Computerised cognitive remediation to enhance mobility in older adults: a single-blind, single-centre, randomised trial

Abstract

Background Decline in executive functions and related cognitive processes is associated with mobility decline, and these functions might be amenable to cognitive remediation. This study aimed to examine whether a computerised cognitive remediation programme would improve walking in adults aged 70 years and older.Methods This single-blind, randomised trial at one academic centre in the USA evaluated the efficacy of an 8-week computerised programme (also known as brain games) of progressive intensity and complexity to improve walking in older adults at high-risk for mobility disability. Inclusion criteria included being 70 years or older; ambulatory; and at high-risk for mobility disability, defined using a cutscore of nine or less (frail range) on the Short Physical Performance Battery and a walking speed of 100 cm/s or less. Individuals with dementia, acute or terminal medical illnesses, recent or planned surgery affecting mobility, mobility limitations solely due to musculoskeletal limitation or pain that prevented them from completing mobility tests, and those who were nursing home residents were excluded. Participants were block randomised (1:1; block size 12 and no stratification) to the intervention group or the control group (low complexity computer games and health education classes). Primary outcomes were change in walking speed at normal pace and walking while talking conditions assessed from baseline to 8 weeks post-intervention by investigators who were masked to group assignment. Groups were compared using the intention-to-treat principle with linear mixed models adjusted for confounders. This trial was registered with ClinicalTrails.gov, NCT02567227.

Does Cognitive Training Improve Mobility, Enhance Cognition, and Promote Neural Activation?

“…The authors reported an improvement in walking, but this was no greater than in the active control group, who also completed the same amount of CCT but with no progress in the difficulty of the games performed (Verghese et al, 2021 ). Here, the authors report that practice effects might explain the improvements seen in both arms and the lack of between-group differences; however, the investigators also discuss an alternate hypothesis that the more robust effect on executive function tests in the cognitive remediation arm compared to the active control may indicate a true training effect, and raises the possibility that even low levels of cognitive remediation (as in their active control arm) lead to cognitive benefits (Verghese et al, 2021 ). Nevertheless, the current study differed in several ways that might explain the discrepancy in results including, smaller sample size, use of healthy elderly population, wait list control, and the inclusion of neurophysiological measures that were lacking in the previous trial.…”

“…From the perspective of clinically meaningful change, both gait speeds were increased by more than 0.08 m/s in the intervention group, which was considered a meaningful change in physical performance (Kwon et al, 2009 ). Recently, a larger CCT study of 383 non-demented seniors at high risk for mobility disability was completed (Verghese et al, 2021 ). The authors reported an improvement in walking, but this was no greater than in the active control group, who also completed the same amount of CCT but with no progress in the difficulty of the games performed (Verghese et al, 2021 ).…”

“…Recently, a larger CCT study of 383 non-demented seniors at high risk for mobility disability was completed (Verghese et al, 2021 ). The authors reported an improvement in walking, but this was no greater than in the active control group, who also completed the same amount of CCT but with no progress in the difficulty of the games performed (Verghese et al, 2021 ). Here, the authors report that practice effects might explain the improvements seen in both arms and the lack of between-group differences; however, the investigators also discuss an alternate hypothesis that the more robust effect on executive function tests in the cognitive remediation arm compared to the active control may indicate a true training effect, and raises the possibility that even low levels of cognitive remediation (as in their active control arm) lead to cognitive benefits (Verghese et al, 2021 ).…”

“…As well, this methodology is intended to provide personalized programs that strategically strengthen the individual's weakest cognitive abilities by emphasizing cognitive strengths in a manner that keeps participants within their comfort zone. The CCT training software in this study (CogniFit) is identical to that employed by Verghese et al ( 2010 , 2016 , 2021 ) in their previous cognitive remediation trials.…”

“…A recent meta-analysis of 10 trials with 351 participants reported that cognitive training interventions can improve mobility-related outcomes, especially during challenging walking conditions requiring higher-order executive functions (Marusic et al, 2018a , b ). More recently, computerized cognitive remediation improved walking and executive functions in older adults aged 70 years and above at high-risk for mobility disability, but not compared to an active control that included low level cognitive remediation training (Verghese et al, 2021 ).…”