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A Study of the Effects of Learning and Practicing Motor Skills on Cognitive

Abilities and Psychological Well-Being among Older Adults with Mild
Cognitive Impairment

Article in Journal of Geriatric Medicine and Gerontology · October 2023

DOI: 10.23937/2469-5858/1510147

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ISSN: 2469-5858
Javanmard and Javanmard. J Geriatr Med Gerontol 2023, 9:147
DOI: 10.23937/2469-5858/1510147
Volume 9 | Issue 2
Journal of Open Access

Geriatric Medicine and Gerontology

Research Article

A Study of the Effects of Learning and Practicing Motor Skills

on Cognitive Abilities and Psychological Well-Being among
Older Adults with Mild Cognitive Impairment
Gholam Hossein Javanmard1 and Shahin Javanmard2* iD
Check for
Associate Professor at Payame Noor University, Iran
1
updates

Faculty of Medicine, Halic University, Turkey

2

*Corresponding author: Dr. Shahin Javanmard, Faculty of Medicine, Halic University, Turkey, Tel: +905435802481

Abstract findings are consistent with the results of neuroscience and

specific theories that see cognition as a type of movement-
Background: Older adults’ mild cognitive impairment (MCI)
dependent brain functioning.
can affect their daily activities. Therefore, researchers
have developed a variety of rehabilitation strategies for this Keywords
impairment.
Mild cognitive impairment (MCI), Motor skills, Cognitive
Aim: This study examines the impact of learning and abilities, Psychological well-being
practicing motor skills on the cognitive functioning and
psychological well-being of patients suspected of being
affected by MCI. Introduction
Method and results: For this purpose, 32 patients aged The aging process has physical, social, neurological,
55-75 year-old men were selected among people suspected
of having MCI syndrome by interviewing and psychological
and psychological challenges. Although, of course, from
evaluation by a psychologist and randomly divided into two a comprehensive viewpoint, it is impossible to draw a
experimental and control groups. Nejati cognitive ability tests line between these fields; to some degree, these lines
(2013) (which evaluates seven cognitive abilities; memory, are contractual. This demarcation examines the problem
inhibitory control and selective attention, decision making,
planning, sustained attention, social cognition, and cognitive from the standpoint of the sciences community, Man
flexibility) and the Oxford Happiness Questionnaire (1989) is a unified whole, and his plurality leads nowhere.
(which evaluates five psychological well-being factors; life Although issues associated with old age are expected to
satisfaction, happiness, self-esteem, self-control, and self- affect some older people, they are not likely to affect
efficacy) was implemented on the groups. Three months and
three weekly sessions were organized for the experimental all of them. No! A person’s history and current lifestyle
group, in which movement skills (adapted from authentic may play a role in the onset or appearance of these
martial arts) were taught and practiced. The multivariate disorders [1].
covariance analysis (MANCOVA) statistical method
analyzed the pre-and post-test data. The results revealed Nevertheless, some of these issues are brain related.
a substantial rise in the average scores of five categories Cognitive decline can sometimes occur as people age
of cognitive skills (memory, decision-making, inhibitory and can be brought on by neurological conditions like
control, sustained attention, cognitive flexibility) and all five
psychological well-being scales in the experimental group. Alzheimer’s [2]. In the same way as any other organ in
the body, the central nervous system, specifically the
Conclusion: The results showed that learning and practicing
movement skills impacted brain functioning, improving brain, is subject to good and bad changes. Age-related
several cognitive abilities and aspects of psychological well- brain changes might have undesirable effects on their
being in older adults who were believed to suffer from MCI own. These unfavorable alterations may result from
syndrome. Furthermore, from a theoretical standpoint, these

Citation: Javanmard GH, Javanmard S (2023) A Study of the Effects of Learning and Practicing Motor
Skills on Cognitive Abilities and Psychological Well-Being among Older Adults with Mild Cognitive
Impairment. J Geriatr Med Gerontol 9:147. [Link]/10.23937/2469-5858/1510147
Accepted: June 28, 2023: Published: June 30, 2023
Copyright: © 2023 Javanmard GH, et al. This is an open-access article distributed under the terms
of the Creative Commons Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are credited.

