The effectiveness and safety of serious games in improving cognitive abilities among elderly people with cognitive impairment: A systematic review and meta-analysis (Preprint)

2021 ◽  
Author(s):  
Alaa Abd-alrazaq ◽  
Mohannad Alajlani ◽  
Dari Alhuwail ◽  
Carla T Toro ◽  
Anna Giannicchi ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Elderly People ◽  
Cognitive Training ◽  
Cognitive Abilities ◽  
Serious Games ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Global Cognition ◽  
Meta Analyses

BACKGROUND Cognitive impairment is a mental disorder that commonly affects elderly people. Serious games, which are games that have a purpose other than entertainment, have been used as a non-pharmacological intervention for improving cognitive abilities. The effectiveness and safety of serious games in improving cognitive abilities have been investigated by several systematic reviews; however, they are limited by design and methodological weaknesses. OBJECTIVE This study aims to assess the effectiveness and safety of serious games in improving cognitive abilities among elderly people with cognitive impairment. METHODS A systematic review of randomized controlled trials (RCTs) was conducted. Eight electronic databases were searched: MEDLINE, EMBASE, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also screened reference lists of the included studies and relevant reviews as well as checked studies citing our included studies. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize results of the included studies. RESULTS Fifteen studies met the eligibility criteria of 466 citations retrieved. Of those, 14 RCTs were eventually included in meta-analyses. We found that, regardless of their type, serious games are more effective than no intervention (P=0.04) and conventional exercises (P=0.002) in improving global cognition among elderly people with cognitive impairment. Further, a subgroup analysis showed that cognitive training games are more effective than no intervention (P=0.05) and conventional exercises (P<0.001) in improving global cognition among elderly people with cognitive impairment. Another subgroup analysis demonstrated that exergames are as effective as no intervention and conventional exercises (P=0.38) in improving global cognition among elderly people with cognitive impairment. Although some studies found adverse events from using serious games, the number of adverse events was comparable between groups. CONCLUSIONS Serious games (in general) and cognitive training games have the potential to improve global cognition among elderly people with cognitive impairment. However, our findings remain inconclusive because the quality of evidence in all meta-analyses was very low, mainly due to the risk of bias raised in the majority of the included studies, high heterogeneity of the evidence, and imprecision of total effect sizes. Therefore, psychologists, psychiatrists, and patients should consider offering serious games as complementary and not a substitute to existing interventions until further, more robust evidence is available. Further studies are needed to assess the effect of exergames, the safety of serious games, and their long-term effect. CLINICALTRIAL Serious games; Cognitive training; Exergames; Mild cognitive impairment; Alzheimer's disease; Dementia; Global cognition; Systematic reviews; Meta-analysis

The effectiveness of serious games in improving executive functions among elderly people with cognitive impairment: A systematic review and meta-analysis (Preprint)

2022 ◽  
Author(s):  
Alaa Abd-alrazaq ◽  
Dari Alhuwail ◽  
Arfan Ahmed ◽  
Mowafa Househ
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Cognitive Impairment ◽  
Executive Functions ◽  
Elderly People ◽  
Cognitive Abilities ◽  
Serious Games ◽  
Small Sample ◽  
Meta Analyses

BACKGROUND Executive functions are one of the known cognitive abilities that decline by age. They are the high-order cognitive processes that enable an individual to concentrate, plan, and take action. Serious games, which are games developed for specific purposes other than entertainment, could play a positive role in improving executive functions. Several systematic reviews have pooled the evidence about the effectiveness of serious games in improving executive functions; however, they are limited by some weaknesses. OBJECTIVE This study aims to investigate the effectiveness of serious games in improving executive functions among elderly people with cognitive impairment. METHODS A systematic review of randomized controlled trials (RCTs) was conducted. To retrieve relevant studies, 8 electronic databases were searched. Further, reference lists of the included studies and relevant reviews were screened, and we checked studies that cited our included studies. Two reviewers independently checked the eligibility of the studies, extracted data from the included studies, assessed the risk of bias, and appraised the quality of the evidence. We used a narrative and statistical approach, as appropriate, to synthesize results of the included studies. RESULTS Out of 548 publications identified, 16 RCTs were eventually included in this review. Our meta-analyses showed that serious games are as effective as no or passive interventions in improving executive functions (P=0.29). Surprisingly, conventional exercises were more effective than serious games in improving executive functions (P=0.03). Our subgroup analysis showed that both types of serious games (cognitive training games (P=0.08) and exergames (P=0.16)) are as effective as conventional exercises in improving executive functions. No difference was found between adaptive serious games and non-adaptive serious games in improving executive functions (P=0.59). CONCLUSIONS Serious games are not superior to no or passive interventions and conventional exercises in improving executive functions among older adults with cognitive impairment. However, our findings remain inconclusive due to the low quality of the evidence, the small sample size in most included studies, and the paucity of studies included in the meta-analyses. Accordingly, until more robust evidence is available, serious games should not be offered by healthcare providers nor used by patients for improving executive functions among older adults with cognitive functions. Further reviews are needed to assess the long-term effect of serious games on specific executive functions or other cognitive abilities among people from different age groups with or without cognitive impairment.

