Treatment for mild cognitive impairment: systematic review

Abstract

Background More people are presenting with mild cognitive impairment (MCI), frequently a precursor to dementia but we do not know how to reduce deterioration. Aims To systematically review Randomised Controlled Trials (RCTs) evaluating effects of any intervention for MCI on cognitive, neuropsychiatric, functional, global outcomes, life quality, or incident dementia. Methods We reviewed the 41 studies fitting predetermined criteria, assessed validity using a checklist, calculated standardised outcomes, and prioritised primary outcome findings in placebo-controlled studies. Results The strongest evidence was that cholinesterase inhibitors did not reduce incident dementia. Cognition improved in single trials of: a heterogeneous psychological group intervention over 6 months; piribedil, a dopamine agonist over 3 months; and donepezil over 48 weeks. Nicotine improved attention over 6 months. There was equivocal evidence that Huannao Yicong improved cognition and social functioning. Conclusions There was no replicated evidence that any intervention was effective. Cholinesterase inhibitors and rofecoxib are ineffective in preventing dementia. Further good quality RCTs are necessary and preliminary evidence suggests these should include trials of psychological group interventions and piribedil.

[P4–026]: Biological Factors Contributing to the Response to Cognitive Training in Mild Cognitive Impairment

“…In cognitive behavioral therapy, homework non-compliance is one of the top most reason for therapy failure and there is a strong association between patients' motivation and homework completion as well as between homework completion and drop-out rate or therapy outcome [47]. Interestingly, when examining the number of completed homework tasks for drop-outs and completers of the intervention, we found that those who did not complete the intervention far less often completed their homework tasks (drop-outs: 3.7 ± 2.6; completers: 7.8 ± 1.7; t(23) = 4.65, p < 0.001), which remained significant when controlling for attendance rates (F (2,22) = 4.49; p < 0.05). Therefore, we believe that homework should be an essential part of cognitive Fig.…”

“…In mild cognitive impairment (MCI), the pre-dementia stage of Alzheimer's disease (AD), pharmacological treatment is ineffective, as acetylcholinesterase inhibitors fail to reduce incident dementia [1,2] and to improve cognition [3].…”

Long-Term Effects Of Combined Treatment With Memantine And Donepezil On Alzheimer's Disease Patients: 72-Week Study

“…Its neuroprotective effects have been observed in various neurological disorders. Importantly, memantine reportedly reduces the release of proinflammatory factors in activated microglia [33,34]. Major neuropathological changes in AD are neuritic plaque and neurofibrillary tangle (NFT), and it has been pointed out that NFT is related to the occurrence of psychological symptoms [35].…”

Mild cognitive impairment and progression to dementia of Alzheimer's disease

“…39 treatMent Currently, there is no evidence for the utilization of drugs for the treatment of individuals with MCI. 40 Nonetheless, several clinical trials have been conducted in an attempt to slow down the appearance of dementia. 41 There was a large clinical trial involving 70 medical centers in North America.…”