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 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 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.

Effectiveness of Outdoor Exercise Parks on Health Outcomes in Older Adults—A Mixed-Methods Systematic Review and Meta-Analysis

2020 ◽  
pp. 1-13
Author(s):  
Yoke Leng Ng ◽  
Keith D. Hill ◽  
Pazit Levinger ◽  
Elissa Burton
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Older Adults ◽  
Meta Analysis ◽  
Small Sample ◽  
Activity Levels ◽  
Single Leg Stance ◽  
Small Sample Sizes ◽  
Meta Analyses

The objective of this systematic review was to examine the effectiveness of outdoor exercise park equipment on physical activity levels, physical function, psychosocial outcomes, and quality of life of older adults living in the community and to evaluate the evidence of older adults’ use of outdoor exercise park equipment. A search strategy was conducted from seven databases. Nine articles met the inclusion criteria. The study quality results were varied. Meta-analyses were undertaken for two physical performance tests: 30-s chair stand test and single-leg stance. The meta-analysis results were not statistically significant. It was not possible to conclude whether exercise parks were effective at improving levels of physical activity. The review shows that older adults value the benefits of health and social interaction from the use of exercise parks. Findings should be interpreted with caution due to the small sample sizes and the limited number of studies.

scholarly journals Protocols for cognitive enhancement. A user manual for Brain Health Services—part 5 of 6

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Andrea Brioschi Guevara ◽  
Melanie Bieler ◽  
Daniele Altomare ◽  
Marcelo Berthier ◽  
Chantal Csajka ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Impairment ◽  
Executive Functions ◽  
Cognitive Decline ◽  
Physical Training ◽  
Cognitive Enhancement ◽  
Memory Performance ◽  
Subjective Cognitive Decline ◽  
Strategic Learning

AbstractCognitive complaints in the absence of objective cognitive impairment, observed in patients with subjective cognitive decline (SCD), are common in old age. The first step to postpone cognitive decline is to use techniques known to improve cognition, i.e., cognitive enhancement techniques.We aimed to provide clinical recommendations to improve cognitive performance in cognitively unimpaired individuals, by using cognitive, mental, or physical training (CMPT), non-invasive brain stimulations (NIBS), drugs, or nutrients. We made a systematic review of CMPT studies based on the GRADE method rating the strength of evidence.CMPT have clinically relevant effects on cognitive and non-cognitive outcomes. The quality of evidence supporting the improvement of outcomes following a CMPT was high for metamemory; moderate for executive functions, attention, global cognition, and generalization in daily life; and low for objective memory, subjective memory, motivation, mood, and quality of life, as well as a transfer to other cognitive functions. Regarding specific interventions, CMPT based on repeated practice (e.g., video games or mindfulness, but not physical training) improved attention and executive functions significantly, while CMPT based on strategic learning significantly improved objective memory.We found encouraging evidence supporting the potential effect of NIBS in improving memory performance, and reducing the perception of self-perceived memory decline in SCD. Yet, the high heterogeneity of stimulation protocols in the different studies prevent the issuing of clear-cut recommendations for implementation in a clinical setting. No conclusive argument was found to recommend any of the main pharmacological cognitive enhancement drugs (“smart drugs”, acetylcholinesterase inhibitors, memantine, antidepressant) or herbal extracts (Panax ginseng, Gingko biloba, and Bacopa monnieri) in people without cognitive impairment.Altogether, this systematic review provides evidence for CMPT to improve cognition, encouraging results for NIBS although more studies are needed, while it does not support the use of drugs or nutrients.

scholarly journals Dietary Patterns and Quality of Life in Older Adults: A Systematic Review

Nutrients ◽  
2018 ◽  
Vol 10 (8) ◽  
pp. 971 ◽  
Author(s):  
Thara Govindaraju ◽  
Berhe Sahle ◽  
Tracy McCaffrey ◽  
John McNeil ◽  
Alice Owen
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Older Adults ◽  
Dietary Patterns ◽  
Cross Sectional ◽  
Self Rated Health ◽  
Set Inclusion ◽  
Demographic Shifts ◽  
Meta Analyses

