NeuroNation MED follows a new approach of gamified (playful) and interactive version of computerized cognitive intervention and is oriented to the recommendations of the official medical guidelines. The medical product was developed according to the current guidelines of the German Society for Neurology (DGN) and the Society for Neuropsychology (GNP):
S2e guideline Diagnostics and therapy of memory disorders in neurological diseases: "Patients with memory disorders should receive specific function- or strategy-oriented cognitive training (evidence level Ib; recommendation grade A). The effectiveness of the method depends on the frequency of training (at least 10 sessions are considered good clinical practice)"[1],
Guideline: diagnosis and treatment of executive dysfunction in neurological disorders: "cognitive exercise methods in general: strength of recommendation A; working memory training: strength of recommendation A"[2],
S2e guideline Diagnostics and Therapy of Attention Deficit Disorders in Neurological Disorders: For therapy, the authors give a recommendation for computer-based training batteries that address specific attentional functions (recommendation strength A)[3].
NeuroNation was also part of the research project "Brain Rehabilitation Assessment and Intervention" (BRAIN)[4], a BMBF-funded collaboration to develop a holistic approach of a sensitive interactive cognitive assessment and a computer-based cognitive training intervention.
In the "Intera-KT" project[5], NeuroNation is collaborating with the Charité University Hospital in Berlin, among others, on the digitization of paper-based cognitive testing procedures. The project goal is to improve the diagnostic reliability and precision of the tests in order to detect and treat diseases at an early stage.
Scientific evidence for the effectiveness of cognitive training with NeuroNation has been demonstrated in many studies in the past and continues to be monitored on an ongoing basis:
In the most recent ongoing study, patients with mild and moderate impairment (F06.7) and patients with post COVID-19 syndrome (U09.9) are being investigated.[6] The aim of the study is to demonstrate the effectiveness of cognitive training with the "NeuroNation MED" app in these patient groups. During the study, patients train with the app three days a week for 45 minutes each for 12 weeks. The control group also receives access to the app after these 12 weeks (waiting control group) and continues to receive normal treatment during this time.
With healthy participants, positive effects have already been found for training with NeuroNation for working memory [7, 8, 9], memory[9], and executive functions[10]. One of these studies from the MSH Medical School Hamburg and the University of Würzburg [10] was able to show a general effectiveness of the training tasks. After 21 training sessions, an improvement in memory, concentration, and general subjective well-being (measured by the Cognitive Failure Questionnaire) was observed in the training group; other cognitive characteristics such as processing speed had also increased. The observed improvements were significantly different from the control group. Another study of older workers:in monotonous work environments also demonstrated reductions in age- and work-related cognitive impairment.[11]
Several studies using NeuroNation as cognitive training with older adults have been completed and are currently in the process of scientific publication. These studies investigated the effect of training on cognitive-motor multitasking[12] or the prevention of cognitive decline as we age (Maintain Your Brain[13, 14, 15], AgeWell.de[16, 17]). The Maintain Your Brain (MYB) study[18] investigates the field of "healthy aging" and is currently the largest study worldwide in this field with 8000 targeted participants. The AgeWell.de project[19] aims to identify the best possible approach to healthy aging in order to prevent or at least mitigate or delay cognitive decline in patients at increased risk of developing dementia. NeuroNation provides the cognitive training in these research projects. A previous study from Finland has already shown promising results: With the right approach to physical training, nutrition and brain training, the risk of cognitive decline was reduced by up to 31%.
In a series of scientific studies on multidisciplinary rehabilitation of patients with Chorea Huntigton [20, 21, 22, 23] NeuroNation was used in the field of cognitive training. The intervention group showed significant improvements in verbal learning and memory, attention, cognitive flexibility, and processing speed.[20] In addition, a positive effect was found on sleep parameters[21] and performance in dual tasks (multitasking). Likewise, a reduced loss of neurons in the hypothalamus (hypothalamic gray matter) was found.[22] Although these studies are based on the results of small samples due to the rarity of the disease, the results of multidisciplinary training are already promising.
Researchers at the University Hospital of Cologne, Germany, investigated the effect of NeuroNation as a home-based training for working memory on visuospatial working memory of patients with Parkinson's.[24,25] They were able to demonstrate the effectiveness of the training also in Parkinson's patients without cognitive impairment with a small effect on verbal working memory. Furthermore, this group of researchers concluded that computerized cognitive training could be an effective intervention to prevent cognitive impairment in this group of patients. The data from this study were also analyzed to predict training success from person characteristics and training parameters.[26, 27] In imaging studies beyond this, improved neuronal efficiency was found to be a correlate of cognitive training.[28] Another study of cognitive training with Parkinson's patients is currently in the process of scientific publication.[29]
Currently, a study evaluating self-administered personalized cognitive training with NeuroNation in adults with ADHD is in preparation at the University Hospital of Bonn, Germany.[30] The aim of the study is to investigate the influence of the new cognitive training program "NeuroNation MED" on cognitive impairments that may occur in the context of attention deficit hyperactivity disorder (ADHD). Furthermore, the influence of the training on social participation, depressive mood and health-related quality of life will be analyzed. Finally, it will also be tested whether the training program is suitable for use with this group of patients and whether the training result is positively evaluated for this group.
