1
ACDC
AdultCognitiveDeclineConscientiousnessProject
2017-1-IT02-KA204-036825
EffectivenessofComputerizedCognitiveTraininginPreventingCognitiveDeclineinOlderAdultswithMildCognitiveImpairment
ACDCprojectisfundedwithsupportfromtheEuropeanCommission.Thisresearchanditscontentreflecttheviewsonlyoftheauthor,andtheCommissioncannotbeheldresponsibleforanyusewhichmaybemadeoftheinformationcontainedtherein.
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Index
I. Background
II. Searchingforevidence
- Methodology
- Results
a) CharacteristicsofIncludedStudies
b) ProgramDescriptionandTargetedDomains
c) OverallEfficacyonCognitiveOutcomes
- Globalcognition
- Verballearning
- Verbalmemory
- Nonverballearning
- Workingmemory
- Attention
- Psychosocialfunctioning
- Otherdomains
III. Conclusions
IV. Conflictofinterestsandfunding
V. References
VI. Annexes:Table1.CharacteristicsofIncludedStudies
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I. Background
Mildcognitiveimpairment(MCI)relatestocognitivedeclinefromapreviousleveloffunctioning,bothbysubjective
and objective evidence. Different clinical criteria can be applied to identify peoplewithMCI and, according to the
definitionused,itsprevalenceestimatesmayvaryfrom5.0%to36.7%andtheyincreasewiththepopulationage[1].
Inbroadterms,thelevelofcognitivedeclineassociatedwithMCIisgreaterthanexpectedforage,butnotassevere
asthatassociatedwithdementia,withminimalimpairmentofInstrumentalActivitiesofDailyLiving(IADL)[2].
MCIincreasestheriskfordementia,withdiagnosedindividualsprogressingatratesupto6-10%peryearcompared
with1-2%inthegeneralpopulation[3].
ThemajorMCIsubtypesareamnestic(aMCI),involvingepisodicmemoryimpairment(withorwithoutimpairmentin
othercognitivedomains),andnon-amnestic(na-MCI),involvingimpairmentincognitivedomainsotherthanmemory
(e.g.language,visuospatialprocessing,executivefunctions).
Fromahealthcareperspective, thehigherprevalenceof thisage-related impairment incognitive functionsand the
contemporary expanding aging population highlight the need to identify quick, effective and low-cost solutions to
delaypathologicalcognitivedecline[4].
Successfully assisting older adults to possibly slow cognitive decline,maintaining quality of life and independence,
remainsindeedamajorchallenge[5].
Since the relative pharmacological treatment ineffectiveness to face this problem [2], there has been a growing
interest inthepotentialfor lifestyle interventions,suchasappropriatementalactivities,to improveormaintainthe
cognitivefunctions.
To this purpose, cognitive training is a specific form of non-pharmacological intervention to address cognitive and
non-cognitive outcomes [6]. It involves guided practice on a set of standardized tasks that aim to address specific
aspectsofcognition,suchasmemory,language,attentionorexecutivefunctions.
Withinthedifferenttasks,varyingdifficultylevelsmaybeofferedtocontinuouslyadjusttaskdifficultybasedonthe
subjectsperformance[7].
Traditional trainingprogramsareusuallydelivered in groupsor face-to face,whichentails identifyinga convenient
meeting location, coordinating schedules and travel time. To overcome these aspects, novel cognitive training
platformshavebeendevelopedandstructuredrecentlyand,inthiscontext,computer-basedcognitiveinterventions
arebecomingapotentiallycost-effectivealternativetotraditionaltrainingforms.
Firstly, they can be easily disseminated, reaching special populations that would otherwise not receive such
interventions (e.g. older adults who have limited access to transportation are difficult to recruit for traditional
cognitivetrainingprograms);secondly,theycanofferamoreflexible,personalizedapproachtoanyonewithaccessto
technology;thirdly,theycanprovidereal-timeperformancefeedbackstoalltheusers.
