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Table 2 Overview of included studies

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

First author and year

Study design

Intervention and Technology

Control

Technology description

Sessions/Duration

Follow-up

Cognitive outcome measures

Other outcome measures

Key findings

Cipriani, 2006 [29]

Pre-post study

Computer based-Cognitive Rehabilitation (cb-CR) programs

NA

TNP software: delivers individualized cognitive rehabilitation exercises in the following cognitive domains: attention, memory, perception, visuospatial cognition, language, and non-verbal intelligence

2 * 16 * 13–45 min sessions for 8 weeks

3 months

MMSE

Attention: Visual search; Executive function: Trail Making test A and B; Behavioral Memory: RBMT; Psychomotor learning: digit symbol test; Verbal fluency: phonemic and semantic verbal fluency

Depression (GDS); Anxiety: STAI-X1, STAI-X2; ADL: AADL; QOL: SF-12

MCI: Only significantly improved in memory (RBMT)

Rozzini, 2007 [40]

RCT

TNP + ChEIs

CG1: ChEIs

CG2: No treatment

TNP Software

20 * 1 h/session, five days/week for four weeks

1 yr

MMSE

Memory: Short story recall; Executive function: Rey’s figure copy and recall, Raven’s colored matrices; Verbal fluency: Letter verbal fluency, Semantic verbal fluency

Mood: depression: GDS; anxiety, apathy Behavioral disturbances: NPI Activities of daily living: BADL

IG: significant improvement in memory, abstract reasoning, and depression

CG1: no improvements on any cognition but benefit in depression

CG2: no improvement in any outcome measures

Talassi, 2007 [36]

CCT

TNP + OT + BT

PR + OT + BT

TNP Software

30–45 min/session, 4 days/week for 3 weeks

Interven-tion end

MMSE

Working memory: forward and backward digit span; Executive function: Rey’s figure copy; Verbal fluency: phonemic and semantic verbal fluency; CDT; Episodic Memory: episodic memory subset of RBMT; Verbal fluency: Phonemic and semantic verbal fluency; Attention: visual search, processing speed: digit symbol test

Mood: depression GDS; anxiety (Stai-Y1,Stai-Y2; ADL: BADL, IADL, PPT;

MCI subjects in IG improved in executive function, visuospatial memory, anxiety, depression, and PPT but not IADL

MCI subjects in CG: no improvements

Barnes, 2009 [22]

RCT

cb-CT

Passive computer activities

Computer-based cognitive training software developed by Posit Science Corporation (San Francisco, CA), involving seven exercises including primary and working auditory memory tasks to improve processing speed and accuracy in the auditory cortex

IG: 100 min/day five days/week for 6 weeks CG: 90 min/day, 5 days/week for 6 weeks

Interven-tion end

Global cognitive function: RBANS total score, 5 RBANS index score

Memory: CVLT-II

Language: COWAT, BNT

Executive function: California Trail Making Test

Attention: Design Fluency test; Working memory: Spatial Span test

Mood: depression (GDS)

IG showed greater improvement on RBANS total scores but no significant between group difference.

Effect sizes for verbal learning and memory measures tended to favor IG.

Effect sizes for language and visuospatial function measures tended to favor CG (control group).

Finn, 2011 [25]

RCT

Computerized Cognitive Training Package

No intervention

Lumosity software on a computer contains four or five cognitive exercise that targeted four cognitive domains

30 sessions, 4–5 sessions/week

Interven-tion end

Executive function: IED; Attention: RVP

Subjective memory impairment: MFQ

Visual memory: PAL

Mood: Depression Anxiety and Stress Scale

IG had significant improvement in visual attention but not processing speed, visual memory, nor mood

Rosen, 2011 [23]

RCT

cb-CT

listening to audio books, reading online newspapers, and playing a visuospatial oriented computer game

Computer-based cognitive training software developed by Posit Science Corporation

IG: 24 sessions, 100 mins/day, 5 days/week

CG:24 sessions, 90 min/day, 5 days/week

Interven-tion end

Global cognitive function: RBANS

Neuroimaging: fMRI

Not specified

IG > CG: improvement in verbal memory and left hippocampal activation CG: declined in VM

Gagnon, 2012 [43]

RCT

Computer-based VP

AC: Computer-based FP

Computer-based divided attention dual-task training: VP: performing both tasks concurrently and varying allocation priorities across the series of blocks, feedbacks are provided; FP: perform both tasks concurrently and to allocate 50/50 attentional resources to each task, no feedbacks provided

