1

ACDC

AdultCognitiveDeclineConscientiousnessProject

2017-1-IT02-KA204-036825

EffectivenessofComputerizedCognitiveTraininginPreventingCognitiveDeclineinOlderAdultswithMildCognitiveImpairment

ACDCprojectisfundedwithsupportfromtheEuropeanCommission.Thisresearchanditscontentreflecttheviewsonlyoftheauthor,andtheCommissioncannotbeheldresponsibleforanyusewhichmaybemadeoftheinformationcontainedtherein.

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Index

I. Background

II. Searchingforevidence

- Methodology

- Results

a) CharacteristicsofIncludedStudies

b) ProgramDescriptionandTargetedDomains

c) OverallEfficacyonCognitiveOutcomes

- Globalcognition

- Verballearning

- Verbalmemory

- Nonverballearning

- Workingmemory

- Attention

- Psychosocialfunctioning

- Otherdomains

III. Conclusions

IV. Conflictofinterestsandfunding

V. References

VI. Annexes:Table1.CharacteristicsofIncludedStudies

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I. Background

Mildcognitiveimpairment(MCI)relatestocognitivedeclinefromapreviousleveloffunctioning,bothbysubjective

and objective evidence. Different clinical criteria can be applied to identify peoplewithMCI and, according to the

definitionused,itsprevalenceestimatesmayvaryfrom5.0%to36.7%andtheyincreasewiththepopulationage[1].

Inbroadterms,thelevelofcognitivedeclineassociatedwithMCIisgreaterthanexpectedforage,butnotassevere

asthatassociatedwithdementia,withminimalimpairmentofInstrumentalActivitiesofDailyLiving(IADL)[2].

MCIincreasestheriskfordementia,withdiagnosedindividualsprogressingatratesupto6-10%peryearcompared

with1-2%inthegeneralpopulation[3].

ThemajorMCIsubtypesareamnestic(aMCI),involvingepisodicmemoryimpairment(withorwithoutimpairmentin

othercognitivedomains),andnon-amnestic(na-MCI),involvingimpairmentincognitivedomainsotherthanmemory

(e.g.language,visuospatialprocessing,executivefunctions).

Fromahealthcareperspective, thehigherprevalenceof thisage-related impairment incognitive functionsand the

contemporary expanding aging population highlight the need to identify quick, effective and low-cost solutions to

delaypathologicalcognitivedecline[4].

Successfully assisting older adults to possibly slow cognitive decline,maintaining quality of life and independence,

remainsindeedamajorchallenge[5].

Since the relative pharmacological treatment ineffectiveness to face this problem [2], there has been a growing

interest inthepotentialfor lifestyle interventions,suchasappropriatementalactivities,to improveormaintainthe

cognitivefunctions.

To this purpose, cognitive training is a specific form of non-pharmacological intervention to address cognitive and

non-cognitive outcomes [6]. It involves guided practice on a set of standardized tasks that aim to address specific

aspectsofcognition,suchasmemory,language,attentionorexecutivefunctions.

Withinthedifferenttasks,varyingdifficultylevelsmaybeofferedtocontinuouslyadjusttaskdifficultybasedonthe

subjectsperformance[7].

Traditional trainingprogramsareusuallydelivered in groupsor face-to face,whichentails identifyinga convenient

meeting location, coordinating schedules and travel time. To overcome these aspects, novel cognitive training

platformshavebeendevelopedandstructuredrecentlyand,inthiscontext,computer-basedcognitiveinterventions

arebecomingapotentiallycost-effectivealternativetotraditionaltrainingforms.

Firstly, they can be easily disseminated, reaching special populations that would otherwise not receive such

interventions (e.g. older adults who have limited access to transportation are difficult to recruit for traditional

cognitivetrainingprograms);secondly,theycanofferamoreflexible,personalizedapproachtoanyonewithaccessto

technology;thirdly,theycanprovidereal-timeperformancefeedbackstoalltheusers.

