Graphical abstract

Introduction

Thailand’s population of older adults has grown rapidly due to improvements in the public health system [1]. Related health issues have become a significant concern, prompting the government to implement measures to enhance older adults’ quality of life [2]. These strategies are integrated into the National Economic and Social Development Plan, which includes healthcare services and social welfare programs for older adults [3].

Dementia is a syndrome characterized by the loss of brain function, leading to declines in memory, learning, personality, behavior, language, calculation, comprehension, creativity, concentration, and intelligence [4]. Symptoms include forgetfulness and difficulty recalling recent events. Brain function deteriorates gradually, eventually affecting daily life. While dementia can occur at any age, it is most common among older adults [5,6]. According to the Department of Health, dementia is the fifth leading cause of death among individuals aged 65 and over. Over 1 million older adults in Thailand suffer from dementia, with a higher prevalence among women. The condition increases with age, affecting 7.1% of those aged 60 to 69, 14.7% of those aged 70 to 79, and 32.5% of those aged 80 and above [7].

Mild cognitive impairment (MCI) is considered an early stage of dementia [8]. Its prevalence varies depending on population characteristics, ranging internationally from 21.5% to 71.3% [9]. In Thailand, MCI prevalence is reported at 18.1% to 33.9%, with rates of 18.7%, 28.5%, 26.4%, and 33.9% among individuals aged 65 to 69, 70 to 74, 75 to 79, and 80 and above, respectively [10]. Risk factors for MCI include non-modifiable factors such as genetics, age, gender, and a history of brain injury, as well as modifiable factors like education, exercise, nutrition, chronic disease management, and avoiding smoking and excessive alcohol consumption [11,12].

Strategies to reduce MCI risk and promote brain capacity include learning new skills, engaging in brain-stimulating activities, regular exercise, stress management, and maintaining mental well-being [13]. Previous interventions for MCI have included memory training, cognitive stimulation therapy, exercise programs, nutrition interventions, social interaction support, and the use of applications and devices for daily routine management and memory reminders [14]. Game-based brain exercise programs are an innovative approach to improving cognitive function in MCI. These programs aim to stimulate brain activity, enhance neuroplasticity, and engage cognitive functions in an enjoyable and interactive way. Games are designed to target multiple cognitive domains, such as memory, attention, executive function, and problem-solving. Research suggests that game-based programs are a promising intervention for preventing MCI and slowing its progression [15,16].

This study’s brain exercise program was developed using the knowledge, attitude, and practice (KAP) model [17], which educates participants about cognitive health, the risks of cognitive impairment, and the benefits of cognitive exercises, particularly game-based activities. The program also incorporates self-efficacy theory to boost participants’ confidence and commitment to engaging in cognitive exercises [18]. The study addresses a gap in research, as Thailand’s growing population of older adults, including in Pathum Thani, increases the likelihood of MCI development [19]. While cognitive enhancement programs have been studied globally, there is limited localized research on game-based interventions tailored to the cultural, social, and environmental context of older individuals in Thailand, particularly in Pathum Thani [20]. Region-specific interventions are essential to address the unique demographic and lifestyle factors of this population [21]. In summary, games provide an engaging, enjoyable, and potentially effective method for improving cognitive functions in older adults [17]. However, there is a lack of research emphasizing preventive measures through early interventions. This program aims to enhance memory, attention, and problem-solving skills by engaging participants in stimulating mental activities through games, thereby slowing cognitive decline.

Materials and Methods

Study Design and Setting

This quasi-experimental study employed a repeated-measures design with 2 groups to evaluate Thai mental state examination (TMSE) scores and MCI knowledge. The intervention group participated in a 6-week brain exercise program featuring weekly game-based cognitive enhancement sessions, followed by a 3-month follow-up period. The control group received a self-administered brain exercise manual for the same duration. Both groups were assessed at 3 time points: baseline, post-intervention, and 3-month follow-up, with data collection occurring between August and December 2023.

