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

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.

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Effectiveness of e-cigarettes in smoking cessation: a systematic review and meta-analysis

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1226 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Oberndorfer ◽

I Grabovac ◽

S Haider ◽

T E Dorner

Keyword(s):

Systematic Review ◽

Smoking Cessation ◽

Meta Analysis ◽

Current Evidence ◽

Promising Alternative ◽

Quality Of Evidence ◽

Different Populations ◽

Meta Analyses

Abstract Background Reports of the effectiveness of e-cigarettes (ECs) for smoking cessation vary across different studies making implementation recommendations hard to attain. We performed a systematic review and meta-analysis to synthesise the current evidence regarding the effectiveness of ECs for smoking cessation. Methods PubMed, PsycInfo and Embase databases were searched for randomized controlled trials comparing nicotine ECs with non-nicotine ECs or with established smoking cessation interventions (nicotine replacement therapy (NRT) and or counselling) published between 01/01/2014 and 01/05/2019. Data from eligible studies were extracted and used for random-effects meta-analyses. Results Our literature review yielded 13190 publications with 10 studies being identified as eligible for systematic review, covering 8362 participants, and 8 for meta-analyses (n = 30 - 6006). Using the last follow-up of eligible studies, the proportion of smokers achieving abstinence was 1.67 [95CI:0.99 - 2.81] times higher in nicotine EC users compared to non-nicotine EC users. The proportion of abstinent smokers was 1.69 [95CI:1.25 - 2.27] times higher in EC users compared to participants receiving NRT. EC users showed a 2.70 [95CI:1.15 - 6.30] times higher proportion of abstinent smokers in comparison to participants solely receiving counselling. Conclusions Our analysis showed modest effects of nicotine-ECs compared to non-nicotine ECs. When compared to NRT or counselling, results suggest that nicotine EC may be more effective for smoking cessation. As ECs also help maintaining routinized behaviour and social aspects of smoking, we hypothesise that this may explain their advantage as a tool for smoking cessation. However, given the small number of included studies, different populations, heterogeneous designs, and the overall moderate to low quality of evidence, it is not possible to offer clear recommendations. More comparable data is needed to strengthen confidence in the quality of evidence. Key messages The number of previous studies assessing the effectiveness of ECs for smoking cessation is limited. Further, comparability of these studies is restricted, weakening the quality of evidence. Although current evidence on the effectiveness of ECs for smoking cessation is inconclusive, our meta-analyses suggest that ECs could be a promising alternative tool in attempts to achieve abstinence.

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Effectiveness of Electronic Cigarettes in Smoking Cessation: A Systematic Review and Meta-analysis

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa181 ◽

2020 ◽

Cited By ~ 4

Author(s):

Igor Grabovac ◽

Moritz Oberndorfer ◽

Jismy Fischer ◽

Winfried Wiesinger ◽

Sandra Haider ◽

...

Keyword(s):

Systematic Review ◽

Smoking Cessation ◽

Random Effects ◽

Electronic Cigarettes ◽

Meta Analysis ◽

Current Evidence ◽

Quality Of Evidence ◽

Registration Number ◽

Meta Analyses

Abstract Introduction Reports of the effectiveness of e-cigarettes (ECs) for smoking cessation vary across different studies making implementation recommendations hard to attain. We performed a systematic review and meta-analysis to assess the current evidence regarding effectiveness of ECs for smoking cessation. Methods PubMed, PsycInfo, and Embase databases were searched for randomized controlled trials comparing nicotine ECs with non-nicotine ECs or with established smoking cessation interventions (nicotine replacement therapy [NRT] and or counseling) published between 1 January 2014 and 27 June 2020. Data from eligible studies were extracted and used for random-effects meta-analyses (PROSPERO registration number: CRD42019141414). Results The search yielded 13 950 publications with 12 studies being identified as eligible for systematic review (N = 8362) and 9 studies for random-effects meta-analyses (range: 30–6006 participants). The proportion of smokers achieving abstinence was 1.71 (95 CI: 1.02–2.84) times higher in nicotine EC users compared with non-nicotine EC users. The proportion of abstinent smokers was 1.69 (95 CI: 1.25–2.27) times higher in EC users compared with participants receiving NRT. EC users showed a 2.04 (95 CI: 0.90–4.64) times higher proportion of abstinent smokers in comparison with participants solely receiving counseling. Conclusions Our results suggest that nicotine ECs may be more effective in smoking cessation when compared with placebo ECs or NRT. When compared with counseling alone, nicotine ECs are more effective short term, but its effectiveness appears to diminish with later follow-ups. Given the small number of studies, heterogeneous design, and the overall moderate to low quality of evidence, it is not possible to offer clear recommendations. Implications The results of this study do not allow for a conclusive argument. However, pooling current evidence points toward a potential for ECs as a smoking cessation tool. Though, given the overall quality of evidence, future studies should aim for more clarity in terms of interventions and larger study populations.

