomized controlled trials involving VR in the interventions provided to individuals with MCI. After searching four international electronic databases, we analyzed six studies involving 279 individuals with MCI. RevMan 5.4 was used for quality assessment and quantitative analysis. Therapeutic application of VR in individuals with MCI resulted in a significant improvement in cognitive function (mean difference = -1.46; 95% confidence interval: -2.53 to -0.39; heterogeneity: χ² = 970.56, df = 18, I² = 98%; and overall effect: Z = 2.67, p = 0.008). However, there was no significant improvement in the subcategories such as global cognition, working memory, executive function, memory function, and attention. In conclusion, feedback stimulation through VR has a potential value in improving cognitive function in individuals with MCI. However, on the basis of the results of the subcategories, a personalized VR program is required for the individual subcategories of cognitive function.

Effectiveness of Computerized Cognitive Training in Delaying Cognitive Function Decline in People With Mild Cognitive Impairment: Systematic Review and Meta-analysis

Background

With no current cure for mild cognitive impairment (MCI), delaying its progression could significantly reduce the disease burden and improve the quality of life for patients with MCI. Computerized cognitive training (CCT) has recently become a potential instrument for improvement of cognition. However, the evidence for its effectiveness remains limited.

Objective

This systematic review aims to (1) analyze the efficacy of CCT on cognitive impairment or cognitive decline in patients with MCI and (2) analyze the relationship between the characteristics of CCT interventions and cognition-related health outcomes.

Methods

A systematic search was performed using MEDLINE, Cochrane, Embase, Web of Science, and Google Scholar. Full texts of randomized controlled trials of CCT interventions in adults with MCI and published in English language journals between 2010 and 2021 were included. Overall global cognitive function and domain-specific cognition were pooled using a random-effects model. Sensitivity analyses were performed to determine the reasons for heterogeneity and to test the robustness of the results. Subgroup analyses were performed to identify the relationship between the characteristics of CCT interventions and cognition-related effectiveness.

Results

A total of 18 studies with 1059 participants were included in this review. According to the meta-analysis, CCT intervention provided a significant but small increase in global cognitive function compared to that in the global cognitive function of the control groups (standardized mean difference=0.54, 95% CI 0.35-0.73; I2=38%). CCT intervention also resulted in a marginal improvement in domain-specific cognition compared to that in the control groups, with moderate heterogeneity. Subgroup analyses showed consistent improvement in global cognitive behavior in the CCT intervention groups.

Conclusions

This systematic review suggests that CCT interventions could improve global cognitive function in patients with MCI. Considering the relatively small sample size and the short treatment duration in all the included studies, more comprehensive trials are needed to quantify both the impact of CCT on cognitive decline, especially in the longer term, and to establish whether CCT should be recommended for use in clinical practice.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42021278884; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=278884

Artificial Cognitive Systems Applied in Executive Function Stimulation and Rehabilitation Programs: A Systematic Review

This article presents a systematic review of studies on cognitive training programs based on artificial cognitive systems and digital technologies and their effect on executive functions. The aim has been to identify which populations have been studied, the characteristics of the implemented programs, the types of implemented cognitive systems and digital technologies, the evaluated executive functions, and the key findings of these studies. The review has been carried out following the PRISMA protocol; five databases have been selected from which 1889 records were extracted. The articles were filtered following established criteria, to give a final selection of 264 articles that have been used for the purposes of this study in the analysis phase. The findings showed that the most studied populations were school-age children and the elderly. The most studied executive functions were working memory and attentional processes, followed by inhibitory control and processing speed. Many programs were commercial, customizable, gamified, and based on classic tasks. Some more recent initiatives have begun to incorporate user-machine interfaces, robotics, and virtual reality, although studies on their effects remain scarce. The studies recognize multiple benefits of computerized neuropsychological stimulation and rehabilitation programs for executive functions in different age groups, but there is a lack of studies in specific population sectors and with more rigorous research designs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13369-022-07292-5.