6 * 1 h/session, 3 times/week for two weeks

Interven-tion end

Attention: dual task (digit span task, visual detection task); Executive subtest of TEA

Attention: Trail Making Test A; Executive function: Trail Making Test B;

QOL: Well-Being Scale

Divided attention: Divided Attention Questionnaire

VP showed significant advantage over FP in improving accuracy and reaction time

FP and VP both produced improvements on focused attention, speed of processing, and switching abilities

No reliable advantage for VP over FP

Herrera, 2012 [42]

RCT

Computer –based Memory and attention training

Stimulating Cognitive activities

Computer-based cognitive training that involved a memory task and an attention task

24 * 60 min/session twice/week for 12 weeks.

6 months

MMSE-recall; Memory: the forward and backward digit span test, BEM-144 12-word-list recall, the 16-item free and cued reminding test, subscore recall of the MMSE, visual recognition subtest from the Doors and People memory battery, the DMS48 test; executive function: Rey–Osterrieth Complex Figure recall test

N/A

Significant improvement in memory, both episodic recall and recognition

Man, 2012 [13]

CCT

VR-based memory training program

Therapist-led program

VR: participants use either the joystick or the direction buttons of the keyboard to control the navigation action and give responses to a memory task

10 sessions, 30 min/session 2–3 times/week

Interven-tion end

Memory: MMQ; Episodic Memory: FOME

ADL: Lawton IADL

VR: significant improvement in total encoding, total recall, delayed recall and MMQ-strategy

Therapist-led: significant improvement in total recall, delayed recall and MMQ-contentment

VR > therapist in improving objective memory; Therapist > VR in subjective memory

Gonzalez-Palau, 2014 [33]

Pre-post study

LLM included CTC and PTC

NA

CTC: Gradior Software: a multi-domain cognitive training program including attention, perception, episodic memory and working memory tasks. Principles of feedback and difficulty adaptation are used

PTC: FFA: an innovative, low-cost game platform. Work our intensity gradually increases

CTC: 40/session, three times/week for 12 weeks

PTC: one-hour session of FFA, three times/week for 12 weeks

Interven-tion end

Global cognitive function: The Mini Examen Cognitivo (MEC 35)

Memory: Logical Memory subtests of the WMS III

Attention: The Color Trail Test 1 and 2

Verbal learning and memory: HVLT-R

Mood: depression(GDS)

For MCI subjects: Significant improvement in global cognitive function, verbal memory,episodic memory, and decrease in symptoms of depression.

Han, 2014 [30]

Pre-post study

Ubiquitous Spaced Retrieval-based Memory Advancement and Rehabilitation Training USMART Program

NA

USMART program app on IPad

24 face-to-face sessions

Interven-tion end

CERAD-K-N including: verbal fluency: the Categorical Fluency test, the Modified BNT; MMSE; memory: WLMT, WLRT, the Word List Recognition Test, CRT; visuospatial: Constructional Praxis Test; Attention: Trail Making Test A; executive function: Trail Making Test B

N/A

Significantly improved only in memory (WLMT); number of training sessions correlated with WLMT scores

Hughes, 2014 [45]

RCT

Interactive video games (Wii)

Healthy aging education program

Nintendo Wii gaming console for interactive video gaming (bowling, golf, tennis, and baseball)

24 * 90 min, 1 session/week for 24 weeks

1 year

Global cognition: CAMCI; Processing speed/ Attention: Tracking A; Executive function: Tracking B; Subjective cognitive ability

Mood/social functioning: CSRQ-25;

ADL: TIADL

IG: No significant improvement in any of the outcome measures. Medium effect size estimates were found for global cognition, subjective cognition, executive function, and gait speed

Fiatarone Singh, 2014 [26]

RCT

IG1: CT + Sham exercise

IG2: PRT + Sham cognitive intervention

IG3: CT + PRT

Sham exercise + Sham cognitive intervention

COGPACK program: computer-based multimodal and multi-domain exercises targeting memory, executive function, attention, and speed of information processing, including 14 progressively more difficult exercises

CG: 60 min

IG: 75 min PRT/CT groups, 100 min combined

2–3 days/week for 6 months

18 months

Global cognition: ADAS-Cog

Executive Function: WAIS-III; Verbal fluency: COWAT, animal naming; Memory: BVRT-R, auditory Logical Memory I and II, subsets of WMS-III, List Learning subsection of ADAS-Cog; Attention: SDMT

