The Enhanced Interactive Physical and Cognitive Exercise System (iPACESTM v2.0): Pilot Clinical Trial of an In-Home iPad-Based Neuro-Exergame for Mild Cognitive Impairment (MCI)

Kathryn Wall, Jessica Stark, Alexa Schillaci, Emilie T Saulnier, Elizabeth McLaren, Kristina Striegnitz, Brian D Cohen, Paul J Arciero, Arthur F Kramer, Cay Anderson-Hanley, Kathryn Wall, Jessica Stark, Alexa Schillaci, Emilie T Saulnier, Elizabeth McLaren, Kristina Striegnitz, Brian D Cohen, Paul J Arciero, Arthur F Kramer, Cay Anderson-Hanley

Abstract

Given increasing longevity worldwide, older adults and caregivers are seeking ways to curb cognitive decline especially for those with mild cognitive impairment (MCI, now mild neurocognitive disorder, mNCD, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-V). This quasi-experimental, within-subjects pilot clinical trial was designed to replicate and extend the study of cognitive benefits for MCI by improving upon our prior interactive Physical and Cognitive Exercise Study (iPACESTM v1.0) by increasing the usability of the neuro-exergame and exploring possible underlying neurobiological mechanisms. Older adults were enrolled in a three-month, in-home trial of a portable neuro-exergame (iPACES™ v2.0) where participants pedaled and steered along a virtual bike path (Memory Lane™). Neuropsychological function was assessed at baseline after component familiarization intervals (e.g., two weeks of exercise-only, game-only, etc.) and after three months of interactive neuro-exergame intervention. Fourteen participants were enrolled in the study and seven completed the final evaluation. Intent-to-treat analyses were conducted with imputed missing data (total n = 14). Significant improvement in executive function (Stroop) was found (d = 0.68, p = 0.02) only. Changes in salivary biomarkers (cortisol and insulin-like growth factor 1; IGF-1) were significantly associated with improved cognition. Further research is needed, but pilot data suggest that a portable in-home neuro-exergame may be an additional, practical tool to fight back against cognitive decline and dementia.

Keywords: Alzheimer’s; IGF-1; cortisol; dementia; executive function; exercise; exergame; mild cognitive impairment; neurocognitive disorder; older adult.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Pilot study design showing component familiarization periods leading to interactive Physical and Cognitive Exercise System (iPACES) intervention.
Figure 2
Figure 2
Illustration of the use of interactive pedaling and steering of the iPACES™ v2.0 neuro-exergame, Memory Lane.
Figure 3
Figure 3
CONSORT Flow Diagram: enrollment and progress of participants through the trial.
Figure 4
Figure 4
Changes in cognition over three-month iPACES neuro-exergame intervention exceed practice effects.

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