title: Gains in cognition through combined cognitive and physical training: the role of training dosage and severity of neurocognitive disorder.
abstract: Physical as well as cognitive training interventions improve specific cognitive functions but effects barely generalize on global cognition. Combined physical and cognitive training may overcome this shortcoming as physical training may facilitate the neuroplastic potential which, in turn, may be guided by cognitive training. This study aimed at investigating the benefits of combined training on global cognition while assessing the effect of training dosage and exploring the role of several potential effect modifiers. In this multi-center study, 322 older adults with or without neurocognitive disorders (NCDs) were allocated to a computerized, game-based, combined physical and cognitive training group (n = 237) or a passive control group (n = 85). Training group participants were allocated to different training dosages ranging from 24 to 110 potential sessions. In a pre-post-test design, global cognition was assessed by averaging standardized performance in working memory, episodic memory and executive function tests. The intervention group increased in global cognition compared to the control group, p = 0.002, Cohen's d = 0.31. Exploratory analysis revealed a trend for less benefits in participants with more severe NCD, p = 0.08 (cognitively healthy: d = 0.54; mild cognitive impairment: d = 0.19; dementia: d = 0.04). In participants without dementia, we found a dose-response effect of the potential number and of the completed number of training sessions on global cognition, p = 0.008 and p = 0.04, respectively. The results indicate that combined physical and cognitive training improves global cognition in a dose-responsive manner but these benefits may be less pronounced in older adults with more severe NCD. The long-lasting impact of combined training on the incidence and trajectory of NCDs in relation to its severity should be assessed in future long-term trials.
authors: Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece.
authors: Panagiotis D
authors: PD
authors: Bamidis
authors: Institute of Psychology and Pedagogy, Clinical and Biological Psychology, Ulm University, Ulm Germany.
authors: Patrick
authors: P
authors: Fissler
authors: Behavioral Neurology and Neuropsychology Unit, 1st and 2nd Department of Neurology, Medical School, National Kapodistrian University of Athens Athens, Greece.
authors: Sokratis G
authors: SG
authors: Papageorgiou
authors: Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece.
authors: Vasiliki
authors: V
authors: Zilidou
authors: Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece.
authors: Evdokimos I
authors: EI
authors: Konstantinidis
authors: Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece.
authors: Antonis S
authors: AS
authors: Billis
authors: Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece.
authors: Evangelia
authors: E
authors: Romanopoulou
authors: Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece ; Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki Greece.
authors: Maria
authors: M
authors: Karagianni
authors: Behavioral Neurology and Neuropsychology Unit, 1st and 2nd Department of Neurology, Medical School, National Kapodistrian University of Athens Athens, Greece.
authors: Ion
authors: I
authors: Beratis
authors: Behavioral Neurology and Neuropsychology Unit, 1st and 2nd Department of Neurology, Medical School, National Kapodistrian University of Athens Athens, Greece.
authors: Angeliki
authors: A
authors: Tsapanou
authors: Behavioral Neurology and Neuropsychology Unit, 1st and 2nd Department of Neurology, Medical School, National Kapodistrian University of Athens Athens, Greece.
authors: Georgia
authors: G
authors: Tsilikopoulou
authors: Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece ; Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki Greece.
authors: Eirini
authors: E
authors: Grigoriadou
authors: Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece ; Cognitive Psychology and Neuropsychology Lab, Department of Psychology, City College, The University of Sheffield International Faculty, Thessaloniki Greece.
authors: Aristea
authors: A
authors: Ladas
authors: Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece ; Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki Greece.
authors: Athina
authors: A
authors: Kyrillidou
authors: Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece ; Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki Greece.
authors: Anthoula
authors: A
authors: Tsolaki
authors: Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece.
authors: Christos
authors: C
authors: Frantzidis
authors: Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece.
authors: Efstathios
authors: E
authors: Sidiropoulos
authors: Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece.
authors: Anastasios
authors: A
authors: Siountas
authors: Behavioral Neurology and Neuropsychology Unit, 1st and 2nd Department of Neurology, Medical School, National Kapodistrian University of Athens Athens, Greece.
authors: Stavroula
authors: S
authors: Matsi
authors: Behavioral Neurology and Neuropsychology Unit, 1st and 2nd Department of Neurology, Medical School, National Kapodistrian University of Athens Athens, Greece.
authors: John
authors: J
authors: Papatriantafyllou
authors: Behavioral Neurology and Neuropsychology Unit, 1st and 2nd Department of Neurology, Medical School, National Kapodistrian University of Athens Athens, Greece.
authors: Eleni
authors: E
authors: Margioti
authors: Behavioral Neurology and Neuropsychology Unit, 1st and 2nd Department of Neurology, Medical School, National Kapodistrian University of Athens Athens, Greece.
authors: Aspasia
authors: A
authors: Nika
authors: Department of Psychiatry and Psychotherapy, University of Regensburg Regensburg, Germany.
authors: Winfried
authors: W
authors: Schlee
authors: Clinical Psychology and Clinical Neuropsychology, University of Konstanz Konstanz, Germany.
authors: Thomas
authors: T
authors: Elbert
authors: Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki Greece ; 3rd Department of Neurology, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece.
authors: Magda
authors: M
authors: Tsolaki
authors: Cognitive Psychology and Neuropsychology Lab, Department of Psychology, City College, The University of Sheffield International Faculty, Thessaloniki Greece.
authors: Ana B
authors: AB
authors: Vivas
authors: Institute of Psychology and Pedagogy, Clinical and Biological Psychology, Ulm University, Ulm Germany.
authors: Iris-Tatjana
authors: IT
authors: Kolassa
keywords: aging; cognitive training; combined intervention; dementia; exergames; mild cognitive impairment; neurocognitive disorder; physical training