Home-Based Electronic Cognitive Therapy in Patients With Alzheimer Disease: Feasibility Randomized Controlled Trial

BACKGROUND

Can home-based computerized cognitive training programs be a useful tool to sustain cognition and quality of life in patients with Alzheimer disease (AD)? To date, the progressive nature of the disease has made this question difficult to answer. Computerized platforms provide more accessibility to cognitive trainings; however, the feasibility of long-term, home-based computerized programs for patients with AD dementia remains unclear.

OBJECTIVE

We aimed to investigate the feasibility of a 24-week home-based intervention program using the Constant Therapy app and its preliminary efficacy on cognition in patients with AD. Constant Therapy is a program developed for patients with speech and cognitive deficits. We hypothesized that patients with AD would use Constant Therapy daily over the course of the 24-week period.

METHODS

Data were collected over a 48-week period. We recruited participants aged between 50 and 90 years with a diagnosis of mild cognitive impairment due to AD or mild AD dementia. Participants were randomly assigned to either the Constant Therapy (n=10) or active control (n=9) group. The Constant Therapy group completed a tablet-based training during the first 24 weeks; the second 24 weeks of computerized training were optional. The active control group completed paper-and-pencil games during the first 24 weeks and were invited to complete an optional Constant Therapy training during the second 24 weeks. Every 6 weeks, the participants completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The participants independently accessed Constant Therapy using an Apple iPad. Our primary feasibility outcomes were the rate of adherence and daily use of Constant Therapy over 24 weeks. Our secondary outcomes were Constant Therapy performance over 24 weeks and change in RBANS scores between the 2 experimental groups.

RESULTS

Feasibility analyses were computed for participants who completed 24 weeks of Constant Therapy. We found that long-term use of the Constant Therapy program was feasible in patients with AD over 24 weeks (adherence 80%; program use 121/168 days, for 32 minutes daily). These participants showed an overall improvement in accuracy and latency (P=.005) in the Constant Therapy scores, as well as specific improvements in visual and auditory memory, attention, and arithmetic tasks. The Constant Therapy group showed improvement in the RBANS coding subtest. No unexpected problems or adverse events were observed.

CONCLUSIONS

Long-term (eg, 24 weeks) computerized cognitive training using Constant Therapy is feasible in patients with AD in the mild cognitive impairment and mild dementia stages. Patients adhered more to Constant Therapy than to the paper-and-pencil training over 24 weeks and improved their performance over time. These findings support the development of future randomized controlled trials that will investigate the efficacy of Constant Therapy to sustain cognitive function in patients with AD.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02521558; https://clinicaltrials.gov/ct2/show/NCT02521558.

Systematic review of the application of virtual reality to improve balance, gait and motor function in patients with Parkinson's disease

BACKGROUND

Virtual reality (VR) is an advanced technique used in physical rehabilitation of neurological disorders, however the effects of VR on balance, gait, and motor function in people with Parkinson's (PD) are still debated. Therefore, the systematic review aimed to determine the role of VR on motor function, balance and gait in PD patients.

METHODS

A comprehensive search to identify similar randomised controlled trials was conducted targeting 5 databases including Web of Science, PubMed, CINHAL, Cochrane Library, and Physiotherapy Evidence Database. A total of 25 studies were found eligible for this systematic review, and the methodological assessment of the quality rating of the studies was accomplished using the physiotherapy evidence database scale by 2 authors.

RESULTS

Out of the 25 included studies, 14 studies reported on balance as the primary outcome, 9 studies were conducted to assess motor function, and 12 assessed gait as the primary outcome. Most studies used the Unified Parkinson disease rating scale UPDRS (part-III) for evaluating motor function and the Berg Balance Scale as primary outcome measure for assessing balance. A total of 24 trials were conducted in clinical settings, and only 1 study was home-based VR trainings. Out of 9 studies on motor function, 6 reported equal improvement of motor function as compared to other groups. In addition, VR groups also revealed superior results in improving static balance among patient with PD.

