CogniFit - Enhancing Cognitive Functioning in Healthly Older Adults: a Systematic Review of the Clinical Significance of Commercially Available Computerized Cognitive Training in Preventing Cognitive Decline

Original name: Enhancing Cognitive Functioning in Healthly Older Adults: a Systematic Review of the Clinical Significance of Commercially Available Computerized Cognitive Training in Preventing Cognitive Decline.

Authors: Tejal M Shah ^{1, 2, 3} , Michael Weinborn ^{1, 2, 4} , Giuseppe Verdile ^{1, 2, 3, 5} , Hamid R Sohrabi ^{1, 2, 3} , Ralph N Martins ^{6, 7, 8} .

• 1. McCusker Alzheimer's Research Foundation, Hollywood Medical Center, Nedlands, WA, Australia, 6009.
• 2. Center of Excellence for Alzheimer's Disease Research & Care, School of Medical Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, Australia, 6027.
• 3. School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, WA, Australia, 6009.
• 4. School of Psychology, University of Western Australia, Crawley, WA, Australia, 6009.
• 5. School of Biomedical Sciences, CHIRI Biosciences, Curtin University, Bentley, WA, Australia, 6102.
• 6. McCusker Alzheimer's Research Foundation, Hollywood Medical Center, Nedlands, WA, Australia, 6009.
• 7. Center of Excellence for Alzheimer's Disease Research & Care, School of Medical Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, Australia, 6027.
• 8. School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, WA, Australia, 6009.

Journal : Neuropsychology Review (2017), 62-80.

Cite this article (APA format):

• Shah, T. M., Weinborn, M., Verdile, G., Sohrabi, H. R., & Martins, R. N. (2017). Enhancing Cognitive Functioning in Healthly Older Adults: a Systematic Review of the Clinical Significance of Commercially Available Computerized Cognitive Training in Preventing Cognitive Decline. Neuropsychology Review , 27 (1), 62-80.

Conclusion of the Study

There are numerous, methodologically-sound scientific studies that utilize the activities from CogniFit in healthy older people, which means that CogniFit has the highest level of empirical evidence.

Context

In recent years there has been an increase in interest in maintaining and improving brain and cognitive health as we age , perhaps related to the high prevalence of neurodegenerative disorders associated with advanced age, such as Alzheimer's. However, the concept of cognitive interventions for the elderly is nothing new: the concepts of neuroplasticity or cognitive reserve, and its relationship with this type of pathology, are already familiar.

Computerized cognitive training is positioned as a beneficial tool for healthy older adults, with mild cognitive impairment (MCI) or with Alzheimer's disease . However, not all these tools have the same efficacy, nor have they been demonstrated with the same number of scientific studies of the same methodological quality. For this reason, conducting a systematic review can be beneficial to understand and categorize computerized cognitive training tools according to the quality of their clinical validations .

Methodology

The systematic review was carried out in different phases. First, two searches were performed: First, relevant cognitive training programs or tools that were commercially available were identified. Then, studies related to these tools were identified and systematically reviewed. The search terms used in the web search engines to identify the programs were “commercial brain / cognitive training programs”, “computerized brain / cognitive training programs” and “software for brain / cognitive training”. To obtain the studies associated with these programs, the PubMed and Google Scholar databases were used with the search terms "cognitive stimulation" OR "brain training" OR "cognitive rehabilitation" OR "cognitive enhancement" OR "Brain fitness software ”OR“ cognitive retention therapy ”OR“ computerized cognitive behavioral therapy ”. These terms were used both with the name of each identified tool, and without it. The search was conducted in September 2015.

The studies chosen had to be published in English, be peer-reviewed, contain clinical trials in healthy people over 50 years of age, and be based on cognitive measures . Conference abstracts, other populations that were not healthy older adults, that included people with dementia, that used video games or that the main measure was not cognitive, were excluded.

Two independent reviewers checked the titles and abstracts of relevant studies. The reviewers focused on the source of the study, the sample size, the age of the users, the duration, intensity, and frequency of the intervention, and the existence of follow-ups after the intervention.

The risk of bias was also analyzed using the Physiotherapy Evidence Database (PEDro) scale, with a scale between 0 and 10, with a score >6 being considered of high quality, and a score <5 of poor quality.

After analyzing the number of clinical trials published by each program, and the methodological quality of each study, the interventions were classified into three levels: Level 1 (that the tool had at least two studies with a good design randomized or quasi-randomized control trial, with one of them having a high quality according to the PEDro scale, and the second with at least a medium quality in this same scale), Level 2 (that only they had a study with a good design of a high quality randomized control trial according to the PEDro scale), and Level 3 (those programs with a moderate or poor design). Those studies that did not have a formally identified control group were not evaluated.

Results and conclusions

After the entire review, a total of 32 commercialized brain training programs were identified, of which 14 were excluded because they were not directed at the population of interest for the study, or because they were applied in a non-computerized format. Of the remaining 18 programs , a total of 7,985 studies were collected, after eliminating duplicates. Of these, 244 full publications were identified and assessed as eligible for the review. Based on the inclusion and exclusion criteria, a total of 26 studies were finally reviewed.

Of all these tools, only two of them have studies that reached Level 1 of empirical evidence, one of them being CogniFit. In these studies, it was observed that CogniFit had improved mobility in healthy older adults, in addition to a series of improvements in various cognitive abilities, such as processing speed, memory, attention, executive functions, visuospatial working memory, learning, hand-eye coordination, etc. Thus, the studies that indicate that CogniFit can improve cognitive abilities in healthy older people have been shown to be of high quality, with the best level of empirical evidence .