The Effectiveness of Computerized Cognitive Training in Patients With Poststroke Cognitive Impairment: Systematic Review and Meta-Analysis

Abstract

Background:Stroke often triggers poststroke cognitive impairment (PSCI) within 6 months, impairing memory, attention, and executive function while exacerbating physical disabilities and mortality. Computerized cognitive training (CCT) is a promising treatment approach. Compared to traditional methods, CCT provides cost-effective, easily accessible, personalized, and repetitive rehabilitation training. Therefore, we performed a systematic review of the efficacy of CCT to improve cognitive function in patients with PSCI and supplemented the findings with a meta-analysis.

Objective:This study aimed to evaluate the efficacy of CCT in comparison to usual care or routine rehabilitation for patients with PSCI, with the aim of providing clinicians and therapists with more effective and convenient therapeutic options.

Methods:A comprehensive systematic search was performed across multiple databases, including PubMed, Web of Science, Embase, Cochrane Library, and Scopus, to identify randomized controlled trials conducted between 2010 and June 2024 that used CCT to enhance cognitive function in patients with PSCI. The primary outcome of interest was cognitive function, evaluated using a standardized cognitive function scale, while secondary outcomes included assessments of patients’ activities of daily living and motor function. The risk of bias was evaluated using the Cochrane Risk of Bias tool, and the quality of evidence was appraised in accordance with the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Meta-analysis was conducted using RevMan 5.3 software published by The Cochrane Collaboration.

Results:A total of 19 trials were included in the meta-analysis (n=875 participants). The findings provided moderate- to high-quality evidence indicating that CCT significantly enhances general cognitive function (15 trials, standardized mean difference [SMD]= 0.46, 95% CI 0.21-0.71; P<.001, I²=60%), attention (11 trials, SMD=–0.45, 95% CI –0.64 to –0.25, P<.001, I²=0%), executive function (6 trials, SMD=0.39, 95% CI 0.12-0.67; P=.01, I²=0%), and quality of life of PSCI patients (9 trials, SMD=0.34, 95% CI 0.15-0.53; P<.001, I²=6%). However, low- to very low–quality evidence indicated that CCT has limited improvement in memory, language function, and motor function in patients with PSCI.

Conclusions:Based on moderate to severe levels of evidence, we conclude that CCT can significantly enhance general cognitive function, attention, executive function, and quality of life in PSCI patients. In addition, short-term high-frequency training was more effective than long-term low-frequency training. This review demonstrates CCT's effectiveness on cognitive function in patients with PSCI, though results vary due to differing intervention programs and CCT systems. Future research should increase sample sizes based on CCT system types and offer intensive, tailored training multiple times weekly. In addition, a structured maintenance plan is essential to sustain long-term benefits and prevent regression.

Trial Registration:PROSPERO CRD42024573594; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024573594