Dietary patterns may be related to quality of life (QoL) of older adults, although evidence from literature is conflicting. The demographic shifts toward ageing populations in many countries increases the importance of understanding the relationship between diet and QoL in older adults. This review was designed to investigate associations between dietary patterns and QoL in older adults. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eight electronic databases were searched to identify articles published in English from January 1975 to March 2018 that investigated associations between dietary patterns and QoL in older adults. Relevant studies were identified based on set inclusion and exclusion criteria, data were extracted and analysed to examine the relationships and possible implications for public health recommendations. The systematic review included 15 articles (One randomized control trial, six prospective cohorts and eight cross sectional). The studies looked at correlations between different dietary patterns and/or adherence to particular dietary patterns and self-reported QoL or self-rated health status. Excluding two studies which showed no significant association, healthy dietary patterns were associated with better self-rated health and QoL in one or more domains, and adherence to healthy dietary patterns like the Mediterranean diet were significantly associated with improvement in at least one of the QoL domains.

scholarly journals Prospective and Retrospective Memory Complaints in Mild Cognitive Impairment and Mild Alzheimer's Disease

2009 ◽  
Vol 10 (1) ◽  
pp. 59-75 ◽  
Author(s):  
Anne Eschen ◽  
Mike Martin ◽  
Ursula Schreiter Gasser ◽  
Matthias Kliegel
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Executive Functions ◽  
Prospective Memory ◽  
Cognitive Abilities ◽  
Retrospective Memory ◽  
Healthy Older Adults ◽  
Memory Complaints

AbstractCurrent management attempts for Alzheimer's disease (AD) focus on the identification of individuals in the preclinical stage. This has led to the development of the diagnostic concept of Mild Cognitive Impairment (MCI), which applies to individuals with declining cognitive abilities but largely preserved everyday functioning. Previous findings indicate that prospective memory deficits are a sensitive marker of preclinical AD and that awareness of prospective memory failures is particularly high, based on its dependence on executive functions. Thus, the goal of this study was to evaluate the usefulness of subjective prospective versus retrospective memory complaints for an initial screening for MCI and their respective associations with executive functions. 71 healthy older adults, 27 MCI patients, and 9 patients with mild AD completed the Prospective and Retrospective Memory Questionnaire (PRMQ) and three executive functions tests. The healthy and the MCI group could not be distinguished by their level of subjective prospective or retrospective memory complaints, but the mild AD patients differed from the other groups by complaining more about retrospective than prospective memory failures. For the healthy older adults, the prospective memory complaints were correlated to an inhibition test, whereas they did not correlate with any of the executive function tests in the MCI patients. In contrast, in both groups the retrospective memory complaints were related to a task switching test. The findings are discussed with respect to differences between the three groups in cognitive abilities, attention to failures of, use of mnemonic aids for, and everyday demands of prospective and retrospective memory.

scholarly journals Effectiveness of Exercise on Osteosarcopenia in Elderly People: A Protocol Systematic Review

2020 ◽  
Author(s):  
Guilherme Elias Vinícius-Souza ◽  
Matias Noll ◽  
Erika Aparecida Silveira
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Physical Exercise ◽  
Good Health ◽  
Complementary Therapy ◽  
Assessment Development ◽  
Physical Exercises ◽  
Review Protocol ◽  
Meta Analyses

Abstract Background: Osteosarcopenia is defined as the concomitant occurrence of sarcopenia and osteopenia or osteoporosis. Older adults with this syndrome have greater fragility and chances of mortality compared to those without these conditions. Exercise has been recommended as a treatment for osteosarcopenia based on interventions with sarcopenic and osteoporotic individuals separately. However, there is no evidence that physical exercise can really be an effective treatment for osteosarcopenia. Our objective is to identify whether physical exercise can improve the osteosarcopenia in older adults and lead to good health outcomes. Methods: We will perform a systematic review on the follow databases: PubMed, Embase, Cochrane, and Scopus. The criterion of inclusion will be clinical trial studies in which the interventions were physical exercises in older adults diagnosed with osteosarcopenia. To assess the risk of bias, the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) and the Black and Downs tools will be used. For each search result, the quality of the evidence will ultimately receive one of four grades: high quality, moderate quality, low quality, or very low quality. Discussion: Through this systematic review protocol, an article on physical exercise recommendations for osteosarcopenia in older adults will be prepared. The results of this study may lead to recommendations for physical exercise as a non-pharmacological treatment or complementary therapy for the prevention of osteosarcopenia.Systematic review registration: Ongoing on Prospero.Ethics and dissemination: Protocol written according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).

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