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decreased neurogenesis and plasticity processes or cognitive rehabilitation. Rehabilitative treatments

reflect issues with other systems, such as cardiovascular frequently result in the recovery of lost abilities,
issues. increased quality of life, and improved mental health
The researchers showed that one of the most in aged people. Furthermore, if MCI is the first stage
prevalent aging illnesses that raise the risk of dementia of a degenerative neurological problem, rehabilitation
is mild cognitive impairment (MCI) [3]. Mild cognitive methods will slow the disease’s progression.
impairment as a term entered the literature in 1988 What are rehabilitations, and how do they operate is
by Reisberg et al. They defined MCI as a significant the query. There have been many different approaches
adverse change in cognitive abilities that could clinically to cognitive rehabilitation, many of which claim to be
be described and occurred during the past ten years. able to slow, stop, or even reverse the progression of
However, a considerable transition has happened over cognitive deficits. However, all rehabilitation techniques
the past decade in the clinical description of cognitive may utilize the brain’s natural potential and capacities.
impairment [4]. Due to ambiguities about this concept,
one of the efforts of researchers in this field has been Neuroscience research has so far demonstrated
to clarify this concept and enumerate criteria for that the brain is an organ that communicates with the
differential diagnosis of mild pathological syndrome world. If this point is emphasized particularly, the brain
with similar cases, such as dementia caused by old age, is a natural extension of the environment and part of it.
Alzheimer’s, Etc. This association impacts the brain’s health, bio-damage,
and optimality. In response to its surroundings, the
MCI syndrome can be described as a clinical brain develops its structure. Brain plasticity or neural
syndrome with an unanticipated cognitive deterioration plasticity is used to describe this brain characteristic.
relative to the person’s age and literacy level that has Neural plasticity may also be defined as the ability of
little impact on every day activities by considering all the the brain to adapt to its surroundings. Of course, a
classifications that are currently accessible. It implies person’s activities alter with aging. Many studies have
that a person is capable of handling everyday life. In demonstrated the advantages of cognitive rehabilitation
other words, MCI is a condition in which a person’s for those with progressive brain diseases, including MCI
cognitive abilities, such as memory and reasoning [9]. However, the fact that those with MCI have more
skills, gradually but noticeably deteriorate. The afflicted flexibility and learning capacity than those with more
individual, their family, and friends may all see these advanced illnesses may suggest that cognitive therapies
changes, yet they do not impact the person’s ability to will be more successful when they are still in the MCI
carry out everyday tasks. Although MCI does not exhibit phase.
other signs of dementia, such as impaired judgment or
thinking, a person with MCI has more memory issues Cognitive training is the most frequently suggested
than expected as they age. form of therapy for MCI. One factor that led to the focus
on this form of rehabilitation was the observation that
MCI is viewed by some researchers [5] as a crucial
pharmacological treatment had little impact on those
step between dementia and cognitive impairment
with cognitive impairment [10]. Cognitive exercises are
brought on by aging. There are two significant varieties
a part of these rehabilitation techniques, and repetition
of MCI: 1) The amnesiac type, which primarily impairs
and practice are believed to enhance or preserve a
memory and may lead the individual to forget crucial
person’s skills. The main objectives of these therapies
information that was previously readily recalled, such
are to slow the course of cognitive impairment, improve
as appointments, conversations, or recent occurrences,
everyday activities and social interactions, and support
and 2) The non-amnesic variety, which has an impact on
cognitive and intellectual abilities other than memory, carers.
such as the steps necessary to finish a difficult task or Computer-based cognitive treatments are one
visual perception [6,7]. of the most popular types of cognitive training and
Numerous statistics on MCI have been gleaned from exercises. In treating neurological illnesses, computer-
epidemiological research. As a result, it is difficult to based cognitive therapies are regarded as an excellent
distinguish this disease from comparable disorders therapeutic tool [11]. This cognitive intervention
due to their overlap. For instance, some illnesses, like involves carrying or using a device designed with
Alzheimer’s disease, are claimed to have their earliest modern technology, such as a laptop, mobile phone,
stage in specific situations [4]. However, some studies tablet, or personal computer. In addition to accessibility,
have indicated that 10-20% of adults over 65 have this adaptability, and affordability, researchers have noted
illness [8]. the benefits of this approach to cognitive therapies [12].
There are no time or location restrictions on the use of
In any case, it has a minor impact on the rehabilitation these sorts of therapies, and their use does not require
aspect of treating MCI as an illness by itself or if it the ongoing assistance of a psychologist or facilitator.
represents the early stage of neurological disorders like
Alzheimer’s. That is, treating these illnesses requires In computer-based cognitive treatments, the patient