CONCLUSION

This systemic review found that the use of VR resulted in substantial improvements in balance, gait, and motor skills in patients with PD when compared to traditional physical therapy exercises or in combination with treatments other than physical therapy. Moreover, VR can be used as a supportive method for physical rehabilitation in patients of PD. However, the majority of published studies were of fair and good quality, suggesting a demand for high quality research in this area.

The application of technology to improve cognition in older adults: A review and suggestions for future directions

The rapidly increasing worldwide population of older adults, along with the increasing prevalence of cognitive impairment and dementia in this population, is a growing health‐care problem. As such, advances in technology‐based cognitive interventions and games are playing an increasingly key role in preserving and improving older adults' cognitive function, especially during the COVID‐19 pandemic when opportunities for face‐to‐face activities or training are few. In this paper, we summarize from previous studies systematic reviews and meta‐analyses on the various types of technology used in cognitive interventions (namely, computerized cognitive training, virtual‐reality interventions and robot‐assisted interventions) and the empirical evidence on the effects of these technologies on global and specific cognitive functions in healthy and clinical populations of older adults (e.g., older adults with mild cognitive impairment or dementia). We also describe older adults' perceptions, experiences and acceptance of these technologies. Finally, we discuss the limitations, challenges and future avenues of research in this field.

Effects of cognitive interventions on quality of life among adults with mild cognitive impairment: A systematic review and meta-analysis of randomised controlled trials

BACKGROUND

There is considerable research exploring the impact of cognitive interventions on cognition in people with mild cognitive impairment (MCI). However, the impact on quality of life (QOL) is not routinely reported. As QOL is a key predictor of health outcomes, it is important to determine the evidence supporting cognitive interventions for improving QOL in people with MCI.

OBJECTIVE

To evaluate the evidence on the effectiveness of cognitive interventions for improving QOL among people with MCI.

DESIGN

Systematic review and meta-analysis.

METHODS

A systematic database search was conducted from inception to December 11, 2021, using four databases. Quality assessment was conducted, and data on the characteristics of the studies and the effects on QOL were extracted. Subgroup analyses and meta-regression were conducted to elucidate the effects of potential moderator variables on QOL measures.

RESULTS

Of the 1550 records initially identified, 17 studies met the criteria for the final meta-analysis. The findings revealed that cognitive interventions produced moderate gains in overall QOL compared to the control group at the posttest (standardized mean difference (SMD): 0.53, 95% confidence interval (CI): [0.23, 0.84]), but no statistically significant differences were found at the end of follow-up (SMD: 0.40, 95% CI: [-0.15,0.94]). Furthermore, the effects of cognitive interventions were moderated by intervention duration, session duration, and study location. However, intervention types, session frequency, intervention components, control condition, total number of sessions, types of QOL measures, and responders to QOL-AD had no statistically significant effects on QOL outcome.

CONCLUSIONS

Cognitive interventions have positive effects on QOL among adults with MCI. However, the high heterogeneity of the included studies calls for more well-designed cognitive intervention trials to examine the association between QOL and relevant moderators.

Effects of Virtual Reality Rehabilitation Training on Cognitive Function and Activities of Daily Living of Patients With Poststroke Cognitive Impairment: A Systematic Review and Meta-Analysis

OBJECTIVE

To determine the effects of virtual reality (VR) rehabilitation training on the cognitive function and activities of daily living (ADL) of patients with poststroke cognitive impairment (PSCI).

DATA SOURCES

Four Chinese databases and 6 English databases were systematically searched for studies published until August 31, 2021, by using Medical Subject Headings of the National Library of Medicine terms such as virtual reality, cognition disorders, cognitive dysfunction, and stroke and free terms such as virtual environment, VR, cognition impairment, cerebrovascular accident, and PSCI.

STUDY SELECTION

Randomized controlled trials treating PSCI with VR training were included. The control groups received conventional treatments such as conventional rehabilitation training and drug therapy; the experimental groups received VR rehabilitation training. The outcome measures were cognitive function and ADL.

