Cognitive benefits of computer games for older adults

Effects of a video game intervention on symptoms, training motivation, and visuo-spatial memory in depression

Background

People with Major Depressive Disorder (MDD) often experience reduced affect, mood, and cognitive impairments such as memory problems. Although there are various treatments for MDD, many of them do not address the cognitive deficits associated with the disorder. Playing 3D video games has been found to improve cognitive functioning in healthy people, but it is not clear how they may affect depressed mood and motivation in people with MDD. The aim of this study was to investigate whether a six-week video game intervention leads to improvements in depressed mood, training motivation, and visuo-spatial (working) memory functions in patients with MDD.

Methods

A total of 46 clinically depressed individuals were randomly assigned to one of three groups: an experimental "3D video gaming" group (n = 14) which played a video game, an active control group (n = 16) which trained with a computer program "CogPack," and a treatment-as-usual group (n = 16) which received a standard clinical treatment including psychotherapy and/or pharmacotherapy. Participants performed a neuropsychological assessment, including self-report questionnaires asking for depressive symptoms, training motivation, and visuo-spatial (working) memory functions before and after the training intervention.

Results

Regarding depressive symptoms, a significant decrease in the proportion of participants who showed clinical levels of depressive symptoms as measured by the Beck Depression Inventory was only found in the 3D video gaming group. Additionally, mean motivational levels of performing the training were significantly higher in the 3D video gaming group when compared with the active control group. Moreover, whereas the 3D Video Gaming group only significantly improved on one visuo-spatial memory test, the active control group improved in all visuo-spatial memory functions. The 3D video gaming group did not perform significantly better than the CogPack group, and the TAU group.

Conclusion

Besides a standalone cognitive training, the current findings suggest that cognitive trainings using a video game have potential to increase subjective well-being, show higher levels of training motivation, and lead to improvements in visuo-spatial (working) memory functions in MDD. However, given the mixed and unblinded nature of this study, the results should be interpreted with caution. Further research with larger samples and follow-up measurements is needed.

Computer-Delivered Cognitive Training and Transcranial Direct Current Stimulation in Patients With HIV-Associated Neurocognitive Disorder: A Randomized Trial

Objective: HIV infection is associated with impaired cognition, and as individuals grow older, they may also experience age-related changes in mental abilities. Previous studies have shown that computer-based cognitive training (CCT) and transcranial direct current stimulation (tDCS) may be useful in improving cognition in older persons. This study evaluated the acceptability of CCT and tDCS to older adults with HIV-associated neurocognitive disorder, and assessed their impact on reaction time, attention, and psychomotor speed. Methods: In a single-blind randomized study, 46 individuals with HIV-associated mild neurocognitive disorder completed neuropsychological assessments and six 20-min training sessions to which they had been randomly assigned to one of the following conditions: (1) CCT with active tDCS; (2) CCT with sham tDCS, or (3) watching educational videos with sham tDCS. Immediately after training and again 1 month later, participants completed follow-up assessments. Outcomes were evaluated via repeated measures mixed effects models. Results: Participant ratings of the intervention were positive. Effects on reaction time were not significant, but measures of attention and psychomotor speed suggested positive effects of the intervention. Conclusion: Both CCT and tDCS were highly acceptable to older persons with HIV infection. CCT and tDCS may improve cognitive in affected individuals. Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT03440840].

Virtual Reality Experience Intervention May Reduce Responsive Behaviors in Nursing Home Residents with Dementia: A Case Series

BACKGROUND

People with advanced dementia often exhibit responsive behaviors such as apathy, depression, agitation, aggression, and psychosis. Non-pharmacological approaches (e.g., listening to music, watching television, doing arts and crafts) are now considered as a first-line strategy to manage responsive behaviors in clinical practice due to the potential risks associated with the antipsychotic medications. To date, no evaluations of immersive non-head mounted virtual reality (VR) experience as a non-pharmacologic approach for people with advanced dementia living in nursing homes have been reported.

OBJECTIVE

To evaluate the feasibility (acceptance and safety) of VR experience.

METHODS

A single site case series (nonrandomized and unblinded) with a convenience sample (N = 24; age = 85.8±8.6 years; Cognitive Performance Scale score = 3.4±0.6) measuring depression and agitation before and after the intervention. The intervention was a 30-min long research coordinator- facilitated VR experience for two weeks (10 sessions).

RESULTS

The intervention was feasible (attrition rate = 0% ; adverse events = 0). A reduction in depression and in agitation was observed after the intervention. However, we suggest extreme caution in interpreting this result considering the study design and small sample size.

CONCLUSION

This study provides the basis for conducting a randomized controlled trial to evaluate the effect of VR experience on responsive behaviors in nursing homes. Since our intervention uses a smart remote-controlled projector without a headset, infectious exposure can be avoided following the COVID-19 pandemic-induced physical distancing policy in care homes.

Dual-Motor-Task of Catching and Throwing a Ball During Overground Walking in Virtual Reality

Virtual Reality is a versatile platform to study human behavior in simulated environments and to develop interventions for functional rehabilitation. In this work, we designed a dual-task paradigm in a virtual environment where both tasks demand motor skills. Twenty-one healthy adults (mean age: 24.1 years) participated in this study. The experiment involved three conditions - normal overground walking, catch and throw a ball while standing, and catch and throw a ball while walking overground -all in the virtual environment. We investigated the dual-task gait characteristics and their correlations with outcomes from cognitive assessments. Results show that subjects walk conservatively with smaller stride lengths, larger stride widths and stride time while catching and throwing. However, they are able to throw the balls more accurately at the target and achieve higher scores. During the dual-task throw, we observed that the participants threw more balls during the stance phase of the gait when the foot was in the terminal stance and pre-swing region. During this region, the body has forward momentum. In addition, the changes in gait characteristics during dual-task throw correlate well with outcome measures in standardized cognitive tests. This study provides a new and engaging paradigm to analyze dual-motor-task cost in a virtual reality environment and it can be used as a basis to compare strategies adopted by different population groups with healthy young adults to execute coordinated motor tasks.

Mobile Game Design Guide to Improve Gaming Experience for the Middle-Aged and Older Adult Population: User-Centered Design Approach

Background

The number of older adult gamers who play mobile games is growing worldwide. Earlier studies have reported that digital games provide cognitive, physical, and socioemotional benefits for older adults. However, current mobile games that understand older adults’ gameplay experience and reflect their needs are very scarce. Furthermore, studies that have analyzed older adults’ game experience in a holistic manner are rare.

Objective

The purpose of this study was to suggest mobile game design guidelines for adults older than 50 years from a holistic gaming experience perspective. Adopting a human-centric approach, this study analyzes middle-aged and older adults’ gameplay experience and suggests practical design guides to increase accessibility and satisfaction.