The effectiveness of serious games in improving memory among elderly people with cognitive impairment: A systematic review and meta-analysis (Preprint)

2021 ◽  
Author(s):  
Alaa Abd-alrazaq ◽  
Dari Alhuwail ◽  
Eiman Al-Jafar ◽  
Arfan Ahmed ◽  
Shuja Mohd Reagu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Working Memory ◽  
Cognitive Impairment ◽  
Verbal Memory ◽  
Serious Games ◽  
Meta Analysis ◽  
The Elderly ◽  
Quality Of Evidence ◽  
Meta Analyses

BACKGROUND Memory, one of the main cognitive functions, is known to decline by age. Serious games have been used for improving memory among the elderly. The effectiveness of serious games in improving memory has been investigated by several systematic reviews; however, they are limited by design and methodological weaknesses. OBJECTIVE This study aims to assess the effectiveness of serious games in improving memory among the elderly with cognitive impairment. METHODS A systematic review of randomized controlled trials (RCTs) was carried out. The search sources included searching 8 databases, screening reference lists of the included studies and relevant reviews, and checking studies that cited the included studies. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Extracted data were synthesized using a narrative approach and a statistical approach (i.e., meta-analysis), as appropriate. RESULTS Out of 466 citations retrieved, 18 studies met the eligibility criteria of this review. Of those, 15 RCTs were eventually included in 10 meta-analyses. We found that serious games are more effective than no or passive interventions in improving non-verbal memory (P=0.002) and working memory (P=0.02), but not verbal memory (P=0.13). The review also showed that serious games are more effective than conventional exercises in improving verbal memory (P=0.004), but not for non-verbal memory (P=0.12) and working memory (P=0.49). Serious games were as effective as conventional cognitive activities in improving verbal memory (P=0.07), non-verbal memory (P=0.94), and working memory (P=0.08) among the elderly with cognitive impairment. Lastly, the effect of adaptive serious games on working memory was comparable to non-adaptive serious games (P=0.08). CONCLUSIONS Serious games have the potential to improve verbal, non-verbal, and working memory among elderly people with cognitive impairment. However, our findings should be interpreted cautiously given that most meta-analyses were based on a few studies (≤3) and judged to have a low quality of evidence. Therefore, serious games should be offered as supplemental to existing proven and safe interventions, rather than a complete substitute until further, more robust evidence is available. Future studies should investigate the short and long-term effects of serious games on memory and other cognitive abilities among people from different age groups with or without cognitive impairment.

scholarly journals Differentiating PSP from MSA using MR planimetric measurements: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Beatrice Heim ◽  
Florian Krismer ◽  
Klaus Seppi
Keyword(s):  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Index Test ◽  
Study Quality ◽  
Parkinsonian Syndromes ◽  
Quantitative Mr ◽  
Meta Analyses ◽  
Planimetric Measurements

AbstractDifferential diagnosis of parkinsonian syndromes is considered one of the most challenging in neurology. Quantitative MR planimetric measurements were reported to discriminate between progressive supranuclear palsy (PSP) and non-PSP-parkinsonism. Several studies have used midbrain to pons ratio (M/P) and the Magnetic Resonance Parkinsonism Index (MRPI) in distinguishing PSP patients from those with Parkinson's disease. The current meta-analysis aimed to compare the performance of these measures in discriminating PSP from multiple system atrophy (MSA). A systematic MEDLINE review identified 59 out of 2984 studies allowing a calculation of sensitivity and specificity using the MRPI or M/P. Meta-analyses of results were carried out using random effects modelling. To assess study quality and risk of bias, the QUADAS-2 tool was used. Eight studies were suitable for analysis. The meta‐analysis showed a pooled sensitivity and specificity for the MRPI of PSP versus MSA of 79.2% (95% CI 72.7–84.4%) and 91.2% (95% CI 79.5–96.5%), and 84.1% (95% CI 77.2–89.2%) and 89.2% (95% CI 81.8–93.8%), respectively, for the M/P. The QUADAS-2 toolbox revealed a high risk of bias regarding the methodological quality of patient selection and index test, as all patients were seen in a specialized outpatient department without avoiding case control design and no predefined threshold was given regarding MRPI or M/P cut-offs. Planimetric brainstem measurements, in special the MRPI and M/P, yield high diagnostic accuracy for the discrimination of PSP from MSA. However, there is an urgent need for well-designed, prospective validation studies to ameliorate the concerns regarding the risk of bias.