DATA EXTRACTION

Two researchers independently extracted key information from eligible studies. The methodological quality of the studies was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions v5.1.0. Meta-analysis was performed using RevMan v5.4. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.

DATA SYNTHESIS

Twenty-one studies (1149 participants) were included. Meta-analyses found that compared with the control group, VR rehabilitation training increased Mini-Mental State Examination, Montreal Cognitive Assessment, Loewenstein Occupational Therapy Cognitive Assessment, Rivermead Behavioral Memory Test Second Edition, Barthel Index, Modified Barthel Index, and FIM scores; event-related potential 300 (P300) amplitude; and the N-acetylaspartate/creatinine (Cr) ratio on proton magnetic resonance spectroscopy (1H-MRS) and reduced P300 latency; Trail Making Test scores; and the choline-containing compounds/Cr ratio on 1H-MRS (all P<.05). These results indicated that VR training improved cognitive function and ADL in PSCI.

CONCLUSIONS

VR rehabilitation training promotes the rehabilitation of cognitive function and recovery of ADL in patients with PSCI and may be a good complementary approach to conventional cognitive interventions.

Computerised cognitive training tools and online nutritional group counselling for people with mild cognitive impairment: study protocol of a completely digital, randomised, controlled trial

INTRODUCTION

People with mild cognitive impairment (MCI) are at increased risk of decreasing cognitive functioning. Computerised cognitive training (CCT) and nutrition have been shown to improve the cognitive capacities of people with MCI. For each variable, we developed two kinds of interventions specialised for people with MCI (CCT: 'individualised' CCT; nutrition: a whole-food, plant-based diet). Additionally, there are two kinds of active control measures (CCT: 'basic' CCT; nutrition: a healthy diet following the current guidelines of the German Nutrition Society). The aim of this study is to investigate the effects of the two interventions on cognition in people with MCI in a 2×2 randomised controlled trial with German participants.

METHODS AND ANALYSIS

Participants will be community-dwelling individuals with a psychometric diagnosis of MCI based on the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination. With N=200, effects with an effect size of f≥0.24 (comparable to Cohen's d≥0.48) can be detected. Screening, baseline, t6 and t12 testing will be conducted via a videoconferencing assessment, telephone, and online survey. Participants will be randomly allocated to one of four groups and will receive a combination of CCT and online nutritional counselling. The CCT can be carried out independently at home on a computer, laptop, or tablet. Nutrition counselling includes 12 online group sessions every fortnight for 1.5 hours. The treatment phase is 6 months with follow-ups after six and 12 months after baseline.

ETHICS AND DISSEMINATION

All procedures were approved by the Friedrich-Alexander-Universität Erlangen-Nürnberg Ethics Committee (Ref. 21-318-1-B). Written informed consent will be obtained from all participants. Results will be published in peer-reviewed scientific journals, conference presentations.

TRIAL REGISTRATION NUMBER

ISRCTN10560738.

Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review

BACKGROUND

The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions.

OBJECTIVE

To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions.

METHODS

We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care.

RESULTS

Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence.

CONCLUSIONS

Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.

Individualised computerised cognitive training for community-dwelling people with mild cognitive impairment: study protocol of a completely virtual, randomised, controlled trial

Background

People with mild cognitive impairment (MCI) are at increased risk of converting to dementia. Cognitive training can improve the cognitive abilities of people with MCI. Computerised cognitive training (CCT) offers several advantages over traditional paper-and-pencil cognitive training and has the potential to be more individualised by matching task difficulty with individual performance. Recent systematic reviews have reported promising effects of CCT on improving the cognitive capacities of people with MCI. However, the quality of existing studies has been limited, and it is still unclear whether CCT can influence the progression to dementia. We developed an ‘individualised’ CCT (MAKSCog) specialised for people with MCI that automatically matches task difficulty with individual performance and an active control training (‘basic’ CCT). The aims of the present study are (a) to evaluate MAKSCog and (b) to investigate whether it can be applied to maintain the cognitive abilities of people with MCI.