Lastly, poor adherence can be a challengewith traditional cognitive training programs. In contrast, computer and
videogamesaredesignedtobefunandexcitingandmayprovidemotivationforolderadultstostickwiththetraining
program[4].
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Inthisresearch,giventheextensivebodyofdatareportingwhetherolderadultscanbenefitfromcognitivetraining
interventions, we specifically focused on the effectiveness of computerized cognitive training in people with mild
cognitiveimpairmenttosummarizethemainavailableevidenceonthetopic.
II. Searchingforevidence
MethodologyThesearchprocesswascarriedoutinthreesteps.
In stepone,weused thePICOstrategy to identify thesearch termsand the researchquestion.PICOrepresentsan
acronymforPatient, Intervention,ComparisonandOutcome.These fourcomponentsare theessentialelementsof
thequestionconstructionforthebibliographicsearchofavailabledata.
Inparticular,wefocusedonthescientificevidenceabouttheeffectivenessofcomputerizedcognitivetraininginolder
adultswithMCI.
Insteptwo,weconductedaliteraturereviewusingthemainelectronicdatabasesMedlineandScopus.
Searchtermspreviouslyidentifiedandusedwere“cognitivetraining”OR“braintraining”OR“computerizedcognitive
training”AND“mildcognitiveimpairment”OR“MCI”OR“cognitivedecline”.
TheliteraturesearchwasperformedandupdatedthroughMarch2018.
Eligible studies were published in English or Italian, peer reviewed reports of randomized controlled trials (RCTs),
systematicreviewsormeta-analyses,evaluatingtheeffectsofcomputer-basedcognitivetrainingonpeoplewithMCI
orwithearly-stagedementia.
Afterscreeningthetitlesandabstracts,we identifiedarecentlypublishedmeta-analysis (2017)whichaddressedall
theessentialelementsofourresearchquestion[8].
Inparticular,itisasystematicreviewoftheeffectivenessofcomputerizedcognitivetraininginolderadultswithmild
cognitive impairment with a statistical analysis of its effects on global cognition and on the individual cognitive
domains,usefultochartpotentialbenefitsoncognitionandbehavioracrossthedistinctdomains.
ItincludesonlyRCTspublishedfromdatabasesinceptionto1stJuly2016.
In step three,we extracted and analyzed all the relevant data from the articleswhichwere included in themeta-
analysisandwespecificallysearchedtheliteratureforthelatestarticlestoupdateit.
Toourknowledge,nonewarticleswerepublishedfrom1stJuly2016to15thMarch2018thatwererelevantforour
research.
Results
a) CharacteristicsofIncludedStudies
Themeta-analysisauthorsscreenedmorethan22,200recordstofinally include16articles:14published inEnglish,
oneinGermanandoneinKoreanwhichweretranslatedbeforebeinganalyzed.Twoweresplitintotwostudieseach
[9],[10],andtwoarticlesreportingoutcomesfromthesametrialwerecombinedintoonestudy[11],[12],resultingin
afinaldatasetof17independentcomparisonsincludedandanalyzed(seeAnnex1,Table1).
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The total numberof participantswas686 (ComputerizedCognitive Training group:N=351,meangroup size:N=21;
Control:N=335,meangroupsize:N=20).Meanagerangedbetween67and81years.
Activecontrol,definedasshamCCTorpsychoeducation,wasreportedin11/17studies.
Intheremainingstudies,passiveactivities(e.g.no-contact,wait-list)wereofferedtothecontrolarm.
Studies combining CCT with other interventions were eligible if the control group received the same adjacent
intervention.
All thearticleswereassessedusing thePEDro-P scale, a critical appraisal todetermine themethodologyqualityof
clinicaltrials.ThereportedmeanPEDro-Pscorewas7.2/9(SD=1.03).
Each computer-based session in the cognitive training group lasted from20minutes to amaximumof 100,with a
meanlengthof63.5minutes.Themeannumberofsessionsperformedbytheexperimentalgroupwas29.9,witha
meanof2.59sessionperweek.
