Structural brain changes after traditional and robot-assisted multi-domain cognitive training in community-dwelling healthy elderly

Geon Ha Kim, Seun Jeon, Kiho Im, Hunki Kwon, Byung Hwa Lee, Ga Young Kim, Hana Jeong, Noh Eul Han, Sang Won Seo, Hanna Cho, Young Noh, Sang Eon Park, Hojeong Kim, Jung Won Hwang, Cindy W Yoon, Hee Jin Kim, Byoung Seok Ye, Ju Hee Chin, Jung-Hyun Kim, Mee Kyung Suh, Jong Min Lee, Sung Tae Kim, Mun-Taek Choi, Mun Sang Kim, Kenneth M Heilman, Jee Hyang Jeong, Duk L Na, Geon Ha Kim, Seun Jeon, Kiho Im, Hunki Kwon, Byung Hwa Lee, Ga Young Kim, Hana Jeong, Noh Eul Han, Sang Won Seo, Hanna Cho, Young Noh, Sang Eon Park, Hojeong Kim, Jung Won Hwang, Cindy W Yoon, Hee Jin Kim, Byoung Seok Ye, Ju Hee Chin, Jung-Hyun Kim, Mee Kyung Suh, Jong Min Lee, Sung Tae Kim, Mun-Taek Choi, Mun Sang Kim, Kenneth M Heilman, Jee Hyang Jeong, Duk L Na

Abstract

The purpose of this study was to investigate if multi-domain cognitive training, especially robot-assisted training, alters cortical thickness in the brains of elderly participants. A controlled trial was conducted with 85 volunteers without cognitive impairment who were 60 years old or older. Participants were first randomized into two groups. One group consisted of 48 participants who would receive cognitive training and 37 who would not receive training. The cognitive training group was randomly divided into two groups, 24 who received traditional cognitive training and 24 who received robot-assisted cognitive training. The training for both groups consisted of daily 90-min-session, five days a week for a total of 12 weeks. The primary outcome was the changes in cortical thickness. When compared to the control group, both groups who underwent cognitive training demonstrated attenuation of age related cortical thinning in the frontotemporal association cortices. When the robot and the traditional interventions were directly compared, the robot group showed less cortical thinning in the anterior cingulate cortices. Our results suggest that cognitive training can mitigate age-associated structural brain changes in the elderly.

Trial registration: ClnicalTrials.gov NCT01596205.

Conflict of interest statement

Competing Interests: Dr. S.W. Seo received research support from the Ministry for Health, Welfare and Family Affairs, Korea. Dr. D.L. Na received research support from Gaha Corporation through a research grant to Samsung Medical Center, and a grant from the Ministry for Health, Welfare and Family Affairs, Korea. All other authors report no disclosures. We do not have any other relevant relationships including employment, consultancy, products in development, marketed products or patent rights from Gaha Corporation. Although Samsung Medical Center has made a contract with Gaha Corporation to receive a royalty from Robocare for the software programs fitted in the robot, none of the authors including Dr. Na benefit from this personally. The authors declare that neither funding from Gaha Corporation nor the reception of royalty from Robocare alters the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Flow of participants in this…
Fig 1. Flow of participants in this study.
The similarity index was defined as follows:similarity index = 2 * nnz(A and B)/(nnz(A) + nnz(B)) where A and B are the baseline and post-intervention connectivity from binary matrices, respectively and nnz refers to the number of non-zero elements in a matrix. If the two binary matrices were the same, the similarity index was assigned a value of 1. We excluded subjects with a similarity index lower than 0.5 in our statistical analyses to reduce the artifactual effects related to the different times of scanning.
Fig 2. Topographical changes in cortical thickness.
Fig 2. Topographical changes in cortical thickness.
(A) Compared to the control group, the intervention group shows attenuated cortical thinning on heteromodal association cortices such as the bilateral medial prefrontal and right middle temporal gyrus. (B) When the traditional and robot groups were directly compared, significantly reduced cortical thinning on the bilateral anterior cingulate cortices and right inferior temporal cortex was evident in the robot group. No area demonstrated less cortical thinning in the traditional group than the robot group.
Fig 3. Topographical changes in nodal strength.
Fig 3. Topographical changes in nodal strength.
(A) There are no significant differences in regional nodal strength between the control and the intervention group. (B)The robot group shows increased nodal strength in the rectus gyrus than the traditional group.
Fig 4. Correlation of changes in cognitive…
Fig 4. Correlation of changes in cognitive functions and changes in cortical thickness.
(A) In the traditional group, changes in the raw scores of visual memory are positively correlated with those of cortical thickness in the right inferior temporalgyrus and right subgenual cingulate region (uncorrected P < 0.001). (B) For the robot group, changes in the raw scores of executive function are positively correlated with those of left temoporo-parietal junction as well as left inferior temporal gyrus (uncorrected P <0.001).

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