Cognitive training for people with mild to moderate dementia.
Cognition-oriented treatmentscommonly categorized as cognitive training, cognitive rehabilitation and cognitive stimulationare promising approaches for the prevention of cognitive and functional decline in older adults. We conducted a systematic overview of meta-analyses investigating the efficacy of cognition-oriented treatments on cognitive and non-cognitive outcomes in older adults with or without cognitive impairment. Review quality was assessed by A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR). We identified 51 eligible reviews, 46 of which were included in the quantitative synthesis. The confidence ratings were "moderate" for 9 (20%), "low" for 13 (28%) and "critically low" for 24 (52%) of the 46 reviews. While most reviews provided pooled effect estimates for objective cognition, non-cognitive outcomes of potential relevance were more sparsely reported. The mean effect estimate on cognition was small for cognitive training in healthy older adults (mean Hedges' g = 0.32, range 0.13-0.64, 19 reviews), mild cognitive impairment (mean Hedges' g = 0.40, range 0.32-0.60, five reviews), and dementia (mean Hedges' g = 0.38, range 0.09-1.16, seven reviews), and small for cognitive stimulation in dementia (mean Hedges' g = 0.36, range 0.26-0.44, five reviews). Meta-regression revealed that higher AMSTAR score was associated with larger effect estimates for cognitive outcomes. The available evidence supports the efficacy of cognition-oriented treatments improving cognitive performance in older adults. The extent to which such effects are of clinical value remains unclear, due to the scarcity of high-quality evidence and heterogeneity in reported findings. An important avenue for future trials is to include relevant non-cognitive outcomes in a more consistent way and, for meta-analyses in the field, there is a need for better adherence to methodological standards. PROSPERO registration number: CRD42018084490.
Background Computerized cognitive training (CCT) is a broad category of drill-and-practice interventions aims to maintain cognitive performance in older adults. Despite a supportive evidence base for general efficacy, it is unclear what types of CCT are most likely to be beneficial and what intervention design factors are essential for clinical implementation. Methods We searched MEDLINE, Embase, and PsycINFO to August 2019 for randomized controlled trials (RCTs) of any type of CCT in cognitively healthy older adults. Risk of bias within studies was assessed using the Cochrane Risk of Bias 2 tool. The primary outcome was change in overall cognitive performance between CCT and control groups. Secondary outcomes were individual cognitive domains. A series of meta-regressions were performed to estimates associations between key design factors and overall efficacy using robust variance estimation models. Network meta-analysis was used to compare the main approaches to CCT against passive or common active control conditions. Results Ninety RCTs encompassing 7219 participants across 117 comparisons were included. The overall cognitive effect size across all trials was small (g=0.18, 95% CI 0.14 to 0.23) with considerable heterogeneity (τ2=0.074, 95% prediction interval -0.36 to 0.73), robust to small-study effect or risk of bias. Effect sizes for individual cognitive domains were small, heterogeneous and statistically significant apart from fluid intelligence and visual processing. Meta-regressions revealed significantly larger effect sizes in trials using supervised training or up to three times per week. Multidomain training was the most efficacious CCT approach against any type of control, with greater benefits in a subset of supervised training studies. Conclusions The efficacy of CCT varies substantially across designs, independent of the type of control. Multidomain supervised CCT appears to be the most efficacious approach, and should be developed to accommodate for individual needs and remote delivery settings. Future research should focus on identifying the intervention components and regimens that could attenuate aging-related cognitive decline.
Introduction Ethnicity influences dementia etiology, prognosis, and treatment, while culture shapes help‐seeking and care. Despite increasing population diversity in high‐income settlement countries, ethnic minorities remain underrepresented in dementia research. We investigated approaches to enhance the recruitment, and consistent collection and analysis of variables relevant to, ethnic minorities in dementia studies to make recommendations for consistent practice in dementia research. Methods We did a scoping review, searching Embase, PsycINFO, Medline, CENTRAL, and CINAHL between January 1, 2010 and January 7, 2020. Dementia clinical and cohort studies that actively recruited ethnic minorities in high‐income countries were included. A steering group of experts developed criteria through which high‐quality studies were identified. Results Sixty‐six articles were retrieved (51 observational; 15 experimental). Use of interpreters and translators (n = 17) was the most common method to facilitate participant recruitment. Race and ethnicity (n = 59) were the most common variables collected, followed by information on native language (n = 14), country of birth (n = 9), and length of time in country of settlement (n = 8). Thirty‐three studies translated or used a culturally validated instrument. Twenty‐three articles conducted subgroup analyses based on ethnicity. Six high‐quality studies facilitated inclusion through community engagement, collected information on multiple aspects of ethnic diversity, and adjusted/substratified to analyze the impact of ethnicity on dementia. Discussion We make recommendations for consistent recruitment, collection, and reporting of variables relating to ethnic and cultural diversity in dementia research.
Cognition-oriented treatments (COTs) -commonly categorized as cognitive training, cognitive rehabilitation and cognitive stimulation -are promising approaches for the prevention of cognitive and functional decline in older adults. We conducted a systematic overview of meta-analyses investigating the efficacy of COTs on cognitive and non-cognitive outcomes in older adults with or without cognitive impairment. Review quality was assessed by AMSTAR 2. We identified 51 eligible reviews, 46 of which were included in the quantitative synthesis. The confidence ratings were "moderate" for 9 (20%), "low" for 13 (28%) and "critically low" for 24 (52%) of the 46 reviews. While most reviews provided pooled effect estimates for objective cognition, non-cognitive outcomes of potential relevance were more sparsely reported. The mean effect estimate on cognition was small for cognitive training in healthy older adults (Hedge's g 0.32, range 0.13-0.64, 19 reviews), mild cognitive impairment (Hedge's g 0.40, range 0.32-0.60, five reviews), and dementia (Hedge's g 0.38, range 0.09-1.16, seven reviews), and small for cognitive stimulation in dementia (Hedge's g 0.36, range 0.26-0.44, five reviews). Meta-regression revealed that higher AMSTAR score was associated with larger effect estimates for cognitive outcomes. The available evidence supports the efficacy of COTs improving cognitive performance in older adults. The extent to which such effects are of clinical value remains unclear, due to the scarcity of high-quality evidence and heterogeneity in reported findings. An important avenue for future trials is to include relevant non-cognitive outcomes in a more consistent way and, for meta-analyses in the field, there is a need for better adherence to methodological standards. PROSPERO registration number: CRD42018084490.
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