Baseline cognitive characteristics of participants undergoing the cognitive trainingwere examined formost studies
usingtheMini-MentalStateExamination(13/17)withameanscorerangingfrom22.88to27.79.
b) ProgramDescriptionandProgram-TargetedCognitiveDomains
Therearemanydifferentavailabletoolsforcognitivetrainingandspecificstructuredsoftwaredesignedforit.
Particularly, most of the studies included in this meta-analysis (11/17) used exercises from structured software
programsthatwereplannedtobecomeprogressivelymoredifficultateachsessionandadjustableaccordingtouser
performance(sothateachpersonisalwaystrainingatthehigherlevel).
The software packages used are: Cogpack®, Brainfitness and InSight by Posit Science, Sociable, Lumosity Inc.,
CogniPlusTrainingProgramandNintendoWii.
Abriefdescriptionofeachsoftwareisreportedbelow:
- Cogpack®[9]consistsin64testsandtrainingprogramswith537differenttasksets,e.g.forvisuomotorcontrol,
comprehension, reaction, vigilance, memory, language, numbers, logic, problem solving, knowledge,
orientation, everyday skills, intellectual and professional skills and other special elements (e.g. labyrinths,
color/wordinterference,3-Dpositioningandassumptionsaboutpublicopinion).Taskscanbeedited,changed,
andexpanded.
- BrainfitnessbyPositScience[5], [10] focusesontheauditorysystemofthebrain,recognizingtothespeecha
central role. It consists in 6 easy-to-use and computer-based exercises that improve the auditory system in
severalways,asspeedingupprocessing,clarifyingsounddiscrimination,sharpeningsoundprecision,improving
soundsequencing,strengtheningauditoryworkingmemoryandenhancingnarrativememory.
- InSightbyPositScience[13]targetskeyrootsofcognitivefunction(thebrain’sabilitytotakeinformationfrom
thesensesquicklyandaccurately)inadditiontoexercisingmemorydirectly.Itconsistsof5gamesdesignedto
improvethevisualsystem,andparticularly:speedingupvisualprocessing,sharpeningvisualprecision,enlarging
usefulfieldofview,expandingdividedattentionandimprovingvisualworkingmemory.
- LumosityInc.[14]isafreeon-linewebsitedesignedtotraincognitive,mathandlanguageskills.Asetof3games
isoffereddaily,alwaysadjustedtouserperformanceandskilllevel.
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- Sociable[15]isaplatformthatofferspersonalizedcognitivetraining,coveringallthecognitiveskills,focusingon
memory, orientation, attention, constructural praxis, executive functions, language and logical reasoning.
Sociable boosts the social interactions of the elderly and motivates them by selected game concepts and
themes.
- CogniPlus[11],[12]isatrainingbatteryforthetrainingofcognitivefunctions.EachCogniPlustrainingistailored
toaspecificdeficit,whichisscientificallyproventobetrainable.Thedomainsare:attention,memory,executive
functions,spatialprocessing,visuomotorskillsandprocessingspeed. InCogniPlustheabilitydimensionsbeing
trainedarealmostalwaysembeddedinlifelikescenarios.
- NintendoWiiisagamewhereparticipantsaretrainedtousetheirarms/bodytosimulatetheactionsrequired
foreachsport.Itwasusedintwodifferentstudies;inthefirststudy[16]onlyNintendoWiibowlingwasused,
whiletheotherone[17]usedNintendoWiisports(whichincludesbowling,golf,tennisandbaseball).
Theothercognitive interventions includedinthemeta-analysisdidnotrefertoanyspecificsoftwareprogram,but
theauthorsdescribedtheexercisetypes.
Inparticular,onestudy[18]used“repetitionlag-training”taskswhichrequiredthelearningofaseriesofwordsand
thediscriminationofthosewordsfromunstudied lures.Threestudiesusedvirtualrealitytasks;oneforsimulating
museumtasks[19],oneforsimulatinghouseholdtasks[20]andoneforsimulatingabikeride[21].
