Discussion
fatigue, cognitive impairment, dementia, MCI, depression, cognitive decline
SECONDARY
The results of this study indicated that the HB-CCT performed in community-dwelling adults with MCI improved cognitive function and reduced depression levels compared to the control group. As patients with MCI typically carry higher risks of developing dementia compared with healthy older adults, continuous efforts to prevent cognitive decline are necessary A significant improvement in the MoCA, our primary outcome, was noted in the HB-CCT group compared with evaluations in the control group. Moreover, the effect level was similar to that shown by CCTs widely used in hospitals and dementia treatment institutions for cognitive therapy, such as CogReHab, COMCOG, Captain’s Log, Rehab.com, and Cog-med Regarding the secondary endpoints, short-term memory, language, and depression evaluations also showed significant improvements in the HB-CCT group compared with the control group. VLT and DST results in our study corresponded with the findings of a previous study by Klimova, and Maresova Additionally, SWF and PWF results in our study were consistent with a previous study that reported the ability of CCTs in improving language-related functions GDS evaluations in our study also showed results in line with previous studies that reported CCT decreasing depression levels in patients In this study, HB-CCT had a positive effect on cognitive improvement and depression reduction in community-dwelling adults with MCI. All participants in this study completed the 8-week study with no drop-outs, which may have been due to the HB-CCT eliciting user interest in improving overall cognition, particularly regarding memory, attention, visual perception, and executive function. The results suggested that a tablet or mobile phone may be easily used to perform large-scale, at-home or community-based cognitive rehabilitation programs. Our results also provide evidence for the advantages in extending the temporal and spatial dimensions of cognitive rehabilitation therapies.The HB-CCT used in this study exhibited greater portability and accessibility compared with conventional CCT programs, such as the CogReHab, COMCOG, Captain’s Log, Rehab.com, and Cogmed. Additionally, a manager was able to remotely monitor treatment participation. Based on treatment outcomes, enhanced feedback with the support of big data may also be provided, suggesting that extending the scope of CCT to homes and communities may be useful.In this study, we found that providing accurate and specific education and solutions through immediate feedback for problems that may arise is essential in HB-CCT, as connecting to Wi-Fi or the internet, or using a new device, may not be easy for many older adults. Among the 25 participants, only 6 were able to directly connect to Wi-Fi and log in to the tablet PC; 19 participants did not know how to connect to Wi-Fi or experienced difficulties with the initial login. The administrator visited their homes on the first day of intervention to resolve these issues. However, none of the participants complained about Wi-Fi or login issues until the completion of the intervention, suggesting that even MCI adults could engage in activities using tablet PC at home with only an initial setup and minimal assistance.The results revealed significant changes in the training stage and solving speed during the sessions. This suggests that participants’ ability to solve tasks more quickly and their overall problem-solving skills gradually increased as they progressed through the training program. However, no significant increase in the training stage was observed after the 7th session. To promote continuous growth beyond the initial sessions in the training stage, we suggest the necessity of continuously monitoring and providing feedback, as well as analyzing factors such as motivation and fatigue that can impact learning outcomes.Among the 25 participants who used HB-CCT, 18 individuals completed all the sessions, and the training sessions achieved an overall adherence rate of 97%, indicating a strong level of commitment. This indicates the potential for sustained participation in home-based cognitive training programs. This suggests that even adults with mild cognitive impairment could engage in activities using a tablet PC at home with only an initial setup and minimal assistance. However, one limitation of this study was that the maximum training stage of the program was set to 20 and could not be increased further, which may have affected the observed lack of a significant increase in the average training stage after seven sessions. This possibly had a negative impact on the interest of the 7 participants who did not complete all the interventions in the program. The high overall completion rate of interventions suggests good engagement and commitment to the program. It is important to address the reasons for non-completion of the intervention by the participants and identify strategies to enhance adherence to future interventions.This study holds the following clinical possibilities. First, HB-CCT can be used to expand rehabilitation therapy from hospital-based settings to community-based settings. In modern healthcare, the importance of patient-centered care and improving the quality of life has grown, leading to an increasing need for options that allow seniors and patients to establish treatment plans and receive personalized care in a home environment Second, as part of the workflow in neurology or neuropsychology clinics, HB-CCT itself can be used as a screening assessment tool or a baseline measurement. HB-CCT yields scores and performance metrics at each session, is accessible at home, and allows for continuous follow-up on its effectiveness. To achieve this, research is required to investigate whether HB-CCT’s composite scores are reliable and valid when compared to other cognitive assessments. Additionally, data collection, standardization validation, and normalization processes will be necessary, especially with a large sample.Third, game-based HB-CCT designed based on cognitive intervention theories can be useful for enhancing user engagement and motivation. To achieve this, research is required to assess the beneficial features that HB-CCT offers to users. Furthermore, detailed evaluations and analyses are needed to determine which game formats within HB-CCT are the most effective and which types of games enhance cognitive abilities most effectively.Fourth, because this HB-CCT uses an intuitive and user-friendly user interface, it can serve as an introductory program for older adults or patients with MCI before moving on to more complex devices or computer programs for evaluation or treatment. Therefore, research is needed to optimize the user-friendliness and accessibility of HB-CCT through various user experiences. Older adults and patients with MCI may face technological difficulties, so an analysis and research into user-friendly user interface, initial setup, monitoring support, regular visits, and user education are essential.There were also limitations in this study. First, no intervention was given to the control group, which may have affected the motivation of individuals. Second, there may have been a learning effect that influenced the improvements, as the cognitive evaluations were repeated during the 8-week period. Third, the small sample size prevented the generalization of our results. The lack of evaluation of executive function tests, independent functional measurements, and imaging assessments could be another potential limitation of this study.To explore these potential possibilities and address the limitations, it is crucial to conduct a randomized controlled study with a larger sample size, lasting for 8 weeks or longer for an extended intervention. It is also necessary to compare the HB-CCT and conventional CCT programs, including evaluations that were lacking in this study, to ensure the validity of our findings.