The researcher obtained permission from the directors of the hospital and primary healthcare unit to conduct the study. After approval, the research team collaborated with these institutions to recruit participants for the intervention and control groups. Healthcare professionals at the hospital and primary healthcare units identified potential participants based on specific criteria, including age, TMSE score history, and general health status. They provided a list of individuals who met the inclusion criteria. Recruitment was conducted within the participants’ local community. After compiling the list of eligible individuals, the researcher scheduled appointments to contact the sample group. Participants were invited to the sub-district health promotion hospital for a second screening, which involved administering the TMSE assessment form and evaluating additional characteristics based on the inclusion and exclusion criteria. Eligible participants were then provided with informed consent forms to sign. Data were collected through face-to-face interviews conducted by the researchers and assistant researchers.

The 6-week brain exercise program for the intervention group consisted of weekly game-based cognitive enhancement sessions, followed by a 3-month follow-up period. The control group received a self-administered brain exercise manual for the same duration. Both groups were assessed at baseline, post-intervention, and 3-month follow-up through 30-minute face-to-face interviews. The same research team conducted all assessments to ensure consistency and uniformity in evaluation procedures throughout the study.

Participants

The study population comprised 175,287 older adults in Pathum Thani Province, Thailand [20]. Participants were selected based on TMSE scores ranging from 12 to 23 and a diagnosis of MCI by medical doctors. A multi-stage sampling method was employed to recruit participants in 2 steps: First, Pathum Thani Province was divided into 7 districts. One district was randomly selected for the intervention group, and another for the control group using a lottery method without replacement to ensure equal probability of selection. Khlong Luang district was assigned to the intervention group, and Lam Luk Ka district to the control group. Both districts shared similar demographic profiles, proportions of older adults in the population, and lifestyles. Then, using purposive sampling, 48 participants from Khlong Luang district were recruited for the intervention group, and 48 participants from Lam Luk Ka district were recruited for the control group, based on the inclusion criteria outlined in Figure 1.

Inclusion criteria

Participants were individuals aged 60 years or older residing in Pathum Thani Province. They had TMSE scores between 12 and 23, were diagnosed with MCI by a medical doctor, could communicate and interact effectively, and voluntarily consented to participate. Exclusion Criteria: Individuals diagnosed with severe dementia, those who were disabled or bedridden, and those with underlying conditions (e.g., heart disease, osteoarthritis, or cancer) that hindered program participation were excluded.

Intervention Details

The brain exercise program utilized a game-based cognitive enhancement approach to reduce MCI among the participants, who were older adults. The program was developed based on the KAP model [17] and self-efficacy theory [18], and drew on cognitive training research using games [22]. The activities were designed to be easy to understand, culturally appropriate, and progressively challenging to maintain participant engagement and motivation [23]. The program tailored activities to participants’ baseline KAP model regarding cognitive health, providing information about MCI [17]. By incorporating self-efficacy theory [18], the program aimed to build participants’ confidence in their ability to improve cognitive health through consistent engagement in brain exercises.

Community involvement was integrated into the intervention to ensure the program’s sustainability and enrich its content. Focus groups with key stakeholders, including the participants, healthcare providers, and village health volunteers, contributed to the program’s development and design. Stakeholders provided feedback on the study objectives and content relevance, which informed adjustments to the intervention. Five experts in medicine, education, public health, geriatric nursing, and behavioral science reviewed the intervention draft to assess content validity using the content validity index (CVI). The program achieved a CVI of 0.90, indicating excellent content validity.

The program employed 2 strategies: (1) providing knowledge about MCI and (2) practicing brain exercises through game-based activities targeting cognitive functions such as memory, attention, executive function, and problem-solving [24]. These activities aimed to restore normal cognitive function and ensure continuous mental stimulation. The research team, along with trained public health staff and nurses, conducted and supervised the intervention. Personnel underwent training to familiarize themselves with the program's details, measurement techniques, and follow-up procedures. The intervention was delivered over 6 weeks, with 1-hour sessions held weekly on Mondays at the hospital. The program consisted of 6 sessions, with baseline assessments conducted before the first session using assessment and interview forms.

