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Gaming with brain-computer interface may help improve cognitive function in elderly men

Pearl Toh
09 Nov 2018

A personalized computerized neurofeedback intervention for training attention and memory shows potential in cognitive training for healthy elderly men, who improved in cognitive performance after the training although no significant improvements were seen in the overall study population.

The training system, known as BRAINMEM, uses EEG-based brain-computer interface (BCI) technology whereby participants control the computer game through a BCI headband with dry EEG electrodes they wore. The game components incorporate cognitive domains of working memory, attention, and delayed recall.

“In recent times, there is a trend toward gamification of training paradigms and employing technology as a vehicle for training delivery,” said the researchers led by Ms Yeo Si Ning of Duke-National University of Singapore Medical School, Singapore.

In the single-centre open-label study, 240 elderly participants in Singapore aged 60–80 (mean age 66 years, 57.3 percent female) were randomized 1:1 to intervention with BRAINMEM or waitlist control. The intervention consisted of 24 sessions over 8 weeks, with three monthly booster sessions. Participants were healthy elderly with no neuropsychiatric diagnosis and who had Mini-Mental State Examination (MMSE) score of 24 and Clinical Dementia Rating (CDR) score of 0–0.5.

At 9 weeks, the primary endpoint of Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) total score was improved in both the intervention and the control groups (3.6 vs 2.9; p=0.64), with no significant difference between both groups.

However, stratifying the analysis by sex reveals that cognitive training intervention significantly improved RBANS total score compared with control in males (6.2 vs -0.2; p=0.006), but not  in females (1.6 vs 5.2; p=0.044).        

The findings remained even after adjusting for baseline score, age, and education level in the ANCOVA analysis (4.06 vs 0.03; p=0.046 for males, and 2.36 vs 4.80; p=0.154 for females).   

Specifically, both the “delayed memory” (4.90 vs 0.25; p=0.0166) and “language” (2.69 vs -3.12; p=0.03) components in the RBANS subscale were significantly improved with intervention vs control among the male participants.  

“It is plausible that the performance disparities between sexes may be due to the interaction of historical sociodemographic differences with the effects of sex hormones and sex differences in brain structure,” Yeo and co-authors pointed out, noting that previous studies in older adults with Alzheimer’s disease also showed better performance in men than women. [Psychol Aging 2016;31:166-175; World J Psychiatry 2016;6:54]

“The significant interaction effects between sex and the treatment group highlight the importance of considering sex differences when investigating and remediating cognitive issues in older adults,” they added.

As most of the participants expressed support for the system in an acceptability questionnaire and were adherent to the training sessions (92.2 percent), the researchers said, “The novelty of the BRAINMEM system can decrease the barrier to engagement among older adults and sustain motivation for participating in CT for the long haul.”

Nonetheless, they cautioned against generalizing the findings to other population as there may be selection bias in the study subjects who could be motivated older adults already leading active lifestyles by responding to the study recruitment. Also, most of them (63.7 percent) attained education above high school levels.  

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