Methods

The present study investigates the effects of CCT on cognition in a randomised controlled intervention study in Germany. Participants are community-dwelling people with a psychometric diagnosis of MCI based on the Montreal Cognitive Assessment (MoCA) and Mini-Mental Status Test (MMSE). Screening and baseline testing are conducted via a videoconferencing assessment and telephone. Participants are randomly allocated. The treatment phase is 6 months with an open phase in which participants can freely decide to continue to use the CCTs. Additionally, both CCTs contain a monthly computerised cognitive assessment that measures different cognitive abilities: information processing speed, memory span, short term memory, and logical reasoning.

Discussion

This is the first study to investigate the effect of MAKSCog, an individualised CCT, specifically developed for people with different subtypes of MCI. A methodological strength is the double-blind, randomised, controlled design and the use of basic CCT as an active control group. The study is conducted entirely virtually with valid telehealth assessments for cognitive function. Methodological limitations might include a restriction to participants who feel comfortable with the use of technology and who own a computer, laptop, or tablet.

Trial registration

ISRCTN ISRCTN14437015. Prospectively registered on 27 February 2020.

Coping strategies for memory problems in everyday life of people with cognitive impairment and older adults: A systematic review

OBJECTIVES

Dealing with memory loss is a major challenge for older people. Coping strategies for memory problems could enable cognitively impaired people to live independently for longer. We conducted a systematic review to summarize evidence on coping strategies for older people and people with cognitive impairment to stabilize everyday life functioning.

METHODS

We systematically searched the databases PubMed, PsychInfo, Scopus and WebofScience using a well-defined search string. Studies were included if they were published between January 1990 and February 2021 and written in English, German, Spanish, French, or Swedish language. Two blind researchers independently checked the studies for inclusion and exclusion criteria and evaluated the quality of the studies using Critical Appraisal Skills Programme-checklists. Evidence was summarized in a narrative synthesis.

RESULTS

A total of 16 relevant studies with adequate quality were identified. These studies reported on three categories of strategies: external, internal, and behavioral coping strategies. External strategies included reminder systems and integrated features in the environment and were used by people with and without cognitive impairments. Internal strategies such as visualization, verbalization, active remembering, and systematic thinking were reported less often by people with cognitive impairment than those without cognitive impairment. Behavioral strategies such as reducing expectations and acceptance of support was most frequently reported by people with cognitive impairment.

CONCLUSIONS

The findings of our systematic review show a great number of coping strategies, which seem to depend on cognitive status. Appropriate training tools incorporating these strategies should be developed.

Meta-analysis of Virtual Reality Based on Delaying Mild Cognitive Impairment

ABSTRACT

To further clarify the effectiveness of virtual reality (VR) in improving cognitive function of patients with mild cognitive impairment (MCI) through meta-analysis, we searched the PubMed, Web of Science, Scopus, MEDLINE, and Cochrane centers for controlled trials of VR in patients with MCI. All analyses were performed using RevMan (Version 5.3; Cochrane Collaboration, Oxford, United Kingdom). The selected data were extracted as 2 × 2 table. All included studies were weighted and aggregated. According to the inclusion criteria and exclusion criteria, five articles were selected for meta-analysis. There was no bias or heterogeneity in the results. We found that the diamond is on the right side of the vertical line and does not intersect with the vertical line. We determined the following values: odds ratio, 1.34; 95% confidence interval, 0.31-2.37; z = 2.55; p = 0.01. VR can effectively improve the cognitive function of MCI patients and delay cognitive impairment, which can be further developed as a treatment to delay the development of MCI.