Session 1: enhancing knowledge and interaction activity

This session introduced and explained the program’s purpose and process while stimulating the brain’s left and right hemispheres and engaging the 5 senses. It provided information on MCI, including its symptoms, risk factors, and prevention methods, through slide presentations and short video clips. A discussion activity on MCI knowledge was facilitated to encourage participant interaction and engagement. The session also included the “One Brain, Two Hands” game, designed to improve executive function and attention. This game required participants to plan, switch between actions, and control movements, directly engaging cognitive flexibility, inhibitory control, and task-switching. Participants focused on specific instructions for hand coordination, such as raising the thumb on the right hand and the pinky on the left hand, then switching hands, or holding the tip of the nose with the right hand and the right ear with the left hand, then switching hands. These activities helped improve selective attention and sustained attention by requiring participants to follow precise instructions and coordinate their movements effectively.

Session 2: play a memory-stimulating game

This session aimed to improve memory and executive function through a series of games. The first game, “Who Is This?,” involved playing audio clips of well-known individuals, such as actors, artists, and singers, and asking participants to guess their identities. This activity enhanced memory recall and recognition. Next, the “Fill in the Clock Hands” game was introduced to train executive functions. Participants were instructed to write down a specific time and draw the corresponding clock hands on a clock face, improving their planning and organizational skills. The final activity, the “Sequence of Events” game, required participants to arrange a series of images in the correct chronological order. This task enhanced problem-solving abilities and task execution by challenging participants to logically sequence events.

Session 3: play a visual training game

This session focused on enhancing attention and visual perception through 3 activities. The “Color Confusion” game, required participants to identify the color of written words (e.g., the word “red” written in blue ink) without reading the text. This activity improved selective and sustained attention by forcing participants to focus on color identification rather than word recognition. The “Spot the Differences” game involved comparing 2 similar images and identifying subtle differences. This task enhanced visual discrimination, a key aspect of visual processing. The “What’s in This Picture” game, engaged visual memory and processing. Participants observed a picture for 10 seconds and then answered questions about its details, challenging them to recall and describe visual information accurately.

Session 4: play a brain-stimulating game

This session aimed to improve attention and memory functions through a variety of activities. Slow dancing encouraged mindfulness and body awareness, indirectly enhancing attention. Imaginative drawing required participants to draw freely based on their imagination. This task encouraged divergent thinking and visual expression, directly engaging attention function. Short film reflection, involved watching a short film about dementia and answering related questions. This activity fostered attention and thematic processing as participants analyzed the film’s content and themes.

Session 5: play a memory training game

This session focused on enhancing memory through 2 activities. The first, the “Missing Half” game, required participants to complete the missing half of an image, stimulating visual memory and detail retention. The second activity, the “Color Ladder” game, involved memorizing and recalling a sequence of colors. Participants were shown a series of colored images and asked to identify which color was missing, improving working memory and the ability to store and manipulate information over short periods.

Session 6: play a thinking process training game

This session aimed to improve cognitive functions, including memory and attention, through a series of activities. The “Fun Math” game required participants to solve mathematical problems involving addition, subtraction, multiplication, and division, engaging attention and cognitive flexibility. The “Picture Association” game involved showing participants a set of related images and asking them to identify the missing associated image from options A, B, C, or D. This activity enhanced associative memory and recall. The “Your Perspective, My Perspective” game required participants to observe an arrangement of cube blocks and answer questions about the shape’s top-down view and the total number of cubes. This task demanded sustained attention and spatial processing. The final activity, a group discussion, allowed participants to synthesize information, share insights, and suggest improvements. They reviewed knowledge about MCI, analyzed the program’s outcomes, and created a Line group for ongoing communication and Q&A. The session concluded with scheduling, follow-up instructions, and post-intervention assessments using the same instruments as at baseline.

After the 6-week program, participants practiced brain exercises at home during a 3-month follow-up period. The research team and village health volunteers conducted biweekly home visits to monitor progress, provide MCI information, and ensure continued engagement with brain exercises. Post-intervention and 3-month follow-up assessments were conducted using the TMSE and MCI knowledge evaluation forms. The control group received a self-administered brain exercise manual covering MCI definitions, symptoms, causes, impacts, diagnosis, and prevention. They underwent the same assessments as the intervention group at baseline, post-intervention, and 3-month follow-up, using interview forms for general data, the TMSE, and MCI knowledge assessments.

Measurement

Participants completed a semi-structured interview form administered by the researcher and written in Thai. The instruments used in this study were developed based on a comprehensive literature review and related studies [16,17,25], and a standard tool was employed to measure MCI in older adults [26]. The tools were divided into 3 parts.

