Executive-function gains but little change in attention and memory with serious games after stroke

Introduction: Cognitive impairment is frequent after stroke, and conventional cognitive training has shown limited benefit. Serious games may add engagement, but their effect on specific domains is unclear. Methods: This PRISMA 2020 systematic review included controlled studies (2010 to 2023) in adults after stroke that compared serious games or game-based virtual reality with conventional cognitive training, usual care or an active control and measured attention, memory or executive function. Five databases were searched, and risk of bias was assessed with RoB 2 and ROBINS-I. Synthesis was by direction of effect, with exploratory pooling of change scores. Results: Serious games outperformed the comparator on at least one attention, memory or executive-function measure in 6 of 10 studies (60%, 95% CI 31 to 83). The advantage appeared in 4 of 9 studies for executive function, 2 of 8 for attention and 1 of 7 for memory. Pooled change in the Trail Making Test A favored the games by a standardized difference of 0.21 (95% CI −0.10 to 0.51). Risk of bias was low in 1 study, with some concerns in 4 and high in 5. Conclusions: Serious games improved executive function in some small trials but did not show a consistent advantage for attention or memory. The evidence is limited by small samples, heterogeneous instruments and frequent risk of bias.