- Thöne-Otto, A. et al., Diagnostik und Therapie von Gedächtnisstörungen bei neurologischen Erkrankungen, S2eLeitlinie, 2020, in: Deutsche Gesellschaft für Neurologie (Hrsg.), Leitlinien für Diagnostik und Therapie in der Neurologie. Online: www.dgn.org/leitlinien
- Müller, S. V., & Klein, T. (2019). Diagnostik und Therapie von exekutiven Dysfunktionen bei neurologischen Erkrankungen (Deutsche Gesellschaft für Neurologie, Hrsg.). https://register.awmf.org/assets/guidelines/030-125l_S2e_LL_Diagnostik-Therapie-exekutive-Dysfunktionen_2020-06.pdf
- Wallesch, C.-W., Sturm, W., Spatt, J., George, S., Hildebrandt, H., Von Giesen, H.-J., Nyffeler, T., & Schoof-Tams, K. (2011). S2e-Leitlinie Diagnostik und Therapie von Aufmerksamkeitsstörungen bei neurologischen Erkrankungen (Deutsche Gesellschaft für Neurologie, Hrsg.).
- https://brain-assessment.org/
- https://intera-kt.com/
- https://drks.de/search/en/trial/DRKS00025133
- Strobach, T., & Huestegge, L. (2017). Evaluating the Effectiveness of Commercial Brain Game Training with Working-Memory Tasks. Journal of Cognitive Enhancement, 1(4), 539–558. https://doi.org/10.1007/s41465-017-0053-0
- Niedeggen, M., Gerlach, L., & Leithäuser, G. (2012). Transfer effects of cognitive training based on working memory tasks. Abstracts zur 27. Jahrestagung der Gesellschaft für Neuropsychologie 2012, 20.–22. September 2012 in Marburg. https://doi.org/10.1024/1016-264X/a000071
- Scholl, F., Enge, S., & Gärtner, M. (2021). Commercial Brain Training: Efficacy, Transfer Effects, and the Influence of Personality Traits: A Study Conducted on Healthy Young Adults. Brain Sciences, 11(8), 1083. https://doi.org/10.3390/brainsci11081083
- Johann, V. E., & Karbach, J. (2020). Effects of game‐based and standard executive control training on cognitive and academic abilities in elementary school children. Developmental Science, 23(4). https://doi.org/10.1111/desc.12866
- Gajewski, P. D., & Falkenstein, M. (2011). Neurocognition of aging in working environments. Zeitschrift Für ArbeitsmarktForschung, 44(4), 307–320. https://doi.org/10.1007/s12651-011-0090-6
- Mack, M., Stojan, R., Bock, O., & Voelcker-Rehage, C. (2022). Cognitive-motor multitasking in older adults: A randomized controlled study on the effects of individual differences on training success. BMC Geriatrics, 22(1), 581. https://doi.org/10.1186/s12877-022-03201-5
- Heffernan, M., Andrews, G., Fiatarone Singh, M. A., Valenzuela, M., Anstey, K. J., Maeder, A. J., McNeil, J., Jorm, L., Lautenschlager, N. T., Sachdev, P. S., Ginige, J. A., Hobbs, M. J., Boulamatsis, C., Chau, T., Cobiac, L., Cox, K. L., Daniel, K., Flood, V. M., Guerrero, Y., … Brodaty, H. (2019). Maintain Your Brain: Protocol of a 3-Year Randomized Controlled Trial of a Personalized Multi-Modal Digital Health Intervention to Prevent Cognitive Decline Among Community Dwelling 55 to 77 Year Olds. Journal of Alzheimer’s Disease, 70(s1), S221–S237. https://doi.org/10.3233/JAD-180572
- Walton, C. C., Lampit, A., Boulamatsis, C., Hallock, H., Barr, P., Ginige, J. A., Brodaty, H., Chau, T., Heffernan, M., Sachdev, P. S., Fiatarone Singh, M. A., & Valenzuela, M. (2019). Design and development of the brain training system for the digital “Maintain Your Brain” dementia prevention trial. JMIR Aging, 2(1), e13135. https://doi.org/10.2196/13135
- https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370631&isReview=true
- Zülke, A., Luck, T., Pabst, A., Hoffmann, W., Thyrian, J. R., Gensichen, J., Kaduszkiewicz, H., König, H.-H., Haefeli, W. E., Czock, D., Wiese, B., Frese, T., Röhr, S., & Riedel-Heller, S. G. (2019). AgeWell.de – study protocol of a pragmatic multi-center cluster-randomized controlled prevention trial against cognitive decline in older primary care patients. BMC Geriatrics, 19(1), 203. https://doi.org/10.1186/s12877-019-1212-1
