Computerized cognitive training shows promise in enhancing memory for dementia patients

By Dr. Priyom Bose, Ph.D.Jan 4 2024Reviewed by Benedette Cuffari, M.Sc.

A recent npj Digital Medicine study reviews the benefits of cognitive intervention among patients with mild cognitive impairment (MCI) or dementia with regard to memory functions.

Study: Computerized cognitive training for memory functions in mild cognitive impairment or dementia: A systematic review and meta-analysis. Image Credit: Shutter z / Shutterstock.com

Background

In patients with MCI or early dementia, impaired memory is the most common symptom that reduces their quality of life. Individuals with Alzheimer’s disease (AD) also exhibit memory impairment in the early phases of the disease.

Relative to individuals with non-amnestic MCI, those with amnestic MCI have a much higher risk of amyloid-β aggregation and AD. Dementia is more common among older individuals with subjective memory complaints (SMC).

A non-pharmacologic approach to reduce the risks of neurodegeneration is cognitive intervention, which augments memory reserve to provide greater resilience to neurodegenation. Research has also shown that cognitive training alters the resting brain state by improving the connectivity in brain networks and cerebral blood flow. Non-pharmacologic strategies are essential, as no medications are currently approved by the United States Food and Drug Administration (FDA) to treat MCI.  

Computerized cognitive training (CCT) can reduce the workload of the trainers and be easily incorporated into existing technology. Internet connectivity and immersive virtual reality (VR) can also be utilized, which can significantly enhance the experience beyond traditional settings.

About this study

The present study reviews the latest research on CCT, offers a more timely and updated analysis of the benefits of CCT in regard to memory function, and compares the efficacy of supervised and unsupervised CCT. Initially, 10,678 literature records were identified, from which duplicates were removed and screening of titles and abstracts was performed. After a series of quality checks, nine studies with 371 dementia patients and 28 studies with 1,489 MCI patients were included.

For individual studies, sample sizes ranged between 13 and 141 participants, with mean ages between 44 and 81 years. The participants were in the early stages of MCI or dementia, as evidenced by their cognitive assessment scores.

CCT was delivered through various devices, such as touchscreen computers or tablets, conventional desktop computers, and computers with VR functionality. The training was offered one to two hours weekly and lasted between two weeks and six months.

Key findings

Both unsupervised and supervised CCT enhanced various memory domains in MCI patients. The training modules incorporated visual, verbal, and working memory components, as memory deficit is associated with a marked decline in quality of life.

Supervised CCT was associated with the most significant benefits; however, unsupervised CCT also improved verbal memory. The observed efficiency of CCT is mainly consistent with those in previous reports. 

The present meta-analysis also documented the beneficial effects of CCT on verbal episodic memory. However, this effect was not observed for visual and working memory. This could be attributed to the early stage of dementia, which made patients more responsive to CCT.

There were some differences in the effectiveness between unsupervised and supervised CCT. Supervised CCT showed higher efficacies in many memory domains, which could be attributed to face-to-face supervision, which reduces distraction and improves adherence. Unsupervised CCT was only effective in enhancing verbal episodic memory. 

Conclusions

The study findings advocate for supervised CCT due to its significantly greater beneficial impact on visual, verbal, and working memory. Most existing research has examined the effects of supervised CCT; however, future research is needed to assess the various aspects of unsupervised CCT and how it can be transformed into self-administered cognitive training.

Despite the stringent inclusion criteria, the present study has some limitations, as only the immediate and short-term post-intervention effects of CCT were assessed. For dementia patients, long-term ongoing support is essential, whereby unsupervised CCT could be more cost-effective. Future studies are needed to explore the longer-term benefits of CCT in greater detail.

Another limitation was the extensive heterogeneity across studies concerning the three memory domains in MCI, possibly due to the inherent heterogeneity in training. CCT designs may vary along with the training frequencies and durations, thus making it difficult to account for this clinical heterogeneity.  

Furthermore, some of the included studies considered both MCI and dementia patients and presented results of a mixed cohort. The exclusion of these studies significantly reduced the sample size; however, it assisted in reporting results separately for the MCI and dementia groups.

The study findings are also prone to publication bias, as unpublished research cannot be easily detected through literature searches.