Effects of Neurofeedback Treatment on Mild Cognitive Impairment

Neurofeedback Tedavisinin Hafif Bilişsel Bozukluk Üzerindeki Etkisi

Mild Cognitive Impairment (MCI) is a general cognitive condition, which stands for the reductions in the cognitive functions of the brain (memory, attention, confusion, recognition problems, etc.) at levels that would not affect daily activities. Early diagnosis and treatment are important as it constitutes a high risk of occurrence of Alzheimer’s disease in advanced cases. While studies with slight adverse effects are preferred for the treatment, clinical studies carried out on the effectiveness of the Neurofeedback (NF) training, which can be counted among these methods, are growing in numbers at the present time.

Neurofeedback in a nutshell

Neurofeedback is a brain training method that teaches the client how to keep their brainwaves at desired levels through the monitoring and real-time analysis of the client’s brainwaves.  In this method, the brain activity of the client is measured via the electrodes attached on their head. As the client is asked to focus their attention or stay still in a comfortable mood to reduce anxiety, depending on their specific problem, they attempt to take their own brainwaves, which are visible on the screen, to a desired level. A visual or auditory feedback is provided (through methods, such as video games/animations/movies, etc.) based on whether the waves have reached the desired threshold. Thus, the client eliminates or diminishes the symptoms of the disease by learning how to regulate their own brainwaves throughout recurrent sessions.

Mild Cognitive Impairment and Neurofeedback Practices

The neurofeedback training shows its effectiveness as a complementary method in the treatment of a great number of psychological problems, such as anxiety, attention deficit and hyperactivity disorder, autism, post-traumatic stress disorder and panic disorder.

Based on the positive effects it has over the control of attention and brain functions, there is an ongoing research to clarify whether this method can be used as a protective method in order to prevent mild cognitive impairment from developing into dementia diseases, such as Alzheimer’s (Marlats et al., 2019).

In a study published recently (Bielas and Michalczyk, 2020), a neurofeedback protocol was implemented to increase the beta wave (12-22 Hz) in middle-aged individuals who did not have any neurological problems and had university degrees, and its effects on the administrative functions of the brain were measured by using the Stroop and Simon test. At the end of the study, while the participants that received the neurofeedback training had a much faster response speed compared to their pre-training performances, the performances shown in this test by the participants, who did not take the training, remained the same.

In a pilot study researching the effects of the neurofeedback practice on clients with mild cognitive impairment (Lavy et al., 2018), the middle-aged, right-handed clients with mild cognitive impairment were given a neurofeedback training for five weeks to increase the upper alpha waveband power, which was found to be associated with memory, and the cognitive performances of the participants were monitored before, after and 30 days following the training. As a result of the study, an increase was observed in the alpha wave frequency upon the neurofeedback application session, yet this condition could not be observed after thirty days. The development in the verbal and non-verbal short-term memory performance of the participants, however, preserved its impact even thirty days after the training.

Although the study was limited due to a small number of participants and the lack of a control group, the post-training follow-up made regarding the neurofeedback trainings was a significant part of the study. As a consequence of the study, the improvement of the cognitive performance through the short-term memory, as well as the short-term memory being particularly affected in age-related memory problems, shows that the Neurofeedback practice could be a method that can have preventive effects over the clients with mild cognitive impairment.

Finally, in a study researching the effects of the NF practice on the functional connections of the brain in general (Liv et al., 2020), the delta, theta, alpha and beta rhythms of 40 middle-aged patients with mild cognitive impairment were analyzed through the EEG coherence and phase synchronization index to create the functional brain networks of the participants. The functional connections between the brain regions were examined through an analysis of the communication between the electrodes placed in different regions of the brain. The participants were subjected to two five-day training periods consisting of one session a day. As a result of the study, while all brainwave rhythms that were analyzed, increased following the neurofeedback training, the increase in the beta rhythm of the brain, which is considered to be associated with the logical thinking, concentration and memory, continued throughout both training periods.

In addition to the improvement of the weak connection between the frontal and parietal regions of the brain, which was observed in the patients with mild cognitive impairment, as observed in the regions of the functional connections, a general improvement was spotted in between the regions located within the hemisphere of the brain and in the functional connections between the hemispheres, compared to the pre-NF training period.

Researchers believe that the increase in all brainwaves following the first training and the reduction in other rhythms in the second training, the beta rhythm excluded, could be related to the brain’s efforts to adapt to the new training. Although the study having a short duration and the lack of a control group are given as the limitations of the study, they emphasize that a long-term neurofeedback training could prevent the progression of the disease by teaching middle-aged clients with mild cognitive impairment how to control their brain functions, based on the improvements observed in the functional connections despite the short-term training.

– Bielas, J., & Michalczyk, Ł. (2020). Beta Neurofeedback Training Improves Attentional Control in the Elderly. Psychological reports, 33294119900348. Advance online publication. https://doi.org/10.1177/0033294119900348
– Lavy, Y., Dwolatzky, T., Kaplan, Z. et al. Neurofeedback Improves Memory and Peak Alpha Frequency in Individuals with Mild Cognitive Impairment. Appl Psychophysiol Biofeedback 44, 41–49 (2019). https://doi.org/10.1007/s10484-018-9418-0
– Li, X., Zhang, J., Li, X. et al. Neurofeedback Training for Brain Functional Connectivity Improvement in Mild Cognitive Impairment. J. Med. Biol. Eng. (2020). https://doi.org/10.1007/s40846-020-00531-w
– Marlats, F., Djabelkhir-Jemmi, L., Azabou, E. et al. Comparison of effects between SMR/delta-ratio and beta1/theta-ratio neurofeedback training for older adults with Mild Cognitive Impairment: a protocol for a randomized controlled trial. Trials 20, 88 (2019). https://doi.org/10.1186/s13063-018-3170-x