Effectiveness of Serious Games for Improving Executive Functions Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis (Preprint)

Abd-alrazaq, Alaa; Alhuwail, Dari; Ahmed, Arfan; Househ, Mowafa · 2022 · Crossref

DOI: 10.2196/preprints.36123

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Summary

This systematic review and meta-analysis investigates the effectiveness of serious games in improving executive functions among older adults with cognitive impairment, such as mild cognitive impairment, Alzheimer’s disease, or dementia. The study was motivated by the global increase in aging populations and the associated rise in cognitive decline, which places significant financial and social burdens on healthcare systems. While previous reviews have examined serious games, they often focused on healthy older adults, included non-randomized studies, or failed to compare serious games against specific active comparators like conventional exercises. This study aimed to address these gaps by synthesizing evidence from randomized controlled trials (RCTs) to determine if serious games are superior to no intervention, passive interventions, or conventional exercises. The researchers conducted a comprehensive search of eight electronic databases, supplemented by backward and forward reference checking, identifying 548 publications. After rigorous screening based on PRISMA guidelines, 16 RCTs involving adults over 60 with confirmed cognitive impairment were included. The studies, published between 2013 and 2021, utilized various serious games, primarily cognitive training games and exergames, delivered via PCs, VR headsets, or consoles. Data were extracted independently by two reviewers, and the risk of bias was assessed using the RoB-2 tool. Meta-analyses were performed using a random-effects model to account for clinical heterogeneity, with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach used to appraise evidence quality. The meta-analysis revealed that serious games were not superior to no or passive interventions in improving executive functions (P=.29). Surprisingly, conventional exercises were found to be more effective than serious games (P=.03). Subgroup analyses indicated that both cognitive training games and exergames were as effective as conventional exercises, with no significant difference found between adaptive and non-adaptive serious games. However, the authors noted that the overall quality of evidence was low due to small sample sizes, high heterogeneity, and the limited number of studies included in the meta-analyses. The study concludes that serious games are not superior to conventional exercises or passive controls for improving executive functions in older adults with cognitive impairment. Consequently, the authors recommend that serious games should not currently be offered by healthcare providers or used by patients for this specific purpose until more robust evidence is available. The findings highlight the need for larger, higher-quality RCTs to assess the long-term effects of serious games on specific executive functions and other cognitive abilities across diverse populations.

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• cognitive impairment