Neurofeedback and the Aging Brain: A Systematic Review of Training Protocols for Dementia and Mild Cognitive Impairment

Lucas R Trambaiolli, Raymundo Cassani, David M A Mehler, Tiago H Falk, Lucas R Trambaiolli, Raymundo Cassani, David M A Mehler, Tiago H Falk

Abstract

Dementia describes a set of symptoms that occur in neurodegenerative disorders and that is characterized by gradual loss of cognitive and behavioral functions. Recently, non-invasive neurofeedback training has been explored as a potential complementary treatment for patients suffering from dementia or mild cognitive impairment. Here we systematically reviewed studies that explored neurofeedback training protocols based on electroencephalography or functional magnetic resonance imaging for these groups of patients. From a total of 1,912 screened studies, 10 were included in our final sample (N = 208 independent participants in experimental and N = 81 in the control groups completing the primary endpoint). We compared the clinical efficacy across studies, and evaluated their experimental designs and reporting quality. In most studies, patients showed improved scores in different cognitive tests. However, data from randomized controlled trials remains scarce, and clinical evidence based on standardized metrics is still inconclusive. In light of recent meta-research developments in the neurofeedback field and beyond, quality and reporting practices of individual studies are reviewed. We conclude with recommendations on best practices for future studies that investigate the effects of neurofeedback training in dementia and cognitive impairment.

Keywords: Alzheimer's disease; dementia; electroencephalography; functional magnetic resonance imaging; mild cognitive impairment; neurofeedback.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Trambaiolli, Cassani, Mehler and Falk.

Figures

Figure 1
Figure 1
PRISMA flowchart describing the literature screening.
Figure 2
Figure 2
Summary of cognitive improvement according to standardized cognitive screening scales. The baseline and post-neurofeedback measures normalized as a percentage of the respective scales. In orange are the studies using patients with formal diagnosis of dementia, and in blue patients with mild-cognitive impairment (MCI). If the study did not report a primary outcome, we adopted a conservative approach and included in this chart results from the scale showing lower improvement. Solid bars represent the baseline scores, and dashed lines the post-intervention values. NF, Neurofeedback; NR, Not Reported.
Figure 3
Figure 3
The Consensus on the Reporting and Experimental Design of Neurofeedback studies (CRED-nf) percentage scores (A) per study, and (B) averaged per category. The Joanna Briggs Institute (JBI) averaged percentage scores (C) per study, and (D) averaged per category. **Methodological information detailed in previous publication from Hohenfeld et al. (2017); *Methodological information detailed in previous publication from Gomez-Pilar et al. (2016).

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