Effective multicomponent interventions in comparison to active control and no interventions on physical capacity, cognitive function and instrumental activities of daily living in elderly people with and without mild impaired cognition - A systematic review and network meta-analysis

Abstract

Multicomponent interventions (MCT) combine physical exercises and cognitive training and seem to be most effective in improving cognition in elderly people. However, literature is inconclusive if MCTs are superior to active comparison interventions, if delivery modes matter, and if people can transfer achieved effects to instrumental activities of daily living (IADL). This network meta-analysis aimed to a) identify MCTs that were effective on physical capacity and/or cognitive function and able to transfer these effects into IADL in elderly people with normal cognition (NC) and mild cognitive impairment (MCI); b) provide a rating on the best interventions per outcome; c) evaluate MCTs' mode of delivery. Eligible studies were randomized controlled trials comparing MCTs to active comparison or no treatments. Six studies in participants with MCI (n = 1088) and eleven studies in participants with NC (n = 670) were included. Five effective MCTs that were superior to physical exercises or cognitive training alone in improving physical capacity and/or cognitive function were detected, however none of these MCTs improved IADL. In people with NC MCTs performed separately or simultaneously were effective. However, in people with MCI MCTs performed separately were more effective. A framework needs to be developed to better understand the mediating effects of physical capacity and cognitive function on IADL and to design MCTs that effectively improve IADL.

Keywords: Ageing; Instrumental activities of daily living; Mild cognitive impairment; Multicomponent intervention; Network meta-analysis.