Mobile technology-based gaming apps to deliver patient-led cognitive gamified training in people receiving haemodialysis

Abstract Cognitive impairment is prevalent in people receiving haemodialysis. We hypothesised that patient-led cognitive gamified training (CGT) during haemodialysis sessions could improve cognitive function and quality of life. In this single-centre pilot study participants were allocated using a non-randomised, cluster-assigned parallel-group design. 47 (37 after 5 dropouts in each arm) people receiving haemodialysis were assigned to either a four-month CGT intervention ( n = 21) or standard care ( n = 26). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), Modified Mini-Mental State Exam (3MSE), and Rapid Objective Working Memory Assessment (ROWMA). Quality of life was evaluated using Kidney Disease Quality of Life Short Form (KDQOL-SF™) v 1.3, Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Instrument, and European Quality of Life Five Dimension (EQ-5D) questionnaires. Thirty-seven participants (mean age 63 years) completed the study. No statistically significant between-group differences were observed for any cognitive or quality of life outcome after four months. A greater proportion of participants in the CGT intervention group demonstrated improvement in 3MSE scores than the control group (81.3% vs. 61.9%), although this did not reach statistical significance ( p = 0.101). Similarly, improvements in MoCA (62.5% vs. 61.9%; p = 0.404) and ROWMA (56.3% vs. 57.1%; p = 0.916) did not differ between groups. Within-group analysis demonstrated a significant improvement in 3MSE scores in the CGT intervention group ( p = 0.011). The CGT intervention group also demonstrated significant reductions in KDQOL-SF™ physical health ( p = 0.041) and overall health related quality of life ( p = 0.015), together with increased EQ-5D pain/discomfort scores ( p = 0.031). Patient-led CGT during haemodialysis is feasible but in the current study had limited potential benefits for preserving cognitive function. Trial Registration: This study was approved (IRAS: 312024) by the National Research Ethics Service Committee London - Harrow (22/L.O./0538) on 21 September 2022.