Evaluation of the Implementation and Effectiveness of Community-Based Brain-Computer Interface Cognitive Group Training in Healthy Community-Dwelling Older Adults: Randomized Controlled Implementation Trial (Preprint)

Abstract

BACKGROUND Cognitive training can improve cognition in healthy older adults OBJECTIVE The objectives are to evaluate the implementation of a community-based computerized cognitive training (CCT) and its effectiveness on cognition, gait, and balance in healthy older adults. METHODS A single-blind randomized controlled trial with baseline and follow-up assessments was conducted in two community centers (CCs) in Singapore. A total of 94 healthy community-dwelling adults aged 55 and above participated in a ten-week CCT program with two-hour instructor-led group classes conducted twice a week. Participants used a mobile application to play games targeting attention, memory, decision making, visuospatial abilities, and cognitive flexibility. Implementation was assessed at the participant-, provider-, and community-level (e.g., reach, implementation, and facilitators & barriers). Effectiveness measures were the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Color Trails Test Part 2 (CTT2), Berg Balance Scale, and GAITRite® walkway measures (single & dual task gait speed, dual task cost, and single & dual task gait variability index (GVI)). RESULTS The data was based on Intention-to-treat (ITT) and Per-protocol (PP) analysis. In the ITT group, single task GVI increased (b = 2.32, P = .02, 95% CI [0.30, 4.35]) and RBANS List Recognition subtest deteriorated (b = -0.57, P = .01, 95% CI [-1.00, -0.14]) in both groups. In the PP group, time taken to complete CCT2 (b = -13.5, P = .01, 95% CI [-23.95, -3.14]) was faster in the intervention group. Single task gait speed was also marginally significantly maintained in the intervention group (b = 5.38, P = .063, 95% CI [-0.30, 11.36]) but declined in the control group. For RBANS subtests, Picture Naming (b = 0.43, P = .04, 95% CI [0.01, 0.85]) improved significantly in both groups while List Recognition subtests (b = -0.54, P = .02, 95% CI [-1.00, -0.08]) performance deteriorated. CONCLUSIONS CCT can be successfully implemented in community settings to improve attention, executive function, and visuospatial abilities while maintaining gait speed amongst healthy older adults. Findings help to identify suitable healthy ageing programs that can be implemented on a larger scale within communities. CLINICALTRIAL ClinicalTrials.gov Identifier NCT04439591