ADL: B-IADL

CT prevented memory decline only up until 6 months

PRT improved global and executive function until 18 months; PRT was better than CT + PRT in improving global and executive function

Manera, 2015 [32]

Pre-post Study

‘Kitchen and Cooking’ Game

NA

Computerized Kitchen and Cooking’ serious game which challenges attention, executive function, and praxis

4 weeks

Interven-tion end

Attention: Trail Making Test A

Visual Memory: the Visual Association Test

Executive function: the Victoria Stroop Test

ADL: IADL, ADL

Significant improvement in executive function. Improvement in MCI > AD. Longer time played correlated with better executive function

Styliadis, 2015 [34]

CCT

IG1: Long-Lasting Memories (LLM) Intervention: combined cognitive training (CT) and physical training (PT)

IG2: CT alone

IG3: PT alone

CG1: Active Control (AC) (documentaries viewing)

CG2: Passive Control

LLM training system CT and PT as follows: CT: Greek adaptation of Brain Fitness Software: 6 self-paced exercises focused on categories: Attention and Auditory Processing Speed.

PT: FFA game platform incorporating Nintendo WII balance games

8 weeks

LLM group: Up to 10 h/week

PT group: Up to 5 h/week

CT group: Up to 5 h/week

AC group: Up to 5 h/week

Interven-tion end

Electroencephalogram (EEG) measures of Cortical activity for delta, theta, beta 1 and beta 2 bands

N/A

A significant training effect was identified in the LLM group revealed by EEG measures but no training effects on the MMSE

Barban, 2016 [39]

RCT

Process-based-Cognitive Training (pb-CT) plus reminiscence therapy (RT) + rest

Reminiscence therapy (RT) + pb-CT

SOCIABLE software on a touch screen computer containing 27 games designed to improve function in 7 cognitive domains: attention, executive function, memory, logical reasoning, orientation, language, and constructional Praxis

24 * 1 h treatment sessions, 2 sessions/week for a about 3 months

Interven-tion end

MMSE

Memory: RAVLT; Executive function: Rey–Osterreith Complex Figure Test, Phonological Verbal Fluency Test; Executive function: Trail Making Test

IADL

pb-CT: Significant training effects on memory in MCI subjects and the effect was maintained after reminiscence period; Significant training effect on MMSE was not maintained during reminiscence period; Medium effect sizes

Gooding, 2016 [35]

CCT

IG1: Computer based Cognitive Training (cb-CT)

IG2: Cognitive Vitality Training (CVT: cb-CT + Neuropsychological and Educational Approach to Remediation (NEAR)

Active Control Group (ACG)

cb-CT: Brain Fitness: repeated drill-and-practice exercises involving memory, attention, and executive functions within domain-specific training modules that allow for adaptive training with titrated difficulty levels.

Same CT exercises delivered within a framework that allows for personalization, individual control, and contextualization of exercises

30 * 60 min/session, twice/week for 16 weeks

4 months

Intellectual functioning: WRAT-3; mMMSE; Verbal learning and Memory: the BSRT, the WMS-R LM I and II subtests

Visual learning and memory: the WMS-R Visual Reproductions (VR) I and II subtests

Mood: depression (BDI-II)

CVT and cb-CT groups had improvements in global cognition, verbal learning, and verbal memory; CVT and cb-CT had significantly greater improvements than ACG in global cognition, verbal memory, and verbal learning; No significant difference between cb-CT and CVT; Largest mood improvement in CVT, significant difference between CVT and ACG but not between CVT and cb-CT

Hyer, 2016 [28]

RCT

Computerized CT program

Sham cognitive training

Cogmed computer training program: Uses multiple rotating exercises daily that are designed to train working memory.

25 * 40 min /day for over 5 to 7 weeks

3 months

Working Memory: WMS-III Span Board subtest, WAIS-III Letter Number Sequencing subtest; Attention: Trail Making Test Part A; Executive function: Trail Making Test Part B); Subjective memory: CFQ

ADL: the Functional Activities Questionnaire

Significant improvement of executive function, verbal and non-verbal working memory in both CG and IG; Significant improvement of subjective memory in IG but not CG.