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can practice whenever and wherever after a learning [15]. Furthermore, excellent cardiorespiratory fitness
session. However, this strategy does have several and a greater hippocampus volume are connected
drawbacks as well. One of those scenarios concerns to superior memory function in children [16]; similar
the accessibility and availability of these therapies in findings have been confirmed in teenage samples [17].
the area and the facilities there. In underdeveloped Moreover, research on the function of motor learning
regions, some older individuals experience economic in brain plasticity has demonstrated that learning motor
and cultural poverty, making it challenging to afford skills is one of the critical components of brain plasticity.
or use these modern instruments. Furthermore, this It was shown by Lakhanian, et al. that learning motor
treatment method has two significant disadvantages: 1- skills improve myelin plasticity in the brain. According to
Separation and deprivation from others. To accomplish the findings of this study, white matter circuitry’s speed
the training, a person needs to be in an appropriate of guiding and ideal timing enhanced after acquiring
atmosphere and away from others to practice, and motor abilities. Furthermore, a survey by Kai, et al. in
2- Sedentary. Using this method, the person should 2014 displayed the importance of movement exercises
accomplish the exercises on the device screen while in brain plasticity. Debas, et al.‘s [18] study on brain
sitting in a fixed position without being physically active. plasticity also revealed that brain plasticity plays a role
in the consolidation of motor sequence learning and
Several studies have demonstrated that these two
motor adaptation.
aspects (sociability and physical activity) are crucial to
developing and maintaining the brain’s health. These Furthermore, some studies have shown that physical
two sources are necessary for brain neuroplasticity exercises, specifically those combined with learning
and growth from the beginning and brain survival. and performing rhythmic movements, or psychomotor
These two elements are essential for preserving “brain activities, increase or improve executive functions. The
fitness” throughout life. The brain is an organ that must prefrontal cortex is well known for its processes related
communicate with its surroundings, especially with the to administrative positions. A study by Abrahamson
social environment. For the brain, “The Second Factor” also demonstrated that physical exercises could result
is equally crucial. in brain plasticity in various manners. According to Chu,
On the one hand, a person’s self-awareness is et al., Taekwondo training for 16 weeks significantly
supplied through engagement with others and social increased biochemical and biological factors (BDNF,
relationships. The brain will not function at its best VEGF, IGF-1), promoting neuroplasticity.
without regular social connections. In contrast, the As a result, the effects of physical activity on
brain is active during movement and maintains neuroplasticity can be linked to changes in the brain’s
and modifies its direction toward the body and cognitive capabilities. The issue of what biochemical
surroundings. Indeed, some researchers even contend processes in the brain lead to neural plasticity may
that cognition starts with exercise and activeness. This be posed in light of the previous sentence. According
approach is supported by the definitions and phases of to Phillips, some of these biochemical mechanisms in
early cognitive development in Jean Piaget’s theory. the interneuron region of the brain that either directly
According to Piaget’s hypothesis, the sensory-motor or indirectly influence the actions that trigger neural
stage is the initial stage of cognitive development. plasticity in the brain include 1- Neurotropic synthesis,
Neuroscientists believe mobility and skill training cause 2- Neurogenesis, 3- Preventing brain inflammation,
the human brain to reorganize structurally and change 4- Coping with Stress, and 5- Increasing antioxidant
its functions. In terms of development and assuming activity. Moreover, studies have demonstrated that the
that neuronal plasticity persists throughout life, it is post-synaptic membrane undergoes modifications. For
crucial to use techniques to accelerate this process, example, the formation of clusters of new spines in the
particularly in adults. areas next to the dendrites of the mouse motor cortex
neurons is one of these structural modifications. The
This issue has been studied extensively. For example, stability of these new dendritic spines has been linked
a meta-analysis of 29 randomized controlled trials (n to the persistence of memory [19].
= 2,049) found that aerobic exercisers demonstrated
refinements in attention, processing speed, memory, According to the existing research literature, some of
and executive function [13]. which were mentioned, it is concluded that movement
and social interactions play an essential role in keeping
Another meta-analysis of 15 prospective trials the brain healthy and rebuilding it. Also, learning is
(33,168 individuals without dementia) revealed that vital to keeping the brain fit. Today, participating in
physical activity had a protective effect at all activity an activity where these three elements-movement,
levels [14]. social contact, and education-are somehow interwoven
Research results on students unmistakably will be advantageous for persons with MCI syndrome.
demonstrated a beneficial relationship between vigorous Hence, group learning and motor skill practice were
physical exercise and excellent academic achievement considered in this study. Therefore, the research

