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

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

DOI: 10.2196/36123

archive: archived pipeline: cataloged verified

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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 (MCI), Alzheimer 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 existed, they were limited by focusing on adults without impairment, including non-randomized studies, or failing to assess evidence quality. This research aimed to address these gaps by strictly analyzing randomized controlled trials (RCTs) involving older adults with confirmed cognitive disorders. The researchers conducted a comprehensive search across eight electronic databases, supplemented by reference list screening, identifying 548 publications. Following strict eligibility criteria—including age over 60, confirmed cognitive impairment, and RCT design—16 studies were included in the final analysis. Two reviewers independently assessed study eligibility, extracted data, and evaluated the risk of bias using the Risk-of-Bias 2 tool. The quality of evidence was appraised using the GRADE approach. Meta-analyses were performed using a random-effects model to account for clinical heterogeneity, comparing serious games against no intervention, passive interventions, and conventional exercises. The included studies utilized various platforms, primarily PCs and VR headsets, with interventions lasting between 3 and 25 weeks. The meta-analysis results indicated 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 revealed that both cognitive training games (P=.08) and exergames (P=.16) were comparable in effectiveness to conventional exercises, with no significant difference observed between adaptive and non-adaptive serious games (P=.59). The overall quality of the evidence was rated as low due to small sample sizes, high heterogeneity, and the limited number of studies included in the meta-analyses. The authors conclude that serious games are not superior to conventional exercises or passive controls for enhancing executive functions in this population. Consequently, they 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 study highlights the need for future research with larger sample sizes and longer follow-up periods to assess the long-term effects of serious games on specific cognitive abilities across diverse age groups.

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• cognitive impairment