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Anemia and the Risk of Cognitive Impairment: An Updated Systematic Review and Meta-Analysis

Brain Sciences ◽

10.3390/brainsci11060777 ◽

2021 ◽

Vol 11 (6) ◽

pp. 777

Author(s):

Woon-Man Kung ◽

Sheng-Po Yuan ◽

Muh-Shi Lin ◽

Chieh-Chen Wu ◽

Md. Mohaimenul Islam ◽

...

Keyword(s):

Systematic Review ◽

Cognitive Impairment ◽

Observational Studies ◽

Web Of Science ◽

Meta Analysis ◽

The Elderly ◽

Previous Evidence ◽

Increased Risk ◽

Meta Analyses ◽

Risk Ratios

Background: Cognitive impairment is one of the most common, burdensome, and costly disorders in the elderly worldwide. The magnitude of the association between anemia and overall cognitive impairment (OCI) has not been established. Objective: We aimed to update and expand previous evidence of the association between anemia and the risk of OCI. Methods: We conducted an updated systematic review and meta-analysis. We searched electronic databases, including EMBASE, PubMed, and Web of Science for published observational studies and clinical trials between 1 January 1990 and 1 June 2020. We excluded articles that were in the form of a review, letter to editors, short reports, and studies with less than 50 participants. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. We estimated summary risk ratios (RRs) with random effects. Results: A total of 20 studies, involving 6558 OCI patients were included. Anemia was significantly associated with an increased risk of OCI (adjusted RR (aRR) 1.39 (95% CI, 1.25–1.55; p < 0.001)). In subgroup analysis, anemia was also associated with an increased risk of all-cause dementia (adjusted RR (aRR), 1.39 (95% CI, 1.23–1.56; p < 0.001)), Alzheimer’s disease [aRR, 1.59 (95% CI, 1.18–2.13; p = 0.002)], and mild cognitive impairment (aRR, 1.36 (95% CI, 1.04–1.78; p = 0.02)). Conclusion: This updated meta-analysis shows that patients with anemia appear to have a nearly 1.39-fold risk of developing OCI than those without anemia. The magnitude of this risk underscores the importance of improving anemia patients’ health outcomes, particularly in elderly patients.

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A Comprehensive Evaluation Between Dexmedetomidine and Midazolam for Intraoperative Sedation in the Elderly: Protocol for a Systematic Review and Meta-analysis of Randomized Controlled Trials

10.21203/rs.3.rs-864588/v1 ◽

2021 ◽

Author(s):

Chunxia Huang ◽

Zunjiang Li ◽

Yingxin Long ◽

Dongli Li ◽

Manhua Huang ◽

...

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

The Elderly ◽

Sedative Effect ◽

Controlled Trials ◽

Safety And Efficacy ◽

Quality Of Evidence ◽

Randomized Controlled

Abstract Background: The sedative effect of intraoperative sedation in elderly surgery exerts critical influence on the prognosis. Comparison on the safety and efficacy between Dexmedetomidine and Midazolam in many clinical randomized controlled trials (RCTs) were inconsistent and suspicious. We aimed to comprehensively evaluate the safety and efficacy between Dexmedetomidine and Midazolam for intraoperative sedation in the elderly via meta-analysis and systematic reviews.Methods: RCTs regarding to the comparison of sedative effects and safety between Dexmedetomidine and Midazolam in elderly patients (aged ≥ 60 years) will be comprehensively searched from 2000.10 to 2021.05 through 4 English databases and 4 Chinese databases. After extraction in duplicate, the systematic review and meta-analysis will be performed on the primary outcomes (hemodynamic changes, sedative effect, cognitive function) and secondary outcomes (analgesic effect, surgical characteristics, complications or adverse reactions) for assessing the two therapy methods using Review manage software (Version 5.3). Sensitivity analysis will be conducted to evaluate the heterogeneity of the results, funnel plot and Egger’s test will be performed to analyze publication bias of the included studies, and test sequential analysis will be applied to assess the robustness and reliability of preliminary meta-analysis results. Finally, rating quality of evidence and strength of recommendations on the meta results will be summarized by rating quality of evidence and strength of recommendations (GRADE) approach. Discussion: This systematic review and meta-analysis will evaluate the safety and efficacy between Dexmedetomidine and Midazolam for intraoperative sedation in the elderly, it will give an insight on the application of Dexmedetomidine and Midazolam, and will provide evidences-based reference for clinical decision makings.Systematic review registration: PROSPERO (CRD42021221897).

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100 Prevalence of Cognitive Impairment in Vascular Surgery Patients: Preliminary Results of A Systematic Review and Meta-Analysis

Age and Ageing ◽

10.1093/ageing/afz196.02 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i34-i36

Author(s):

J Houghton ◽

A Nickinson ◽

S Nduwayo ◽

B Bridgwood ◽

C Pepper ◽

...