Part 1: baseline characteristics interview form

This tool, developed by the researcher, assessed baseline characteristics through 9 items in both open-ended and closed-ended formats. The questionnaire covered aspects such as sex, age, marital status, education level, occupation, membership in a club for older adults, caregiver status, family type, and chronic diseases.

Part 2: TMSE

The TMSE is a widely accepted and valid assessment tool developed by the Train the Brain Forum Committee [26] to evaluate MCI in older adults in community or clinical settings. It is simple to use, efficient, highly sensitive, and validated for use in the Thai language. The test consists of questions and tasks divided into 6 sections: orientation, registration, attention, calculation, language, and recall. The TMSE has a total score of 30 points, with scores of 23 or below indicating MCI.

Part 3: knowledge about MCI assessment form

This tool, developed by the researcher based on relevant literature [27], assessed knowledge of MCI in older adults. It comprised 15 questions with “correct” or “incorrect” response options. Each correct answer earned 1 point, while incorrect answers earned zero points. Scores were interpreted using Bloom’s criteria [28]: 0–8 indicated low knowledge, 9–11 indicated moderate knowledge, and 12–15 indicated high knowledge of MCI.

The validity of the tools was assessed by 3 experts—a geriatrician, a public health specialist, and a geriatric nurse—using the index of item-objective congruence (IOC). The IOC values ranged from 0.90 to 1.00. Reliability was tested through a pilot study involving 30 older adults from the same districts as the study sample, though they were not included in the actual study. The data were analyzed for reliability, resulting in a Cronbach’s alpha coefficient of 0.90 for the TMSE and a Kuder-Richardson-20 (KR-20) value of 0.95 for knowledge of MCI.

Bias

The researchers implemented several strategies to minimize potential bias. First, they clearly defined participant selection criteria to avoid favoring specific characteristics, such as health status or familiarity with games. Second, baseline characteristics were controlled using statistical testing to ensure no significant differences between the intervention and control groups at the study’s outset. The chi-square test (or Fisher exact test) was used to compare baseline characteristics, and the results showed no significant differences (p>0.05), indicating demographic similarity between the groups and reducing the potential for confounding variables. Third, evaluators were trained to administer tests consistently, minimizing discrepancies in measurement. Fourth, both baseline and post-intervention assessments, along with follow-ups, were used to measure changes over time. Finally, incentives and regular encouragement were provided to retain participants throughout the study period.

Study Size

The sample size was calculated using the G*Power program, with an effect size of 0.80 [29], an alpha level of 0.05, a power of 0.95, and an allocation ratio (N2/N1) of 1. The calculation determined that 48 participants were needed for each group.

Statistical Methods

Data analysis was conducted using IBM SPSS ver. 29.0.1 (IBM Corp.), with a significance level set at 0.05. Descriptive statistics, including minimum and maximum values, frequency, percentage, mean, and standard deviation (SD), were employed. The chi-square test (or Fisher exact test) was used to compare baseline characteristics between the intervention and control groups before the experiment. Repeated-measures analysis of variance (ANOVA) was used to examine the effect of the brain exercise program on TMSE scores and knowledge of MCI among participants, both between and within groups, at 3 time points. The assumption of normality was assessed using the Kolmogorov–Smirnov test, which confirmed that the dependent variables, including TMSE scores (p=0.22) and knowledge of MCI scores (p=0.20), were normally distributed (p>0.05). The assumption of sphericity was tested using the Mauchly test, which was significant (p<0.001), indicating a violation of the sphericity assumption. Therefore, the Greenhouse-Geisser correction was applied to adjust the degrees of freedom for ANOVA. Post-hoc comparisons were performed using Bonferroni correction, with i-values adjusted for multiple comparisons to control for family-wise error.

Ethics Statement

The study protocol was approved by the Institutional Review Board of Valaya Alongkorn Rajabhat University under the Royal Patronage (IRB No: 0028/2023), with certification granted on August 4, 2023. The IRB confirmed informed consent, and participants were required to provide informed consent before participating in the research.

