Computerized Cognitive Training in Cognitively Healthy Older Adults: A Systematic Review and Network Meta-Analysis

Abstract

Background Computerized cognitive training (CCT) is a broad category of drill-and-practice interventions aims to maintain cognitive performance in older adults. Despite a supportive evidence base for general efficacy, it is unclear what types of CCT are most likely to be beneficial and what intervention design factors are essential for clinical implementation. Methods We searched MEDLINE, Embase, and PsycINFO to August 2019 for randomized controlled trials (RCTs) of any type of CCT in cognitively healthy older adults. Risk of bias within studies was assessed using the Cochrane Risk of Bias 2 tool. The primary outcome was change in overall cognitive performance between CCT and control groups. Secondary outcomes were individual cognitive domains. A series of meta-regressions were performed to estimates associations between key design factors and overall efficacy using robust variance estimation models. Network meta-analysis was used to compare the main approaches to CCT against passive or common active control conditions. Results Ninety RCTs encompassing 7219 participants across 117 comparisons were included. The overall cognitive effect size across all trials was small (g=0.18, 95% CI 0.14 to 0.23) with considerable heterogeneity (τ2=0.074, 95% prediction interval -0.36 to 0.73), robust to small-study effect or risk of bias. Effect sizes for individual cognitive domains were small, heterogeneous and statistically significant apart from fluid intelligence and visual processing. Meta-regressions revealed significantly larger effect sizes in trials using supervised training or up to three times per week. Multidomain training was the most efficacious CCT approach against any type of control, with greater benefits in a subset of supervised training studies. Conclusions The efficacy of CCT varies substantially across designs, independent of the type of control. Multidomain supervised CCT appears to be the most efficacious approach, and should be developed to accommodate for individual needs and remote delivery settings. Future research should focus on identifying the intervention components and regimens that could attenuate aging-related cognitive decline.

Developmental neuroscience of cognitive control: the futurepath and layout

“…而另 一些研究则发现, 由于认知能力的提升存在天花板, 因 此相比于提升空间较大的儿童和老年人, 成年早期被 试的训练效果反而更差 [79,103] . 因此, 认知控制不同维 [77] . 前人的研究发现, 认知 训练的确可以提高不同年龄组, 包括儿童、成年早期 和老年组的认知控制水平 [89,108] , 但训练的短期效果以 及迁移能力却存在差异.…”

Behaviour Change Techniques in Computerized Cognitive Training for Cognitively Healthy Older Adults: A Systematic Review

“…Findings from the landmark ACTIVE trial suggest that the gains in cognitive function, particularly from training that focused on speed of processing, may translate into sustained maintenance of daily functioning, reduced risk of driving cessation and reduced incidence of dementia 10 years after training (Edwards et al, 2016(Edwards et al, , 2017Rebok et al, 2014;Ross et al, 2016). Lampit et al (2014bLampit et al ( , 2020 have published the two most comprehensive reviews to date of the effectiveness of CCT trials in cognitively healthy older adults (aged ≥ 60 years). Their first meta-analysis of 51 trials indicated a small but statistically significant effect on global cognitive functioning favouring CCT over the control group (Hedges' g = 0.22, 95% confidence interval [CI] = 0.15-0.29) (Lampit et al, 2014b).…”

“…An update of this review included a total of 90 papers and showed similar efficacy (Hedges' g = 0.18, CI = 0.14-0.23) (Lampit et al, 2020). The majority of the trials included in these reviews were tightly controlled, group-based trials with relatively small numbers of participants (n < 50), and most employed high intensity protocols to deliver the CCT intervention, particularly in terms of the time commitment required for participants to complete the intervention (Lampit et al, 2014b(Lampit et al, , 2020.…”

A Pilot Study Evaluating the Development and Implementation of a Feasible, Evidence-based, Group Cognitive Training Program Within an Older People’s Mental Health Service

“…There is now a solid body of evidence demonstrating e cacy of CT for improving cognition in psychiatric populations including schizophrenia [4] and major depression [5], in healthy older adults [6], and in groups at risk of developing dementia, i.e. those with mild cognitive impairment (MCI) [2,3,7,8].…”