Behavioural and neuronal substrates of serious game-based computerised cognitive training in cognitive decline: randomised controlled trial

Abstract

Background: Investigations of computerised cognitive training (CCT) show heterogeneous results in slowing age-related cognitive decline.

Aims: To comprehensively evaluate the effectiveness of serious games-based CCT, integrating control conditions, neurophysiological and blood-based biomarkers, and subjective measures.

Method: In this bi-centric randomised controlled trial with parallel groups, 160 participants (mean age 71.3 years) with cognitive impairment ranging from subjective decline to mild cognitive impairment, were pseudo-randomised to three arms: an intervention group receiving CCT immediately, an active control (watching documentaries) and a waitlist condition, which both started the CCT intervention after the control period. Both active arms entailed a 3-month intervention period comprising a total of 60 at-home sessions (five per week) and weekly on-site group meetings. In the intervention group, this was followed by additional 6 months of CCT, with monthly booster sessions to assess long-term training effects. Behavioural and subjective changes were assessed in 3-month intervals. Biological effects were measured by amyloid blood markers and magnetic resonance imaging obtained before and after training.

Results: Adherence to the training protocol was consistently high across groups and time points (4.87 sessions per week). Domain-specific cognitive scores showed no significant interaction between groups and time points. Significant cognitive and subjective improvements were observed after long-term training. Voxel-based morphometry revealed no significant changes in grey matter volume following CCT, nor did amyloid levels moderate its effectiveness.

Conclusions: Our study demonstrates no benefits of 3 months of CCT on cognitive or biological outcomes. However, positive effects were observed subjectively and after long-term CCT, warranting the inclusion of CCT in multicomponent interventions.

Keywords: Computerised cognitive training; mild cognitive impairment; patient-reported outcome measures; subjective cognitive decline; voxel-based morphometry.

Fig. 1

Study design and hypothetical model: in the three study arms participants perform cognitive assessments four times, with an interval of 3 months in between. Bold lines mark the intervals of computerised cognitive training.

Fig. 2

Cognitive outcomes per time point per group as composite scores per cognitive domain. Bold lines indicate the interval of CCT. Brackets indicate significance P ≤ 0.01. ACG, active control group; CCT, computerised cognitive training group; WCG, waitlist control group.

Fig. 3

Patients reported outcome measures per time point per group. Means and s.d. are shown for each rating. (a and b): perceived cognitive change: this bar chart represents the self- and informant-perceived cognitive change over the course of the study for the three different groups: active control group (ACG), computerised cognitive training group (CCT) and waitlist control group (WCG). The cognitive change is measured on a ten-point Likert scale, with higher scores indicating greater perceived improvement. The bars on the graph represent the mean cognitive change score across the time between each time point. The black boxes indicate the interval of CCT. The x-axis represents the three different groups, and the y-axis represents the change in perceived cognitive change. (c and d): dementia worries: this bar chart represents self- and informant-perceived change in dementia worries. Dementia worries are measured on a ten-point Likert scale, with higher scores indicating a higher degree of dementia worries. The points on the graph represent the mean dementia worries score at each time point across the study, and the error bars represent the s.d. Bold lines indicate the CCT interval. Brackets indicate a significant change (P < 0.05). The x-axis represents the time points of the study, and the y-axis represents the perceived dementia worries score. Each group is represented by a different colour, and the key to these colours is provided in the figure legend.