Methods

We organized a living laboratory project called the “Intergenerational Play Workshop.” In this workshop, 40 middle-aged and older adults (mean age 66.75 years, age range 50-85 years) played commercial mobile games of various genres with young adult partners for 1 month (8 sessions). Using a convergent parallel mixed-method design, we conducted a qualitative analysis of dialogue, game diaries, and behavioral observations during the workshop and a quantitative analysis of the satisfaction level of the game elements for the mobile games that they played.

Results

This project was active from April 2019 to December 2021, and the data were collected at the workshops from July 1 to August 28, 2019. Based on the identified themes of positive and negative experiences from the qualitative data, we proposed 45 design guides under 3 categories: (1) cognitive and physical elements, (2) psychological and socioemotional elements, and (3) consumption contextual elements. Our empirical research could reaffirm the proposals from previous studies and provide new guidelines for improving the game design. In addition, we demonstrate how existing commercial games can be evaluated quantitatively by using the satisfaction level of each game’s elements and overall satisfaction level.

Conclusions

The final guidelines were presented to game designers to easily find related information and enhance the overall understanding of the game experience of middle-aged and older adults.

Digital Gaming Interventions in Psychiatry: Evidence, Applications and Challenges

Human evolution has regularly intersected with technology. Digitalization of various services has brought a paradigm shift in consumerism. Treading this path, mental health practice has gradually moved to Digital Mental Health Interventions (DMHI), to improve service access and delivery. Applied games are one such innovation that has gained recent popularity in psychiatry. Based on the principles of gamification, they target psychosocial and cognitive domains, according to the deficits in various psychiatric disorders. They have been used to deliver cognitive behaviour therapy, cognitive training and rehabilitation, behavioural modification, social motivation, attention enhancement, and biofeedback. Research shows their utility in ADHD, autistic spectrum disorders, eating disorders, post-traumatic stress, impulse control disorders, depression, schizophrenia, dementia, and even healthy aging. Virtual reality and artificial intelligence have been used in conjunction with gaming interventions to improvise their scope. Even though these interventions hold promise in engagement, ease of use, reduction of stigma, and bridging the mental-health gap, there are pragmatic challenges, especially in developing countries. These include network quality, infrastructure, feasibility, socio-cultural adaptability, and potential for abuse. Keeping this in the background, this review summarizes the scope, promise, and evidence of digital gaming in psychiatric practice, and highlights the potential caveats in their implementation.

Game-based brain training for improving cognitive function in community-dwelling older adults: A systematic review and meta-regression

BACKGROUND

Given that increasing aging is associated with a natural decline in cognitive function, identifying effective interventions that can help to prevent cognitive decline in older adults is a research priority.

OBJECTIVE

To synthesize the best evidence to assess the effectiveness of game-based brain training in improving cognitive function and to evaluate the preferred design features of the intervention.

METHODS

Twelve databases, trial registries, and gray literature resources were systematically searched for in randomized controlled trials. Meta-analysis and random-effects meta-regression were conducted using Comprehensive Meta-analysis Software 3.0. Overall effect was measured using Hedges's g and determined using Z-statistics. Cochran's Q test and I² were used to investigate heterogeneity. The Grading of Recommendation, Assessment, Development, and Evaluation system was used to assess overall quality of evidence.

RESULTS

Fifteen trials among 759 older adults were conducted. Meta-analysis revealed that game-based brain training significantly improved processing speed (g = 0.23), selective attention (g = 0.40), and short-term memory (g = 0.35) versus a control group. Our subgroup analyses emphasized that non-time pressure games, multiplayer, computer platform, provider support, sessions ≤ 3 times per week for ≤ 60 min. each comprised a preferable design. Meta-regression identified game design (β = 0.211, p = 0.008) that had statistically significant effects on processing speed. Egger's regression asymmetry test (p = 0.293) suggested no publication bias.

CONCLUSIONS

Game-based brain training can be considered a supplementary intervention for improving cognitive functions in community-dwelling older adults. Future trials should use well-designed trials with large sample sizes.

Technologically-enhanced psychological interventions for older adults: a scoping review

Background

The world population is getting older. As life expectancy increases, traditional health care systems are facing different challenges in terms of cost reduction and high-quality service delivery capability. New ways to improve older adults’ quality of life have been explored, taking advantage of new technological solutions. Our focus is on the integration of technology in clinical treatments to facilitate or deliver psychological interventions meant to improve well-being in older adults. Our aims were to describe the main technology-based interventions supporting seniors’ quality of life or psychological well-being and to provide greater clarity to what is described in the current literature as their effects on seniors’ cognitive and psychological outcomes and healthcare policies.

Methods

We reviewed the scientific literature looking for studies that investigated how technology can be implemented into clinical psychology treatments for older adults. Our search was conducted using the following databases: PubMed, PsycINFO, Scopus, ISI Web of Science, and CINAHL. The search provided 350 articles, mostly (≈90%) dated after 2002. Abstract analysis narrowed the selection to 150 papers, according to their relevance and actuality as judged by a restricted group of independent researchers.

Results

Through a thematic analysis, we found that virtual reality (VR), robots, telemedicine, software, video games, and smartphone applications could potentially support older adults’ psychological treatment with a positive impact on healthcare systems.

Conclusion

Findings from the literature are encouraging, although most of these results are only preliminary.

Reflective and Reflexive Stress Responses of Older Adults to Three Gaming Experiences In Relation to Their Cognitive Abilities: Mixed Methods Crossover Study

BACKGROUND

The gamification of digital health provisions for older adults (eg, for rehabilitation) is a growing trend; however, many older adults are not familiar with digital games. This lack of experience could cause stress and thus impede participants' motivations to adopt these technologies.

OBJECTIVE

This crossover longitudinal multifactorial study aimed to examine the interactions between game difficulty, appraisal, cognitive ability, and physiological and cognitive responses that indicate game stress using the Affective Game Planning for Health Applications framework.

METHODS

A total of 18 volunteers (mean age 71 years, SD 4.5; 12 women) completed a three-session study to evaluate different genres of games in increasing order of difficulty (S₁-BrainGame, S₂-CarRace, and S₃-Exergame). Each session included an identical sequence of activities (t₁-Baseline, t₂-Picture encode, t₃-Play, t₄-Stroop test, t₅-Play, and t₆-Picture recall), a repeated sampling of salivary cortisol, and time-tagged ambulatory data from a wrist-worn device. Generalized estimating equations were used to investigate the effect of session×activity or session×activity×cognitive ability on physiology and cognitive performance. Scores derived from the Montreal Cognitive Assessment (MoCA) test were used to define cognitive ability (MoCA-high: MoCA>27, n=11/18). Kruskal-Wallis tests were used to test session or session×group effects on the scores of the postgame appraisal questionnaire.