Feasibility and Efficacy of Virtual Reality Interventions to Improve Psychosocial Functioning in Psychosis: Systematic Review

BACKGROUND

Functional recovery in psychosis remains a challenge despite current evidence-based treatment approaches. To address this problem, innovative interventions using virtual reality (VR) have recently been developed. VR technologies have enabled the development of realistic environments in which individuals with psychosis can receive psychosocial treatment interventions in more ecological settings than traditional clinics. These interventions may therefore increase the transfer of learned psychosocial skills to real-world environments, thereby promoting long-term functional recovery. However, the overall feasibility and efficacy of such interventions within the psychosis population remain unclear.

OBJECTIVE

This systematic review aims to investigate whether VR-based psychosocial interventions are feasible and enjoyable for individuals with psychosis, synthesize current evidence on the efficacy of VR-based psychosocial interventions for psychosis, and identify the limitations in the current literature to guide future research.

METHODS

This research followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Literature searches were conducted in PubMed and PsycINFO in May 2021. We searched for peer-reviewed English articles that used a psychosocial intervention with a VR component. Participants in the included studies were diagnosed with schizophrenia, schizoaffective disorder, or another psychotic disorder. The included studies were divided into four categories as follows: cognitive remediation interventions, social skills interventions, vocational skills interventions, and auditory verbal hallucinations and paranoia interventions. The risk of bias assessment was performed for each study.

RESULTS

A total of 18 studies were included in this systematic review. Of these 18 studies, 4 (22%) studies used a cognitive remediation intervention, 4 (22%) studies used a social skills intervention, 3 (17%) studies used a vocational skills intervention, and 7 (39%) studies implemented an intervention aimed at improving auditory verbal hallucinations or paranoia. A total of 745 individuals with psychosis were included in the study. All the studies that evaluated feasibility showed that VR-based psychosocial interventions were feasible and enjoyable for individuals with psychosis. The preliminary evidence on efficacy included in this review suggests that VR-based psychosocial interventions can improve cognitive, social, and vocational skills in individuals with psychosis. VR-based interventions may also improve the symptoms of auditory verbal hallucinations and paranoia. The skills that participants learned through these interventions were durable, transferred into real-world environments, and led to improved functional outcomes, such as autonomy, managing housework, and work performance.

CONCLUSIONS

VR-based interventions may represent a novel and efficacious approach for improving psychosocial functioning in psychosis. Therefore, VR-based psychosocial interventions represent a promising adjunctive therapy for the treatment of psychosis, which may be used to improve psychosocial skills, community functioning, and quality of life.

Virtual reality and mental health in older adults: a systematic review

IMPORTANCE

Virtual reality (VR) is a promising tool with the potential to enhance care of cognitive and affective disorders in the aging population. VR has been implemented in clinical settings with adolescents and children; however, it has been less studied in the geriatric population.

OBJECTIVE

The objective of this study is to determine the existing levels of evidence for VR use in clinical settings and identify areas where more evidence may guide translation of existing VR interventions for older adults.

DESIGN AND MEASUREMENTS

We conducted a systematic review in PubMed and Web of Science in November 2019 for peer-reviewed journal articles on VR technology and its applications in older adults. We reviewed article content and extracted the number of study participants, study population, goal of the investigation, the level of evidence, and categorized articles based on the indication of the VR technology and the study population.

RESULTS

The database search yielded 1554 total results, and 55 articles were included in the final synthesis. The most represented study design was cross-sectional, and the most common study population was subjects with cognitive impairment. Articles fell into three categories for VR Indication: Testing, Training, and Screening. There was a wide variety of VR environments used across studies.

CONCLUSIONS

Existing evidence offers support for VR as a screening and training tool for cognitive impairment in older adults. VR-based tasks demonstrated validity comparable to some paper-based assessments of cognition, though more work is needed to refine diagnostic specificity. The variety of VR environments used shows a need for standardization before comparisons can be made across VR simulations. Future studies should address key issues such as usability, data privacy, and confidentiality. Since most literature was generated from high-income countries (HICs), it remains unclear how this may be translated to other parts of the world.