Keyword(s):

Systematic Review ◽

Cognitive Impairment ◽

Vascular Surgery ◽

Cognitive Assessment ◽

Assessment Tool ◽

Carotid Artery Disease ◽

Meta Analysis ◽

Risk Of Bias ◽

Quality Of Evidence

Abstract Introduction Single-centre studies have shown a high prevalence of undiagnosed cognitive impairment in patients undergoing vascular surgery. The aim of this meta-analysis was to estimate the pooled prevalence of cognitive impairment in vascular surgery patients. Methods A systematic review and meta-analysis was performed of studies reporting cognitive impairment in vascular surgery patients (PROSPERO registration: CRD42019134684). Databases searched included: Medline, Embase, Emcare, CINAHL, PsychINFO and Scopus. Studies were excluded if they: did not use a validated cognitive assessment tool, included patients with asymptomatic or sub-threshold (for treatment) disease, or excluded patients with cognitive impairment. Quality of included studies was assessed using Newcastle-Ottawa scores (NOS), risk of bias was assessed using the ROBINS-E tool, and quality of evidence assessed using GRADE criteria. A pooled estimate of prevalence was calculated using the inverse-variance method separately for carotid artery disease (CAD), lower extremity arterial disease (LEAD), and studies including patients with multiple vascular surgery presentations. Data were pooled using random effects models and estimated prevalence presented with 95% confidence intervals (95%CI). Subgroup analyses were performed by cognitive assessment tool used. Authors of 24 studies meeting inclusion criteria that did not report numbers of cognitively impaired patients were contacted to enable inclusion: responses are awaited. Results After de-duplication of search results, 7,169 records were screened and 11 studies (911 patients) included in the meta-analysis. Nine studies were deemed high quality (NOS ≥7) however 8 studies had a serious risk of bias. Only one study explicitly stated provision for recruiting patients without capacity. Six different tools were used to assess cognitive function (MoCA, MMSE, ACE-R, HDS-R, Mini-Cog and a global cognitive score). Two studies found an association of cognitive impairment with post-op delirium whilst one did not, and a further study showed an association with increased length of stay. Pooled estimate of prevalence of cognitive impairment in CAD patients was 38% (95%CI 17%, 62%; 7 studies), and in “vascular surgery patients” was 61% (95%CI 47%, 74%, 3 studies). Only one study reported prevalence of cognitive impairment in LEAD patients alone of 19% (95%CI 14%, 24%). Quality of evidence was moderate to very low. Conclusions Cognitive impairment is highly prevalent in vascular surgery patients highlighting the need for close collaboration between vascular surgeons and geriatricians.

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Abstract 15323: How Often Should Chest Compressions be Paused to Assess the Cardiac Rhythm? A Systematic Review and Meta-analysis

Circulation ◽

10.1161/circ.132.suppl_3.15323 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Joshua C Reynolds ◽

Violetta Raffay ◽

Eddy Lang ◽

Peter T Morley ◽

Kevin Nation

Keyword(s):

Systematic Review ◽

Cardiac Rhythm ◽

Observational Studies ◽

Meta Analysis ◽

Chest Compressions ◽

Quality Of Evidence ◽

Rhythm Analysis ◽

Meta Analyses ◽

Quality Evidence

Objectives: Most guidelines recommend pausing chest compressions at 2-min intervals to analyze the cardiac rhythm. We assessed the literature on the optimal interval at which to pause chest compressions in adults for cardiac rhythm analysis in any setting. Methods: To conduct this systematic review and meta-analysis, we searched PubMed, Embase, and Cochrane databases through January 2, 2015, including human studies addressing any two different intervals of rhythm analysis. We excluded animal studies, manikin studies, case reports, editorials, and studies published only in abstract form. We assessed for bias per the Cochrane Handbook criteria for randomized controlled trials (RCT) and observational studies, then used GRADE methodology to evaluate the quality of evidence for functional outcome, survival, and return of spontaneous circulation. Two reviewers independently screened titles/abstracts, and resolved disagreement by consensus. We summarized study results using RR for RCTs and OR for observational studies. Meta-analyses were performed with Mantel-Haenszel random effects model. Results: Of 1,135 papers identified, 8 were included (3 RCT and 5 observational studies) encompassing 15,242 subjects. Quality of evidence was very low or low (downgraded for risk of bias and indirectness). RCT comparing specific time intervals (3-minutes vs. immediate analysis; 1-minute vs. 2-minutes; 3-minutes vs. 1-minute) demonstrated no benefit in either arm. Meta-analyses of 5 observational studies demonstrated moderate pooled benefit of a bundled ‘minimally interrupted chest compression’ protocol dictating 200-compression intervals over historical controls treated with 1- or 3-minute intervals per the 2000 guidelines (ROSC: OR 1.9, 95% CI 1.3, 2.7; survival to discharge: OR 2.9, 95% CI 2.1, 3.8; good functional outcome: OR 2.9, 95% CI 1.6, 5.4). No pooled estimate had significant heterogeneity. Conclusion: We found no quality evidence to support pausing chest compressions at any singular interval to assess the cardiac rhythm in adults in cardiac arrest in any setting. Very low quality evidence suggests improved outcomes in patients receiving a bundled 200-compression interval protocol compared to 1- or 3-minute intervals.