RESULTS

Session×activity effects were significant on all ambulatory measures (χ²₁₀>20; P<.001) other than cortisol (P=.37). Compared with S₁ and S₂, S₃ was associated with approximately 10 bpm higher heart rate (P<.001) and approximately 5 muS higher electrodermal activity (P<.001), which were both independent of the movement caused by the exergame. Compared with S₁, we measured a moderate but statistically significant drop in the rate of hits in immediate recall and rate of delayed recall in S₃. The low-MoCA group did not differ from the high-MoCA group in general characteristics (age, general self-efficacy, and perceived stress) but was more likely to agree with statements such as digital games are too hard to learn. In addition, the low-MoCA group was more likely to dislike the gaming experience and find it useless, uninteresting, and visually more intense (χ²₁>4; P<.04). Group differences in ambulatory signals did not reach statistical significance; however, the rate of cortisol decline with respect to the baseline was significantly larger in the low-MoCA group.

CONCLUSIONS

Our results show that the experience of playing digital games was not stressful for our participants. Comparatively, the neurophysiological effects of exergame were more pronounced in the low-MoCA group, suggesting greater potential of this genre of games for cognitive and physical stimulation by gamified interventions; however, the need for enjoyment of this type of challenging game must be addressed.

Maladaptive avoidance patterns in Parkinson's disease are exacerbated by symptoms of depression

Parkinson's disease (PD) is a chronic, progressive neurodegenerative disorder, characterized by a loss of dopaminergic neurons in the substantia nigra pars compacta. Given that dopamine is critically involved in learning and other cognitive processes, such as working memory, dopamine loss in PD has been linked both to learning abnormalities and to cognitive dysfunction more generally in the disease. It is unclear, however, whether avoidance behavior is impacted in PD. This is significant, as this type of instrumental behavior plays an important role in both decision-making and emotional (dys) function. Consequently, the aim of the present study was to examine avoidance learning and operant extinction in PD using a computer-based task. On this task, participants control a spaceship and attempt to shoot an enemy spaceship to gain points. They also learn to hide in safe areas to protect from (i.e., avoid) aversive events (on-screen explosions and point loss). The results showed that patients with PD (N = 25) acquired an avoidance response during aversive periods to the same extent as healthy age-matched controls (N = 19); however, patients demonstrated greater hiding during safe periods not associated with aversive events, which could represent maladaptive generalization of the avoidance response. Furthermore, this impairment was more pronounced during the extinction phase, and in patients who reported higher levels of depression. These results demonstrate for the first time that PD is associated with maladaptive avoidance patterns, which could possibly contribute to the emergence of depression in the disease.

Immersive Experience Model of the Elderly Welfare Centers Supporting Successful Aging

This study investigates the application of immersive experience services to leisure facilities for the successful aging of the elderly. In the past, the social image of the elderly was that of passive beings who needed care due to physical and cognitive decline associated with biological aging. However, the concept of “successful aging” actively highlighting the positive aspects of aging and trying to promote longer and healthier life has started to acquire importance in recent years. In this context, elderly welfare centers can be described as facilities that encourage learning, leisure, and social activities of the elderly with impaired physical and cognitive functions. The use of recent immersive experience technologies such as virtual reality and mixed reality (MR), in order to mitigate physical and spatial constraints and provide an immersion into the desired environment and situation, could contribute substantially to the health of the elderly. However, the application of immersive technologies is concentrated on the provision of entertainment, education, and medical facilities. The number of previous studies on the immersion experiences of the elderly is limited, and the connection between immersion experiences and various services and programs that promote successful aging at elderly welfare centers requires further research. This study analyzes the function and space of the elderly welfare centers for successful aging through the review of previous studies and classifies immersion technology categories based on the review of the relevant literature. The study analyzes the health benefits of immersive experience technologies and related products and services and proposes an immersive experience service model for the elderly welfare center. The results of the study could provide a valuable input for the spatial application of immersive experience technologies for successful aging in the future.

Non-Immersive Virtual Reality for Rehabilitation of the Older People: A Systematic Review into Efficacy and Effectiveness

: Objective: the objective of this review is to analyze the advances in the field of rehabilitation through virtual reality, while taking into account non-immersive systems, as evidence have them shown to be highly accepted by older people, due to the lowest "cibersikness" symptomatology.

DATA SOURCES

a systematic review of the literature was conducted in June 2019. The data were collected from Cochrane, Embase, Scopus, and PubMed databases, analyzing manuscripts and articles of the last 10 years.

STUDY SELECTION

we only included randomized controlled trials written in English aimed to study the use of the virtual reality in rehabilitation. We selected 10 studies, which were characterized by clinical heterogeneity.

DATA EXTRACTION

quality evaluation was performed based on the Physioterapy Evidence Database (PEDro) scale, suggested for evidence based review of stroke rehabilitation. Of 10 studies considered, eight were randomized controlled trials and the PEDro score ranged from four to a maximum of nine.

DATA SYNTHESIS

VR (Virtual Reality) creates artificial environments with the possibility of a patient interaction. This kind of experience leads to the development of cognitive and motor abilities, which usually positively affect the emotional state of the patient, increasing collaboration and compliance. Some recent studies have suggested that rehabilitation treatment interventions might be useful and effective in treating motor and cognitive symptoms in different neurological disorders, including traumatic brain injury, multiple sclerosis, and progressive supranuclear palsy.

CONCLUSIONS

as it is shown by the numerous studies in the field, the application of VR has a positive impact on the rehabilitation of the most predominant geriatric syndromes. The level of realism of the virtual stimuli seems to have a crucial role in the training of cognitive abilities. Future research needs to improve study design by including larger samples, longitudinal designs, long term follow-ups, and different outcome measures, including functional and quality of life indexes, to better evaluate the clinical impact of this promising technology in healthy old subjects and in neurological patients.

Study Protocol: Does an Acute Intervention of High-Intensity Physical Exercise Followed by a Brain Training Video Game Have Immediate Effects on Brain Activity of Older People During Stroop Task in fMRI?-A Randomized Controlled Trial With Crossover Design

Background: Elderly people are affected by processes leading to decline in various aspects of daily living that impair their quality of life. Regarding neurological aspects, executive functions have been shown to be valuable for daily life and to slow decline during aging. Most intervention studies intended to improve cognitive functions during aging specifically address long-term destructive processes and countermeasures. However, to an increasing degree, studies also investigate the acute benefits that prove to be useful for daily life, such as physical exercise or video games in the form of exercise video gaming (“exergaming”). Because little is known about the change in cognitive ability following acute intervention of a combination of physical exercise and video gaming, especially for older people, this work is designed as an attempt to address this matter.

Methods: This study is a randomized crossover controlled trial to test the response to an acute bout of high-intensity physical exercise followed by a short session with a brain training (Brain Age) video game in physically active and cognitively healthy older adults (60–70 years). The response is measured using Stroop task performance (cognitive task for executive function) and related brain activity assessed with functional magnetic resonance imaging (fMRI). The control conditions are low-intensity physical exercise and Tetris for video gaming.