Theremainingstudies[22],[23]usedothertypesofexercise(e.g.memorizingandrecognizingpictures,correlating
wordssemantically,solvingpuzzle).
Ingeneral,duringaCCTsession,4or5exerciseswereadministeredtoparticipantsintheCCTgroups.
Mostofthetasksthatparticipantshadtocarryout involvedattentiondomain(11/17),executivefunctions(10/17),
memory(verbal(8/17)andnonverbal/visual(7/17)),followedbyspeedprocessing(6/17)andvisuospatialprocessing
(5/17).
a) OverallefficacyonCognitiveOutcomes
Standardizedmean differences and their 95% confidence interval of change in cognitive outcomesmeasureswere
calculatedbetweentheCCTgroupandthecontrolgroup,frombaselinetopost-training.
ApositivestandardizedmeandifferenceindicatesatherapeuticeffectofCCToverandabovethecontrol(Fig.1).
Differenttestswereusedtomeasurethecognitiveoutcomeacrossthestudies.Alistoftheresultscategorizedbythe
cognitivedomainisreportedbelow.
- Globalcognition
TheeffectofCCTonglobalcognitionwasmeasuredin12/17studiesanditwasfoundtobemoderateandstatistically
significant.Therewasnodifferencebetweentheeffectacrossactiveorpassivecontrolledtrials.
- Verballearning
TheeffectofCCTonverballearningwasmeasuredin3/17studiesanditwasfoundtobemoderateandstatistically
significant.
- Verbalmemory
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TheeffectofCCTonverbalmemorywasmeasuredin7/17studiesanditwasfoundtobemoderateandstatistically
significant.
- Nonverballearning
The effect of CCT on nonverbal learning was measured in 8/17 studies and it was found to be moderate and
statisticallysignificant.
- Workingmemory
Theeffect of CCTonworkingmemorywasmeasured in 9/17 studies and itwas found tobe large and statistically
significant.
- Attention
The effect of CCT on attention wasmeasured in 11/17 studies and it was found to bemoderate and statistically
significant.
- Psychosocialfunctioning
TheeffectofCCTonpsychosocial functioningwasmeasured in8/17 studiesand itwas found tobemoderateand
statisticallysignificant.
- Otherdomains
Statistically non-significant results were found for nonverbal memory, executive functions, processing speed,
visuospatialskills,languageorInstrumentalActivitiesofDailyLiving(IADL).
III. Conclusions
Based on the results of 17 randomized controlled trials of moderate quality, CCT is an effective intervention for
enhancingcognitioninpeoplewithmildcognitiveimpairment.
Fig.1.EfficacyofComputerizedCognitiveTraining(CCT)inpeoplewithmildcognitiveimpairmentwithinindividualdomains.
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In particular, participants in CCT groups improved significantly over the intervention period,while controls did not
showany cognitive change, as itwas found in the global cognition domain.Most of the trials used (70%) used an
activecontrolcondition,buttheeffectsacrossactive-andpassive-controlledtrialswerecomparable.
Inaddition,moderateeffectsizesonmostmemoryandlearningdomainswererelevant.
Also attention, defined as a behavioral and cognitive process of selectively concentrating on a discrete aspect of
informationwhileignoringperceivableinformation,significantlybenefitedfromthecomputer-basedtraining.
On theotherhand,CCT lackedofefficacyonexecutive functionsbut, sincecognitive traininggains typically reflect
training content, this result may be due to insufficient training on executive processes (mainly fluid intelligence,
inhibitorycontrolandreasoning)withinstudies.
Surprisingly,theeffectsofCCTonspeedandvisuospatialprocessingwerefoundtobestatisticallynotsignificanteven
thoughCCTexercisesaretypically timedand involvedvisuospatialskills.Moreover, thesedomainswereamongthe
mostresponsiveinothermeta-analysesonhealthyadultsandpatientswithParkinsondisease.
Again,changingthetrainingcontentandfocusingspecificallyonprocessingspeedandvisuospatialmayimprovethis
result.