Lastly, poor adherence can be a challengewith traditional cognitive training programs. In contrast, computer and

videogamesaredesignedtobefunandexcitingandmayprovidemotivationforolderadultstostickwiththetraining

program[4].

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Inthisresearch,giventheextensivebodyofdatareportingwhetherolderadultscanbenefitfromcognitivetraining

interventions, we specifically focused on the effectiveness of computerized cognitive training in people with mild

cognitiveimpairmenttosummarizethemainavailableevidenceonthetopic.

II. Searchingforevidence

MethodologyThesearchprocesswascarriedoutinthreesteps.

In stepone,weused thePICOstrategy to identify thesearch termsand the researchquestion.PICOrepresentsan

acronymforPatient, Intervention,ComparisonandOutcome.These fourcomponentsare theessentialelementsof

thequestionconstructionforthebibliographicsearchofavailabledata.

Inparticular,wefocusedonthescientificevidenceabouttheeffectivenessofcomputerizedcognitivetraininginolder

adultswithMCI.

Insteptwo,weconductedaliteraturereviewusingthemainelectronicdatabasesMedlineandScopus.

Searchtermspreviouslyidentifiedandusedwere“cognitivetraining”OR“braintraining”OR“computerizedcognitive

training”AND“mildcognitiveimpairment”OR“MCI”OR“cognitivedecline”.

TheliteraturesearchwasperformedandupdatedthroughMarch2018.

Eligible studies were published in English or Italian, peer reviewed reports of randomized controlled trials (RCTs),

systematicreviewsormeta-analyses,evaluatingtheeffectsofcomputer-basedcognitivetrainingonpeoplewithMCI

orwithearly-stagedementia.

Afterscreeningthetitlesandabstracts,we identifiedarecentlypublishedmeta-analysis (2017)whichaddressedall

theessentialelementsofourresearchquestion[8].

Inparticular,itisasystematicreviewoftheeffectivenessofcomputerizedcognitivetraininginolderadultswithmild

cognitive impairment with a statistical analysis of its effects on global cognition and on the individual cognitive

domains,usefultochartpotentialbenefitsoncognitionandbehavioracrossthedistinctdomains.

ItincludesonlyRCTspublishedfromdatabasesinceptionto1stJuly2016.

In step three,we extracted and analyzed all the relevant data from the articleswhichwere included in themeta-

analysisandwespecificallysearchedtheliteratureforthelatestarticlestoupdateit.

Toourknowledge,nonewarticleswerepublishedfrom1stJuly2016to15thMarch2018thatwererelevantforour

research.

Results

a) CharacteristicsofIncludedStudies

Themeta-analysisauthorsscreenedmorethan22,200recordstofinally include16articles:14published inEnglish,

oneinGermanandoneinKoreanwhichweretranslatedbeforebeinganalyzed.Twoweresplitintotwostudieseach

[9],[10],andtwoarticlesreportingoutcomesfromthesametrialwerecombinedintoonestudy[11],[12],resultingin

afinaldatasetof17independentcomparisonsincludedandanalyzed(seeAnnex1,Table1).

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The total numberof participantswas686 (ComputerizedCognitive Training group:N=351,meangroup size:N=21;

Control:N=335,meangroupsize:N=20).Meanagerangedbetween67and81years.

Activecontrol,definedasshamCCTorpsychoeducation,wasreportedin11/17studies.

Intheremainingstudies,passiveactivities(e.g.no-contact,wait-list)wereofferedtothecontrolarm.

Studies combining CCT with other interventions were eligible if the control group received the same adjacent

intervention.

All thearticleswereassessedusing thePEDro-P scale, a critical appraisal todetermine themethodologyqualityof

clinicaltrials.ThereportedmeanPEDro-Pscorewas7.2/9(SD=1.03).

Each computer-based session in the cognitive training group lasted from20minutes to amaximumof 100,with a

meanlengthof63.5minutes.Themeannumberofsessionsperformedbytheexperimentalgroupwas29.9,witha

meanof2.59sessionperweek.