Results

Participants

A total of 48 older adults were initially recruited for both the intervention and control groups, selected from 2 randomly assigned districts. All 48 participants in the intervention group and 48 in the control group completed the study, with no dropouts. Post-intervention and 3-month follow-up evaluations were conducted using the same assessment tools for both groups.

Descriptive Data of Baseline Characteristics Variables

Table 1 shows that the baseline characteristics were comparable between the intervention and control groups, with no significant differences (p>0.05). Among the 96 participants, 57.3% were female, and 71.9% were aged 60–69 years, with an average age of 68.9 years (SD=6.4). Most participants were married (67.7%), had completed primary school (66.7%), and were employed (70.8%). Additionally, 55.2% were members of a club for older adults, 69.8% had a caregiver, and 84.4% lived in nuclear families. Chronic diseases were prevalent (89.6%), with hypertension (47.9%), dyslipidemia (41.7%), diabetes (33.3%), dyspepsia (8.3%), knee osteoarthritis (8.3%), heart disease (6.3%), and glaucoma/cataracts (5.2%) being the most common conditions.

Effects of the Brain Exercise Program on MCI by TMSE Between and Within Groups

Table 2 presents the results of a repeated-measures ANOVA analyzing the effectiveness of the brain exercise program on MCI, as measured by TMSE scores. A statistically significant difference was found between the intervention and control groups (F(1,94)=208.25, p<0.001). Within-subjects testing revealed significant changes in TMSE scores over the 3 time points (p<0.001), indicating a significant interaction between time and intervention. Post-hoc pairwise comparisons using the Bonferroni correction (Table 3) showed no significant differences in TMSE scores between the intervention group (mean±SD, 17.46±2.80) and control group (mean±SD, 16.96±2.89) at baseline (p>0.05). However, significant differences were observed at post-intervention, with the intervention group scoring higher (mean±SD, 26.33±3.43) than the control group (mean±SD, 17.94±2.87; p<0.001). This difference persisted at the 3-month follow-up, with the intervention group (mean±SD, 27.81±2.41) outperforming the control group (mean±SD, 19.02±2.86; p<0.001). These findings indicate that the intervention group showed significantly greater improvement in MCI, as measured by TMSE scores, than the control group (Figure 2).

Effects of the Brain Exercise Program on Knowledge of MCI Between and Within Groups

Table 2 also presents the results of repeated-measures ANOVA analyzing the effectiveness of the brain exercise program on knowledge of MCI. A statistically significant difference was found between the intervention and control groups (F(1,94)=24.70, p<0.001). Within-subjects testing revealed significant changes in knowledge of MCI scores over the 3 time points (p<0.001), indicating a significant interaction between time and intervention. Post-hoc pairwise comparisons using Bonferroni correction (Table 3) showed no significant differences in knowledge of MCI scores between the intervention group (mean±SD, 9.17±3.69) and control group (mean±SD, 8.73±2.28) at baseline (p>0.05).

However, significant differences were observed post-intervention, with the intervention group scoring higher (mean±SD, 11.69±3.16) than the control group (mean±SD, 9.81±2.69; p=0.002). This difference further increased at the 3-month follow-up, with the intervention group (mean±SD, 13.46±1.96) outperforming the control group (mean±SD, 9.10±3.02; p<0.001). These results demonstrate that the intervention group achieved significantly higher knowledge of MCI than the control group (Figure 3).

Discussion

The brain exercise program utilizing game-based cognitive enhancement effectively reduced MCI and increased knowledge of MCI among older adults in Thailand. The findings are discussed below.

This study demonstrated that the brain exercise program successfully improved participants’ knowledge of MCI. Significant differences in knowledge scores were observed between the intervention and control groups, with notable improvements in the intervention group before and after the program. These findings align with Xue et al. [30], who found that a game-based training intervention significantly enhanced participants’ understanding of MCI. Similarly, Phirom et al. [29] reported that participants in the intervention group showed significant cognitive improvements, as measured by Montreal cognitive assessment scores (p=0.001), compared to the control group. The combination of interactive physical-cognitive, game-based training, and MCI education proved effective in boosting knowledge and cognitive function among community-dwelling older adults. This is consistent with Ishibashi et al. [14], who demonstrated that cognitive interventions involving video games improved processing speed and working memory by increasing knowledge of MCI and encouraging brain exercises among older adults.

