Computerized Cognitive Training in Cognitively Healthy Older Adults: A Systematic Review and Network Meta-Analysis

BackgroundComputerized cognitive training (CCT) is a broad category of drill-and-practice interventions aims to maintain cognitive performance in older adults. Despite a supportive evidence base for general efficacy, it is unclear what types of CCT are most likely to be beneficial and what intervention design factors are essential for clinical implementation. MethodsWe searched MEDLINE, Embase, and PsycINFO to August 2019 for randomized controlled trials (RCTs) of any type of CCT in cognitively healthy older adults. Risk of bias within studies was assessed using the Cochrane Risk of Bias 2 tool. The primary outcome was change in overall cognitive performance between CCT and control groups. Secondary outcomes were individual cognitive domains. A series of meta-regressions were performed to estimates associations between key design factors and overall efficacy using robust variance estimation models. Network meta-analysis was used to compare the main approaches to CCT against passive or common active control conditions. ResultsNinety RCTs encompassing 7219 participants across 117 comparisons were included. The overall cognitive effect size across all trials was small (g=0.18, 95% CI 0.14 to 0.23) with considerable heterogeneity ({tau}2=0.074, 95% prediction interval -0.36 to 0.73), robust to small-study effect or risk of bias. Effect sizes for individual cognitive domains were small, heterogeneous and statistically significant apart from fluid intelligence and visual processing. Meta-regressions revealed significantly larger effect sizes in trials using supervised training or up to three times per week. Multidomain training was the most efficacious CCT approach against any type of control, with greater benefits in a subset of supervised training studies. ConclusionsThe efficacy of CCT varies substantially across designs, independent of the type of control. Multidomain supervised CCT appears to be the most efficacious approach, and should be developed to accommodate for individual needs and remote delivery settings. Future research should focus on identifying the intervention components and regimens that could attenuate aging-related cognitive decline.