- Röhr, S., Zülke, A., Luppa, M., Brettschneider, C., Weißenborn, M., Kühne, F., Zöllinger, I., Samos, F.-A. Z., Bauer, A., Döhring, J., Krebs-Hein, K., Oey, A., Czock, D., Frese, T., Gensichen, J., Haefeli, W. E., Hoffmann, W., Kaduszkiewicz, H., König, H.-H., … Riedel-Heller, S. G. (2021). Recruitment and Baseline Characteristics of Participants in the AgeWell.de Study—A Pragmatic Cluster-Randomized Controlled Lifestyle Trial against Cognitive Decline. International Journal of Environmental Research and Public Health, 18(2), 408. https://doi.org/10.3390/ijerph18020408
- https://www.maintainyourbrain.org/
- https://www.gesundheitsforschung-bmbf.de/de/agewell-de-eine-multizentrische-cluster-randomisierte-kontrollierte-multikomponenten-6945.php
- Bartlett, D. M., Govus, A., Rankin, T., Lampit, A., Feindel, K., Poudel, G., Teo, W.-P., Lo, J., Georgiou-Karistianis, N., Ziman, M. R., & Cruickshank, T. M. (2020). The effects of multidisciplinary rehabilitation on neuroimaging, biological, cognitive and motor outcomes in individuals with premanifest Huntington’s disease. Journal of the Neurological Sciences, 416, 117022. https://doi.org/10.1016/j.jns.2020.117022
- Bartlett, D. M., Poudel, G., Maddison, K. J., Lampit, A., Dann, L., Eastwood, P. R., Lazar, A. S., Ziman, M. R., & Cruickshank, T. M. (2020). Effect of multidisciplinary rehabilitation on sleep outcomes in individuals with preclinical Huntington disease: An exploratory study. Annals of Physical and Rehabilitation Medicine, 63(6), 570–573. https://doi.org/10.1016/j.rehab.2019.11.003
- Bartlett, D. M., Dominguez D, J. F., Lazar, A. S., Kordsachia, C. C., Rankin, T. J., Lo, J., Govus, A. D., Power, B. D., Lampit, A., Eastwood, P. R., Ziman, M. R., & Cruickshank, T. M. (2020). Multidisciplinary rehabilitation reduces hypothalamic grey matter volume loss in individuals with preclinical Huntington’s disease: A nine-month pilot study. Journal of the Neurological Sciences, 408, 116522. https://doi.org/10.1016/j.jns.2019.116522
- Reyes, A., Rankin, T., Pulverenti, T. S., Bartlett, D., Georgiou-Karistianis, N., Lampit, A., Ziman, M., & Cruickshank, T. (2021). The effect of multidisciplinary therapy on dual task performance in preclinical Huntington’s disease: An exploratory study. Annals of Physical and Rehabilitation Medicine, 64(4), 101421. https://doi.org/10.1016/j.rehab.2020.06.006
- Giehl, K., Ophey, A., Reker, P., Rehberg, S., Hammes, J., Barbe, M. T., Zokaei, N., Eggers, C., Husain, M., Kalbe, E., & van Eimeren, T. (2020). Effects of home-based working memory training on visuo-spatial working memory in Parkinson’s Disease: A randomized controlled trial. Journal of Central Nervous System Disease, 12, 117957351989946. https://doi.org/10.1177/1179573519899469
- Ophey, A., Giehl, K., Rehberg, S., Eggers, C., Reker, P., van Eimeren, T., & Kalbe, E. (2020). Effects of working memory training in patients with Parkinson’s disease without cognitive impairment: A randomized controlled trial. Parkinsonism & Related Disorders, 72, 13–22. https://doi.org/10.1016/j.parkreldis.2020.02.002
- Ophey, A., Wenzel, J., Paul, R., Giehl, K., Rehberg, S., Eggers, C., Reker, P., van Eimeren, T., Kalbe, E., & Kambeitz-Ilankovic, L. (2022). Cognitive performance and learning parameters predict response to working memory training in Parkinson’s disease. Journal of Parkinson’s Disease, 12(7), 2235–2247. https://doi.org/10.3233/JPD-223448
- Ophey, A., Rehberg, S., Giehl, K., Eggers, C., Reker, P., van Eimeren, T., & Kalbe, E. (2021). Predicting working memory training responsiveness in Parkinson’s disease: Both “system hardware” and room for improvement are needed. Neurorehabilitation and Neural Repair, 35(2), 117–130. https://doi.org/10.1177/1545968320981956
- Giehl, K., Ophey, A., Hammes, J., Rehberg, S., Lichtenstein, T., Reker, P., Eggers, C., Kalbe, E., & van Eimeren, T. (2020). Working memory training increases neural efficiency in Parkinson’s disease: A randomized controlled trial. Brain Communications, 2(2), fcaa115. https://doi.org/10.1093/braincomms/fcaa115
- https://ichgcp.net/clinical-trials-registry/NCT04259827
- https://drks.de/search/de/trial/DRKS00030767