These findings suggest that the intervention program effectively motivates older adults to gain a deeper understanding of MCI [31]. The program was designed with a strong educational focus, delivering knowledge about MCI through slide presentations and short video clips. These materials covered key topics, including (1) symptoms of MCI, (2) risk factors, and (3) preventive measures. Following the presentations, participants engaged in discussion activities, which allowed them to ask questions, clarify doubts, and reflect on what they had learned [32]. This interactive format reinforced knowledge retention and ensured participants understood and remembered the information [27]. By integrating these educational components, the program made learning about MCI both informative and enjoyable, ultimately increasing participants’ knowledge of the condition.

The findings also revealed that the brain exercise program effectively reduced MCI, as evidenced by changes in TMSE scores across 3 time periods. The intervention group showed greater increases in TMSE scores compared to the control group. This aligns with Arshad et al. [33], who found significant improvements in Mini-Mental State Examination scores after a 6-week brain training game intervention. Similarly, Boonkerd et al. [34] reported that a neurobic exercise-based brain training program resulted in higher cognitive ability scores in the intervention group compared to the control group. These findings are further supported by Wang et al. [16], who demonstrated that game-based brain training can enhance cognitive functions in older adults, and Dell’Osso et al. [35], who highlighted video games as a promising method for cognitive training and neurorehabilitation. Additionally, Sanghuachang et al. [36] identified neurobic exercise programs as effective nursing interventions for improving memory performance in older adults with MCI. Systematic reviews on exergaming, which combines exercise with gaming, also highlighted its innovative, enjoyable, and safe nature, with statistically significant improvements in cognitive function for individuals with MCI [37].

These results can be attributed to the program’s design, which was based on cognitive training research and incorporated games specifically tailored to improve cognitive abilities. These games were not only engaging but also supported by evidence demonstrating their efficacy in enhancing brain function [38]. By utilizing games, the program created an interactive environment where participants could strengthen cognitive skills in a non-tedious and stress-free manner [39,40]. While this study did not evaluate cognitive improvement in individual domains, it compared overall cognitive function between the intervention and control groups using the TMSE, a comprehensive tool measuring memory, attention, executive function, and problem-solving. The games targeted key cognitive domains affected by MCI: (1) Memory: Games involving word, pattern, or sequence recall improved short-term and working memory. (2) Attention: Games requiring focus on details or tasks with increasing difficulty enhanced sustained attention and concentration. (3) Executive Function: Games targeting planning, decision-making, and flexible thinking strengthened higher-level cognitive processes. (4) Problem-Solving: Games involving logical reasoning and puzzle-solving encouraged critical thinking and adaptive problem-solving skills. The program fostered the development of new neural pathways, enhancing the brain’s resilience against MCI progression [41]. The improvement in TMSE scores reflected this enhanced cognitive function, demonstrating that regular engagement with these games contributed to better cognitive performance over time. Higher TMSE scores indicated improved cognitive function and reduced MCI severity.

The interactive and playful nature of the games kept participants highly engaged, a critical factor in the program’s success. Older adults are more likely to adhere to a program they find enjoyable, which was a key strength of this intervention [42–44]. This finding aligns with self-efficacy theory [18], which emphasizes an individual’s belief in their ability to perform behaviors necessary to achieve specific outcomes. The mastery experiences provided by the game-based program played a significant role in enhancing self-efficacy. As participants completed games targeting specific cognitive functions—such as memory, attention, and problem-solving—they gained a sense of accomplishment [45,46]. These positive experiences boosted participants’ confidence in their cognitive abilities, reinforcing their belief in the possibility of cognitive improvement, which ultimately contributed to higher TMSE scores and reduced MCI symptoms [47].