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Pre-emptive epidural analgesia for acute and chronic post-thoracotomy pain in adults: a systematic review and meta-analysis

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-101708 ◽

2020 ◽

Vol 45 (12) ◽

pp. 1006-1016

Author(s):

Sun-Kyung Park ◽

Susie Yoon ◽

Bo Rim Kim ◽

Suk Hyung Choe ◽

Jae-Hyon Bahk ◽

...

Keyword(s):

Systematic Review ◽

Epidural Analgesia ◽

Pain Intensity ◽

Meta Analysis ◽

Control Group ◽

Quality Of Evidence ◽

Grade Method ◽

Meta Analyses ◽

Thoracotomy Incision

Background and objectivesEpidural analgesia is the gold standard for post-thoracotomy pain management and can be started before or after surgical incision. This systematic review and meta-analysis investigated whether pre-emptive epidural analgesia before thoracotomy incision reduces acute and chronic post-thoracotomy pain in adults compared with epidural analgesia after incision.MethodsWe searched databases including MEDLINE, Embase, and CENTRAL for randomized controlled trials comparing epidural analgesia initiated before (pre-emptive group) and after (control group) thoracotomy incision in adults. The primary outcomes were the pain intensity during rest and coughing within 72 hours after surgery and the incidence of pain 1 to 6 months after surgery. Data were combined with random-effects meta-analyses. We rated the quality of evidence as high, moderate, low, and very low using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method.ResultsWe included 19 trials with 1062 participants involving 529 in the pre-emptive group and 533 in the control group. The pain intensity was significantly lower at rest within 72 hours after surgery (19 studies, n=1062) and during coughing within 48 hours after surgery (11 studies, n=638), and the incidence of pain was significantly lower 1 to 6 months after surgery (6 studies, n=276) in the pre-emptive group than in the control group. The quality of evidence was moderate or low in the primary outcomes.ConclusionsOur review provides low-quality evidence that pre-emptive epidural analgesia reduces the intensity of acute pain and the incidence of chronic pain after thoracotomy in adults.Protocol registration numberCRD42019131620.

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Effectiveness of Cognitive Rehabilitation in Parkinson’s Disease: A Systematic Review and Meta-Analysis

Journal of Personalized Medicine ◽

10.3390/jpm11050429 ◽

2021 ◽

Vol 11 (5) ◽

pp. 429

Author(s):

Itsasne Sanchez-Luengos ◽

Yolanda Balboa-Bandeira ◽

Olaia Lucas-Jiménez ◽

Natalia Ojeda ◽

Javier Peña ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Parkinson’S Disease ◽

Working Memory ◽

Executive Functions ◽

Processing Speed ◽

Verbal Memory ◽

Cognitive Rehabilitation ◽

Meta Analysis

Cognitive deficits influence the quality of life of Parkinson’s disease (PD) patients. In order to reduce the impact of cognitive impairment in PD, cognitive rehabilitation programs have been developed. This study presents a systematic review and meta-analysis regarding the effectiveness of cognitive rehabilitation in non-demented PD patients. Twelve articles were selected according to PRISMA guidelines. The systematic review showed that attention, working memory, verbal memory, executive functions and processing speed were the most frequently improved domains. Meta-analysis results showed moderate effects on global cognitive status (g = 0.55) and working memory (g = 0.50); small significant effects on verbal memory (g = 0.41), overall cognitive functions (g = 0.39) and executive functions (g = 0.30); small non-significant effects on attention (g = 0.36), visual memory (g = 0.29), verbal fluency (g = 0.27) and processing speed (g = 0.24); and no effect on visuospatial and visuoconstructive abilities (g = 0.17). Depressive symptoms showed small effect (g = 0.24) and quality of life showed no effect (g = −0.07). A meta-regression was performed to examine moderating variables of overall cognitive function effects, although moderators did not explain the heterogeneity of the improvement after cognitive rehabilitation. The findings suggest that cognitive rehabilitation may be beneficial in improving cognition in non-demented PD patients, although further studies are needed to obtain more robust effects.

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

10.2196/preprints.34592 ◽

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

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

10.2196/preprints.36123 ◽

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.

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