Public Health

Developing efficient cognitive training programs for the older population is a major public health goal due to its potential benefits on cognition and quality of life. A promising training approach is emphasis change, which can benefit executive/attention control and multitasking abilities. The aim of this digital pilot randomized controlled trial was to assess the effects of the emphasis change using a new web-based platform that simulates real-life multitasking demands, the Breakfast Game.

A community-based sample of 38 cognitively healthy participants (M = 65.8, SD = 3.6), highly educated (M = 16.4, SD = 2.0) were randomized between two conditions: 1) Emphasis Change (EC): participants were instructed to place particular emphasis on specific aspects of the game; and 2) Active Control (AC) - gameplay with standard instructions. Participants underwent 13 online sessions using the Breakfast Game. Each session lasted one hour and occurred 3 times a week at participants' homes. Five out of the 13 sessions were supervised via videoconference. Participants completed a neuropsychological assessment via videoconference at baseline and after the intervention (clinicaltrials.gov ID: NCT05506852).

At baseline, participants from both conditions showed similar levels of cognitive performance and computer literacy (p > .05). The trial presented high adherence (94.5%) and retention rates (89%), with a loss of 2 participants per group. Both groups show a learning curve, with time effects in the game outcomes (p < .05). A time-by-group interaction (p = .04) was observed for one game accuracy measure (e.g., range of stop times), indicating greater training gain in the EC group. Regarding the transfer effects, there were time-by-group interactions (p = .02; p = .03) in the primary outcome (Alphanumeric Task), showing greater improvement in the EC in modulating their attention allocation. There was a modest effect in the secondary transfer outcome, the executive functions composite score (p = .03), mainly driven by working memory and divided attention tasks. There were no changes in the self-efficacy and mood measures.

Online emphasis change training using the Breakfast Game is feasible with modest effects and promising benefits on divided attention/executive control in older adults. Further research should improve the features of the Breakfast Game and clarify the dose-response relationship.