Depressionisassociatedwithmildcognitiveimpairment.Notably,psychologicalfunctioning(depression,qualityoflife
andneuropsychiatric symptoms) showed a positive improvement after theCCT training and this suggests that CCT
mayalsobenefitgeneralmood.
ReliableeffectswerenotseenonInstrumentalActivitiesofDailyLiving(IADL)andlanguageoutcomes,butrelatively
fewstudiesinvestigatedthesedomains.
Inconclusion,CCTisefficaciousonglobalcognition,memory,workingmemoryandattentionandhelpsimprove
psychologicalfunctioning,includingdepressingsymptoms,inpeoplewithmildcognitiveimpairment.
These results are robust and indicate a beneficial therapeutic role for CCT in this population and, since themany
advantagesthatitoffers,itshouldbeconsideredasacost-effectivetooltopreventcognitivedeclineandtomaintain
qualityoflifeandindependenceinolderpeople.
IV. Conflictofinterestsandfunding
Theauthorsdeclarethattheresearchwasconductedintheabsenceofanycommercialorfinancialrelationshipsthat
couldbeconstruedasapotentialconflictofinterest.
ThisresearchwasfundedbytheACDCAdultCognitiveDeclineConsciousness(Erasmus+projectnumber:2017-1-IT02-
KA204-036825).
V. References
[1] P. S. Sachdevet al., «The Prevalence ofMild Cognitive Impairment in DiverseGeographical and Ethnocultural
Regions:TheCOSMICCollaboration»,PLoSONE,vol.10,n.11,nov.2015.[2] R. C. Petersenetal., «Practice guidelineupdate summary:Mild cognitive impairment:Reportof theGuideline
Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology»,
Neurology,vol.90,n.3,pagg.126–135,gen.2018.
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[3] N. J.Gateset al., «Study ofMental Activity andRegular Training (SMART) in at risk individuals: A randomised
doubleblind,shamcontrolled,longitudinaltrial»,BMCGeriatr.,vol.11,pag.19,apr.2011.[4] A.M. Kueider, J.M. Parisi, A. L.Gross, eG.W.Rebok, «ComputerizedCognitive TrainingwithOlderAdults:A
SystematicReview»,PLoSONE,vol.7,n.7,pag.e40588,lug.2012.[5] D. E. Barnes et al., «Computer-based cognitive training for mild cognitive impairment: results from a pilot
randomized,controlledtrial»,AlzheimerDis.Assoc.Disord.,vol.23,n.3,pagg.205–210,set.2009.[6] A. Bahar-Fuchs, L. Clare, e B.Woods, «Cognitive training and cognitive rehabilitation for personswithmild to
moderatedementiaoftheAlzheimer’sorvasculartype:areview»,AlzheimersRes.Ther.,vol.5,n.4,pag.35,ago.2013.
[7] L. Clare, «Cognitive training and cognitive rehabilitation for people with early-stage dementia», Rev. Clin.Gerontol.,vol.13,n.01,feb.2003.
[8] N.T.M.Hill,L.Mowszowski,S.L.Naismith,V.L.Chadwick,M.Valenzuela,eA.Lampit,«ComputerizedCognitive
TraininginOlderAdultsWithMildCognitiveImpairmentorDementia:ASystematicReviewandMeta-Analysis»,
Am.J.Psychiatry,vol.174,n.4,pagg.329–340,apr.2017.[9] M.A.FiataroneSinghetal.,«TheStudyofMentalandResistanceTraining(SMART)Study—ResistanceTraining
and/orCognitiveTraining inMildCognitive Impairment:ARandomized,Double-Blind,Double-ShamControlled
Trial»,J.Am.Med.Dir.Assoc.,vol.15,n.12,pagg.873–880,dic.2014.[10]A. L. Gooding et al., «Comparing three methods of computerised cognitive training for older adults with
subclinicalcognitivedecline»,Neuropsychol.Rehabil.,vol.26,n.5–6,pagg.810–821,set.2016.[11]M.Hagovska, P. Takac, eO.Dvzonic, «Effect of a combining cognitive and balanced training on the cognitive,
postural and functional statusof seniorswithamild cognitivedeficit ina randomized, controlled trial»,Eur. J.Phys.Rehabil.Med.,vol.52,n.1,pag.9,2016.
