[ARTICLE] Technology-based cognitive training and rehabilitation interventions for individuals with mild cognitive impairment: a systematic review

Abstract

Background

Individuals with mild cognitive impairment (MCI) are at heightened risk of developing dementia. Rapid advances in computing technology have enabled researchers to conduct cognitive training and rehabilitation interventions with the assistance of technology. This systematic review aims to evaluate the effects of technology-based cognitive training or rehabilitation interventions to improve cognitive function among individuals with MCI.

Methods

We conducted a systematic review using the following criteria: individuals with MCI, empirical studies, and evaluated a technology-based cognitive training or rehabilitation intervention. Twenty-six articles met the criteria.

Results

Studies were characterized by considerable variation in study design, intervention content, and technologies applied. The major types of technologies applied included computerized software, tablets, gaming consoles, and virtual reality. Use of technology to adjust the difficulties of tasks based on participants’ performance was an important feature. Technology-based cognitive training and rehabilitation interventions had significant effect on global cognitive function in 8 out of 22 studies; 8 out of 18 studies found positive effects on attention, 9 out of 16 studies on executive function, and 16 out of 19 studies on memory. Some cognitive interventions improved non-cognitive symptoms such as anxiety, depression, and ADLs.

Conclusion

Technology-based cognitive training and rehabilitation interventions show promise, but the findings were inconsistent due to the variations in study design. Future studies should consider using more consistent methodologies. Appropriate control groups should be designed to understand the additional benefits of cognitive training and rehabilitation delivered with the assistance of technology.

Background

Due to the aging of the world’s population, the number of people who live with dementia is projected to triple to 131 million by the year 2050 []. Development of preventative strategies for individuals at higher risk of developing dementia is an international priority []. Mild cognitive impairment (MCI) is regarded as an intermediate stage between normal cognition and dementia []. Individuals with MCI usually suffer with significant cognitive complaints, yet do not exhibit the functional impairments required for a diagnosis of dementia. These people typically have a faster rate of progression to dementia than those without MCI [], but the cognitive decline among MCI subjects has the potential of being improved []. Previous systematic reviews of cognitive intervention studies, both cognitive training and cognitive rehabilitation, have demonstrated promising effects on improving cognitive function among subjects with MCI [].

Recently, rapid advances in computing technology have enabled researchers to conduct cognitive training and rehabilitation interventions with the assistance of technology. A variety of technologies, including virtual reality (VR), interactive video gaming, and mobile technology, have been used to implement cognitive training and rehabilitation programs. Potential advantages to using technology-based interventions include enhanced accessibility and cost-effectiveness, providing a user experience that is immersive and comprehensive, as well as providing adaptive responses based on individual performance. Many computerized cognitive intervention programs are easily accessed through a computer or tablet, and the technology can objectively collect data during the intervention to provide real-time feedback to participants or therapists. Importantly, interventions delivered using technology have shown better effects compared to traditional cognitive training and rehabilitation programs in improving cognitive function and quality of life []. The reasons for this superiority are not well-understood but could be related to the usability and motivational factors related to the real-time interaction and feedback received from the training system [].

Three recent reviews of cognitive training and rehabilitation for use with individuals with MCI and dementia suggest that technology holds promise to improve both cognitive and non-cognitive outcomes []. The reviews conducted by Coyle, et al. [] and Chandler, et al. [] were limited by accessing articles from only two databases, and did not comprehensively cover available technologies. Hill, et al. [] limited their review to papers published until July 2016 and included only older adults aged 60 and above. More technology-based intervention studies have been conducted since then, and only including studies with older adults 60 and above could limit the scope of the review given that adults can develop early-onset MCI in their 40s []. Therefore, the purpose of this review is to 1) capture more studies using technology-based cognitive interventions by conducting a more comprehensive search using additional databases 2) understand the effect of technology-based cognitive interventions on improving abilities among individuals with MCI; and 3) examine the effects of multimodal technology-based interventions and their potential superiority compared to single component interventions.[…]

 

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