Discussion: This study is intended to provide insight into the alteration of executive function and its related brain activity from an acute intervention with a combination of physical exercise and video gaming in older people. The protocol might not be implementable in daily life to improve cognitive abilities. However, the results can support future studies that investigate cognition and the combination of physical exercise and video gaming. Moreover, it can provide real-life implications.

Trial registration: This trial was registered in The University Hospital Medical Information Network Clinical Trials Registry (UMIN000033054). Registered 19 July 2018, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000037687.

The impact of behavioral interventions on cognitive function in healthy older adults: A systematic review

Behavioral interventions to improve cognitive function in older adults are widespread and can vary from theater classes to cognitive training programs. However, the effectiveness in maintaining different cognitive domains varies greatly both across and within intervention types. To date, no systematic reviews have synthesized findings across more than a few types of interventions (e.g., cognitive vs. exercise). This systematic review examined 11 types of behavioral interventions and the respective transfer to 19 cognitive domains, as well as transfer to everyday function. Study inclusion criteria were: peer-reviewed articles in English, samples of healthy adults aged 65 and older, and randomized controlled trials of behavioral interventions with reported cognitive outcomes. The 2017 search yielded 75 eligible articles comprising cognitive training, exercise training, combination interventions, cognitively-stimulating activities, and action video games. In general, process- (n = 26) and strategy-based (n = 16) cognitive training improved the trained domains but had weak transfer to non-trained domains. Aerobic training (n = 13) most consistently improved executive function, and strength/resistance (n = 8) and aerobic/resistance combination training (n = 6) most consistently improved cognitive inhibition and visual working memory. Combination interventions (n = 15 nonfactorial, n = 3 factorial) showed promise in improving verbal delayed recall and executive function. Few studies examined cognitively-stimulating activities or action video games, leaving inconclusive results about their effect on cognitive function. Few studies examined everyday function (n = 9), however, process- and strategy-based training demonstrated notable long-term transfer. Recommendations for future research and practice are highlighted.

Affective Game Planning for Health Applications: Quantitative Extension of Gerontoludic Design Based on the Appraisal Theory of Stress and Coping

User retention is the first challenge in introducing any information and communication technologies (ICT) for health applications, particularly for seniors who are increasingly targeted as beneficiaries of such technologies. Interaction with digital technologies may be too stressful to older adults to guarantee their adoption in their routine selfcare. The second challenge, which also relates to adoption, is to supply empirical evidence that support the expectations of their beneficial outcomes. To address the first challenge, persuasive technologies such as serious games (SGs) are increasingly promoted as ludic approaches to deliver assistive care to older adults. However, there are no standards yet to assess the efficacy of different genres of games across populations, or compare and contrast variations in health outcomes arising from user interface design and user experience. For the past 3 decades, research has focused either on qualitative assessment of the appeal of digital games for seniors (by game designers) or on the quantitative evaluation of their clinical efficacy (by clinical researchers). The consensus is that interindividual differences play a key role in whether games can be useful or not for different individuals. Our challenge is to design SGs that retain their users long enough to sustain beneficial transfer effects. We propose to add a neuropsychological experimental framework (based on the appraisal theory of stress and coping) to a Gerontoludic design framework (that emphasizes designing positive and meaningful gaming experience over benefit-centric ones) in order to capture data to guide SG game development. Affective Game Planning for Health Applications (AGPHA) adds a model-driven mixed-methods experimental stage to a user-centered mechanics-dynamics-aesthetics game-design cycle. This intersectoral framework is inspired by latest trends in the fields of neuroimaging and neuroinformatics that grapple with similar challenges related to the psychobiological context of an individual's behaviors. AGPHA aims to bring users, designers, clinicians, and researchers together to generate a common data repository that consists of 4 components to define, design, evaluate, and document SGs. By unifying efforts under a standard approach, we will accelerate innovations in persuasive and efficacious ICTs for the aging population.

Intrinsic Resting-State Activity in Older Adults With Video Game Experience

Playing video games is a prevalent leisure activity in current daily life, and studies have found that video game experience has positive effects in several cognitive domains. However, few studies have examined the effect of video game experience on the amplitude of low-frequency fluctuations (ALFF) among older adults. In the current study, we compared behavioral performance in the flanker task and ALFF activities of older adults, of whom 15 were video game players (VGPs) and 18 non-video game players (NVGPs). The results showed that VGPs outperformed NVGPs in the flanker task and that VGPs showed significantly increased ALFF relative to NVGPs in the left inferior occipital gyrus, left cerebellum and left lingual gyrus. Furthermore, the ALFF in the left inferior occipital gyrus and left lingual gyrus was positively correlated with cognitive performance as measured by Mini-Mental State Examination (MMSE) scores. These results revealed that playing video games might improve behavioral performance and change intrinsic brain activity in older adults. Future video game training studies in older adults are warranted to provide more evidence of the positive effects of video game experience on behavioral and brain function.

Effects of exergame training combined with omega-3 fatty acids on the elderly brain: a randomized double-blind placebo-controlled trial

Background

Older adults often suffer from age- and behavior-related brain changes affecting neuronal functioning and, therefore, cognitive and motor functions. The improvement of these functions might decrease falls and improve mobility. Previous studies indicate that video game-based physical exercise, so-called exergames, or omega-3 fatty acids (FAs) improve motor and cognitive functioning through brain adaptations. The aim of this study was to assess the effects of exergame training combined with fish oil supplementation on neuronal system levels in the brain and behavioral measurements in older adults. We hypothesized that the combination would differently affect these factors compared to the sole administration of exergame.

Methods

Fifty-eight participants were randomly assigned to one of two groups (N = 29 each group) in a parallel, double-blind, randomized controlled trial lasting 26 weeks. The experimental group received daily fish oil, whereas the control group received daily olive oil. After 16 weeks, both groups started with an exergame training. Measurements were performed pre, during, and post intervention. Primary outcomes were recruitment curves using transcranial magnetic stimulation and response-locked potentials using electroencephalography. Secondary outcomes included executive functions and gait parameters. Blood samples were taken to control for FAs.

Results

Forty-three individuals (mean age 69.4 ± 4.6 years) completed the study (N_experimental = 22, N_control = 21). The results showed no significant time × group interaction effects for any parameters. Blood samples demonstrated significant time × group interaction effects. Post-hoc tests showed a significant increase of omega-3 FAs (p < .001) and a significant decrease of omega-6 FAs (p < .001) for the experimental group.

