Is there an optimal cognitive application to be used for cognitive remediation in clinical psychiatric practice?

Cognitive dysfunction is a common characteristic across a number of psychiatric conditions. With growing technological advances, application based cognitive remediation (cognitive apps) is becoming steadily popular due to its accessibility, ease of use and minimal interference with the activities of daily life. However, despite a number of benefits that application based cognitive training possesses, it is not clear, whether the utilisation of these apps is a reliable approach that can be recommended in clinical psychiatric practice in order to restore cognition. In the present review, we have analysed eleven applications which trained the cognitive domains of memory, attention, language, processing speed, executive function and perception with respect to the structure and function of the applications, duration of use and measuring and monitoring of user progress and assessed them, based on the published data, for efficacy in the general population and clinical subgroups of the population. We conclude that, given that there are differences between the apps, given that there is a difference between the general population using these apps and groups suffering pathological conditions using them, given that cognitive deficits are caused by different pathological processes in different illnesses and that different illnesses present with different ranges of deficits, it is not possible to make blanket recommendations for the use of the apps. Nor is there sufficient published evidence for any of the apps to be specifically recommended for cognitive remediation. More evidence, such as trials of specific apps in different conditions, trials of specific apps against therapist guided techniques and blind trials of different apps against each other are necessary before recommendations of particular apps for particular remedial treatments can be made. Nor can 'brain training' in normal populations be seen as preventing cognitive decline or be seen as proof that cognitive remediation can improve cognition in pathological groups. Our paper serves as a useful reference to what apps are available, how they compare, and what the published evidence is, with a view to planning further research.