Cultural aspects significantly influenced the design of the games and activities, making the intervention more effective. The brain exercises were culturally relevant, tailored to the context of Pathum Thani. Activities incorporated culturally familiar themes, symbols, or references to ensure engagement and relatability. For example, images in activities like “Spot the Differences” or “What’s in This Picture?” featured local landmarks, traditional markets, or religious symbols familiar to participants. Cultural practices and values also influenced activity selection. For instance, slow-dancing activities incorporated Thai music or traditional rhythms, resonating with cultural preferences and encouraging participation. Thai culture’s emphasis on social harmony and community engagement was leveraged to create a supportive learning environment. For example, participants were encouraged to share insights or reflect on a short film about dementia, aligning with communal values. In conclusion, cultural adaptation played a pivotal role in the program’s success, particularly for populations of older adults with unique social, linguistic, and cognitive needs.

In summary, the game-based brain exercise program successfully improved TMSE scores, reflecting enhanced cognitive functioning and reduced MCI severity among older adults [48]. However, this study had several limitations. First, both the intervention and control groups were located in rural areas, limiting the generalizability of the findings to urban populations due to differences in lifestyle, sociodemographic factors, and economic conditions. Second, the program’s short duration (6 weeks with a 3-month follow-up) limits insights into its long-term effects. Future studies should extend the follow-up period to 6 or 12 months to assess sustainability. Third, the non-randomized study design introduces potential selection bias. To address this, future studies should employ matching techniques to pair participants based on key variables like age, gender, baseline cognitive function, or health status. Statistical methods such as analysis of covariance can also control for baseline differences. Fourth, the program focused primarily on game-based cognitive enhancement and may have overlooked other factors influencing cognitive health, such as physical exercise, nutrition, social interaction, and mental health.

Conclusion

In conclusion, the brain exercise program utilizing game-based cognitive enhancement successfully improved participants’ knowledge of MCI and cognitive performance, as demonstrated by increased TMSE scores. These improvements indicated enhanced cognitive abilities and reduced MCI severity, suggesting that game-based brain exercise programs can be valuable tools in addressing cognitive decline and promoting mental well-being among older adults. As recommendations for practice, the program can be integrated into comprehensive geriatric care services in hospitals or clinics. Physicians and geriatric specialists could recommend it to older patients showing early signs of cognitive decline, using it as a cognitive rehabilitation tool alongside other therapies. Further research should explore developing the brain exercise program through mobile applications to promote cognitive health in older adults. Additionally, future studies could examine the benefits of integrating physical activity or social interaction elements into the program. Lastly, domain-specific assessments should be used to explore how different cognitive areas are affected by the intervention.

HIGHLIGHTS

• Mild cognitive impairment is recognized as an early stage of dementia.

• A game-based brain exercise program was developed based on cognitive training research. These activities were simple, culturally relevant, and progressively challenging to maintain engagement and motivation among older participants. The games targeted multiple cognitive functions, including memory, attention, executive function, and problem-solving.

• The results suggest that the game-based brain exercise program has the potential to improve cognitive function in older adults.

Article information

Ethics Approval

The study received approval from the Research Ethics Committee on Human Research at Valaya Alongkorn Rajabhat University. The project was assigned identification numbers REC No. 0028/2023 and COA No. 0028/2023 and obtained certification on August 4, 2023. The study was performed in accordance with the principles of the Declaration of Helsinki.

Conflicts of Interest

The authors have no conflicts of interest to declare.

Funding

None.

Availability of Data

The datasets are not publicly available but are available from the corresponding author upon reasonable request.

Authors’ Contributions

Conceptualization: PK, PT, NK; Data curation: PK, SR, WP; Formal analysis: PT, SM, CP; Investigation: PK, PT, SR, WP; Methodology: all authors; Project administration: PK, PT; Resources: PT, CP; Supervision: PK, PT; Validation: PT, NK; Visualization: PT; Writing–original draft: PT; Writing–review & editing: all authors. All authors read and approved the final manuscript.

Acknowledgements

We extend our sincere appreciation to the participants of this study for their enthusiasm, commitment, and willingness to engage in the brain exercise program. We also wish to thank the local health authorities and community organizations in Pathum Thani for their support and collaboration throughout the project. The authors did not receive any financial support for the research.

Figure 1.

The flowchart of sampling and measurements timeline.

Figure 2.

Mean scores of mild cognitive impairments as measured by Thai mental state examination (TMSE) scores between the intervention and control group in 3 tests.

Figure 3.

Mean scores of knowledge of mild cognitive impairment (MCI) between the intervention and control group in 3 tests.

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