Background/Objectives: This study evaluated a novel rehabilitation tool that combines prismatic adaptation (PA) and cognitive training through serious games (SGs) in patients with mild cognitive impairment (MCI) due to prodromal Alzheimer’s dementia or consequent to Parkinson’s disease. While non-pharmacological interventions have been shown to improve cognition or delay dementia onset, their underlying neurobiological mechanisms, such as brain plasticity, remain unclear. Leveraging studies suggesting neuromodulatory effects of PA, we investigated whether the combined PA+SGs treatment could influence plasticity-related mechanisms, assessed through brain-derived neurotrophic factor (BDNF) serum levels, compared to cognitive training with only SGs and standard cognitive rehabilitation (SCR). Methods: Twenty three MCI patients were randomized into three intervention groups: PA+SGs (experimental group), SG-only (control group), and SCR (control group), completing ten treatment sessions. Patients underwent neuropsychological assessments and blood sampling pre- and post-treatment. Results: At baseline, demographic, clinical, and biological characteristics were comparable across groups. Post-treatment, though differences from control groups were not statistically significant, the PA+SGs group showed significant within-group improvements in memory, with trend-level changes also in executive function and visuospatial abilities, which, however, did not reach the significance threshold. Notably, only the PA+SGs group exhibited increased BDNF levels, which positively correlated with memory and language performance. Conclusions: Our findings suggest that combining PA with cognitive training may enhance cognitive functioning in MCI patients, yielding results comparable to SCR. Furthermore, PA appears to enhance neuroplasticity mechanisms that may support the behavioral improvements observed in cognitive training. Future research should validate these findings and further explore the relationship between cognitive impairment and its rehabilitation, while also considering the underlying neurobiological mechanisms.

Background/Aim Heart transplantation (HTx) represents the definitive treatment for patients with end-stage heart failure (HF). Neurological complications, particularly cognitive impairment (CI), may influence prognosis, thereby affecting the overall benefits of HTx. CI in HF is associated with disease severity, extracardiac dysfunction, and peri- or intra-operative factors such as prolonged ventilation, cerebral hypoperfusion, and systemic inflammation. However, existing studies on CI in HTx candidates are highly heterogeneous, limiting comparability and highlighting the need for a clearer understanding of its impact in both candidates and recipients. Methods This systematic review was registered with PROSPERO (CRD42024549051) and conducted in accordance with PRISMA guidelines. PubMed, Scopus, and Embase were searched for studies published between 2013 and June 2025. Eligible studies assessed cognitive function in adult HF patients undergoing HTx. Results Of 1188 records screened, eight studies met the inclusion criteria. Most cognitive studies employed the Montreal Cognitive Assessment (MoCA), while two used comprehensive neuropsychological batteries. Evidence confirmed that CI is common among HF and HTx populations. Incorporating cognitive status into frailty assessments enhanced prediction of adverse outcomes, including prolonged hospitalization and reduced survival. Cognitive decline was frequently observed in the immediate post-transplant period, often linked to high-dose immunosuppressive therapy and anemia, while long-term improvements were reported in attention, memory, and executive function. Conclusions Cognitive assessment is essential in HTx candidates, as CI has a major impact on survival. Further studies are needed to clarify long-term cognitive trajectories and the role of immunosuppressive therapy in shaping outcomes.