Comparative efficacy of digital cognitive training regimens on verbal fluency in older adults: A systematic review and network meta-analysis

BACKGROUND: Verbal fluency is a core marker for early cognitive decline in older adults. This study aimed to compare the relative efficacy of different digital cognitive training (DCT) regimens on verbal fluency in older adults, and identify the optimal intervention and moderators. METHODS: A search was conducted across PubMed, Web of Science, PsycINFO and IEEE Xplore from January 2015 to November 2025, and included randomized controlled trials (RCTs) of DCT for verbal fluency in adults aged ≥ 65 years. We conducted pairwise meta-analysis and frequentist network meta-analysis (NMA), with Bayesian model validation, subgroup analysis and meta-regression. Risk of bias was assessed with RoB 2.0, and evidence quality with GRADE. FINDINGS: 20 RCTs with 1358 participants were included. Compared with passive control, computerized cognitive training (CCT) combined with social/language activities had the optimal efficacy (SMD=0.47, 95%CI [0.02, 0.93], SUCRA=0.84), with greater benefits in older adults with cognitive impairment and lower education level. Furthermore, optimal therapeutic gains were observed following an initial acclimation period (i.e., >20 h of intervention duration). CONCLUSIONS: CCT combined with social/language activities is the most effective DCT regimen to improve verbal fluency in older adults, especially for those with cognitive impairment and lower education level.The research protocol has been pre-registered on the Open Science Framework (OSF)( Registration DOI: 10.17605/OSF.IO/UGR7Y).This work was supported by the National Natural Science Foundation (NNSF) of China under Grant Nos. 32371132.