Gains in cognition through combined cognitive and physical training: the role of training dosage and severity of neurocognitive disorder

Panagiotis D Bamidis, Patrick Fissler, Sokratis G Papageorgiou, Vasiliki Zilidou, Evdokimos I Konstantinidis, Antonis S Billis, Evangelia Romanopoulou, Maria Karagianni, Ion Beratis, Angeliki Tsapanou, Georgia Tsilikopoulou, Eirini Grigoriadou, Aristea Ladas, Athina Kyrillidou, Anthoula Tsolaki, Christos Frantzidis, Efstathios Sidiropoulos, Anastasios Siountas, Stavroula Matsi, John Papatriantafyllou, Eleni Margioti, Aspasia Nika, Winfried Schlee, Thomas Elbert, Magda Tsolaki, Ana B Vivas, Iris-Tatjana Kolassa, Panagiotis D Bamidis, Patrick Fissler, Sokratis G Papageorgiou, Vasiliki Zilidou, Evdokimos I Konstantinidis, Antonis S Billis, Evangelia Romanopoulou, Maria Karagianni, Ion Beratis, Angeliki Tsapanou, Georgia Tsilikopoulou, Eirini Grigoriadou, Aristea Ladas, Athina Kyrillidou, Anthoula Tsolaki, Christos Frantzidis, Efstathios Sidiropoulos, Anastasios Siountas, Stavroula Matsi, John Papatriantafyllou, Eleni Margioti, Aspasia Nika, Winfried Schlee, Thomas Elbert, Magda Tsolaki, Ana B Vivas, Iris-Tatjana Kolassa

Abstract

Physical as well as cognitive training interventions improve specific cognitive functions but effects barely generalize on global cognition. Combined physical and cognitive training may overcome this shortcoming as physical training may facilitate the neuroplastic potential which, in turn, may be guided by cognitive training. This study aimed at investigating the benefits of combined training on global cognition while assessing the effect of training dosage and exploring the role of several potential effect modifiers. In this multi-center study, 322 older adults with or without neurocognitive disorders (NCDs) were allocated to a computerized, game-based, combined physical and cognitive training group (n = 237) or a passive control group (n = 85). Training group participants were allocated to different training dosages ranging from 24 to 110 potential sessions. In a pre-post-test design, global cognition was assessed by averaging standardized performance in working memory, episodic memory and executive function tests. The intervention group increased in global cognition compared to the control group, p = 0.002, Cohen's d = 0.31. Exploratory analysis revealed a trend for less benefits in participants with more severe NCD, p = 0.08 (cognitively healthy: d = 0.54; mild cognitive impairment: d = 0.19; dementia: d = 0.04). In participants without dementia, we found a dose-response effect of the potential number and of the completed number of training sessions on global cognition, p = 0.008 and p = 0.04, respectively. The results indicate that combined physical and cognitive training improves global cognition in a dose-responsive manner but these benefits may be less pronounced in older adults with more severe NCD. The long-lasting impact of combined training on the incidence and trajectory of NCDs in relation to its severity should be assessed in future long-term trials.

Keywords: aging; cognitive training; combined intervention; dementia; exergames; mild cognitive impairment; neurocognitive disorder; physical training.

Figures

FIGURE 1
FIGURE 1
Flow of participant chart. Flow of participants within the intervention and passive control group.
FIGURE 2
FIGURE 2
Intervention effects on global cognition. Intervention and passive control group comparison of z-standardized pre- and post-test global cognition. The asterisk indicates a significant beneficial effect of the intervention compared to the control group on post-test performance accounted for baseline cognitive performance, education, age and study center, p = 0.002, Cohen’s d = 0.31. Arrows represent SE.
FIGURE 3
FIGURE 3
Moderation and dose-response effects for global cognition. (A) Change in global cognition (partial residuals accounting for covariates) of the intervention group (light gray), compared to the passive control group (dark gray) within cognitively healthy participants, participants with mild cognitive impairment (MCI) and dementia. Arrows represent SE. (B) Change in global cognition (partial residuals accounting for covariates) as a function of the number of training sessions within a subsample which were either cognitively healthy or diagnosed with mild cognitive impairment.

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Source: PubMed

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