Conclusion

The combination of exergame training and fish oil did not lead to additional beneficial effects. To trigger possible effects, future studies should carefully consider study design aspects; e.g. study duration, individual nutritional supplementation dose, omega-3 FAs supplementation composition, and placebo. Furthermore, studies should consider neuroimaging methods as these might be more sensitive to assess early brain adaptations. Thus, future studies should be aware of several aspects running a combinatory study that includes omega-3 FAs according to their expected effects.

Trial registration

Swiss National Clinical Trials SNCTP000001623 and ISRCTN12084831 registered 30 November 2015.

Maximizing New Technologies to Treat Depression

In an era of rapid technological evolution, mental healthcare providers are tapping into technology that offers feasible and effective alternatives to reach patients who suffer from depression. This paper provides a brief history and description of current technologies, frequently used taxonomies, and specific applications for the assessment and treatment of depression. These include online healthcare communities and social media, automated screening, wearable technology, and virtual reality therapy. A review of a secondary analysis that incorporated technology used with patients experiencing depressive symptoms is provided and future trends in mHealth or cellular-based technologies to treat depression are explored.

An Interactive Home-Based Cognitive-Motor Step Training Program to Reduce Fall Risk in Older Adults: Qualitative Descriptive Study of Older Adults' Experiences and Requirements

Background

Falls are a major contributor to the burden of disease in older adults. Home-based exercise programs are effective in reducing the rate and risk of falls in older adults. However, adherence to home-based exercise programs is low, limiting the efficacy of interventions. The implementation of technology-based exercise programs for older adults to use at home may increase exercise adherence and, thus, the effectiveness of fall prevention interventions. More information about older adults’ experiences when using technologies at home is needed to enable the design of programs that are tailored to older adults’ needs.

Objective

This study aimed to (1) explore older adults’ experiences using SureStep, an interactive cognitive-motor step training program to reduce fall risk unsupervised at home; (2) explore program features that older adults found encouraged program uptake and adherence; (3) identify usability issues encountered by older adults when using the program; and (4) provide guidance for the design of a future technology-based exercise program tailored to older adults to use at home as a fall prevention strategy.

Methods

This study was part of a larger randomized controlled trial. The qualitative portion of the study and the focus of this paper used a qualitative descriptive design. Data collectors conducted structured, open-ended in-person interviews with study participants who were randomly allocated to use SureStep at home for 4 months. All interviews were audiotaped and ranged from 45 to 60 min. Thematic analysis was used to analyze collected data. This study was guided by Pender’s Health Promotion Model.

Results

Overall, 24 older adults aged 70 to 97 years were interviewed. Findings suggest older adults are open to use technology-based exercise programs at home, and in the context of optimizing adherence to home-based exercise programs for the prevention of falls, findings suggest that program developers should develop exercise programs in ways that provide older adults with a fun and enjoyable experience (thus increasing intrinsic motivation to exercise), focus on improving outcomes that are significant to older adults (thus increasing self-determined extrinsic motivation), offer challenging yet attainable exercises (thus increasing perceived self-competence), provide positive feedback on performance (thus increasing self-efficacy), and are easy to use (thus reducing perceived barriers to technology use).

Conclusions

This study provides important considerations when designing technology-based programs so they are tailored to the needs of older adults, increasing both usability and acceptability of programs and potentially enhancing exercise participation and long-term adherence to fall prevention interventions. Program uptake and adherence seem to be influenced by (1) older adults’ perceived benefits of undertaking the program, (2) whether the program is stimulating, and (3) the perceived barriers to exercise and technology use. Older adults shared important recommendations for future development of technologies for older adults to use at home.

Executive Functioning of Older Adults Correlates with Performance of Touchscreen App-Based Puzzles

BACKGROUND

The use of touchscreen tablets has become common in healthcare. This technology has the potential to be used as a motivational tool for cognitive training. Age-related decline in executive functioning (EF) and dexterity may lead to poor performance using tablet applications (apps), but the impact on performance of app-based puzzles has not been studied.

OBJECTIVES

(1) To characterize and compare the experience performance of playing tablet apps of older and younger adults, (2) To determine if EF and dexterity contribute to performance of app-based puzzles.

MATERIALS AND METHODS

We performed a cross-sectional study of community-dwelling healthy older (n = 35) and younger adults (n = 34). EF was measured by the Trail Making Test (part B) (TMT-B) and the Weekly Calendar Planning Activity. Dexterity was assessed using the Nine-Hole Peg Test. Participants played three unfamiliar app-based puzzles requiring EF and filled out the short feedback questionnaire.

RESULTS

All participants succeeded in playing the apps and reported enjoyment, however, older adults perceived less success and control. Significant differences in EF, dexterity, and performance were found between groups. EF of older adults (TMT-B) accounted for 17.7%-36.8% (P < 0.05) of the total variance of performance.

CONCLUSION

These findings have implications for the use of tablet apps for older adults. Longer instruction and training periods may be required for training EF among older adults.

Exergames Inherently Contain Cognitive Elements as Indicated by Cortical Processing

Exergames are increasingly used to train both physical and cognitive functioning, but direct evidence whether and how exergames affect cortical activity is lacking. Although portable electroencephalography (EEG) can be used while exergaming, it is unknown whether brain activity will be obscured by movement artifacts. The aims of this study were to assess whether electrophysiological measurements during exergaming are feasible and if so, whether cortical activity changes with additional cognitive elements. Twenty-four young adults performed self-paced sideways leaning movements, followed by two blocks of exergaming in which participants completed a puzzle by leaning left or right to select the correct piece. At the easy level, only the correct piece was shown, while two pieces were presented at the choice level. Brain activity was recorded using a 64-channel passive EEG system. After filtering, an adaptive mixture independent component analysis identified the spatio-temporal sources of brain activity. Results showed that it is feasible to record brain activity in young adults while playing exergames. Furthermore, five spatially different clusters were identified located frontal, bilateral central, and bilateral parietal. The frontal cluster had significantly higher theta power in the exergaming condition with choice compared to self-paced leaning movements and exergaming without choice, while both central clusters showed a significant increase in absolute alpha-2 power in the exergaming conditions compared to the self-paced movements. This is the first study to show that it is feasible to record brain activity while exergaming. Furthermore, results indicated that even a simple exergame without explicit cognitive demands inherently requires cognitive processing. These results pave the way for studying brain activity during various exergames in different populations to help improve their effective use in rehabilitation settings.

Alternative Treatment Modalities and Its Effect in Older Populations

Aging is an inevitable multifactorial process. Advances in health care and technology have led to an increase on expected life span that can reach an average of 90 years in the next few decades. Lifestyle changes that include activity, nutrition, stress management, and alternatives low-impact exercises like yoga and tai chi can help us modify some of these age-related changes and lead to an increase in the health span and quality of life of the older adults.

