Author(s): MANSER, P., DE BRUIN, E.D., Institution: ETH ZURICH, Country: SWITZERLAND, Abstract-ID: 2110

INTRODUCTION:
The combination of exergame-based motor-cognitive training with resonance breathing guided by heart rate variability biofeedback (HRV-BF) targets various relevant mechanisms of action to alleviate the pathological state in individuals with mild neurocognitive disorder (mNCD).
METHODS:
This randomized controlled trial (RCT) investigated the effectiveness of adding a novel intervention approach that combines exergame-based motor-cognitive training with HRV-BF to usual care, compared to usual care alone, in individuals with mNCD. The individualized intervention was delivered via the ‘Brain-IT’ training concept that was iteratively co-designed, tested, and refined with patient and public involvement [1]. We assessed global (primary outcome) and domain-specific cognitive performance, spatiotemporal parameters of gait, instrumental activities of daily living, psychosocial factors, and resting cardiac vagal modulation. In addition, we evaluated brain structure and function with (functional) magnetic resonance imaging to explore possible underlying neural changes of the training in relation to adaptations in cognitive performance. Analyses of covariance were computed and partial eta-squared (η2p) effect sizes with 90% confidence intervals (CI90%) were calculated.
RESULTS:
We observed a significant (p = 0.007) effect with a large effect size (η2p [CI90%] = 0.197 [0.034, 0.371]) for global cognitive performance in favor of the intervention group. A post-hoc power analysis revealed a statistical power of 0.832 for this analysis. 55% of participants in the intervention group and 23% of participants in the control group were responders, showing a clinically relevant improvement in global cognitive performance. For our secondary outcomes, we observed significant effects with large effect sizes in favor of the intervention group for immediate (p = 0.022, η2p [CI90%] = 0.154 [0.013, 0.332]) and delayed (p = 0.007, η2p [CI90%] = 0.204 [0.034, 0.382]) verbal recall, and a borderline significant effect with a moderate effects size for an improvement of quality of life (p = 0.065, η2p [CI90%] = 0.097 [0, 0.263]). The remaining (underpowered) statistical analyses revealed no consistent effects on behavioral outcomes.
CONCLUSION:
‘Brain-IT’ training is effective for improving global cognitive performance as well as immediate and delayed verbal recall. Confirmatory RCTs are warranted to (i) be able to conclude about potential near- and far-transfer effects of the training, (ii) investigate whether the observed improvements in cognitive performance translate to influencing the progression rates to dementia, and (iii) elucidate the underlying biological mechanisms of action of this novel type of intervention.

References:
1. Manser P, de Bruin ED. Making the Best Out of IT: Design and Development of Exergames for Older Adults With Mild Neurocognitive Disorder - A Methodological Paper. Front Aging Neurosci. 2021;13:734012. doi: https://doi.org/10.3389/fnagi.2021.734012.