Effect of virtual reality exercise on interventions for patients with Alzheimer's disease: A systematic review

Virtual reality (VR) interventions are increasingly being used in rehabilitating and treating patients with neurological disorders. This study aimed to explore the effects of VR exercise interventions for patients with Alzheimer's disease (AD). A systematic review of the published literature on randomized controlled trials of VR technology applied to patients with AD was conducted using the preferred reporting entry for systematic reviews and Meta-analysis guidelines. Descriptive analyses were performed to assess the quality of the studies in terms of the characteristics of the included studies, samples, diagnoses, types of VR technologies, subjective and objective levels of immersion, and quality of studies. Eight studies were included, including a pooled sample of 362 patients with AD. A systematic review showed that most studies focused on patients with AD's cognitive and physical functions. The main finding was that VR interventions could help improve cognitive and physical balance in patients with AD. However, future studies should emphasize design and use well-accepted assessment tools to validate the effects of VR interventions further.

Study of virtual reality for mild cognitive impairment: A bibliometric analysis using CiteSpace

Objectives

Non-invasive and low-cost virtual reality (VR) technology is important for early evaluation and intervention in mild cognitive impairment (MCI). This study aimed to demonstrate the current status of overseas and domestic research as well as the focus and frontier of VR technology among individuals with MCI through a bibliometric analysis.

Methods

Studies from the core collection of Web of Science™ between 1995 and 2020 were used; furthermore, CiteSpace 5.7 R3 was utilized to analyse information on authors/cited authors, keywords, burst words, and cited references.

Results

In total, 230 publications were identified. Most studies were published in the USA (45 publications) and Italy (41 publications), where Guiseppe Riva ranks first (14 publications), and Tarnanas I is the author with the highest centrality (0.44). The hot topics in VR applications in the MCI population are ‘physical activity,’ ‘people,’ ‘single-blind,’ ‘disease,’ ‘walking,’ ‘technology,’ ‘working memory,’ and ‘risk’ in recent years. The keyword ‘mild cognitive impairment’ has attracted extensive attention since 2012, showing the strongest citation outbreak (8.28). The clustering results of the literature show the research types and emerging trends, including ‘exergame,’ ‘serious games,’ ‘spatial navigation,’ ‘activities of daily living,’ ‘exercise,’ ‘enriched environment’ and ‘wayfinding.‘

Conclusions

Cognitive assessment and nonpharmacological intervention research on patients with MCI have become the focus of dementia prevention in recent years. Virtual technology, combined with traditional methods such as exercise therapy, provides new ideas for innovative cognitive evaluation and cognitive intervention.

Virtual reality-based cognitive stimulation using GRYDSEN software as a means to prevent age-related cognitive-mobility disorders – a pilot observational study

The human aging process is associated with systematic deterioration of cognitive and motor performance. Age-related deficits in motor skills and symptoms of cognitive decline, such as memory, attention and executive functioning problems, are major contributors to a loss of functional independence and reduced quality of life of the elderly. The virtual reality system presented can be used as an aid for effective training of those skills. The use of virtual reality training for therapeutic purposes is promising – not only does it provide encouraging medical and psychological effects but it may also be considered as an interesting leisure activity for seniors. The paper presents a pilot study which aims to qualitatively assess the usefulness of a VR technology-based solution for training cognitive and motor functions. The pre-test phase of the study was conducted on 9 subjects aged 62-81 (M = 71.66; SD = 7.00), who were asked to evaluate the performed tasks in terms of novelty and attractiveness. All subjects completed the pilot study. The SUS result was 55.56 (SD = 9.90), which is a marginal result. However, the UEQ result showed that all aspects of the game were reported as satisfactory. The pilot studies show that VR is well tolerated by the elderly. As demonstrated by the results, the system has moderate utility, but may be a promising solution for training cognitive-motor skills.