scholarly journals Predictability of rotational tooth movement with orthodontic aligners comparing software-based and achieved data: A systematic review and meta-analysis of observational studies

2021 ◽  
pp. 146531252110272
Author(s):  
Despina Koletsi ◽  
Anna Iliadi ◽  
Theodore Eliades
Keyword(s):  
Effect Size ◽  
Tooth Movement ◽  
Data Extraction ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Patient Treatment ◽  
Qualitative Synthesis ◽  
Meta Analyses ◽  
Enamel Reduction

Objective: To evaluate all available evidence on the prediction of rotational tooth movements with aligners. Data sources: Seven databases of published and unpublished literature were searched up to 4 August 2020 for eligible studies. Data selection: Studies were deemed eligible if they included evaluation of rotational tooth movement with any type of aligner, through the comparison of software-based and actually achieved data after patient treatment. Data extraction and data synthesis: Data extraction was done independently and in duplicate and risk of bias assessment was performed with the use of the QUADAS-2 tool. Random effects meta-analyses with effect sizes and their 95% confidence intervals (CIs) were performed and the quality of the evidence was assessed through GRADE. Results: Seven articles were included in the qualitative synthesis, of which three contributed to meta-analyses. Overall results revealed a non-accurate prediction of the outcome for the software-based data, irrespective of the use of attachments or interproximal enamel reduction (IPR). Maxillary canines demonstrated the lowest percentage accuracy for rotational tooth movement (three studies: effect size = 47.9%; 95% CI = 27.2–69.5; P < 0.001), although high levels of heterogeneity were identified (I2: 86.9%; P < 0.001). Contrary, mandibular incisors presented the highest percentage accuracy for predicted rotational movement (two studies: effect size = 70.7%; 95% CI = 58.9–82.5; P < 0.001; I2: 0.0%; P = 0.48). Risk of bias was unclear to low overall, while quality of the evidence ranged from low to moderate. Conclusion: Allowing for all identified caveats, prediction of rotational tooth movements with aligner treatment does not appear accurate, especially for canines. Careful selection of patients and malocclusions for aligner treatment decisions remain challenging.

P14.71 An assessment of the reporting and methodological quality of meningioma systematic reviews and meta-analyses

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii51-ii52
Author(s):  
A M George ◽  
S Gupta ◽  
S M Keshwara ◽  
M A Mustafa ◽  
C S Gillespie ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Neurofibromatosis Type ◽  
Risk Of Bias ◽  
Measurement Tool ◽  
High Quality ◽  
Meta Analyses

Abstract BACKGROUND Systematic reviews and meta-analyses constitute the highest level of research evidence and for a disease with limited clinical trial activity, are often relied upon to help inform clinical practice. This review of reviews evaluates both the reporting & methodological quality of meningioma evidence syntheses. MATERIAL AND METHODS Potentially eligible meningioma reviews published between 1st January 1990 and 31st December 2020 were identified from eight electronic databases. Inclusion required the study to meet the Cochrane guideline definition of a systematic review or meta-analysis. Reviews concerning neurofibromatosis type 2, spinal and pediatric meningiomas were excluded. The reporting and methodological quality of articles were assessed against the following modified guidelines: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), A MeaSurement Tool to Assess Systematic Reviews (AMSTAR2) and the Risk of Bias in Systematic Reviews (ROBIS) guidelines. RESULTS 117 systematic reviews were identified, 57 of which included meta-analysis (48.7%). The number of meningioma systematic reviews published each year has increased with 63 studies (53.9%) published between 01/2018 and 12/2020. A median of 17 studies (IQR 9–29) were included per review. Impact factor of journals publishing a systematic review with or without a meta-analysis was similar (median 2.3 vs 1.8, P=0.397). The mean PRISMA scores for systematic reviews with a meta-analysis was 21.11 (SD 4.1, 78% adherence) and without was 13.89 (SD 3.4, 63% adherence). Twenty-nine systematic reviews with meta-analysis (51%) and 11 without meta-analysis (18%) achieved greater than 80% adherence to PRISMA recommendations. Methodological quality assessment using AMSTAR2 revealed one study (0.9%) as high quality whilst 111 (94.8%) studies were graded as critically low. One hundred and two articles (87.2%) did not utilize a comprehensive search strategy as defined by the AMSTAR2 tool. Ninety-nine studies (84.6%) obtained a high level of concern for potential bias as per the ROBIS assessment. One hundred and eight articles (92.3%) failed to present information that a protocol had been established prior to study commencement and 76 articles (65.0%) did not conduct a risk of bias assessment. Across the three tools, domains relating to the establishment of a protocol prior to review commencement and conducting appropriate risk of bias assessments were frequently low scoring. CONCLUSION Overall reporting and methodological quality of meningioma systematic reviews was sub-optimal. Established critical appraisal tools and reporting guidelines should be utilized a priori to assist in producing high-quality systematic reviews.

