Multimodal Cognitive Enhancement Therapy for Patients with Mild Cognitive Impairment and Mild Dementia: A Multi- Center, Randomized, Controlled, Double-Blind, Crossover Trial

Abstract

We developed and evaluated the effect of Multimodal Cognitive Enhancement Therapy (MCET) consisting of cognitive training, cognitive stimulations, reality orientation, physical therapy, reminiscence therapy, and music therapy in combination in older people with mild cognitive impairment (MCI) or mild dementia. This study was a multi-center, double-blind, randomized, placebo-controlled, two-period cross-over study (two 8-week treatment phases separated by a 4-week wash-out period). Sixty-four participants with MCI or dementia whose Clinical Dementia Rating was 0.5 or 1 were randomized to the MCET group or the mock-therapy (placebo) group. Outcomes were measured at baseline, week 9, and week 21. Fifty-five patients completed the study. Mini-Mental State Examination (effect size = 0.47, p = 0.013) and Alzheimer's Disease Assessment Scale-Cognitive Subscale (effect size = 0.35, p = 0.045) scores were significantly improved in the MCET compared with mock-therapy group. Revised Memory and Behavior Problems Checklist frequency (effect size = 0.38, p = 0.046) and self-rated Quality of Life - Alzheimer's Disease (effect size = 0.39, p = 0.047) scores were significantly improved in the MCET compared with mock-therapy. MCET improved cognition, behavior, and quality of life in people with MCI or mild dementia more effectively than conventional cognitive enhancing activities did.

Cognitive Therapy for Dementia Patients: A Systematic Review

“…Next, some studies showed a positive effect on depression scores among patients who received intervention [60], but some studies also showed no effects [70]. The studies that assessed quality of life of the patient and the caregiver found that quality did not improve more than in control conditions in most studies, except for Han et al [70] that found a positive effect on the quality of life of the patient (but not the caregiver). Finally, considering the quality of the studies examining mixed interventions, we found no important differences between the different studies.…”

“…Some studies included elderly at risk for dementia [67], elderly with mild cognitive impairments [63,70], patients with mild to moderate dementia [64,66], moderate to severe dementia [69], diagnosed with Alzheimer disease [61,62,64,65,68], or a combination of these patients [59,60]. Assessment of cognitive impairment was mostly conducted with the MMSE, but also with other measurements (ADAS-Cog, Clinical Dementia Ranking -CDR).…”

“…For the current systematic review, 12 published trials were selected that met the inclusion criteria [59][60][61][62][63][64][65][66][67][68][69][70] and integrated both interventions. All studies were rated as RCT+.…”

A mixed methods systematic review of multimodal non-pharmacological interventions to improve cognition for people with dementia

“…A further five were non-randomised (QA 100%) and seven were quantitative descriptive (QA 100%) (see Quality Appraisal in Online Appendix 3). Han et al (2017) was the only double-blind or cross-over trial. Three were conducted across multiple centres: Graessel et al (2011) and Oswald, Gunzelmann, and Ackermann (2007) in German nursing homes, and Serda`i Ferrer and del Valle (2014) in Spanish day hospitals.…”

“…For example, Graessel et al (2011) had the most sessions (288), Oswald et al (2007) had the most weeks (52) and Ibarria et al (2016) had the greatest total time commitment of 979 hours (approximated, see Table 3). Because of the nature of a cross-over trial, the length of wash-out period and the relatively short 32 Dementia 0(0) intervention time of eight weeks in Han et al (2017) they acknowledged that these may have limited the effect of the Multimodal Cognitive Enhancement Therapy (MCET). Since they achieved a small ES for the dementia subgroup, perhaps the overall ES was only hindered by the study duration, and that a longer study might have been more efficacious.…”