College of Rehabilitation Medicine (JW, YH, JH), Fujian University of Traditional Chinese Medicine, Fuzhou, China; The Academy of Rehabilitation Industry (JW, YH, SL, ZL), Fujian University of Traditional Chinese Medicine, Fuzhou, China; Key Laboratory of Cognitive Rehabilitation of Fujian Province (JW, YH, SL, ZL, JH), Fuzhou, China.
The Academy of Rehabilitation Industry (JW, YH, SL, ZL), Fujian University of Traditional Chinese Medicine, Fuzhou, China; Key Laboratory of Cognitive Rehabilitation of Fujian Province (JW, YH, SL, ZL, JH), Fuzhou, China.
Am J Geriatr Psychiatry. 2023 Oct;31(10):820-832. doi: 10.1016/j.jagp.2023.04.008. Epub 2023 Apr 15.
The neural mechanisms underlying the beneficial effects of a computerized cognitive training (CCT) program for improving episodic memory in older persons with mild cognitive impairment (MCI) remain unclear. This study aimed to use both functional and structural brain changes to elucidate the treatment effects of CCT on enhancing episodic memory.
DESIGN, SETTING, AND PARTICIPANTS: Single-blinded, multicenter randomized controlled trial on 60 older adults with MCI in Fuzhou, China.
Participants were randomly assigned to either an 8-week 24-hour CCT program or a health education program as the control.
Clinical outcomes included changes in scores on the immediate and/or delayed recall subtests of the Chinese auditory verbal learning test (CAVLT) and rey complex figure test (CFT), and changes in gray matter volume and the functional connectivity of the posterior cingulate cortex (PCC) and hippocampus in the Papez circuit on magnetic resonance imaging.
Significant group-by-time effects showed greater improvements in both immediate and delayed recall scores of CAVLT and delayed recall scores of Rey CFT in participants receiving the CCT program compared to those in the health education program. Among the CCT participants, seed-based analyses revealed decreases in functional connectivity of the PCC and hippocampus with neural substrates in the parietal and occipital regions. The decreased PCC and precuneus connectivity were found to mediate patients' improvements in immediate recall function.
An 8-week CCT program was effective for improving episodic memory in older individuals with MCI. The decrease in connectivity originating from the PCC and hippocampus is suggestive of potential plastic changes in the Papez circuit, which could have alleviated the age-related compensatory mechanism. The findings of this study also shed light on expanding the content and extending the frequency and duration of the CCT program in future studies.
计算机认知训练（CCT）对改善轻度认知障碍（MCI）老年人情景记忆的有益效果的神经机制仍不清楚。本研究旨在利用功能和结构脑变化来阐明 CCT 增强情景记忆的治疗效果。
设计、地点和参与者：在中国福州进行的一项针对 60 名 MCI 老年人的单盲、多中心随机对照试验。
参与者被随机分配到 8 周 24 小时 CCT 方案或健康教育方案作为对照组。
临床结果包括中国听觉言语学习测试（CAVLT）即时和/或延迟回忆子测验和 Rey 复杂图形测试（CFT）的分数变化，以及磁共振成像上后扣带回皮层（PCC）和海马体的灰质体积和功能连接的变化在 Papez 回路中。
组间时间效应显著，接受 CCT 方案的参与者在 CAVLT 的即时和延迟回忆分数以及 Rey CFT 的延迟回忆分数方面均有较大改善，而接受健康教育方案的参与者则无改善。在 CCT 参与者中，基于种子的分析显示 PCC 和海马体与顶叶和枕叶区域的神经基底之间的功能连接减少。发现 PCC 和楔前叶连接的减少介导了患者即时回忆功能的改善。
8 周 CCT 方案可有效改善 MCI 老年人的情景记忆。来自 PCC 和海马体的连接减少提示 Papez 回路中存在潜在的可塑性变化，这可能缓解了与年龄相关的代偿机制。本研究的结果还为未来研究中扩大 CCT 方案的内容、延长其频率和持续时间提供了依据。