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question of this study is whether learning and practicing depression questionnaire. This test defines
motor skills will be able to affect the cognitive functions happiness as the strength of pleasant feelings,
and characteristics related to the psychological well- satisfaction, and the absence of negative
being of people suspected of MCI. emotions. This questionnaire has 29 questions,
each of which includes four statements as a
Method response scale and is evaluated on a Likert scale
The current study approach is semi-experimental, from zero to three (not at all, rarely, sometimes,
using a pre-and post-test design. This study’s statistical always). This quiz has a score range of zero to
population comprised 55-75 year-old males who were 87, with 87 being the highest level of happiness.
members of the Bonab City Senior Citizens Organization. Alipour, Nurbala, Ejei, and Matiyan translated
The research sample was selected using the available and standardized the questionnaire for Iranian
and voluntary sampling method in 32 people suspected society. The reliability of this questionnaire
of MCI syndrome. This group was randomly divided into has been shown in independent studies to be
two groups of 16 people, the experimental group and between 0.80 and 0.90, while its validity is about
the waiting group (control). For the experimental group, 0.70. [21].
the program of learning and practicing movement skills
3) Learning and practicing Motor skills program: The
(derived from authentic martial arts, especially Kung Fu)
program for learning and practicing movement
was held for twelve weeks and three 45-minute sessions
skills was adapted from regular training sessions
each week. The session moderator was a cognitive
and martial arts learning, with revisions to adapt
neuroscience specialist with adequate professional skills
the sessions to the participants’ ages. In this study,
in martial arts. In this research, two questionnaires of
martial arts are sports with historical origins and
the Nejati cognitive abilities test [20] (which evaluates
forms of forms or official forms made up of sub-
seven cognitive abilities; memory, inhibitory control and
movements, movements, axes, and, eventually,
selective attention, decision making, planning, sustained
forms. Learning forms takes time and a coach’s
attention, social cognition, and cognitive flexibility)
supervision. Therefore, it is necessary to divide
and the Oxford happiness questionnaire (1989) (which
each state into sub-movements, movements, and
evaluates five factors of psychological well-being; life
axes and study and rehearse them separately.
satisfaction, happiness, self-esteem, self-control, self-
efficacy) was carried out as a pre-and post-test on the In the training program, the coach did preliminary
groups. exercises at the start of each session by modifying
and considering the sample’s age. Then, following the
Tools physical preparation of the model, he examined their
As a pre-and post-test, this study administered acquired skill movements collectively and repaired
two assessments of Oxford’s cognitive abilities and the issues (Table 1). Finally, the coach demonstrated
happiness to the experimental and control groups some exercises and had the sample group repeat
(pending). Furthermore, the experimental group was them numerous times. This three-month learning and
given a curriculum for acquiring and practicing motor practicing movement skills program for the experimental
skills. group included three sessions per week.
1) Nejati’s Cognitive Abilities Test: Nejati created Table 2 shows the average scores obtained from two
and standardized this questionnaire in Iran. implementations of the cognitive questionnaire in the
The questionnaire has 30 Likert scale responses pre-and post-test phases to study the influence of the
that assess seven cognitive abilities: memory, independent variable (learning and practicing motor
inhibitory control and selective attention, abilities) on the subscales of cognitive skills.
decision-making, planning, sustained attention,
social cognition, and cognitive flexibility. Except Furthermore, Table 3 reveals that after applying
for questions 24, 25, and 26, which are evaluated the independent variable, i.e., learning and practicing
in reverse, the allotted score for each question movement skills, the average scores of all happiness
ranges from 1 to 5. The lowest and most excellent subscales rise.
possible scores are 36 and 180, respectively. To evaluate the assumptions made in this study,
The questionnaire’s validity and reliability have multivariate covariance analysis was performed. To do
been demonstrated in studies. According to this, the premises of multivariate covariance analysis
one research, this test’s Cronbach’s alpha was were initially investigated. The Kolmogorov-Smirnov
0.83, and its validity using Pearson’s correlation test was used for this purpose to check the normality
coefficient was 0.0001 [20]. of the distribution of pre-and post-test scores, the
2) Oxford happiness questionnaire (1989): Oxford homogeneity of the error variance of the dependent
happiness test was developed by Argyle, Martin, variables from the Levene’s test, the uniformity of the
and Crosland; This test is based on the Beck regression slope from the analysis of the interactive