Targeted cognitive game training enhances cognitive performance in multiple sclerosis patients treated with interferon beta 1-a

Background

Prevention of cognitive decline in Multiple Sclerosis (MS) is of major importance. We explored the effect of a 6 months computerized game training program on cognitive performance in MS patients with mild cognitive impairment.

Methods

This was a single-center, randomized prospective study. We enrolled in this study 100 eligible MS patients treated with Interferon-beta-1a (Rebif). All had mild cognitive impairment in either executive function or information processing speed. Patients were randomized 1:1 to either use the cognitive games platform by HappyNeuron (HN) or receive no intervention. Executive function and information processing speed scores were measured at 3 and 6 months from baseline to evaluate the effect of game training on cognitive scores.

Results

In both executive function and information processing speed, the game Training group showed significant improvement after 3 and 6 months. The Non-Training group showed mild deterioration in both domains at 3 months, and further deterioration that became significant at 6 months in executive function. Furthermore, at 6 months, the percent of patients in the Training group that improved or remained stable in both cognitive domains was significantly higher compared to the Non-Training group.

Conclusions

Our findings suggest that cognitive game training has a beneficial effect on cognitive performance in MS patients suffering from mild cognitive impairment. While further evaluation is required to assess the longevity of that effect, we nonetheless recommend to MS patients to be engaged in cognitive gaming practice as part of a holistic approach to treating their condition.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12984-021-00968-3.

Effects of virtual reality cognitive training in individuals with mild cognitive impairment: A systematic review and meta-analysis

BACKGROUND

Virtual reality (VR) is used to improve specific health needs by combining multiple technologies; it is increasingly being used in the medical field, showing satisfactory effects, especially in the management of chronic disease. The aim of this study was to assess the effects of VR cognitive training for individuals with mild cognitive impairment (MCI).

METHODS

Peer-reviewed articles were searched from the PubMed, Embase, Web of Science, the Cochrane Library, Science Direct, and EBSCOhost databases, as well as CNKI, Sinomed, Vip. and Wan Fang, through 23 May 2021. We only included randomized controlled trials (RCTs) enrolling participants with MCI.

RESULTS

Seventeen RCTs were included, with a total of 744 participants. Evidence of moderate quality showed that VR cognitive training significantly enhanced MCI patients' global cognitive function, as measured by the Montreal Cognitive Assessment (standardized mean difference [SMD] = 0.42; 95% confidence interval [CI], 0.04-0.79; p = 0.03) and executive function, as measured by trail making test A (SMD = -0.58; 95% CI, -0.80 to -0.35; p < 0.001). The meta-analysis indicated that the effects of VR cognitive training on delayed memory, immediate memory, attention and instrumental activities of daily living were not statistically significant (p > 0.05).

CONCLUSION

The available data showed that VR cognitive training might be beneficial for improving global cognitive function and executive function in individuals with MCI, although the effects were short term.

Research trends in computerized cognitive training contents with text network

Computerized Cognitive Training (CCT) contents used to improve patients’ cognitive ability with Mild Cognitive Impairment (MCI) can provide customized training through individual data collection and analysis. However, studies on transfer effect of improving other untrained cognitive domains while performing the contents are insufficient. The present paper intended to collect literature published by PubMed, EMBASE, Cochrane Library, and Web of Science until December 2019 and analyze the trends of CCT and the transfer effect in each training area. Studies on CCT (82/891) have been increasing each year, and universities (60/82) in the United States (17/82) have published the most. In the literature that reported clinical effect (18/82), the cognitive domain mostly studied was memory (14/18), and the N-Back (3/14) method accounted for most of the training contents. Moreover, the contents that showed the highest degree, closeness, and betweenness centrality (BC) indices were the memory area, and video accounted for the highest among the intervention methods. In particular, the closeness centrality (CC) index of the memory and attention contents showed similar results. It can be interpreted that the possibility of the transfer effect occurring from memory and attention areas is the highest since the semantic distance (i.e. the similarity of the training process) between the attention contents and memory contents was the closest. The effectiveness of the actual transfer effect between the memory and attention should be verified.