Baseline cognitive characteristics of participants undergoing the cognitive trainingwere examined formost studies

usingtheMini-MentalStateExamination(13/17)withameanscorerangingfrom22.88to27.79.

b) ProgramDescriptionandProgram-TargetedCognitiveDomains

Therearemanydifferentavailabletoolsforcognitivetrainingandspecificstructuredsoftwaredesignedforit.

Particularly, most of the studies included in this meta-analysis (11/17) used exercises from structured software

programsthatwereplannedtobecomeprogressivelymoredifficultateachsessionandadjustableaccordingtouser

performance(sothateachpersonisalwaystrainingatthehigherlevel).

The software packages used are: Cogpack®, Brainfitness and InSight by Posit Science, Sociable, Lumosity Inc.,

CogniPlusTrainingProgramandNintendoWii.

Abriefdescriptionofeachsoftwareisreportedbelow:

- Cogpack®[9]consistsin64testsandtrainingprogramswith537differenttasksets,e.g.forvisuomotorcontrol,

comprehension, reaction, vigilance, memory, language, numbers, logic, problem solving, knowledge,

orientation, everyday skills, intellectual and professional skills and other special elements (e.g. labyrinths,

color/wordinterference,3-Dpositioningandassumptionsaboutpublicopinion).Taskscanbeedited,changed,

andexpanded.

- BrainfitnessbyPositScience[5], [10] focusesontheauditorysystemofthebrain,recognizingtothespeecha

central role. It consists in 6 easy-to-use and computer-based exercises that improve the auditory system in

severalways,asspeedingupprocessing,clarifyingsounddiscrimination,sharpeningsoundprecision,improving

soundsequencing,strengtheningauditoryworkingmemoryandenhancingnarrativememory.

- InSightbyPositScience[13]targetskeyrootsofcognitivefunction(thebrain’sabilitytotakeinformationfrom

thesensesquicklyandaccurately)inadditiontoexercisingmemorydirectly.Itconsistsof5gamesdesignedto

improvethevisualsystem,andparticularly:speedingupvisualprocessing,sharpeningvisualprecision,enlarging

usefulfieldofview,expandingdividedattentionandimprovingvisualworkingmemory.

- LumosityInc.[14]isafreeon-linewebsitedesignedtotraincognitive,mathandlanguageskills.Asetof3games

isoffereddaily,alwaysadjustedtouserperformanceandskilllevel.

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- Sociable[15]isaplatformthatofferspersonalizedcognitivetraining,coveringallthecognitiveskills,focusingon

memory, orientation, attention, constructural praxis, executive functions, language and logical reasoning.

Sociable boosts the social interactions of the elderly and motivates them by selected game concepts and

themes.

- CogniPlus[11],[12]isatrainingbatteryforthetrainingofcognitivefunctions.EachCogniPlustrainingistailored

toaspecificdeficit,whichisscientificallyproventobetrainable.Thedomainsare:attention,memory,executive

functions,spatialprocessing,visuomotorskillsandprocessingspeed. InCogniPlustheabilitydimensionsbeing

trainedarealmostalwaysembeddedinlifelikescenarios.

- NintendoWiiisagamewhereparticipantsaretrainedtousetheirarms/bodytosimulatetheactionsrequired

foreachsport.Itwasusedintwodifferentstudies;inthefirststudy[16]onlyNintendoWiibowlingwasused,

whiletheotherone[17]usedNintendoWiisports(whichincludesbowling,golf,tennisandbaseball).

Theothercognitive interventions includedinthemeta-analysisdidnotrefertoanyspecificsoftwareprogram,but

theauthorsdescribedtheexercisetypes.

Inparticular,onestudy[18]used“repetitionlag-training”taskswhichrequiredthelearningofaseriesofwordsand

thediscriminationofthosewordsfromunstudied lures.Threestudiesusedvirtualrealitytasks;oneforsimulating

museumtasks[19],oneforsimulatinghouseholdtasks[20]andoneforsimulatingabikeride[21].

