Gamified Cognitive Training Using Digital Mahjong in Older Adults: A Randomized Controlled Trial (Preprint)
Bibliographic record
Abstract
BACKGROUND Gamified digital training may support long-term engagement in aging populations, yet randomized evidence linking behavioral effects to convergent neuroimaging outcomes remains limited. OBJECTIVE To test whether a home-based digital Mahjong (DMG) program enhances cognition in community-dwelling older adults and to characterize training-related brain changes using multimodal MRI. METHODS We conducted a single-blind, parallel-group randomized controlled trial in Taipei, Taiwan (July 2020–November 2021). Community-dwelling adults aged ≥55 years were randomized (1:1) to a 6-month DMG intervention or to no intervention. The intervention consisted of two 30-minute sessions per week delivered via an iPad app, in which participants played against three computer-controlled opponents, and included an incentivized walking component (Mi Band step tracking with in-game tokens). Primary MRI outcomes were gray matter volume (GMV), regional homogeneity (ReHo), fractional amplitude of low-frequency fluctuations (fALFF), and global brain connectivity (GBC). Secondary outcomes included cognition (Montreal Cognitive Assessment), physical activity (IPAQ), mental health (Brief Resilience Scale; Demoralization Scale–Mandarin Version), quality of life (EQ-5D with VAS), physical fitness/body composition, and blood biomarkers. Per-protocol analyses were performed. Voxel-wise imaging analyses used ANCOVA in SPM12 with FWE correction at the cluster level (p<.05). RESULTS Sixty participants were enrolled (30 per group); 29 in the intervention and 27 in the control group completed primary endpoint assessments. Compared with controls, the DMG group showed a greater improvement in MoCA delayed recall (between-group difference -0.79 points; 95% CI -1.538 to -0.042; p=.04). Neuroimaging revealed increased ReHo in the right insula (FWE-corrected p<.05) and decreased GMV in the left frontal pole/orbitofrontal cortex, with reduced fALFF in the left frontal pole. Changes in delayed recall were positively associated with right insular ReHo and also showed significant associations with right anterior cingulate gyrus (ReHo) and with left inferior frontal gyrus and right paracingulate gyrus (fALFF) (all FWE-corrected p<.05). In exploratory dose analyses, right insular ReHo correlated with total practice sessions (r=0.48, p=.009). Among physiological outcomes, the intervention group had a larger reduction in diastolic blood pressure (e.g., -3.50 mmHg; 95% CI -6.91 to -0.09; p=.04), while thyroid-stimulating hormone decreased but remained within the normal range. CONCLUSIONS A 6-month home-based digital Mahjong program with scheduled twice-weekly practice improved delayed recall in older adults and induced targeted functional brain changes—most prominently increased right-insular homogeneity—whereas structural frontal alterations did not mirror cognitive gains. Gamified training is a feasible approach to engage salience- and control-related networks and support memory; larger multi-arm studies with preregistered dose–response tests are warranted. CLINICALTRIAL ClinicalTrials.gov NCT05808426
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".