Cognitive Interventions for Cognitively Healthy, Mildly Impaired, and Mixed Samples of Older Adults: A Systematic Review and Meta-Analysis of Randomized-Controlled Trials

Cognitive interventions may improve cognition, delay age-related cognitive declines, and improve quality of life for older adults. The current meta-analysis was conducted to update and expand previous work on the efficacy of cognitive interventions for older adults and to examine the impact of key demographic and methodological variables. EBSCOhost and Embase online databases and reference lists were searched to identify relevant randomized-controlled trials (RCTs) of cognitive interventions for cognitively healthy or mildly impaired (MCI) older adults (60+ years). Interventions trained a single cognitive domain (e.g., memory) or were multi-domain training, and outcomes were assessed immediately post-intervention using standard neuropsychological tests. In total, 279 effects from 97 studies were pooled based on a random-effects model and expressed as Hedges' g (unbiased). Overall, results indicated that cognitive interventions produce a small, but significant, improvement in the cognitive functioning of older adults, relative to active and passive control groups (g = 0.298, p < .001, 95% CI = 0.248-0.347). These results were confirmed using multi-level analyses adjusting for nesting of effect sizes within studies (g = 0.362, p < .001, 95% CI = 0.275, 0.449). Age, education, and cognitive status (healthy vs. MCI) were not significant moderators. Working memory interventions proved most effective (g = 0.479), though memory, processing speed, and multi-domain interventions also significantly improved cognition. Effects were larger for directly trained outcomes but were also significant for non-trained outcomes (i.e., "transfer effects"). Implications for future research and clinical practice are discussed. This project was pre-registered with PROSPERO (#42016038386).

What Older People Like to Play: Genre Preferences and Acceptance of Casual Games

BACKGROUND

In recent computerized cognitive training studies, video games have emerged as a promising tool that can benefit cognitive function and well-being. Whereas most video game training studies have used first-person shooter (FPS) action video games, subsequent studies found that older adults dislike this type of game and generally prefer casual video games (CVGs), which are a subtype of video games that are easy to learn and use simple rules and interfaces. Like other video games, CVGs are organized into genres (eg, puzzle games) based on the rule-directed interaction with the game. Importantly, game genre not only influences the ease of interaction and cognitive abilities CVGs demand, but also affects whether older adults are willing to play any particular genre. To date, studies looking at how different CVG genres resonate with older adults are lacking.

OBJECTIVE

The aim of this study was to investigate how much older adults enjoy different CVG genres and how favorably their CVG characteristics are rated.

METHODS

A total of 16 healthy adults aged 65 years and above playtested 7 CVGs from 4 genres: casual action, puzzle, simulation, and strategy video games. Thereafter, they rated casual game preference and acceptance of casual game characteristics using 4 scales from the Core Elements of the Gaming Experience Questionnaire (CEGEQ). For this, participants rated how much they liked the game (enjoyment), understood the rules of the game (game-play), learned to manipulate the game (control), and make the game their own (ownership).

RESULTS

Overall, enjoyment and acceptance of casual game characteristics was high and significantly above the midpoint of the rating scale for all CVG genres. Mixed model analyses revealed that ratings of enjoyment and casual game characteristics were significantly influenced by CVG genre. Participants' mean enjoyment of casual puzzle games (mean 0.95 out of 1.00) was significantly higher than that for casual simulation games (mean 0.75 and 0.73). For casual game characteristics, casual puzzle and simulation games were given significantly higher game-play ratings than casual action games. Similarly, participants' control ratings for casual puzzle games were significantly higher than that for casual action and simulation games. Finally, ownership was rated significantly higher for casual puzzle and strategy games than for casual action games.

CONCLUSIONS

The findings of this study show that CVGs have characteristics that are suitable and enjoyable for older adults. In addition, genre was found to influence enjoyment and ratings of CVG characteristics, indicating that puzzle games are particularly easy to understand, learn, and play, and are enjoyable. Future studies should continue exploring the potential of CVG interventions for older adults in improving cognitive function, everyday functioning, and well-being. We see particular potential for CVGs in people suffering from cognitive impairment due to dementia or brain injury.

Combining Exergame Training with Omega-3 Fatty Acid Supplementation: Protocol for a Randomized Controlled Study Assessing the Effect on Neuronal Structure/Function in the Elderly Brain

A common problem in the older population is the risk of falling and related injury, immobility, and reduced survival. Age-related neuronal changes, e.g., decline in gray-and white-matter, affect neuronal, cognitive, and motor functioning. The improvement of these factors might decrease fall events in elderly. Studies showed that administration of video game-based physical exercise, a so-called exergame, or omega-3 fatty acid (FA) may improve motor and/or cognitive functioning through neuronal changes in the brain of older adults. The aim of this study is to assess the effects of a combination of exergame training with omega-3 FA supplementation on the elderly brain. We hypothesize that an intervention using a combination approach differently affects on the neuronal structure and function of the elderly's brain as compared to the sole administration of exergame training. The study is a parallel, double-blinded, randomized controlled trial lasting 26 weeks. Sixty autonomous living, non-smoking, and right-handed healthy older (>65 years) adults who live independently or in a senior residency are included, randomized, and allocated to one of two study groups. The experimental group receives a daily amount of 13.5 ml fish oil (including 2.9 g of omega-3 FA), whereas the control group receives a daily amount of 13.5 ml olive oil for 26 weeks. After 16 weeks, both groups start with an exergame training program three times per week. Measurements are performed on three time-points by treatment blinded investigators: pre-intervention measurements, blood sample after 16 week, and post-intervention measurements. The main outcomes are motor evoked potentials of the right M. tibialis anterior (transcranial magnetic stimulation) and response-related potentials (electroencephalography) during a cognitive test. For secondary outcomes, reaction time during cognitive tests and spatio-temporal parameters during gait performance are measured. Statistics will include effect sizes and a 2 × 2-ANOVA with normally distributed data or the non-parametric equivalent for data not fulfilling normal distribution. The randomized controlled study is the first to investigate the effectiveness of exergame training combined with omega-3 FA in counteracting age- and behavioral-dependent neuronal changes in the brain. This study has been registered in the Swiss National Clinical Trials (SNCTP000001623) and the ISRCTN (ISRCTN12084831) Portals.