Significant between group difference in working memory (Span Board) and in adjustment (FAQ)

Klados, 2016 [37]

CCT

Long Lasting Memories (LLM) Intervention (Cognitive Training (CT) + Physical Training (PT))

Active Control (AC): watching documentary and answering questionnaire

Brain Fitness Software FitForAll

CT: 1 h/day, 3–5 days/week for 8 weeks

PT: 1 h/day, 3–5 sessions/week for 8 weeks for 8 weeks

Interven-tion end

Cortical Activity, Cortical Functional Connectivity: beta band

Not specified

IG showed beta band functional connectivity of MCI patients

Lin, 2016 [44]

RCT

VSOP

MLA

Software INSIGHT: online program designed by Posit Science, included five training tasks: eye for detail, peripheral challenge, visual sweeps, double decision, and target tracker

1 h/day

4 days/week for 6 weeks

Interven-tion end

Processing speed: The Useful Field of View

Executive function: The EXAMINER

ADL: TIADL

Neuroimaging data: magnetic resonance imaging

IG > CG: improvement in trained (processing speed and attention) and untrained (working memory) cognitive domains, IADL, CEN and DMN

Vermeij, 2016 [31]

Pre-post study

WM training program

NA

Cogmed computer program

25 sessions, 45 min per session for 5 weeks

3 months

Working memory: WAIS-III Digit Span forward and backward, WMS-III Spatial Span forward and backward; Verbal memory: Dutch equivalent of RAVLT; Figural Fluency: RFFT; Cognitive impairment: CFQ

N/A

IG: Significant improvement in trained verbal and visuospatial working memory tasks as well as executive function. Training gain was larger in the healthy elderly (HE) and was only maintained among HEs. Improvements in non-trained near-transfer tasks, maintained after 3 months follow-up

Bahar-Fuchs, 2017 [27]

RCT

home-based individually-tailored and adaptive cb-CT

AC

CogniFit Software: a computer-based program involving 33 tasks designed to train a broad range of cognitive abilities

2 sessions/day, 3 days/week, for 8–12 weeks

12 weeks

Composite score global cognition

Memory: L’Hermitte Board, Logical Memory, RAVLT

Verbal fluency: SydBat

Processing speed: the Trails A and B tasks

Self-reported cognitive function

Mood

MCI in IG: greater improvement in memory, learning, and global cognition.

No training effect in mood, self-reported memory

Training gains in MCI (including ADL) were consolidated over time large effect sizes of intervention at the follow-up assessments in learning, delayed memory, and global cognitive function, medium effect size in non-memory composite

Delbroek, 2017 [47]

RCT

VR dual task training with the BioRescue

No intervention

BioRescue Software: nine exercises to train balance, weight bearing, memory, attention and dual tasking. Led by a therapist, participants stand on a platform, adjustable difficulties based on performances

Gradually increased from 18 min in week 1 to 30 min in week 5

Interven-tion end

The Dutch version of MoCA

Motivation: The Dutch version of IMI

emotions: OERS

IG significantly improved on balance, but not on global cognitive function or cognitive-motor dual tasking or gait performance

Hagovská, 2017 [12]

RCT

Cb-CT

Classical group-based cognitive training

CogniPlus program: on a computer, includes five sub-programs that involved activities that are similar to everyday activities, targets attention, working memory, long-term memory, planning of everyday activities, and visual-motor abilities.

20 *30 min, 2 sessions/week for 10 weeks

10 weeks

Self-reported functional activities: FAQ Global cognition: ACE

Attention: The Stroop Test

QOL: Spitzer QOL index

Functional activities: The Functional Activities Questionnaire

IG demonstrated larger improvements in QoL and attention than CG.

The transfer to functional activities was the same between groups

Mansbach, 2017 [38]

CCT

cb-CR

No intervention

Memory Match online cognitive rehabilitation module: designed to improve attention and visual memory, requires the participant to visually pair “matching pictures” by remembering their location

9*30 min/session

Interven-tion end

Global cognitive functioning: BCAT

AD8 Dementia Screening

Interview, KPT

Attitudes about their cognitive abilities: SRI

Mood: depression: GDS-SF

IG > CG in global cognition at post-intervention assessment

Savulich, 2017 [41]

RCT

CT

No intervention

Game Show on iPad: a novel learning and memory game, target to improve episodic memory

8 sessions, 1 h/session

Interven-tion end for 4 weeks

MMSE;

Episodic memory and new learning: CANTAB PAL; Visual/spatial abilities: BVMT-R; Processing speed: CANTAB CRT

