Effects of computer-based cognitive training combined with physical training for older adults with cognitive impairment: A four-arm randomized controlled trial

I-Ching Chuang; Hui-Yan Chiau; Wan-Wen Liao; Yih-Ru Wu; Chih-Hung Chang; Ching-Yi Wu

doi:10.1177/20552076231203633

Effects of computer-based cognitive training combined with physical training for older adults with cognitive impairment: A four-arm randomized controlled trial

Digit Health. 2023 Sep 20:9:20552076231203633. doi: 10.1177/20552076231203633. eCollection 2023 Jan-Dec.

Authors

I-Ching Chuang^{1

2}, Hui-Yan Chiau³, Wan-Wen Liao⁴, Yih-Ru Wu^{2

5}, Chih-Hung Chang^{6

7

8}, Ching-Yi Wu^{1

9

10}

Affiliations

¹ Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan.
² Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan.
³ Institute of Cognitive Neuroscience, National Central University, Taoyuan.
⁴ Department of Gerontological Health Care, National Taipei University of Nursing and Health Sciences, Taipei City.
⁵ College of Medicine, Chang Gung University, Taoyuan.
⁶ Program in Occupational Therapy, Washington University in St Louis School of Medicine, St Louis, MO, USA.
⁷ Department of Medicine, Washington University in St Louis School of Medicine, St Louis, MO, USA.
⁸ Department of Orthopaedic Surgery, Washington University in St Louis School of Medicine, St Louis, MO, USA.
⁹ Healthy Aging Research Center, Chang Gung University, Taoyuan.
¹⁰ Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan.

Abstract

Objective: Combined physical (PHY) and cognitive (COG) training in sequential (SEQ) and simultaneous (SIMUL) sessions may delay the progression of cognitive impairment. To date, no study has directly compared in older adults with cognitive impairment the effects of COG training, PHY training, SEQ motor-cognitive training and SIMUL motor-cognitve training on specific indices of cognitive performance and activities of daily living (ADL). The purpose of this study was to determine whether SEQ and SIMUL motor-cognitive training can improve treatment outcomes compared with PHY or COG training alone. We also aimed to compare the effects of SEQ versus SIMUL motor-cognitive training on cognitive functions and instrumental ADL (IADL) in older adults with cognitive impairment.

Methods: A cluster randomized controlled trial was conducted. Eighty older adults with cognitive impairment were randomly assigned to COG, PHY, SEQ or SIMUL training groups. The intervention consisted of 90-min training sessions, totaling 36 sessions. Outcome measures were the Montreal Cognitive Assessment, three subtests of the Wechsler Memory Scale (WMS) and the Lawton IADL scale.

Results: Significant interaction effects between group and time were found in WMS-spatial span (p = 0.04) and WMS-word lists (p = 0.041). For WMS-spatial span, the SIMUL group showed outperformed the COG (p = 0.039), PHY (p = 0.010) and SEQ groups (p = 0.017). For WMS-word lists, the SEQ group improve more than COG (p = 0.013), PHY (p = 0.030) and SIMUL (p = 0.019) groups. No significant differences were found in IADL performance among four groups (p = 0.645).

Conclusions: Our study showed SEQ and SIMUL motor-cognitive training led to more pronounced improvements in visuospatial working memory or verbal memory compared with isolated COG or PHY training for community-based older adults with cognitive impairment. For enhancing effects on IADL, we suggest the use of sensitive measurement tools and context-enriched cognitive training involving real-life task demands.

Keywords: Cognitive impairment; cognitive training; physical training.