Objectives: Immersive virtual reality has tremendous potential to improve cognition in populations with cognitive impairment. We conducted a feasibility and proof-of-concept study to assess the potential of virtual reality and electroencephalography, with or without an intelligent agent, that adapts the presented material to the emotions elicited by the environment.Method: Older adults with subjective cognitive decline recruited from the community received a virtual reality-based intervention taking place in one of two virtual environments, a train (Part 1, N = 19) or a music theatre, complemented by the intelligent agent (Part 2, N = 19). A comparative control group (N = 19) receiving no intervention was also included. All participants completed measures of affect and cognition before and after the intervention. The intervention groups completed measures of cybersickness and user experience after the intervention.Results: Participants did not suffer from increased cybersickness following either intervention. They also reported a positive to highly positive user experience concerning the following aspects: attractivity, hedonic quality-identity and hedonic quality-stimulation. The measures of affect showed no pre-post change when comparing either intervention to the control condition. However, a reduction of negative affect was observed following the train intervention for participants with a high self-reported negative affect at baseline. Finally, there was a significant improvement in working memory when comparing either intervention group to the control condition.Conclusion: Our results support the feasibility and tolerability of the technology, and a positive impact on cognition, paving the way for a larger-scale randomized clinical trial to confirm efficacy.

Background: Working memory (WM) capacity declines with advancing age, which impacts the ability to carry out complex cognitive activities in everyday life. Updating and inhibition processes have been identified as some of the most critical attentional control processes of WM and are linked to age-related WM decline. The general aim of the Attentional Control Training in Older People (ACTOP) study was to perform a side-by-side comparison of updating and inhibition training to examine their respective efficacy and transfer in cognitively healthy older adults.Method: The study was a three-arm, double-blind, randomized controlled trial registered with the US National Institutes of Health clinical trials registry. Ninety older adults were randomly assigned to 12 half-hour sessions of updating (N-back type exercises), inhibition (Stroop-like exercises) computerized training or active control (general knowledge quiz game). A group of thirty younger adults completed all proximal and WM transfer tasks without training to assess age-related deficits prior to training and whether training reduces these deficits.Results: Piecewise mixed models show quick improvement of performance during training for both updating and inhibition training. During updating training, the progression was more pronounced for the most difficult (3-back) than for the least (1-back) difficult level until the ninth session. Updating and inhibition training groups improved performance on all proximal and WM transfer measures but these improvements did not differ from the active control group. Younger adults outperformed older ones on all transfer tasks prior to training. However, this was no longer the case following training for two transfer tasks regardless of the training group.Conclusion: The overall results from this study suggest that attentional control training is effective in improving updating and inhibition performance on training tasks. The optimal dose to achieve efficacy is ~9 half-hour sessions and the dose effect was related to difficulty level for updating training. Despite an overall improvement of older adults on all transfer tasks, neither updating nor inhibition training provided additional improvements in comparison with the active control condition. This suggests that the efficacy of process-based training does not directly affect transfer tasks.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03532113

Background To prevent age-related cognitive impairment, many intervention programs offer exercises targeting different central cognitive processes. However, the effects of different process-based training programs are rarely compared within equivalent experimental designs. Objective Using a randomized double-blind controlled trial, this project aims to examine and compare the impact of 2 process-based interventions, inhibition and updating, on the cognition and brain of older adults. Methods A total of 90 healthy older adults were randomly assigned to 1 of 3 training conditions: (1) inhibition (Stroop-like exercises), (2) updating (N-back-type exercises), and (3) control active (quiz game exercise). Training was provided in 12 half-hour sessions over 4 weeks. First, the performance gain observed will be measured on the trained tasks. We will then determine the extent of transfer of gain on (1) untrained tasks that rely on the same cognitive process, (2) complex working memory (WM) measurements hypothesized to involve 1 of the 2 trained processes, and (3) virtual reality tasks that were designed to mimic real-life situations that require WM. We will assess whether training increases cortical volume given that the volume of the cortex is determined by cortical area and thickness in regions known to be involved in WM or changes task-related brain activation patterns measured with functional magnetic resonance imaging. Dose effects will be examined by measuring outcomes at different time points during training. We will also determine whether individual characteristics moderate the effect of training on cognitive and cerebral outcomes. Finally, we will evaluate whether training reduces the age-related deficit on transfer and brain outcomes, by comparing study participants to a group of 30 younger adults. Results The project was funded in January 2017; enrollment began in October 2017 and data collection was completed in April 2019. Data analysis has begun in June 2020 and the first results should be published by the end of 2020 or early 2021. Conclusions The results of this study will help understand the relative efficacy of 2 attentional control interventions on the cognition and the brain of older adults, as well as the moderating role of individual characteristics on training efficiency and transfer. Trial Registration ClinicalTrials.gov NCT03532113; https://clinicaltrials.gov/ct2/show/NCT03532113 International Registered Report Identifier (IRRID) DERR1-10.2196/20430