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. 2013 Sep;203(3):255-64.
doi: 10.1192/bjp.bp.113.127811.

Treatment for mild cognitive impairment: systematic review

Claudia Cooper  1 , Ryan Li, Constantine Lyketsos, Gill Livingston
Affiliations

Treatment for mild cognitive impairment: systematic review

Claudia Cooper et al. Br J Psychiatry. 2013 Sep.

Erratum in

  • Br J Psychiatry. 2014 Jan;204(1):81

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 the effects of any intervention for MCI on cognitive, neuropsychiatric, functional, global outcomes, life quality or incident dementia.

Method: We reviewed 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 needed and preliminary evidence suggests these should include trials of psychological group interventions and piribedil.

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Conflict of interest statement

All other authors report no conflicts of interest.

Declarations of interest: CL has received grant support (research or CME) from NIMH, NIA, Associated Jewish Federation of Baltimore, Weinberg Foundation, Forest, Glaxo-Smith-Kline, Eisai, Pfizer, Astra-Zeneca, Lilly, Ortho-McNeil, Bristol-Myers, Novartis, National Football League, Elan, Functional Neuromodulation Inc.; he has been a Consultant/Advisor to Astra-Zeneca, Glaxo-Smith Kline, Eisai, Novartis, Forest, Supernus, Adlyfe, Takeda, Wyeth, Lundbeck, Merz, Lilly, Pfizer, Genentech, Elan, NFL Players Association, NFL Benefits Office, Avanir, Zinfandel, BMS; and received Honorarium or travel support from Pfizer, Forest, Glaxo-Smith Kline, Health Monitor.

Figures

Figure 1
Figure 1
Details of search strategy
Figure 2
Figure 2
Forest plots showing between group comparisons for standardised primary outcomes post-intervention for all studies citing one or two primary outcomes(see text for study duration) Figure 2A: Studies with outcomes expressed as Standardised Mean Difference (with 95% confidence intervals) Figure 2B: Studies with outcomes expressed as Standardised Mean Change from baseline (with 95% confidence intervals) Figure 2C: Studies reporting Hazard Ratios (95% confidence intervals) for incident dementia or Alzheimer’s disease (log scale) Figure 2D: Studies for which outcomes expressed as odds ratio for response (95% Confidence intervals) (log scale) See Table 1 for key to abbreviations
Figure 2
Figure 2
Forest plots showing between group comparisons for standardised primary outcomes post-intervention for all studies citing one or two primary outcomes(see text for study duration) Figure 2A: Studies with outcomes expressed as Standardised Mean Difference (with 95% confidence intervals) Figure 2B: Studies with outcomes expressed as Standardised Mean Change from baseline (with 95% confidence intervals) Figure 2C: Studies reporting Hazard Ratios (95% confidence intervals) for incident dementia or Alzheimer’s disease (log scale) Figure 2D: Studies for which outcomes expressed as odds ratio for response (95% Confidence intervals) (log scale) See Table 1 for key to abbreviations
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Comment in

References

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