Newly Developed TV-Based Cognitive Training Games Improve Car Driving Skills, Cognitive Functions, and Mood in Healthy Older Adults: Evidence From a Randomized Controlled Trial

Abstract

Background : Cognitive training in a laboratory improves car driving skills of older car drivers. However, it remains unclear whether other types of cognitive training at home have beneficial effects on driving skills. Using our developed cognitive training games that can be played on a television with a set-top box in a person’s home, we investigated the effects of a 6-week cognitive training program on driving skills, which included on-road evaluation (primary outcome), and cognitive functions and emotional states (secondary outcome) in older people. Methods : In this double-blinded randomized control trial (RCT), 60 older licensed drivers were randomly assigned into one of the two groups: a cognitive training game for car driving (CTCD) group and an active control cognitive training game (ACT) group. Participants in the CTCD group played the CTCD (processing speed, dual attention, and speed prediction) for 20 min in five sessions per week for 6 weeks. Participants in the ACT group played the ACT (selecting the larger number; selecting a number from largest to smallest; play a game of rock, article, scissors) for 20 min in five sessions per week for 6 weeks. We measured driving skills, various cognitive functions, and emotional states before and after the 6-week intervention period. Results : Our main results showed that compared to the ACT group, the CTCD group demonstrated improved driving skills (adjusted p = 0.034). Moreover, the CTCD group demonstrated improved inhibition (stroop, adjusted p = 0.042: reverse Stroop, adjusted p = 0.043) and processing speed performance symbol search (SS), adjusted p = 0.049; digit symbol coding (adjusted p = 0.047), compared to the ACT group. The CTCD group scored higher on vigor–activity mood (adjusted p = 0.041) as measured using the Profile of Mood State. Discussion : This randomized controlled trial provides scientific evidence for the benefits of the 6-week CTCD program on driving skills and cognitive functions, such as processing speed, inhibition, and vigor–activity mood, in healthy older people. Our results suggest that cognitive training is useful to improve the driving skills of older adults. Trial registration : This trial was registered at The University Hospital Medical Information Network Clinical Trials Registry (UMIN 000029769). Registered 31 October 2017, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034010

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“…The "aovp" function of the lmPerm package was used for all ANCOVAs with permutation tests [62], it is suitable for verifying the effectiveness of intervention tests with small sample size [14,63,64]. Moreover, effect sizes (η 2 ) were calculated by the sum of squares between the groups and the sum of squares of the ANCOVA permutation test with eta squared (η 2 ) [65].…”

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“…Finally, we pooled the F values from 20 data sets. The analysis procedure was the same as the previous study (Nouchi et al, 2019). We used Bonferroni correction methods to adjust all p-values [adjusted p-value = raw p-value * 14 (number of tests)].…”

“…We measured mood states using Profile of Mood States (POMS) ( Heuchert and McNair, 2012 ; Yokoyama and Watanabe, 2015 ) because (1) the POMS can measure acute mood changes ( Yokoyama and Watanabe, 2015 ), (2) it was suitable to measure mood in middle and older adults ( Gibson, 1997 ), and (3) most previous acute exercise studies had employed it ( Yeung, 1996 ). The following descriptions in POMS2 are mostly reproduced from our earlier report ( Nouchi et al, 2019 ). POMS2 has seven subscales with five-point scales (total of 35 items).” POMS2 can measure mood states for the prior week of Tension–Anxiety (TA), Depression–Dejection (DD), Anger–Hostility (AH), Vigor–Activity (VA), Fatigue–Inertia (FI), Confusion–Bewilderment (CB), and Friendliness (F).” We also calculated total mood disturbance (TMD) score [total score of negative mood subscale (TA + DD + AH + FI + CB) minus VA score], which represents general mood states.…”

“…We measured mood states using Profile of Mood States (POMS) (Heuchert and McNair, 2012;Yokoyama and Watanabe, 2015) because (1) the POMS can measure acute mood changes (Yokoyama and Watanabe, 2015), (2) it was suitable to measure mood in middle and older adults (Gibson, 1997), and (3) most previous acute exercise studies had employed it (Yeung, 1996). The following descriptions in POMS2 are mostly reproduced from our earlier report (Nouchi et al, 2019). POMS2 has seven subscales with five-point scales (total of 35 items)."…”

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“…The “aovp” function of the lmPerm package was used for all ANCOVAs with permutation tests (Wheeler et al, 2016 ). As permutation indicates significance when the number of samples is limited (Wheeler, 2016 ), it is suitable for verifying the effectiveness of intervention tests with a small sample size (Nouchi et al, 2013 , 2019 ; Kulason et al, 2018 ). Moreover, effect sizes ( η 2 ) were calculated by the sum of squares between the groups and the sum of squares by the permutation test of ANCOVA with eta squared ( η 2 ; Cohen, 1988 ).…”