GDS-SF

Anxiety and depression: HADS; Apathy: AES

IG > CG: significantly better performance in episodic memory, visuospatial abilities, MMSE, and less apathy

  1. Pb-CT = Process-based cognitive training, Cb-CR = computer-based cognitive rehabilitation, Cb-CT = computer-based cognitive training, TNP = Neuropsychological Training, WLMT = memory Word List Memory Test, USMART = Ubiquitous Spaced Retrieval-based Memory Advancement and Rehabilitation Training, MSS = Memory Support System, PT = Physical training, CT = cognitive training, LLM = long lasting memories, CCT = clinical controlled trials, or, computerized cognitive training, WM = working memory, ACG = Active Control Group, CVT = Cognitive Vitality Training, NEAR: motivational therapeutic milieu based on Neuropsychological and Educational Approach to Remediation (NEAR) model, FFA = FitForAll, PRT = Progress resistance training, VR = virtual reality, PR = Physical rehabilitation, OT = Occupational therapy, BT = Behavioral training, ChEIs = cholinesterase inhibitors, VP = Variable Priority, FP = Fixed Priority, VSOP = Vision-based speed-of-processing, MLA = mental leisure activities, TIADL = The Timed Instrumental Activities of Daily Living, QOL-AD = The Quality of Life-AD, PTC = physical training component, CAMCI = The Computerized Assessment of Mild Cognitive Impairment, CSRQ-25 = Cognitive Self-Report Questionnaire-25, RAVLT = the Rey Auditory Verbal Learning Test, AADL = advanced activity of daily living, RBMT = Rivermead behavioral memory test, RBMT = Rivermead behavioral memory test, CERAD-K-N the Korean version of the CERAD Neuropsychological Assessment Battery, DRS-2 = Dementia Rating Scale-2, E-Cog = The Everyday Cognition, WAIS-III = Wechsler Adult Intelligence Scale-Third Edition, WMS-III = Wechsler Memory Scale-Third Edition, CFQ = Cognitive Failures Questionnaire, RFFT = the Ruff Figural Fluency Test, SCWT the Stroop Color-Word Task, IADL = Instrumental Activities of Daily Living scale, ADL = the Independence in Activity of Daily Living index, WRAT-3 = Wide Range Achievement Test–3rd Edition, BSRT = Buschke Selective Reminding Test, MFQ = Memory Functioning Questionnaire, IED = Intra−/extra-dimensional set shifting, RVP = a mea Rapid visual information processing, MFQ = Memory Functioning Questionnaire, PAL Paired-associates learning, SDMT = Symbol Digit Modalities Test, BVRT-R = Benton Visual Retention Test-Revised 5th Edition, B-IADL Bayer Activities of Daily Living, ADAS-Cog = Alzheimer’s Disease Assessment Scale-cognitive subscale, MoCA = the Montreal Cognitive Assessment, IMI = Intrinsic Motivation Inventory, OERS = Observed Emotion Rating Scale, NPI = Neuropsychiatric Inventory, BADL = Basic Activities Daily Living, CDT = clock-drawing test, PPT = physical performance test, TEA = Test of Everyday Attention, GDS = Geriatric Depression Scale, GAI = Geriatric Anxiety Scale, AES = Apathy Evaluation Scale, MMQ Multifactorial Memory Questionnaire, FOME = Fuld Object Memory Evaluation, CVLT-II = California Verbal Learning Test – II, COWAT = Controlled Oral Word Association Test, BNT = Boston Naming Test, BCAT = The Brief Cognitive Assessment Tool, FAQ = Functional Activities Questionnaire, ACE = Addenbrooke’s Cognitive Examination, EXAMINER = Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research, BCAT = The Brief Cognitive Assessment Tool, SRI = self-rating inventory of Cognitive Ability, KPT = Kitchen Picture Test of Practical Judgment, GDS-SF = Geriatric Depression Scale-Short Form, CANTAB PAL = Cambridge Neuropsychological Test Automated Battery Paired Associates Learning, BVMT-R = Brief Visuospatial Memory Test-Revised, CANTAB CRT = Cambridge Neuropsychological Test Automated Battery Choice Reaction Time, AES = Apathy Evaluation Scale, HADS = Hospital Anxiety and Depression Scale, CEN = central executive network, WLRT = Word List Recall Test, MN = mode network, CRT = Constructional Recall Test, VTA = Visual Association Test