Differential effects of cognition-focused interventions for people with Alzheimer’s disease: A meta-analysis.

Oltra-Cucarella, Javier; Ferrer‐Cascales, Rosario; Clare, Linda; Espert, Raúl; Tirapu, Javier; Sánchez‐SanSegundo, Miriam

doi:10.1037/neu0000449

Cited by 16 publications

(17 citation statements)

References 124 publications

(147 reference statements)

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“…Most participants had never thought about rehabilitation being relevant to dementia care, signifying the work to be done for health professionals to embrace the evidence. To bridge this gap, a reframing of practice is required to encourage health professionals to value the individualised outcomes that are achievable for people with dementia (Oltra-Cucarella et al, 2018). This may be most successfully done by restructuring rehabilitation training programs to move away from the current focus on higher participation outcomes.…”

Section: Discussionmentioning

confidence: 99%

Health Professional Perspectives on Rehabilitation for People With Dementia

et al. 2019

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Background and Objectives Multidisciplinary rehabilitation is not incorporated into the usual care pathway for dementia despite increasing demand from key advocates. Clinician views regarding the relevance of rehabilitation in dementia care are not well known. This qualitative study explored the perspectives of health professionals regarding barriers to provision of multidisciplinary rehabilitation programs for people with dementia. Research Design and Methods Sixteen health professionals from a variety of settings and professional backgrounds were purposively sampled using maximum variation sampling. Semi-structured interviews were conducted to explore attitudes toward the care of people with dementia and beliefs about the feasibility and value of multidisciplinary rehabilitation in this population. Thematic analysis was used to identify themes. Results Participating clinicians acknowledged problems with existing dementia care pathways in Australia but rarely conceptualized rehabilitation as relevant to this pathway. Analyses yielded two main and related themes: (i) difficulty defining worthwhile outcomes of a rehabilitation program for people with dementia and (ii) perceived barriers to participation in this population. Clinicians felt that achievable outcomes for people with dementia were not sufficiently worthwhile for investment. Discussion and Implications Broader acceptance of multidisciplinary rehabilitation as relevant to dementia care will require a reframing of practice that both educates emerging health professionals regarding the outcomes that may be achievable for people with dementia and persuades staff to appreciate that the investment is worthwhile.

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Section: Discussionmentioning

confidence: 99%

Health Professional Perspectives on Rehabilitation for People With Dementia

et al. 2019

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“…After reviewing the abstracts, 13 articles with reviews and meta-analyses were left. Of the 13, 4 addressed a population of healthy older adults [26][27][28][29], 6 addressed a population of older persons with MCI [30][31][32][33][34][35], and 3 addressed a population of older adults with dementia [36][37][38]. The 4 reviews and meta-analyses with a population of healthy older adults included a total of 109 studies.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of Cognitive Interventions in Older Adults: A Review

Sanjuán

Navarro

Calero

2020

EJIHPE

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(1) Introduction: With older adults, cognitive intervention programs are most often used for preventing or reversing a decline in cognitive functions, but it has been recently noted that there are insufficient high-quality research studies that report the effects of cognitive intervention on the cognitive functioning of older adults. (2) Objective: To analyze the available evidence concerning the effect of cognitive interventions for improving or maintaining the general cognitive status of older adults who present different cognitive levels. (3) Method: a review of studies published between 2010 and 2019 using the following databases: PubMed, PsycINFO, Cochrane, Google Scholar, ProQuest and Medline. (4) Results: We selected 13 systematic reviews and/or meta-analyses. The results showed that the cognitive intervention programs improved general cognitive functioning and specific cognitive functions regardless of the initial cognitive level; that cognitive decline was slowed in older persons with dementia; and there was improvement in activities of daily living. Regarding duration of the results, benefits were maintained for periods of 2 months to 5 years. (5) Conclusion: Cognitive interventions have proven effective for maintaining and/or improving cognitive functioning in older adults regardless of their initial cognitive status. Even so, there are few studies that follow up these results to see whether they are maintained in the long term and whether there is transfer to other skills of daily life. However, we were able to observe in the present review how the participants’ cognitive level varied according to sociodemographic differences, and to identify which components of cognitive programs make them more effective. Based on the results found, we highlight the importance of designing cognitive intervention programs that meet these effectiveness criteria, in order to maximize the positive effects of such programs when working with a population of older adults.

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“…Sherman et al (2017) included cognitive stimulation in their review of cognitive interventions in MCI but did not identify any eligible trials. Finally, although a protocol for a meta-analysis of cognitive rehabilitation for people with dementia was recently published (Kudlicka et al, 2019), no current reviews were identified that reported meta-analytic results for cognitive rehabilitation, and it was recently concluded that the number of cognitive rehabilitation trials for Alzheimer's disease (Oltra-Cucarella et al, 2018) and other progressive neurodegenerative disorders (Clare et al, 2018) is still limited. Since cognitive rehabilitation is the cognition-oriented treatment approach that is most directly targeted towards producing functional change , future trials exploring the effects of cognitive rehabilitation on functional abilities is an important area of investigation, especially considering the weak evidence for functional improvement following cognitive training and cognitive stimulation.…”

Section: Overall Completeness Of the Evidencementioning

confidence: 99%

Cognition-Oriented Treatments for Older Adults: a Systematic Overview of Systematic Reviews

et al. 2020

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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.

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Differential effects of cognition-focused interventions for people with Alzheimer’s disease: A meta-analysis.

Abstract: This work supports previous findings questioning the efficacy of CT or CS for AD. Moving toward CFIs focused on relevant goals and including measures related to the skills, abilities or activities that are the focus of the intervention is encouraged. (PsycINFO Database Record

Cited by 16 publications

References 124 publications

Health Professional Perspectives on Rehabilitation for People With Dementia

Health Professional Perspectives on Rehabilitation for People With Dementia

Effectiveness of Cognitive Interventions in Older Adults: A Review

Cognition-Oriented Treatments for Older Adults: a Systematic Overview of Systematic Reviews

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