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Table 1: Five stages of the program for learning and practicing movement skills.

Level Type of Activity Goal The expected result at the brain level
1 Basic stretching movements Initial warming up of joints and Joint-muscular preparation
muscles
2 Slow running Increase cardiovascular activity Increase blood supply to muscles and brain
3 Regular general exercises General warming up of joints and mental-motor (muscular-brain) preparation
muscles
4 Practicing and reviewing streamlining cognitive skills in activation of neural plasticity processes (including
movement units learned in the brain, including Attention, its type of neurogenesis)
previous sessions learning, and memory
5 Design and implementation of Increase in brain neural activity Creating connections and brain circuits and
new movement units by the by learning and practicing new using new neurons resulting from neurogenesis,
class instructor motor skills especially in the hippocampus.

Table 2: Shows that, except for the average scores of the planning and social cognition subscales, the average scores of the five
cognitive skill subscales have increased.

Groups of dependent variables Pre-test Post-test

Cognitive skills Control group Experimental group Control group Experimental group
mean (standard mean (standard mean (standard mean (standard
deviation) deviation) deviation) deviation)
Memory (0.78) 2.52 (0.80) 2.33 (0.74) 2.37 (0.60) 23.3
Inhibitory control and selective attention (0.82) 2.08 (0.79) 2.03 (0.80) 2.09 (0.58) 3.07
Decision making (0.63) 2.05 (0.68) 2.20 (0.60) 2.29 (0.55) 3.12
Planning (0.67) 2.01 (0.69) 2.05 (0.70) 2/03 (0.66) 2.03
Sustained attention (0.73) 2.13 (0.65) 2.04 (0.76) 2.15 (0.54) 3.17
Social cognition (0.79) 2.06 (0.73) 2.10 (0.81) 2.13 (0.63) 2.09
Cognitive flexibility (0.65) 2.00 (0.71) 2.04 (0.63) 2.07 (0.66) 3.08
Total score 14.85 14.79 47.93 19.79

Table 3: The meaning of happiness subscales of two control and experimental groups of older people suspected of MCI in pre-
and post-test.