[12]M.HagovskáeZ.Olekszyová,«Impactofthecombinationofcognitiveandbalancetrainingongait,fearandrisk
offallingandqualityoflifeinseniorswithmildcognitiveimpairment:Fearandriskoffallinginseniors»,Geriatr.Gerontol.Int.,vol.16,n.9,pagg.1043–1050,set.2016.
[13]F. Lin et al., «Cognitive and Neural Effects of Vision-Based Speed-of-Processing Training in Older Adults withAmnesticMildCognitiveImpairment:APilotStudy»,J.Am.Geriatr.Soc.,vol.64,n.6,pagg.1293–1298,giu.2016.
[14]M.FinneS.McDonald,«ComputerisedCognitiveTrainingforOlderPersonsWithMildCognitiveImpairment:A
PilotStudyUsingaRandomisedControlledTrialDesign»,BrainImpair.,vol.12,n.3,pagg.187–199,dic.2011.[15]F. Barban et al., «Protecting cognition from aging and Alzheimer’s disease: a computerized cognitive training
combined with reminiscence therapy: Protecting late-life cognition with a combined training», Int. J. Geriatr.Psychiatry,vol.31,n.4,pagg.340–348,apr.2016.
[16]R. Wittelsberger, S. Krug, S. Tittlbach, e K. Bös, «Auswirkungen von Nintendo-Wii® Bowling auf
Altenheimbewohner»,Z.FürGerontol.Geriatr.,vol.46,n.5,pagg.425–430,lug.2013.[17]T.F.Hughes,J.D.Flatt,B.Fu,M.A.Butters,C.-C.H.Chang,eM.Ganguli,«Interactivevideogamingcompared
withhealtheducationinolderadultswithmildcognitiveimpairment:afeasibilitystudy:Interactivevideogaming
andMCI»,Int.J.Geriatr.Psychiatry,vol.29,n.9,pagg.890–898,set.2014.[18]M.FinneS.McDonald,«Repetition-lagtrainingto improverecollectionmemory inolderpeoplewithamnestic
mildcognitive impairment.Arandomizedcontrolledtrial»,AgingNeuropsychol.Cogn.,vol.22,n.2,pagg.244–258,mar.2015.
[19]I.Tarnanas,A.Tsolakis,eM.Tsolaki,«AssessingvirtualrealityEnvironmentsasCognitiveStimulationMethodfor
PatientswithMCI,inTechnologiesofInclusiveWeel-Being»,Ed.BrooksALBrahnamJainLCBerl.Springer,pagg.39–74,2014.
[20]M. Y. Kim, K. S. Lee, e J. Choi, «Effectiveness of Cognitive Training based on Virtual Reality for the Elderly», JKoreanAcadRehabilMed,n.29,pagg.429–433.
[21]N.Barcelosetal.,«AerobicandCognitiveExercise(ACE)PilotStudyforOlderAdults:ExecutiveFunctionImproves
withCognitiveChallengeWhileExergaming»,J.Int.Neuropsychol.Soc.,vol.21,n.10,pagg.768–779,nov.2015.
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[22]L.Rozzini,D.Costardi,B.V.Chilovi,S.Franzoni,M.Trabucchi,eA.Padovani,«Efficacyofcognitiverehabilitation
inpatientswithmildcognitiveimpairmenttreatedwithcholinesteraseinhibitors»,Int.J.Geriatr.Psychiatry,vol.22,n.4,pagg.356–360,apr.2007.