Theremainingstudies[22],[23]usedothertypesofexercise(e.g.memorizingandrecognizingpictures,correlating

wordssemantically,solvingpuzzle).

Ingeneral,duringaCCTsession,4or5exerciseswereadministeredtoparticipantsintheCCTgroups.

Mostofthetasksthatparticipantshadtocarryout involvedattentiondomain(11/17),executivefunctions(10/17),

memory(verbal(8/17)andnonverbal/visual(7/17)),followedbyspeedprocessing(6/17)andvisuospatialprocessing

(5/17).

a) OverallefficacyonCognitiveOutcomes

Standardizedmean differences and their 95% confidence interval of change in cognitive outcomesmeasureswere

calculatedbetweentheCCTgroupandthecontrolgroup,frombaselinetopost-training.

ApositivestandardizedmeandifferenceindicatesatherapeuticeffectofCCToverandabovethecontrol(Fig.1).

Differenttestswereusedtomeasurethecognitiveoutcomeacrossthestudies.Alistoftheresultscategorizedbythe

cognitivedomainisreportedbelow.

- Globalcognition

TheeffectofCCTonglobalcognitionwasmeasuredin12/17studiesanditwasfoundtobemoderateandstatistically

significant.Therewasnodifferencebetweentheeffectacrossactiveorpassivecontrolledtrials.

- Verballearning

TheeffectofCCTonverballearningwasmeasuredin3/17studiesanditwasfoundtobemoderateandstatistically

significant.

- Verbalmemory

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TheeffectofCCTonverbalmemorywasmeasuredin7/17studiesanditwasfoundtobemoderateandstatistically

significant.

- Nonverballearning

The effect of CCT on nonverbal learning was measured in 8/17 studies and it was found to be moderate and

statisticallysignificant.

- Workingmemory

Theeffect of CCTonworkingmemorywasmeasured in 9/17 studies and itwas found tobe large and statistically

significant.

- Attention

The effect of CCT on attention wasmeasured in 11/17 studies and it was found to bemoderate and statistically

significant.

- Psychosocialfunctioning

TheeffectofCCTonpsychosocial functioningwasmeasured in8/17 studiesand itwas found tobemoderateand

statisticallysignificant.

- Otherdomains

Statistically non-significant results were found for nonverbal memory, executive functions, processing speed,

visuospatialskills,languageorInstrumentalActivitiesofDailyLiving(IADL).

III. Conclusions

Based on the results of 17 randomized controlled trials of moderate quality, CCT is an effective intervention for

enhancingcognitioninpeoplewithmildcognitiveimpairment.

Fig.1.EfficacyofComputerizedCognitiveTraining(CCT)inpeoplewithmildcognitiveimpairmentwithinindividualdomains.

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In particular, participants in CCT groups improved significantly over the intervention period,while controls did not

showany cognitive change, as itwas found in the global cognition domain.Most of the trials used (70%) used an

activecontrolcondition,buttheeffectsacrossactive-andpassive-controlledtrialswerecomparable.

Inaddition,moderateeffectsizesonmostmemoryandlearningdomainswererelevant.

Also attention, defined as a behavioral and cognitive process of selectively concentrating on a discrete aspect of

informationwhileignoringperceivableinformation,significantlybenefitedfromthecomputer-basedtraining.

On theotherhand,CCT lackedofefficacyonexecutive functionsbut, sincecognitive traininggains typically reflect

training content, this result may be due to insufficient training on executive processes (mainly fluid intelligence,

inhibitorycontrolandreasoning)withinstudies.

Surprisingly,theeffectsofCCTonspeedandvisuospatialprocessingwerefoundtobestatisticallynotsignificanteven

thoughCCTexercisesaretypically timedand involvedvisuospatialskills.Moreover, thesedomainswereamongthe

mostresponsiveinothermeta-analysesonhealthyadultsandpatientswithParkinsondisease.

Again,changingthetrainingcontentandfocusingspecificallyonprocessingspeedandvisuospatialmayimprovethis

result.

