Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 18, 2025
Open Peer Review Period: Jun 18, 2025 - Aug 13, 2025
Date Accepted: Oct 17, 2025
(closed for review but you can still tweet)
Effect of Dual-Task Training on Cognitive Function in Community-Dwelling Older Adults With Mild Cognitive Impairment: A Sequential Multiple Assignment Randomized Trial
ABSTRACT
Background:
Non-pharmacological interventions are important prevention strategies for mild cognitive impairment (MCI), but effects vary significantly between individuals based on personal characteristics, while current practice relies on experience-based approaches lacking personalized, adaptive intervention strategies.
Objective:
The objective of our study was to develop and evaluate evidence-based adaptive intervention strategies for optimizing cognitive function among older adults with MCI using a Sequential Multiple Assignment Randomized Trial (SMART) design, comparing the effectiveness of cognitive training combined with virtual reality Taichi versus offline Taichi versus control, and to identify baseline characteristics that predict treatment response for personalized intervention delivery.
Methods:
We recruited 92 community-dwelling adults aged ≥60 years diagnosed with mild cognitive impairment (MCI) from three districts in Shanghai, China. A 24-week sequential multiple assignment randomized trial (SMART) was conducted between April and December 2023. During the first stage (weeks 1-12), participants were randomly assigned to control (n=26) or intervention groups receiving cognitive training (CT) combined with either offline Taichi (OffTC, n=33) or virtual reality Taichi (VRTC, n=34). Non-responders at week 12 were re-randomized to alternative or intensified interventions during the second stage (weeks 13-24). Primary outcome was Memory Guard score (MGs) at 24 weeks. Dynamic treatment regimen analysis assessed optimal adaptive strategies using regression models.
Results:
81 participants completed the trial. CT+VRTC is significantly greater cognitive improvement compared to control (5.10 MGs, Cohen d=1.425, P<0.0001) and CT+OffTC (3.61 MGs, Cohen d=1.009, P=0.0007). Dynamic treatment regimen analysis revealed VRTC-based adaptive strategies consistently better than static approaches, with treatment intensification more effective than modality switching for non-responders. Participants with diabetes showed enhanced treatment response, while those with hypertension showed reduced responsiveness.
Conclusions:
Technology-enhanced dual-task training with adaptive intervention strategies provides superior cognitive benefits for MCI prevention. SMART design enables adaptive treatment optimization based on individual characteristics, representing a potential opportunity for precise management in community settings. Clinical Trial: ChiCTR2100042748
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