Feasibility of a narrative driven mobile video game cognitive training intervention to enhance executive function in post-stroke cognitive impairment

Serious games are a potential treatment for post-stroke cognitive impairment (PSCI), but most remain task-oriented with limited adherence. This explorative study examined the feasibility and acceptability of a narrative mobile game-based intervention for PSCI. Stroke survivors ≥ 6 months post-onset with Montreal Cognitive Assessment (MoCA) < 26 were enrolled from a neurology outpatient clinic. Individuals with neurodegenerative dementia, major psychiatric or neurological comorbidities, or severe functional limitations were excluded. Four executive tasks (attention, inhibition, updating, working memory) were embedded in a mystery adventure game with adaptive leveling. Participants trained independently at home on a tablet for 30 min, 5 days per week, over 4 weeks (± 1). Adherence was monitored through a web dashboard. At baseline and post-intervention, MoCA, frontal tests, and Beck Depression Inventory were assessed. Eighteen participants completed the study with mean adherence of 118%. Frontal z-scores improved (change from baseline 0.44 ± 0.47, P<.001) along with Stroop test color reading (0.91 ± 0.87, P<.001), digit symbol coding (0.40 ± 0.65, P=.013), trail-making A (0.52 ± 0.80, P=.014), and Corsi span (1.44 ± 1.54, P=.002). MoCA score increased (2.22 ± 2.90, P=.007), while depression did not change. Findings suggest narrative mobile game-based cognitive training is feasible and potentially beneficial for PSCI, warranting further randomized trials.