[23]C.Herrera,C.Chambon,B.F.Michel,V.Paban,eB.Alescio-Lautier,«Positiveeffectsofcomputer-basedcognitive
traininginadultswithmildcognitiveimpairment»,Neuropsychologia,vol.50,n.8,pagg.1871–1881,lug.2012.[24]D. E. Barnes et al., «Computer-based Cognitive Training for Mild Cognitive Impairment: Results from a Pilot
Randomized,ControlledTrial»,AlzheimerDis.Assoc.Disord.,vol.23,n.3,pagg.205–210,lug.2009.
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VI. Annexes
Table1.CharacteristicsofIncludedStudiesa
Study NandControlType
MeanAge
(Years)b
MeanMMSEorEquivalent
ProgramDescription Program-TargetedCognitiveDomains
SessionLenght
(minutes)
Sessions/Week
TotalTraining(hours)
PEDro-P
ScaleKimetal.[20] CCTN=15
Control(Active)N=15
78.7 26.7 UnspecifiedsoftwareParticipantswerepracticedinperforminghouseholdtasksusingvirtualreality.
- 30 3 6 7
Rozzinietal.[22]
CCTN=15Control(Active)N=22
- 26.2 Unspecifiedsoftware- Memory:participantsweretrained
inrecognitiontasksforwordlists,imagesandsequencesofitems;
- Attention:participantswerepracticedinrespondingatthepresentationofatargetorinrecognizingandchoosingamongdifferentpossibilitiesthetwoimages-targetspresentedsimultaneously;
- Language:participantswereexercisedincorrelatingwordssemanticallyandinperceivingdifferentimagesorassociatingcouplesoffigures;
- Visuo-spatial:participantswerepracticedinsolvingpuzzles,visualsearchtasksandlocationofvisualinformation.
- Verbalmemory- Nonverbalmemory- Attention- Language- Executivefunctions- Visuospatial
processing
60 5 60 8
Barnesetal.[24]
CCTN=22Control(Active)N=25
74 - BrainFitnessbyPositScienceTheprograminvolved7exercisesthatweredesignedtoimproveprocessing
- Processingspeed- Verbalmemory- Workingmemory
100 5 50 8
12
speedandaccuracy;primaryandworkingauditorymemorytaskswerewovenimplicitlyintotheexercises.
Finnetal.[14] CCTN=8Control(Passive)N=8
72.69 27.76 LumosityInc.Exercisetypes:- Birdwatching- Colormatch- Lostinmigration- Memorymatch- Raindrops- Spatialspeedmatch
- Attention- Processingspeed- Nonverbalmemory- Executivefunctions
20 3-5 10 7
Herreraetal.[23]
CCTN=11Control(Active)N=11
76.63 27.27 UnspecifiedsoftwareExercisetypes:- Visualrecognition:participantswere
askedtomemorizeandrecognizepictures,withorwithoutadistractor;
- Visuospatialrecognition:participantswereaskedtomemorizeobjectspositionsandrecognizethislayout;
- Visualrecognition/workingmemory:participantswereaskedtomemorizepicturesoldandnewandcontinuouslyrecognizethem;
- Visualfocusedattention:participantswereaskedtodetectatargetpicture;
- Visuospatialfocusedattention:participantswereaskedtorecognizeanddetectatargetpictureindifferentscreenparts;
- Dividedattention(trial):participantswereaskedtorecognizepictures
- Verbalmemory- Nonverbalmemory- Verballearning- Nonverballearning- Attention- Processingspeed
60 2 24 8
13
thatcorrespondedtowordsheardamongdistractors.
Tarnanasetal.[19]
CCTN=32Control(Active)N=39
70.05 26.5 UnspecifiedsoftwareParticipantswerepracticedinperformingmuseumtasksusingvirtualreality.
- 90 2 60 7
Wittelsbergeretal.[16]
CCTN=17Control(Passive)N=10
70.07 22.88 NintendoWiibowling - 60 2 12 5
Finnetal.[18] CCTN=12Control(Passive)N=12
73.95 27.79 UnspecifiedsoftwareParticipantswereaskedtolearnaseriesofwordsandsubsequentdiscriminatethosewordsfromunstudiedlures.