Depressionisassociatedwithmildcognitiveimpairment.Notably,psychologicalfunctioning(depression,qualityoflife

andneuropsychiatric symptoms) showed a positive improvement after theCCT training and this suggests that CCT

mayalsobenefitgeneralmood.

ReliableeffectswerenotseenonInstrumentalActivitiesofDailyLiving(IADL)andlanguageoutcomes,butrelatively

fewstudiesinvestigatedthesedomains.

Inconclusion,CCTisefficaciousonglobalcognition,memory,workingmemoryandattentionandhelpsimprove

psychologicalfunctioning,includingdepressingsymptoms,inpeoplewithmildcognitiveimpairment.

These results are robust and indicate a beneficial therapeutic role for CCT in this population and, since themany

advantagesthatitoffers,itshouldbeconsideredasacost-effectivetooltopreventcognitivedeclineandtomaintain

qualityoflifeandindependenceinolderpeople.

IV. Conflictofinterestsandfunding

Theauthorsdeclarethattheresearchwasconductedintheabsenceofanycommercialorfinancialrelationshipsthat

couldbeconstruedasapotentialconflictofinterest.

ThisresearchwasfundedbytheACDCAdultCognitiveDeclineConsciousness(Erasmus+projectnumber:2017-1-IT02-

KA204-036825).

V. References

[1] P. S. Sachdevet al., «The Prevalence ofMild Cognitive Impairment in DiverseGeographical and Ethnocultural

Regions:TheCOSMICCollaboration»,PLoSONE,vol.10,n.11,nov.2015.[2] R. C. Petersenetal., «Practice guidelineupdate summary:Mild cognitive impairment:Reportof theGuideline

Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology»,

Neurology,vol.90,n.3,pagg.126–135,gen.2018.

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[3] N. J.Gateset al., «Study ofMental Activity andRegular Training (SMART) in at risk individuals: A randomised

doubleblind,shamcontrolled,longitudinaltrial»,BMCGeriatr.,vol.11,pag.19,apr.2011.[4] A.M. Kueider, J.M. Parisi, A. L.Gross, eG.W.Rebok, «ComputerizedCognitive TrainingwithOlderAdults:A

SystematicReview»,PLoSONE,vol.7,n.7,pag.e40588,lug.2012.[5] D. E. Barnes et al., «Computer-based cognitive training for mild cognitive impairment: results from a pilot

randomized,controlledtrial»,AlzheimerDis.Assoc.Disord.,vol.23,n.3,pagg.205–210,set.2009.[6] A. Bahar-Fuchs, L. Clare, e B.Woods, «Cognitive training and cognitive rehabilitation for personswithmild to

moderatedementiaoftheAlzheimer’sorvasculartype:areview»,AlzheimersRes.Ther.,vol.5,n.4,pag.35,ago.2013.

[7] L. Clare, «Cognitive training and cognitive rehabilitation for people with early-stage dementia», Rev. Clin.Gerontol.,vol.13,n.01,feb.2003.

[8] N.T.M.Hill,L.Mowszowski,S.L.Naismith,V.L.Chadwick,M.Valenzuela,eA.Lampit,«ComputerizedCognitive

TraininginOlderAdultsWithMildCognitiveImpairmentorDementia:ASystematicReviewandMeta-Analysis»,

Am.J.Psychiatry,vol.174,n.4,pagg.329–340,apr.2017.[9] M.A.FiataroneSinghetal.,«TheStudyofMentalandResistanceTraining(SMART)Study—ResistanceTraining

and/orCognitiveTraining inMildCognitive Impairment:ARandomized,Double-Blind,Double-ShamControlled

Trial»,J.Am.Med.Dir.Assoc.,vol.15,n.12,pagg.873–880,dic.2014.[10]A. L. Gooding et al., «Comparing three methods of computerised cognitive training for older adults with

subclinicalcognitivedecline»,Neuropsychol.Rehabil.,vol.26,n.5–6,pagg.810–821,set.2016.[11]M.Hagovska, P. Takac, eO.Dvzonic, «Effect of a combining cognitive and balanced training on the cognitive,

postural and functional statusof seniorswithamild cognitivedeficit ina randomized, controlled trial»,Eur. J.Phys.Rehabil.Med.,vol.52,n.1,pag.9,2016.

