Accepted for/Published in: JMIR Serious Games
Date Submitted: Dec 24, 2023
Date Accepted: Jun 26, 2024
The Effects of Electronic Serious Games on Older Adults with Alzheimer's Dementia(AD) and Mild Cognitive Impairment(MCI): Systematic Review With Meta-Analysis of Randomized Controlled Trials
ABSTRACT
Background:
Serious games (SGs) are nonpharmacological interventions that have been widely applied among older adults. To date, no evidence has been published regarding the effect of digital SGs on cognitive ability, daily behavioral ability, or depression in elderly people suffering from cognitive impairment. This meta-analysis examined the effectiveness of digital serious games in improving cognitive ability, enhancing daily behavioral ability and alleviating depression in older adults.
Objective:
We searched the following databases to identify relevant high-quality RCTs: PubMed, UWE Library database, MEDLINE, the Cochrane Library, Embase, PsycINFO, Scopus, SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang Data, Wanfang MED ONLINE, Yiigle and Web of Science. Terms such as SG were used as keywords.
Methods:
We searched the databases up to November 13, 2023. Stata 15.0 software and Review Manager 5.3 were used to screen the studies, extract the data, code the data, and perform meta-analysis. The eligibility criteria were developed in accordance with the PICOS framework: (i) population - older adults with cognitive impairment; (ii) intervention - digital serious games intervention; (iii) comparison - digital serious games intervention group and routine health care; (iv) outcomes - cognitive ability, daily behavior ability and depression; and (v) research design – randomized controlled trial.
Results:
A total of 714 individuals across 14 papers were included. All participants were older adults. Digital serious game therapy significantly increased cognitive ability [SMD = 一2.11, 95% CI (一1.42, 一2.80, p＜0.00001)] [SMD = 2.75, 95% CI (1.98, 3.51, p＜0.00001)], significantly increased daily behavioral ability [SMD = 0.53, 95% CI (0.06, 0.99, p=0.03)], and significantly reduced depressive symptoms in older adults with cognitive impairment [SMD = - 2.08, 95% CI (-2.94, -1.22, p＜0.00001)]. Sensitivity analysis was performed, and a funnel plot was constructed. No publication bias was detected based on the results of Begg’s and Egger’s tests.
Conclusions:
Overall, digital serious games may be associated with higher scores on the Mini-Mental State Examination and Montreal Cognitive Assessment, an increase in daily behavioral ability, and less severe depression. Future research should examine strategies for increasing adherence to digital serious game therapy to improve outcomes in terms of cognitive ability, daily behavioral ability and mental health. Clinical Trial: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRDCRD42023486090
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