- Verballearning- Verbalmemory
90 2 9 6
Hughesetal.[17]
CCTN=10Control(Active)N=10
77.4 27.1 NintendoWiisports
- 90 1 36 7
FiataroneSinghetal.(study1)[9]
CCTN=27Control(Active)N=22
70.1 27 Cogpack
- Verbalmemory- Nonverbalmemory- Executivefunctions- Attention- Processingspeed
90 2 78 9
FiataroneSinghetal.(study2)[9]
CCTN=24Control(Active)N=27
70.1 27 Cogpack
- Verbalmemory- Nonverbalmemory- Executivefunctions- Attention- Processingspeed
90 2 78 9
Barbanetal.[15]
CCTN=46Control(Passive)N=60
73.54 27.74 SociableExercisetypes:- Episodicmemory:participantswere
askedtorememberalist,torememberobjectlocationsin
- Verbalmemory- Nonverbalmemory- Executivefunctions- Language- Attention
60 2 24 8
14
domesticenvironmentsandtofindpairsofimages;
- AttentionalExecutiveFunctions:participantswereaskedtoselectivelypayattentiontostimuliavoidingdistractors,toabstract,toexplainsimilarities,tocategorizeobjects,todeductatargetbyexcludingthedistractors;
- Orientation:participantswereaskedtomoveintoahouse;
- Logicalreasoning:participantswereaskedtocompareavisualpatternwithamissingelement;
- Constructionalpraxis:participantswereaskedtodoapuzzle;
- Language:participantswereaskedtocouplesynonymsorantonyms.
- Visuospatialprocessing
Hagovskaetal.[11][12]
CCTN=40Control(Passive)N=38
66.97 26.33 CogniPlus- Attentionintensity“Alert”:drivinga
car- Long-termmemory“Names”:
rememberingnamesandsurnamesinconnectionwithfaces
- Executivefunctions“Pland”:solvingtasks
- Workingmemory“Nback”:rememberingtwoorthreepicturespreviouslypresentedthroughtime
- Visual-motorcoordination“Vismo”:followingaspaceshiponthescreenandkeepingitinsideacircle
- Eachexercisefeaturedupto28progressivedifficultylevels
- Verbalmemory- Nonverbalmemory- Verballearning- Nonverballearning- Workingmemory- Executivefunctions- Attention- Visuospatial
processing
30 2 10 7
15
adjustableaccordingtousersperformance.
Barcelosetal.[21]
CCTN=8Control(Active)N=9
80.6 20.8c UnspecifiedsoftwareParticipantsweretrainedtoridevirtualrealityenhancedandrecumbentstationarybikesthroughasceniclandscape,wheretheywereinstructedtocollectdifferentcoloredcoinsandcorrespondingcoloreddragons.
- Executivefunctions- Attention- Visuospatial
processing
20-45 2 18 6
Goodingetal.(study1)[10]
CCTN=31Control(Active)N=20
75.59j 50.62d BrainFitnessbyPositScience
- Memory- Attention- Executivefunctions
60 2 30 5
Goodingetal.(study2)[10]
CVTN=23Control(Active)N=20
75.59j 50.84d BrainFitnessbyPositScience
- Memory- Attention- Executivefunctions
60 2 30 5
Linetal.[13] CCTN=10Control(Active)N=11
73.0 25.02c InSightbyPositScienceExercisetypes:- Eyefordetails- Peripheralchallenge- Visualsweeps- Doubledecisions- Targettracker
- Processingspeed- Visuospatial
processing- Executivefunctions- Attention
60 4 24 7
aAbbreviations:CCT=ComputerizedCognitiveTraining;CVT=CognitiveVitalityTraining;PED-roP=PhysiotherapyEvidenceDatabaseRatingScale.bWeightedmeanage.cMeasuredusingtheMontrealCognitiveAssessment(1-30scale).dMeasuredusingtheModifiedMini-MentalStateExamination(1-100scale).eSummarystatisticsfromstudy1andstudy.
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