Adaptations of Prefrontal Brain Activity, Executive Functions, and Gait in Healthy Elderly Following Exergame and Balance Training: A Randomized-Controlled Study

During aging, the prefrontal cortex (PFC) undergoes age-dependent neuronal changes influencing cognitive and motor functions. Motor-learning interventions are hypothesized to ameliorate motor and cognitive deficits in older adults. Especially, video game-based physical exercise might have the potential to train motor in combination with cognitive abilities in older adults. The aim of this study was to compare conventional balance training with video game-based physical exercise, a so-called exergame, on the relative power (RP) of electroencephalographic (EEG) frequencies over the PFC, executive function (EF), and gait performance. Twenty-seven participants (mean age 79.2 ± 7.3 years) were randomly assigned to one of two groups. All participants completed 24 trainings including three times a 30 min session/week. The EEG measurements showed that theta RP significantly decreased in favor of the exergame group [L₍₁₄₎ = 6.23, p = 0.007]. Comparing pre- vs. post-test, EFs improved both within the exergame (working memory: z = -2.28, p = 0.021; divided attention auditory: z = -2.51, p = 0.009; divided attention visual: z = -2.06, p = 0.040; go/no-go: z = -2.55, p = 0.008; set-shifting: z = -2.90, p = 0.002) and within the balance group (set-shifting: z = -2.04, p = 0.042). Moreover, spatio-temporal gait parameters primarily improved within the exergame group under dual-task conditions (speed normal walking: z = -2.90, p = 0.002; speed fast walking: z = -2.97, p = 0.001; cadence normal walking: z = -2.97, p = 0.001; stride length fast walking: z = -2.69, p = 0.005) and within the balance group under single-task conditions (speed normal walking: z = -2.54, p = 0.009; speed fast walking: z = -1.98, p = 0.049; cadence normal walking: z = -2.79, p = 0.003). These results indicate that exergame training as well as balance training positively influence prefrontal cortex activity and/or function in varying proportion.

Computer Activities for Persons With Dementia

PURPOSE OF THE STUDY

The study examined participant's experience and individual characteristics during a 7-week computer activity program for persons with dementia.

DESIGN AND METHODS

The descriptive study with mixed methods design collected 612 observational logs of computer sessions from 27 study participants, including individual interviews before and after the program. Quantitative data analysis included descriptive statistics, correlational coefficients, t-test, and chi-square. Content analysis was used to analyze qualitative data.

RESULTS

Each participant averaged 23 sessions and 591min for 7 weeks. Computer activities included slide shows with music, games, internet use, and emailing. On average, they had a high score of intensity in engagement per session. Women attended significantly more sessions than men. Higher education level was associated with a higher number of different activities used per session and more time spent on online games. Older participants felt more tired. Feeling tired was significantly correlated with a higher number of weeks with only one session attendance per week. More anticholinergic medications taken by participants were significantly associated with a higher percentage of sessions with disengagement. The findings were significant at p < .05. Qualitative content analysis indicated tailoring computer activities appropriate to individual's needs and functioning is critical. All participants needed technical assistance.

IMPLICATIONS

A framework for tailoring computer activities may provide guidance on developing and maintaining treatment fidelity of tailored computer activity interventions among persons with dementia. Practice guidelines and education protocols may assist caregivers and service providers to integrate computer activities into homes and aging services settings.

A pilot study of cognitive training with and without transcranial direct current stimulation to improve cognition in older persons with HIV-related cognitive impairment

BACKGROUND

In spite of treatment advances, HIV infection is associated with cognitive deficits. This is even more important as many persons with HIV infection age and experience age-related cognitive impairments. Both computer-based cognitive training and transcranial direct current stimulation (tDCS) have shown promise as interventions to improve cognitive function. In this study, we investigate the acceptability and efficacy of cognitive training with and without tDCS in older persons with HIV.

PATIENTS AND METHODS

In this single-blind randomized study, participants were 14 individuals of whom 11 completed study procedures (mean age =51.5 years; nine men and two women) with HIV-related mild neurocognitive disorder. Participants completed a battery of neuropsychological and self-report measures and then six 20-minute cognitive training sessions while receiving either active or sham anodal tDCS over the left dorsolateral prefrontal cortex. After training, participants completed the same measures. Success of the blind and participant reactions were assessed during a final interview. Assessments were completed by an assessor blind to treatment assignment. Pre- and post-training changes were evaluated via analysis of covariance yielding estimates of effect size.

RESULTS

All participants believed that they had been assigned to active treatment; nine of the 11 believed that the intervention had improved their cognitive functioning. Both participants who felt the intervention was ineffective were assigned to the sham condition. None of the planned tested interactions of time with treatment was significant, but 12 of 13 favored tDCS (P=0.08). All participants indicated that they would participate in similar studies in the future.

CONCLUSION

Results show that both cognitive training via computer game playing and tDCS were well accepted by older persons with HIV infection. Results are suggestive that tDCS may improve cognitive function in persons with HIV infection. Further study of tDCS as an intervention for HIV-related cognitive dysfunction is warranted.

Older Adult Video Game Preferences in Practice: Investigating the Effects of Competing or Cooperating

Video game interventions with the aim to improve cognition have shown promise for both younger (e.g., Powers et al., 2013) and older adults (e.g., Toril, Reales, and Ballesteros, 2014). Most studies suggest that fast-paced action games produce the largest benefits, but a recent video game intervention with older adults found that an action game intervention can result in poor adherence (Boot et al., 2013). To increase intervention adherence, we investigated older adult video game preferences that might bolster adherence by having participants play a competitive game (Mario Kart DS) or a cooperative game (Lego Star Wars: The Complete Saga) alone or with a partner. Although hypotheses regarding cooperative and multi-player gameplay were not supported, converging evidence suggests multi-player game play may lead to greater enjoyment, which was related to intervention adherence in a previous study (Boot et al., 2013). Insights for gaming intervention studies in older populations are also provided.

Effect of virtual reality on cognitive dysfunction in patients with brain tumor

Objective

To investigate whether virtual reality (VR) training will help the recovery of cognitive function in brain tumor patients.

Methods

Thirty-eight brain tumor patients (19 men and 19 women) with cognitive impairment recruited for this study were assigned to either VR group (n=19, IREX system) or control group (n=19). Both VR training (30 minutes a day for 3 times a week) and computer-based cognitive rehabilitation program (30 minutes a day for 2 times) for 4 weeks were given to the VR group. The control group was given only the computer-based cognitive rehabilitation program (30 minutes a day for 5 days a week) for 4 weeks. Computerized neuropsychological tests (CNTs), Korean version of Mini-Mental Status Examination (K-MMSE), and Korean version of Modified Barthel Index (K-MBI) were used to evaluate cognitive function and functional status.

Results

The VR group showed improvements in the K-MMSE, visual and auditory continuous performance tests (CPTs), forward and backward digit span tests (DSTs), forward and backward visual span test (VSTs), visual and verbal learning tests, Trail Making Test type A (TMT-A), and K-MBI. The VR group showed significantly (p<0.05) better improvements than the control group in visual and auditory CPTs, backward DST and VST, and TMT-A after treatment.

Conclusion

VR training can have beneficial effects on cognitive improvement when it is combined with computer-assisted cognitive rehabilitation. Further randomized controlled studies with large samples according to brain tumor type and location are needed to investigate how VR training improves cognitive impairment.