Systematic review and meta-analysis of smart-technology vs. face-to-face physical activity interventions in older adults (Preprint)

2022 ◽  
Author(s):  
Cassandra D'Amore ◽  
Julie C Reid ◽  
Matthew Chan ◽  
Samuel Fan ◽  
Amanda Huang ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Community Dwelling ◽  
Smart Technology ◽  
Face To Face ◽  
Meta Analyses ◽  
Community Dwelling Older Adults

BACKGROUND This is a systematic review of randomized controlled trials and a meta-analysis comparing smart-technology to face-to-face physical activity (PA) interventions, in community-dwelling older adults, mean age greater than or equal 60 years. OBJECTIVE To determine the effect of smart-technology interventions compared to face-to-face PA interventions on PA and physical function in older adults. Our secondary outcomes were depression, anxiety, and health-related quality of life. METHODS We searched four electronic databases from inception to February 2021. Two independent reviewers screened titles/abstracts, full texts, and performed data extraction and risk of bias assessments using the Cochrane risk of bias tool. GRADE was used to evaluate the quality of the evidence. We provided a narrative synthesis on all included studies and, where possible, we performed meta-analyses for similar outcomes. RESULTS 19 studies with a total of 3455 patients were included. Random-effects meta-analyses showed that smart-technology interventions resulted in improved step count (mean difference 1440 steps, 95% confidence interval (CI) 500, 2390) and total PA (standardized mean difference 0.17, 95% CI 0.02, 0.32) compared to face-face interventions. The quality of the evidence for the effects of smart-technology interventions was very low based on GRADE criteria. There was no difference between groups for measures of physical function. CONCLUSIONS Interventions that include smart-technology may improve daily step counts by an average of 1440 steps in community dwelling older adults, however the quality of the evidence was very low. Future studies are needed to improve the certainty of results.

scholarly journals Does Far Transfer Exist? Negative Evidence From Chess, Music, and Working Memory Training

2017 ◽  
Vol 26 (6) ◽  
pp. 515-520 ◽  
Author(s):  
Giovanni Sala ◽  
Fernand Gobet
Keyword(s):  
Working Memory ◽  
Cognitive Abilities ◽  
Meta Analysis ◽  
Music Instruction ◽  
Working Memory Training ◽  
Memory Training ◽  
Negative Evidence ◽  
Far Transfer ◽  
Meta Analyses

Chess masters and expert musicians appear to be, on average, more intelligent than the general population. Some researchers have thus claimed that playing chess or learning music enhances children’s cognitive abilities and academic attainment. We here present two meta-analyses assessing the effect of chess and music instruction on children’s cognitive and academic skills. A third meta-analysis evaluated the effects of working memory training—a cognitive skill correlated with music and chess expertise—on the same variables. The results show small to moderate effects. However, the effect sizes are inversely related to the quality of the experimental design (e.g., presence of active control groups). This pattern of results casts serious doubts on the effectiveness of chess, music, and working memory training. We discuss the theoretical and practical implications of these findings; extend the debate to other types of training such as spatial training, brain training, and video games; and conclude that far transfer of learning rarely occurs.

scholarly journals Acupuncture for Vascular Mild Cognitive Impairment: A Systematic Review of Randomised Controlled Trials

2013 ◽  
Vol 31 (4) ◽  
pp. 368-374 ◽  
Author(s):  
Huijuan Cao ◽  
Yuyi Wang ◽  
Dennis Chang ◽  
Li Zhou ◽  
Jianping Liu
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Vascular Cognitive Impairment ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Randomised Controlled ◽  
State Examination

Background Vascular mild cognitive impairment (VMCI) is the most common type of vascular cognitive impairment induced by cerebrovascular disease. No effective medicines are currently available for VMCI. Objective To assess the effectiveness and safety of acupuncture for VMCI. Methods Seven electronic databases were searched for randomised controlled trials which investigated the effects of acupuncture compared with no treatment, placebo or conventional therapies on cognitive function or other clinical outcomes in patients with VMCI. The quality of the trials selected was evaluated according to the ‘risk of bias’ assessment provided by the Cochrane Handbook for Systematic Reviews of Interventions. RevMan V.5.1 software was employed for data analysis. Results Twelve trials with 691 participants were included. The methodological quality of all included trials was unclear and/or they had a high risk of bias. Meta-analysis showed acupuncture in conjunction with other therapies could significantly improve Mini-Mental State Examination scores (mean difference 1.99, 95% CI 1.09 to 2.88, random model, p<0.0001, 6 trials). No included trials mentioned any adverse events of the treatment. Conclusions The current clinical evidence is not of sufficient quality for wider application of acupuncture to be recommended for the treatment of VMCI, and further large, rigorously designed trials are warranted.

Sign in / Sign up

Export Citation Format

Share Document