[12]M.HagovskáeZ.Olekszyová,«Impactofthecombinationofcognitiveandbalancetrainingongait,fearandrisk

offallingandqualityoflifeinseniorswithmildcognitiveimpairment:Fearandriskoffallinginseniors»,Geriatr.Gerontol.Int.,vol.16,n.9,pagg.1043–1050,set.2016.

[13]F. Lin et al., «Cognitive and Neural Effects of Vision-Based Speed-of-Processing Training in Older Adults withAmnesticMildCognitiveImpairment:APilotStudy»,J.Am.Geriatr.Soc.,vol.64,n.6,pagg.1293–1298,giu.2016.

[14]M.FinneS.McDonald,«ComputerisedCognitiveTrainingforOlderPersonsWithMildCognitiveImpairment:A

PilotStudyUsingaRandomisedControlledTrialDesign»,BrainImpair.,vol.12,n.3,pagg.187–199,dic.2011.[15]F. Barban et al., «Protecting cognition from aging and Alzheimer’s disease: a computerized cognitive training

combined with reminiscence therapy: Protecting late-life cognition with a combined training», Int. J. Geriatr.Psychiatry,vol.31,n.4,pagg.340–348,apr.2016.

[16]R. Wittelsberger, S. Krug, S. Tittlbach, e K. Bös, «Auswirkungen von Nintendo-Wii® Bowling auf

Altenheimbewohner»,Z.FürGerontol.Geriatr.,vol.46,n.5,pagg.425–430,lug.2013.[17]T.F.Hughes,J.D.Flatt,B.Fu,M.A.Butters,C.-C.H.Chang,eM.Ganguli,«Interactivevideogamingcompared

withhealtheducationinolderadultswithmildcognitiveimpairment:afeasibilitystudy:Interactivevideogaming

andMCI»,Int.J.Geriatr.Psychiatry,vol.29,n.9,pagg.890–898,set.2014.[18]M.FinneS.McDonald,«Repetition-lagtrainingto improverecollectionmemory inolderpeoplewithamnestic

mildcognitive impairment.Arandomizedcontrolledtrial»,AgingNeuropsychol.Cogn.,vol.22,n.2,pagg.244–258,mar.2015.

[19]I.Tarnanas,A.Tsolakis,eM.Tsolaki,«AssessingvirtualrealityEnvironmentsasCognitiveStimulationMethodfor

PatientswithMCI,inTechnologiesofInclusiveWeel-Being»,Ed.BrooksALBrahnamJainLCBerl.Springer,pagg.39–74,2014.

[20]M. Y. Kim, K. S. Lee, e J. Choi, «Effectiveness of Cognitive Training based on Virtual Reality for the Elderly», JKoreanAcadRehabilMed,n.29,pagg.429–433.

[21]N.Barcelosetal.,«AerobicandCognitiveExercise(ACE)PilotStudyforOlderAdults:ExecutiveFunctionImproves

withCognitiveChallengeWhileExergaming»,J.Int.Neuropsychol.Soc.,vol.21,n.10,pagg.768–779,nov.2015.

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[22]L.Rozzini,D.Costardi,B.V.Chilovi,S.Franzoni,M.Trabucchi,eA.Padovani,«Efficacyofcognitiverehabilitation

inpatientswithmildcognitiveimpairmenttreatedwithcholinesteraseinhibitors»,Int.J.Geriatr.Psychiatry,vol.22,n.4,pagg.356–360,apr.2007.