Immersive technology and the elderly: a mini-review

Technologies that provide immersive experiences continue to become more ubiquitous across all age groups. This paper presents a review of the literature to provide a snapshot of the current state of research involving the use of immersive technologies and the elderly. A narrative literature review was conducted using the ScienceDirect, EBSCOhost, Springerlink and ERIC databases to summarize primary studies from which conclusions were drawn into a holistic interpretation. The majority of the studies examined the effect of immersive technologies on elder peoples' age-related declines, including sensory and motor changes (vision, hearing, motor skills), cognitive changes and social changes. Various immersive technologies have been described and tested to address these age-related changes, and have been categorized as 'games and simulations', 'robotics' and 'social technologies'. In most cases, promising results were found for immersive technologies to challenge age-related declines, especially through the increase of morale.

Preferred computer activities among individuals with dementia: a pilot study

Computers offer new activities that are easily accessible, cognitively stimulating, and enjoyable for individuals with dementia. The current descriptive study examined preferred computer activities among nursing home residents with different severity levels of dementia. A secondary data analysis was conducted using activity observation logs from 15 study participants with dementia (severe = 115 logs, moderate = 234 logs, and mild = 124 logs) who participated in a computer activity program. Significant differences existed in preferred computer activities among groups with different severity levels of dementia. Participants with severe dementia spent significantly more time watching slide shows with music than those with both mild and moderate dementia (F [2,12] = 9.72, p = 0.003). Preference in playing games also differed significantly across the three groups. It is critical to consider individuals' interests and functional abilities when computer activities are provided for individuals with dementia. A practice guideline for tailoring computer activities is detailed.

How Interventions Might Improve Cognition in Healthy Older Adults

Many of the cognitive declines in healthy aging are moderated by experience, suggesting that interventions may be beneficial. Goals for aging outcomes include improving performance on untrained tasks, remediating observed cognitive declines, and ensuring preservation of functional ability. This selective review evaluates current progress towards these goals. Most research focuses on untrained tasks. Interventions associated with this outcome include games and exercises practicing specific cognitive skills, as well as aerobic exercise, and modestly benefit a relatively narrow range of cognitive tasks. Few studies have directly tested improvements in tasks on which individuals have been shown to experience longitudinal decline, so this goal has not been realized, though remediation can be examined rather easily. Little work has been done to develop psychometrically strong functional outcomes that could be used to test preservation of independence in everyday activities. Virtual reality approaches to functional assessment show promise for achieving the third goal.

A cognitive-motor intervention using a dance video game to enhance foot placement accuracy and gait under dual task conditions in older adults: a randomized controlled trial

BACKGROUND

Computer-based interventions have demonstrated consistent positive effects on various physical abilities in older adults. This study aims to compare two training groups that achieve similar amounts of strength and balance exercise where one group receives an intervention that includes additional dance video gaming. The aim is to investigate the different effects of the training programs on physical and psychological parameters in older adults.

METHODS

Thirty-one participants (mean age ± SD: 86.2 ± 4.6 years), residents of two Swiss hostels for the aged, were randomly assigned to either the dance group (n = 15) or the control group (n = 16). The dance group absolved a twelve-week cognitive-motor exercise program twice weekly that comprised progressive strength and balance training supplemented with additional dance video gaming. The control group performed only the strength and balance exercises during this period. Outcome measures were foot placement accuracy, gait performance under single and dual task conditions, and falls efficacy.

RESULTS

After the intervention between-group comparison revealed significant differences for gait velocity (U = 26, P = .041, r = .45) and for single support time (U = 24, P = .029, r = .48) during the fast walking dual task condition in favor of the dance group. No significant between-group differences were observed either in the foot placement accuracy test or in falls efficacy.

CONCLUSIONS

There was a significant interaction in favor of the dance video game group for improvements in step time. Significant improved fast walking performance under dual task conditions (velocity, double support time, step length) was observed for the dance video game group only. These findings suggest that in older adults a cognitive-motor intervention may result in more improved gait under dual task conditions in comparison to a traditional strength and balance exercise program.

TRIAL REGISTRATION

This trial has been registered under ISRCTN05350123 (www.controlled-trials.com)

Cognitive and cognitive-motor interventions affecting physical functioning: a systematic review

BACKGROUND

Several types of cognitive or combined cognitive-motor intervention types that might influence physical functions have been proposed in the past: training of dual-tasking abilities, and improving cognitive function through behavioral interventions or the use of computer games. The objective of this systematic review was to examine the literature regarding the use of cognitive and cognitive-motor interventions to improve physical functioning in older adults or people with neurological impairments that are similar to cognitive impairments seen in aging. The aim was to identify potentially promising methods that might be used in future intervention type studies for older adults.

METHODS

A systematic search was conducted for the Medline/Premedline, PsycINFO, CINAHL and EMBASE databases. The search was focused on older adults over the age of 65. To increase the number of articles for review, we also included those discussing adult patients with neurological impairments due to trauma, as these cognitive impairments are similar to those seen in the aging population. The search was restricted to English, German and French language literature without any limitation of publication date or restriction by study design. Cognitive or cognitive-motor interventions were defined as dual-tasking, virtual reality exercise, cognitive exercise, or a combination of these.

RESULTS

28 articles met our inclusion criteria. Three articles used an isolated cognitive rehabilitation intervention, seven articles used a dual-task intervention and 19 applied a computerized intervention. There is evidence to suggest that cognitive or motor-cognitive methods positively affects physical functioning, such as postural control, walking abilities and general functions of the upper and lower extremities, respectively. The majority of the included studies resulted in improvements of the assessed functional outcome measures.

CONCLUSIONS

The current evidence on the effectiveness of cognitive or motor-cognitive interventions to improve physical functioning in older adults or people with neurological impairments is limited. The heterogeneity of the studies published so far does not allow defining the training methodology with the greatest effectiveness. This review nevertheless provides important foundational information in order to encourage further development of novel cognitive or cognitive-motor interventions, preferably with a randomized control design. Future research that aims to examine the relation between improvements in cognitive skills and the translation to better performance on selected physical tasks should explicitly take the relation between the cognitive and physical skills into account.

Use of virtual reality technique for the training of motor control in the elderly. Some theoretical considerations

Virtual augmented exercise, an emerging technology that can help to promote physical activity and combine the strengths of indoor and outdoor exercise, has recently been proposed as having the potential to increase exercise behavior in older adults. By creating a strong presence in a virtual, interactive environment, distraction can be taken to greater levels while maintaining the benefits of indoor exercises which may result in a shift from negative to positive thoughts about exercise. Recent findings on young participants show that virtual reality training enhances mood, thus, increasing enjoyment and energy. For older adults virtual, interactive environments can influence postural control and fall events by stimulating the sensory cues that are responsible in maintaining balance and orientation. However, the potential of virtual reality training has yet to be explored for older adults. This manuscript describes the potential of dance pad training protocols in the elderly and reports on the theoretical rationale of combining physical game-like exercises with sensory and cognitive challenges in a virtual environment.