Groups The dependent Pre-test Post-test

variables
Control group mean Experimental group Control group Experimental group
(standard deviation)
mean (standard mean (standard mean (standard
deviation) deviation) deviation)
Life satisfaction (3.24) 17.03 (3.35) 17.24 (4.06) 17.15 (2.76) 18.02
Happiness (1.19) 9.17 (2.23) 8.89 (2/62) 9/16 (1.65) 9.56
Self-esteem (0.97) 8.93 (1.19) 8.59 (2.88) 9.02 (1.87) 9.61
Self-control (1.16) 6.34 (1.54) 6.77 (1.68) 6.05 (1.65) 7.82
Efficacy (0.89) 5.26 (1.07) 5.12 (1.55) 5.19 (1.44) 6.27
Mean total score 46.73 46.61 46.57 51.28

Table 4: The results of MANCOVA on the variable of cognitive abilities and happiness in the post-test stage in the groups.

Statistical indicators Sum of squares Df F Significance level

The dependent variable 354.234 1 157.763 0.001
Cognitive abilities 1825.981 1 139.251 0.001

effects of the pre-test, and the assumption of average validated was the linearity of the correlations between
correlation of the dependent variables. The results of the dependent variables.
Bartlett’s and Mbox’s tests, which were used to assess
Table 4 demonstrates that using the pre-test as
the homogeneity of the variance-covariance matrices of
a control, the significance levels in the two tests
the dependent variables, demonstrated that the given
connected to the total scores of cognitive skills and
assumptions are correct. Furthermore, evaluated and
happiness suggest a significant difference between the

