title: A pilot randomized controlled trial using EEG-based brain-computer interface training for a Chinese-speaking group of healthy elderly.
abstract: BACKGROUND
  There is growing evidence that cognitive training (CT) can improve the cognitive functioning of the elderly. CT may be influenced by cultural and linguistic factors, but research examining CT programs has mostly been conducted on Western populations. We have developed an innovative electroencephalography (EEG)-based brain-computer interface (BCI) CT program that has shown preliminary efficacy in improving cognition in 32 healthy English-speaking elderly adults in Singapore. In this second pilot trial, we examine the acceptability, safety, and preliminary efficacy of our BCI CT program in healthy Chinese-speaking Singaporean elderly.
  
  
  METHODS
  Thirty-nine elderly participants were randomized into intervention (n=21) and wait-list control (n=18) arms. Intervention consisted of 24 half-hour sessions with our BCI-based CT training system to be completed in 8 weeks; the control arm received the same intervention after an initial 8-week waiting period. At the end of the training, a usability and acceptability questionnaire was administered. Efficacy was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which was translated and culturally adapted for the Chinese-speaking local population. Users were asked about any adverse events experienced after each session as a safety measure.
  
  
  RESULTS
  The training was deemed easily usable and acceptable by senior users. The median difference in the change scores pre- and post-training of the modified RBANS total score was 8.0 (95% confidence interval [CI]: 0.0-16.0, P=0.042) higher in the intervention arm than waitlist control, while the mean difference was 9.0 (95% CI: 1.7-16.2, P=0.017). Ten (30.3%) participants reported a total of 16 adverse events - all of which were graded "mild" except for one graded "moderate".
  
  
  CONCLUSIONS
  Our BCI training system shows potential in improving cognition in both English- and Chinese-speaking elderly, and deserves further evaluation in a Phase III trial. Overall, participants responded positively on the usability and acceptability questionnaire.
authors.affiliation: Department of Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Tih-Shih
authors.initials: TS
authors.lastname: Lee
authors.affiliation: Department of Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Shin Yi
authors.initials: SY
authors.lastname: Quek
authors.affiliation: Department of Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Siau Juinn Alexa
authors.initials: SJ
authors.lastname: Goh
authors.affiliation: Singapore Clinical Research Institute, Singapore.
authors.forename: Rachel
authors.initials: R
authors.lastname: Phillips
authors.affiliation: Institute for Infocomm Research, Agency for Science, Technology and Research, Singapore.
authors.forename: Cuntai
authors.initials: C
authors.lastname: Guan
authors.affiliation: Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Yin Bun
authors.initials: YB
authors.lastname: Cheung
authors.affiliation: Department of Psychological Medicine, National University of Singapore, Singapore.
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.affiliation: Institute for Infocomm Research, Agency for Science, Technology and Research, Singapore.
authors.forename: Chuan Chu
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Institute for Infocomm Research, Agency for Science, Technology and Research, Singapore.
authors.forename: Zheng Yang
authors.initials: ZY
authors.lastname: Chin
authors.affiliation: Institute for Infocomm Research, Agency for Science, Technology and Research, Singapore.
authors.forename: Haihong
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of General Psychiatry/Department of Research, Institute of Mental Health, Singapore.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Psychological Medicine, National University of Singapore, Singapore.
authors.forename: Tze Pin
authors.initials: TP
authors.lastname: Ng
authors.affiliation: Department of Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore.
authors.forename: K Ranga Rama
authors.initials: KR
authors.lastname: Krishnan
mesh_terms: D000368:Aged; D044466:Asian People; D001288:Attention; D062207:Brain-Computer Interfaces; D003071:Cognition; D004569:Electroencephalography; D006801:Humans; D007858:Learning; D008568:Memory; D009483:Neuropsychological Tests; D017060:Patient Satisfaction; D011788:Quality of Life; D012846:Singapore
keywords: attention; cognitive training; memory; neuro-feedback