[23]C.Herrera,C.Chambon,B.F.Michel,V.Paban,eB.Alescio-Lautier,«Positiveeffectsofcomputer-basedcognitive

traininginadultswithmildcognitiveimpairment»,Neuropsychologia,vol.50,n.8,pagg.1871–1881,lug.2012.[24]D. E. Barnes et al., «Computer-based Cognitive Training for Mild Cognitive Impairment: Results from a Pilot

Randomized,ControlledTrial»,AlzheimerDis.Assoc.Disord.,vol.23,n.3,pagg.205–210,lug.2009.

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VI. Annexes

Table1.CharacteristicsofIncludedStudiesa

Study NandControlType

MeanAge

(Years)b

MeanMMSEorEquivalent

ProgramDescription Program-TargetedCognitiveDomains

SessionLenght

(minutes)

Sessions/Week

TotalTraining(hours)

PEDro-P

ScaleKimetal.[20] CCTN=15

Control(Active)N=15

78.7 26.7 UnspecifiedsoftwareParticipantswerepracticedinperforminghouseholdtasksusingvirtualreality.

- 30 3 6 7

Rozzinietal.[22]

CCTN=15Control(Active)N=22

- 26.2 Unspecifiedsoftware- Memory:participantsweretrained

inrecognitiontasksforwordlists,imagesandsequencesofitems;

- Attention:participantswerepracticedinrespondingatthepresentationofatargetorinrecognizingandchoosingamongdifferentpossibilitiesthetwoimages-targetspresentedsimultaneously;

- Language:participantswereexercisedincorrelatingwordssemanticallyandinperceivingdifferentimagesorassociatingcouplesoffigures;

- Visuo-spatial:participantswerepracticedinsolvingpuzzles,visualsearchtasksandlocationofvisualinformation.

- Verbalmemory- Nonverbalmemory- Attention- Language- Executivefunctions- Visuospatial

processing

60 5 60 8

Barnesetal.[24]

CCTN=22Control(Active)N=25

74 - BrainFitnessbyPositScienceTheprograminvolved7exercisesthatweredesignedtoimproveprocessing

- Processingspeed- Verbalmemory- Workingmemory

100 5 50 8

12

speedandaccuracy;primaryandworkingauditorymemorytaskswerewovenimplicitlyintotheexercises.

Finnetal.[14] CCTN=8Control(Passive)N=8

72.69 27.76 LumosityInc.Exercisetypes:- Birdwatching- Colormatch- Lostinmigration- Memorymatch- Raindrops- Spatialspeedmatch

- Attention- Processingspeed- Nonverbalmemory- Executivefunctions

20 3-5 10 7

Herreraetal.[23]

CCTN=11Control(Active)N=11

76.63 27.27 UnspecifiedsoftwareExercisetypes:- Visualrecognition:participantswere

askedtomemorizeandrecognizepictures,withorwithoutadistractor;

- Visuospatialrecognition:participantswereaskedtomemorizeobjectspositionsandrecognizethislayout;

- Visualrecognition/workingmemory:participantswereaskedtomemorizepicturesoldandnewandcontinuouslyrecognizethem;

- Visualfocusedattention:participantswereaskedtodetectatargetpicture;

- Visuospatialfocusedattention:participantswereaskedtorecognizeanddetectatargetpictureindifferentscreenparts;

- Dividedattention(trial):participantswereaskedtorecognizepictures

- Verbalmemory- Nonverbalmemory- Verballearning- Nonverballearning- Attention- Processingspeed

60 2 24 8

13

thatcorrespondedtowordsheardamongdistractors.

Tarnanasetal.[19]

CCTN=32Control(Active)N=39

70.05 26.5 UnspecifiedsoftwareParticipantswerepracticedinperformingmuseumtasksusingvirtualreality.

- 90 2 60 7

Wittelsbergeretal.[16]

CCTN=17Control(Passive)N=10

70.07 22.88 NintendoWiibowling - 60 2 12 5

Finnetal.[18] CCTN=12Control(Passive)N=12

73.95 27.79 UnspecifiedsoftwareParticipantswereaskedtolearnaseriesofwordsandsubsequentdiscriminatethosewordsfromunstudiedlures.

