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Meta-Analysis
. 2015 Apr 2;5(4):e005247.
doi: 10.1136/bmjopen-2014-005247.

Do cognitive interventions improve general cognition in dementia? A meta-analysis and meta-regression

J D Huntley  1 , R L Gould  1 , K Liu  1 , M Smith  1 , R J Howard  1
Affiliations
Meta-Analysis

Do cognitive interventions improve general cognition in dementia? A meta-analysis and meta-regression

J D Huntley et al. BMJ Open. .

Erratum in

Abstract

Objectives: To review the efficacy of cognitive interventions on improving general cognition in dementia.

Method: Online literature databases and trial registers, previous systematic reviews and leading journals were searched for relevant randomised controlled trials. A systematic review, random-effects meta-analyses and meta-regression were conducted. Cognitive interventions were categorised as: cognitive stimulation (CS), involving a range of social and cognitive activities to stimulate multiple cognitive domains; cognitive training (CT), involving repeated practice of standardised tasks targeting a specific cognitive function; cognitive rehabilitation (CR), which takes a person-centred approach to target impaired function; or mixed CT and stimulation (MCTS). Separate analyses were conducted for general cognitive outcome measures and for studies using 'active' (designed to control for non-specific therapeutic effects) and non-active (minimal or no intervention) control groups.

Results: 33 studies were included. Significant positive effect sizes (Hedges’ g) were found for CS with the mini-mental state examination (MMSE) (g=0.51, 95% CI 0.35 to 0.66; p<0.001) compared to non-active controls and (g=0.35, 95% CI 0.06 to 0.64; p=0.019) compared to active controls. Significant benefit was also seen with the Alzheimer's disease Assessment Scale-Cognition (ADAS-Cog) (g=-0.26, 95% CI -0.445 to -0.08; p=0.005). There was no evidence that CT or MCTS produced significant improvements on general cognition outcomes and not enough CR studies for meta-analysis. The lowest accepted minimum clinically important difference was reached in 11/17 CS studies for the MMSE, but only 2/9 studies for the ADAS-Cog. Additionally, 95% prediction intervals suggested that although statistically significant, CS may not lead to benefits on the ADAS-Cog in all clinical settings.

Conclusions: CS improves scores on MMSE and ADAS-Cog in dementia, but benefits on the ADAS-Cog are generally not clinically significant and difficulties with blinding of patients and use of adequate placebo controls make comparison with the results of dementia drug treatments problematic.

Keywords: GERIATRIC MEDICINE.

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Figures

Figure 1
Figure 1
Flow diagram of selection of studies.
Figure 2
Figure 2
Forest Plot of CS versus non-active controls-MMSE outcome. CS, cognitive stimulation; MMSE, mini-mental state examination.
Figure 3
Figure 3
Forest Plot of CS versus active controls-MMSE outcome. CS, cognitive stimulation; MMSE, mini-mental state examination.
Figure 4
Figure 4
Forest Plot of CS versus non-active controls-ADAS-Cog outcome. ADAS-Cog, Alzheimer's disease Assessment Scale-cognitive subscale; CS, cognitive stimulation.
See this image and copyright information in PMC

References

    1. Clare L, Woods R. Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer's disease: a review. Neuropsychol Rehabil 2004;14:385–401. 10.1080/09602010443000074 - DOI
    1. NICE. CG42 dementia. Supporting people with dementia and their carers in health and social care. National Institute for Health and Care Excellence, 2006. (modified 2012).
    1. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–98. 10.1016/0022-3956(75)90026-6 - DOI - PubMed
    1. Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer's disease. Am J Psychiatry 1984;141:1356–64. 10.1176/ajp.141.11.1356 - DOI - PubMed
    1. Woods B, Aguirre E, Spector AE et al. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev 2012;2:CD005562 10.1002/14651858.CD005562.pub2 - DOI - PubMed

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