Beta wave enhancement neurofeedback improves cognitive functions in patients with mild cognitive impairment

Abstract

Background: Mild cognitive impairment (MCI) is a symptom characterizing cognitive decline and a transitional state between normal aging and dementia; however, there is no definitive diagnosis and treatment for MCI. Neurofeedback (NF), which is a training mechanism that employs operant conditioning to regulate brain activity, has been increasingly investigated concerning its beneficial effects for dementia and MCI.Methods: This study investigated cognitive improvement and hemodynamic changes in the prefrontal cortex (PFC) following NF training in patients with MCI. Five patients with MCI received NF training for enhanced beta band activity in the dorsolateral PFC-16 sessions for 8 weeks-with each session divided into 9 5-minute trials. The primary outcome measure was a cognitive assessment tool: the Korean version of the Montreal Cognitive Assessment. The secondary outcome measures were the Central Nervous System Vital Signs for neurocognitive testing, hemodynamic changes using functional near-infrared spectroscopy in the PFC during a working-memory task, and Beck Depression Inventory scores.Results: After completing the training, patients' cognitive function significantly improved in domains such as composite memory, cognitive flexibility, complex attention, reaction time, and executive function. Increased electroencephalogram beta power was observed over NF training sessions (Spearman rank correlation test: r = 0.746, P = .001). The threshold value for gaining positive feedback from pre-NF baseline on beta power significantly increased (Spearman rank correlation test: r = 0.805, P = .001). Hemodynamic response in PFC changed after NF training, and individual differences were identified. Specifically, hypoactivation of the hemodynamic response by emotional distraction recovered following NF training. Conclusion:We suggest that patients' cognitive processing efficiency was improved by the NF training. These beneficial results suggest that NF training may have potential therapeutic applications to prevent the progression from MCI to dementia.Trial registration number: Clinical Research Information Service (KCT0003433).Abbreviations: AD = Alzheimer disease, BA = Brodmann area, BDI = Beck Depression Inventory, CBF = cerebral blood flow, CNSVS = Central Nervous System Vital Signs, deoxy-Hb = deoxygenated hemoglobin, dlPFC = dorsolateral prefrontal cortex, DMTS = delayed match-to-sample, EEG = electroencephalogram, fMRI = functional magnetic resonance imagery, fNIRS = Editor: Massimo Tusconi.

SMR/Theta Neurofeedback Training Improves Cognitive Performance and EEG Activity in Elderly With Mild Cognitive Impairment: A Pilot Study

“…Jirayucharoensak et al (2019) described their NF games, some of which were focused on calculating number but they did not link them to their results (Jirayucharoensak et al, 2019). NF training suggests being concentrate on the game without any given strategy (Jang et al, 2019). The participant is informed about the expected result but he has to find his own strategy to focus.…”

Z-score neurofeedback, heart rate variability biofeedback, and brain coaching for older adults with memory concerns

“…The specific NFB protocol utilized in this study, z-score NFB, was selected due to our clinical experience with the protocol for treatment of ADHD (Groeneveld et al, 2019) and other clinical conditions (unpublished data). Several recent studies have demonstrated improved cognitive function in subjects with MCI following more traditional NFB training methods (Jang et al, 2019;Jirayucharoensak et al, 2019;Lavy et al, 2019). As discussed in the Introduction, there are a multitude of supportive studies of NFB in the published literature for a variety of conditions, with the strongest support level existing for its use in ADHD ((Van Doren et al, 2018), for example).…”

Neurofeedback and the Aging Brain: A Systematic Review of Training Protocols for Dementia and Mild Cognitive Impairment

“…Samples including patients with dementia are shown in orange, and those studying patients with MCI are shown in blue. One interesting factor is the low score presented by the MCI population in one study (Jang et al, 2019), suggesting that these participants may be already in transitory stages to dementia (Flicker et al, 1991). On the other hand, the study presenting higher scores at baseline (Jirayucharoensak et al, 2019) included both MCI patients and healthy participants in the neurofeedback group, which may explain the bar level.…”

“…However, with the used study design it is not possible to disentangle the reason for this improvement as it may result from neurofeedback specific, neurofeedback non-specific effects (e.g., increased motivation or attention) that occurred in context of the motor imagery NF training, or from the working memory task. Jang et al (2019) published a non-controlled pilot EEGneurofeedback study in which five MCI patients (66.6 ± 3.5 years) were instructed to develop their own strategies to upregulate the beta (12-15 Hz) frequency band on the F6 location (allegedly recording the activity of the dorsolateral prefrontal cortex). After 16 training sessions, patients showed a significant improvement in the Korean version of the MoCA scale of 20.67%, an improvement that is larger than what is considered a minimum detectable change (Feeney et al, 2016).…”

“…NF, Neurofeedback; NR, Not Reported. (Surmeli et al, 2016;Hohenfeld et al, 2017;Jang et al, 2019;Jirayucharoensak et al, 2019;Lavy et al, 2019), only five studies reported changes in standardized cognitive screening instruments (Figure 2). The averaged difference across these studies weighted by the sample size of each sample is 8.1%.…”