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test and control groups in the dependent variables at Furthermore, their cognitive function is strongly related
the post-test stage. Furthermore, the rise in post-test to the amount of oxygen in the brain.
scores demonstrates the influence of the independent A new study at the University of Oregon discovered
variable (learning and practicing motor skills) on the that a brief physical exercise increases the expression
dependent variables (cognitive abilities and happiness). of a specific gene, increasing the synaptic connection
Discussion between neurons and synaptic growth in the
hippocampus. Thus, a short practice before educational
The effects of learning and practicing movement activities, such as studying, helps to improve learning.
skills on cognitive abilities and psychological well-being Additionally, despite the influence of movement on
features of older adults suspected of mild cognitive entire brain activities and the overall chemical state of
impairment (MCI) were investigated in this study. The the brain, studies reveal that physical workouts change
findings indicated that applying the independent variable dopamine (DA), norepinephrine (NE), and serotonin (5-
(i.e., learning and practicing motor skills) effectively HT), the three primary monoamine neurotransmitters.
influenced the dependent variables considered in the
study (i.e., some subscales of cognitive abilities and all Furthermore, data from animal and human research
the characteristics related to psychological well-being shows that physical exercise enhances mental health,
mentioned under the happiness title). possibly through the actions of neurotransmitters. For
example, physical workouts that influence the serotonin
The influence of the independent variable was seen system efficiently alleviate anxiety and protect the brain
in the case of seven cognitive variables tested: memory, against excessive stress.
inhibitory control and selective attention, decision-
Furthermore, a study published in the journal
making, planning, sustained attention, social cognition,
Neuroscience found that strenuous exercise might
and cognitive flexibility. These have grown considerably
boost the levels of two essential neurotransmitters in
in the experimental group, especially memory,
the brain, glutamate, and GABA. The study of 38 healthy
inhibitory control, selective attention, decision-making,
people found that eight to twenty minutes of activity
sustained attention, and cognitive flexibility. Following
on a stationary cycle, with the heart rate reaching 85%
that, the MANCOA study revealed that these alterations
of the maximum attainable in each person, raises GABA
are substantial. In keeping with these findings, a
and glutamate levels.
large body of scientific literature demonstrates that
mobility is vital in brain development and maintenance. Furthermore, follow-up studies revealed that,
Many studies have shown that physical exercises can while these effects diminish with time, they continue
maintain or even improve cognitive abilities of the to a lesser level in the long term. People’s glutamate
brain in old age by influencing the process of neural levels at rest, for example, were shown to be related
plasticity, increasing or modulating neurotransmitters, to the amount of physical activity they had done in the
neurogenesis, increasing and facilitating cerebral blood preceding week.
flow, controlling the cardiovascular system, increasing GABA and glutamate levels were higher in the visual
myelination, and preserving newly born neurons. In and anterior cingulate cortex, essential for footplate
addition, physical activity generally affects the function control and specific emotional and cognitive processing.
of the cerebral cortex and other bodily systems,
including the neuromuscular system, which appears Moreover, according to some studies above, martial
crucial in cognitive functioning. arts offer the cognitive advantages observed in specific
sports training and unique benefits. The brain is involved
As Hall and colleagues demonstrated, physical in intricate learning processes that are also musical
workouts favorably influence the activity of the left when learning and performing martial arts techniques.
frontal area. Physical exercise has also been found in On the one hand, based on the study findings, there
other studies to impact the movement of the frontal is agreement that sports workouts are beneficial to
brain region. Mild, even short-term, exercise has been people of all ages. Nevertheless, studies have shown
demonstrated in studies to improve brain function. that learning rigorous and challenging sports workouts,
However, only 10 minutes of intense movement a type of skill acquisition may benefit brain health in
improves cognitive performance. Studies have shown terms of its plasticity.
that physical activity increases the number of brain
capillaries, hence improving blood circulation. It also Acknowledgments
raises the quantity of oxygen in the blood, which the brain Statement for people/funding: NA.
needs as fuel. The capacity of the brain to accomplish
activities is affected by oxygen concentration. Higher Author Contribution
blood oxygen concentrations have been shown in GJ provided data, conducted all statistical analyses,
studies to improve cognitive function in healthy young and helped to write the manuscript, and SJ helped to
people. For instance, they can recall more words from a design the study and write the manuscript. All authors
list and complete visual and spatial tasks more quickly. reviewed the final manuscript.

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Conflict of Interest 10. Klimova B (2016) Computer-Based cognitive training in

aging. Frontiers Aging Neurosci 8: 313.
All co-authors have seen and agree with the 11. Irazoki E, Sánchez-Gómez MC, Contreras-Somoza LM,
manuscript’s contents, and there is no financial interest Toribio-Guzmán JM, Martín-Cilleros MV, et al. (2021) A
to report. Therefore, we certify that the submission is qualitative study of the cognitive rehabilitation program
an original work and is not under review at any other GRADIOR for people with cognitive impairment: Outcomes
publication. of the focus group methodology. J Clin Med 10: 859.
12. Gooding AL, Choi J, Fiszdon JM, Wilkins K, Kirwin PD,
Transparency Declaration et al. (2016) Comparing three methods of computerised
cognitive training for older adults with subclinical cognitive
The lead authors confirm that this publication is an decline. Neuropsychol Rehabil 26: 810-821.
honest, accurate, and transparent description of the
13. Smith-Ray RL, Hughes SL, Prohaska TR, Little DM,
study; that no critical components of the investigation
Jurivich DA, et al. (2015) Impact of cognitive training on
have been omitted; and that any deviations from the balance and gait in older adults. J Gerontol B Psychol Sci
intended research (and, if applicable, recorded) have Soc Sci 70: 357-366.
been explained. 14. Sofi F, Valecchi D, Bacci D, Abbate R, Gensini GF, et al.
(2011) Physical activity and risk of cognitive decline: A
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