Brain-IT

Background:

Preventing disabilities due to cognitive impairment has been declared a public health priority by the World Health Organization. Potentially modifiable risk factors for cognitive impairment include diabetes mellitus, hypertension, obesity, depression, physical or cognitive inactivity, and smoking. Estimates suggest that up to half of world’s cases of Alzheimer’s disease (AD) - the leading cause of mild to major neurocognitive disorders (m-MNCD) - may be attributable to these seven modifiable risk factors. Changes in lifestyle that target these risk factors may hold promise for slowing down cognitive decline or reducing the risk for developing dementia. Physical inactivity is associated with most of the other modifiable risk factors. Therefore, increasing physical activity may have an impact on m-MNCDs prevalence. Additionally, mental stimulation helps building a ‘cognitive reserve’, which enables individuals to continue functioning at a ‘normal’ level despite experiencing neurodegenerative changes. The literature suggests that combining physical and cognitive training seems the most effective type of training for improving cognitive functioning in older adults with mNCD. However, it is often challengig to motivate patients with mNCD to adhere to physical or cognitive training.

Technological innovations (e.g., exergames) provide new options to engage older adults with mNCD in simultaneous motor-cognitive training. Among the key advantages of exergaming compared to conventional motor-cognitive training is that exergames are highly accepted in individuals with mNCD and increase or enhance participants’ motivation to engage in rehabilitation activities. According to the literature, there are consistent positive effects of exergaming on cognitive functioning in patients with mNCD. Nonetheless, most previous studies have used exergames or exergame-based training concepts that were not specifically developed for individuals with mNCD. The literature points to opportunities for improvement in research and rehabilitation by adapting existing exergames or developing novel exergames and exergame-based training concepts specifically tailored to the requirements and needs of patients with mNCD. Taking the intended users’ characteristics, needs, experiences, and perspectives into account seems of crucial importance when designing and developing (exergame-based) training interventions to ensure quality and use of the final training concept. Therefore, it has been recommended, that an interactive and participatory design that explicitly includes end users throughout different iterative cycles of development is adopted.

Objectives:

On this basis, in the project “Brain-IT” we strive to:

(a) determine the most suitable components for an exergame-based training intervention in older adults with mNCD;
(b) explore novel strategies for a real-time adaptive exergame system to individually tailor exergame demands according to the users’ physical and/or cognitive capabilities;
(c) incorporate the acquired knowledge into an exergame-based intervention concept with the aim to halt and/or reduce cognitive decline and improve quality of life and finally;
(d) to evaluate the effectiveness of the resulting intervention concept in older adults with mNCD.

Methods and current status:

The project is guided by the “Multidisciplinary Iterative Design of Exergames (MIDE): A Framework for Supporting the Design, Development, and Evaluation of Exergames for Health” that is structured in three phases: Phase 1 - Contextual Research; Phase 2 - Game Design & Development; and Phase 3 – System Evaluation.

We have completed phases 1 and 2, that included objectives (a) to (c). The target group, therapists, and experts from different fields were involved in this process to ensure that the resulting “Brain-IT” training concept met the requirements and needs of older adults with mNCD and to foster the usability and acceptance of the approach in “real life.” This interactive and participatory design and development process allowed the identification of the key requirements for exergame design as well as the training characteristics. These formed the basis for determining the components of the resulting “Brain-IT” training concept. It ensures the implementation of effective training components and is specifically tailored to the requirements and needs of older adults with mNCD.

The resulting “Brain-IT” training concept consists of individually adapted exergame–based simultaneous motor-cognitive training that is adopted with a deficit-oriented focus on the neurocognitive domains of (1) learning and memory, (2) executive function, (3) complex attention, and (4) visuospatial skills. Additionally, the „Brain-IT” training includes resonance breathing guided by heart rate variability biofeedback to account for symptoms of depression, anxiety, and stress. According to the training concept, each participant is instructed to train at least 5x/week for 24 min per session resulting in a weekly training volume of ≥ 120 min. All training sessions take place at the participant’s homes.

We are currently investigating the effectiveness of the “Brain-IT” training. As primary outcome, global cognitive functioning is measured. As secondary outcomes, the effects of the “Brain-IT” training on (a) domain-specific cognitive functioning (i.e., learning and memory, complex attention, executive function, and visuospatial skills), (b) brain structure and function measured with (f)MRI, (c) spatiotemporal parameters of gait, (d) instrumental activities of daily living (IADL), and (e) psychosocial factors (i.e., quality of life, and levels of depression, anxiety, and stress), and (f) cardiac vagal modulation (i.e., resting vagally-mediated heart rate variability) are measured.

Project videos:

A Promo Video of the project can be found external pageherecall_made

A Promo-Video 2.0 about our ongoing RCT can be found external pageherecall_made

Media Coverage:

1. “Spielerisch gegen Demenz” - Schweiz am Wochenende (19 November 2022) - DownloadLinkvertical_align_bottom 
2. “Synapsis News - Ausgabe Nr. 2022/4” (November 2022) - external pageLinkcall_made 
3. “Synapsis News - Ausgabe Nr. 2022/5" (December 2022) - external pageLinkcall_made 
4. “Synapsis News - Ausgabe Nr. 2023/1” (March 2023) - external pageLinkcall_made 
5. “Gegen das Vergessen: Demenz verstehen und verlangsamen” - DeinAdieu (09 May 2023) - DownloadLinkvertical_align_bottom
6. "Gamen gegen Demenz" - Beobachter (March 2024) - external pageLinkcall_made

Publications related to the ‘Brain-IT’ project:

1. “Can Reactivity of Heart Rate Variability Be a Potential Biomarker and Monitoring Tool to Promote Healthy Aging? A Systematic Review With Meta-Analyses” - Frontiers in Physiology (29 July 2021) - Downloadhttps://doi.org/10.3389/fphys.2021.686129vertical_align_bottom
2. “Making the Best Out of IT: Design and Development of Exergames for Older Adults With Mild Neurocognitive Disorder – A Methodological Paper” - Frontiers in Aging Neuroscience (9 December 2021) - Downloadhttps://doi.org/10.3389/fnagi.2021.734012vertical_align_bottom
3. “Design Considerations for an Exergame-Based Training Intervention for Older Adults With Mild Neurocognitive Disorder: Qualitative Study Including Focus Groups With Experts and Health Care Professionals and Individual Semistructured In-depth Patient Interviews” - JMIR Serious Games (5 January 2023) - Downloadhttps://games.jmir.org/2023/1/e37616vertical_align_bottom
4. “Effectiveness of an Individualized Exergame-Based Motor-Cognitive Training Concept Targeted to Improve Cognitive Functioning in Older Adults With Mild Neurocognitive Disorder: Study Protocol for a Randomized Controlled Trial” - JMIR Research Protocols (6 February 2023) - Downloadhttps://www.researchprotocols.org/2023/1/e41173/vertical_align_bottom
5. "Feasibility, usability, and acceptance of “Brain-IT”—A newly developed exergame-based training concept for the secondary prevention of mild neurocognitive disorder: a pilot randomized controlled trial" - Frontiers in Aging Neuroscience (21 September 2023) - external pagehttps://www.frontiersin.org/articles/10.3389/fnagi.2023.1163388/fullcall_made