- Verballearning- Verbalmemory

90 2 9 6

Hughesetal.[17]

CCTN=10Control(Active)N=10

77.4 27.1 NintendoWiisports

- 90 1 36 7

FiataroneSinghetal.(study1)[9]

CCTN=27Control(Active)N=22

70.1 27 Cogpack

- Verbalmemory- Nonverbalmemory- Executivefunctions- Attention- Processingspeed

90 2 78 9

FiataroneSinghetal.(study2)[9]

CCTN=24Control(Active)N=27

70.1 27 Cogpack

- Verbalmemory- Nonverbalmemory- Executivefunctions- Attention- Processingspeed

90 2 78 9

Barbanetal.[15]

CCTN=46Control(Passive)N=60

73.54 27.74 SociableExercisetypes:- Episodicmemory:participantswere

askedtorememberalist,torememberobjectlocationsin

- Verbalmemory- Nonverbalmemory- Executivefunctions- Language- Attention

60 2 24 8

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domesticenvironmentsandtofindpairsofimages;

- AttentionalExecutiveFunctions:participantswereaskedtoselectivelypayattentiontostimuliavoidingdistractors,toabstract,toexplainsimilarities,tocategorizeobjects,todeductatargetbyexcludingthedistractors;

- Orientation:participantswereaskedtomoveintoahouse;

- Logicalreasoning:participantswereaskedtocompareavisualpatternwithamissingelement;

- Constructionalpraxis:participantswereaskedtodoapuzzle;

- Language:participantswereaskedtocouplesynonymsorantonyms.

- Visuospatialprocessing

Hagovskaetal.[11][12]

CCTN=40Control(Passive)N=38

66.97 26.33 CogniPlus- Attentionintensity“Alert”:drivinga

car- Long-termmemory“Names”:

rememberingnamesandsurnamesinconnectionwithfaces

- Executivefunctions“Pland”:solvingtasks

- Workingmemory“Nback”:rememberingtwoorthreepicturespreviouslypresentedthroughtime

- Visual-motorcoordination“Vismo”:followingaspaceshiponthescreenandkeepingitinsideacircle

- Eachexercisefeaturedupto28progressivedifficultylevels

- Verbalmemory- Nonverbalmemory- Verballearning- Nonverballearning- Workingmemory- Executivefunctions- Attention- Visuospatial

processing

30 2 10 7

15

adjustableaccordingtousersperformance.

Barcelosetal.[21]

CCTN=8Control(Active)N=9

80.6 20.8c UnspecifiedsoftwareParticipantsweretrainedtoridevirtualrealityenhancedandrecumbentstationarybikesthroughasceniclandscape,wheretheywereinstructedtocollectdifferentcoloredcoinsandcorrespondingcoloreddragons.

- Executivefunctions- Attention- Visuospatial

processing

20-45 2 18 6

Goodingetal.(study1)[10]

CCTN=31Control(Active)N=20

75.59j 50.62d BrainFitnessbyPositScience

- Memory- Attention- Executivefunctions

60 2 30 5

Goodingetal.(study2)[10]

CVTN=23Control(Active)N=20

75.59j 50.84d BrainFitnessbyPositScience

- Memory- Attention- Executivefunctions

60 2 30 5

Linetal.[13] CCTN=10Control(Active)N=11

73.0 25.02c InSightbyPositScienceExercisetypes:- Eyefordetails- Peripheralchallenge- Visualsweeps- Doubledecisions- Targettracker

- Processingspeed- Visuospatial

processing- Executivefunctions- Attention

60 4 24 7

aAbbreviations:CCT=ComputerizedCognitiveTraining;CVT=CognitiveVitalityTraining;PED-roP=PhysiotherapyEvidenceDatabaseRatingScale.bWeightedmeanage.cMeasuredusingtheMontrealCognitiveAssessment(1-30scale).dMeasuredusingtheModifiedMini-MentalStateExamination(1-100scale).eSummarystatisticsfromstudy1andstudy.

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