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. 2020 May 7;22(5):e14617.
doi: 10.2196/14617.

Web-Based Intervention Effects on Mild Cognitive Impairment Based on Apolipoprotein E Genotype: Quasi-Experimental Study

Anthoula C Tsolaki  1   2 , Magda Tsolaki  3 , Niki Pandria  1 , Eftychia Lazarou  3 , Olymbia Gkatzima  4 , Vasiliki Zilidou  1 , Maria Karagianni  1 , Zafiroula Iakovidou-Kritsi  5 , Vasilios K Kimiskidis  6 , Panagiotis D Bamidis  1
Affiliations

Web-Based Intervention Effects on Mild Cognitive Impairment Based on Apolipoprotein E Genotype: Quasi-Experimental Study

Anthoula C Tsolaki et al. J Med Internet Res. .

Abstract

Background: Apolipoprotein E (APOE) ε4 allele is a major genetic risk factor for Alzheimer disease and mild cognitive impairment (MCI). Computer-based training programs can improve cognitive performance in elderly populations. However, the effects of computer-based interventions on MCI APOE ε4 carriers have never been studied before.

Objective: The effects of different web-based interventions and the APOE isoform-specific differences in training outcomes are investigated.

Methods: Using a quasi-experimental study design, 202 participants with MCI aged 60 years and older took part in three different intervention programs (physical and cognitive [Long-Lasting Memories, or LLM], cognitive [Active Control, or AC], or physical intervention [Physical Training Control, or PTC]) via an innovative information and communication technologies exergaming platform. Participants in each interventional group were subdivided into APOE ε4 carriers and non-APOE ε4 carriers. All participants underwent an extensive neuropsychological evaluation before and after the training, blood tests, and brain imaging.

Results: All interventions resulted in multiple statistically significant cognitive benefits after the intervention. Verbal learning (California Verbal Learning Test: immediate recall test score-LLM: P=.04; AC: P<.001), working memory (digit span forward and backward test scores-AC: P=.03; PTC: P=.02 and P=.006, respectively), and long-term memory (California Verbal Learning Test: delayed recall test score-LLM: P=.02; AC: P=.002; and PTC: P=.02) were improved. There was no statistically significant difference among the intervention effects. APOE ε4 presence moderates intervention effects as the LLM intervention improved only their task-switching processing speed (Trail Making Test, Part B: P=.03) and the PTC intervention improved only the working memory (digit span backward: P=.03). No significant performance alteration was noted for the APOE ε4+ cognitive AC training group.

Conclusions: None of the applied interventions could be identified as the optimal one; it is suggested, however, that combined cognitive and physical training and physical training via exergaming may be more effective for the high-risk MCI ΑPOE ε4+ subgroup.

Keywords: APOE ε4; Alzheimer disease; computerized training; exergaming; mild cognitive impairment.

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Conflict of interest statement

Conflicts of Interest: PDB discloses potential (non-financial and beyond the context of the submitted work) conflicts of interest with PositScience: there is a co-marketing agreement between the company and the Aristotle University of Thessaloniki to exploit Brain HQ within the LLM Care self-funded initiative that emerged as the non-for-profit business exploitation of the Long-Lasting Memories (LLM Project) (www.longlastingmemories.eu) originally funded by the ICT-CIP-PSP Program of the European Commission. Brain HQ now forms part of LLM Care, a technology transfer/self-funded initiative that emerged as the non-for-profit business exploitation of LLM. FitForAll (FFA) has been developed in the Aristotle University of Thessaloniki during the Long-Lasting Memories (LLM Project) (www.longlastingmemories.eu) originally funded by the ICT-CIP-PSP Program of the European Commission. It now forms part of LLM Care, a technology transfer/self-funded initiative that emerged as the non-for-profit business exploitation of LLM.

Figures

Figure 1
Figure 1
Study flowchart with the number of the participants screened and allocated in each interventional group. MCI: mild cognitive impairment; LLM: Long-Lasting Memories; APOE: apolipoprotein E.
See this image and copyright information in PMC

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