Meta-Analysis
doi: 10.1002/14651858.CD013069.pub2.
Cognitive training for people with mild to moderate dementia
Affiliations
- PMID: 30909318
- PMCID: PMC6433473
- DOI: 10.1002/14651858.CD013069.pub2
Item in Clipboard
Meta-Analysis
Cognitive training for people with mild to moderate dementia
Cochrane Database Syst Rev.
.
Abstract
Background: Cognitive impairment, a defining feature of dementia, plays an important role in the compromised functional independence that characterises the condition. Cognitive training (CT) is an approach that uses guided practice on structured tasks with the direct aim of improving or maintaining cognitive abilities.
Objectives: • To assess effects of CT on cognitive and non-cognitive outcomes for people with mild to moderate dementia and their caregivers.• To compare effects of CT with those of other non-pharmacological interventions, including cognitive stimulation or rehabilitation, for people with mild to moderate dementia and their caregivers.• To identify and explore factors related to intervention and trial design that may be associated with the efficacy of CT for people with mild to moderate dementia and their caregivers.
Search methods: We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group Specialised Register, on 5 July 2018. ALOIS contains records of clinical trials identified through monthly searches of several major healthcare databases and numerous trial registries and grey literature sources. In addition to this, we searched MEDLINE, Embase, PsycINFO, CINAHL, LILACS, Web of Science Core Collection, ClinicalTrials.gov, and the World Health Organization's trials portal, ICTRP, to ensure that searches were comprehensive and up-to-date.
Selection criteria: We included randomised controlled trials (RCTs) that described interventions for people with mild to moderate dementia and compared CT versus a control or alternative intervention.
Data collection and analysis: We extracted relevant data from published manuscripts and through contact with trial authors if required. We assessed risk of bias using the Cochrane 'Risk of bias' tool. We divided comparison conditions into active or passive control conditions and alternative treatments. We used a large number of measures and data to evaluate 19 outcomes at end of treatment, as well as 16 outcomes at follow-up in the medium term; we pooled this information in meta-analyses. We calculated pooled estimates of treatment effect using a random-effects model, and we estimated statistical heterogeneity using a standard Chi² statistic. We graded the evidence using GradePro.
Main results: The 33 included trials were published between 1988 and 2018 and were conducted in 12 countries; most were unregistered, parallel-group, single-site RCTs, with samples ranging from 12 to 653 participants. Interventions were between two and 104 weeks long. We classified most experimental interventions as 'straight CT', but we classified some as 'augmented CT', and about two-thirds as multi-domain interventions. Researchers investigated 18 passive and 13 active control conditions, along with 15 alternative treatment conditions, including occupational therapy, mindfulness, reminiscence therapy, and others.The methodological quality of studies varied, but we rated nearly all studies as having high or unclear risk of selection bias due to lack of allocation concealment, and high or unclear risk of performance bias due to lack of blinding of participants and personnel.We used data from 32 studies in the meta-analysis of at least one outcome. Relative to a control condition, we found moderate-quality evidence showing a small to moderate effect of CT on our first primary outcome, composite measure of global cognition at end of treatment (standardised mean difference (SMD) 0.42, 95% confidence interval (CI) 0.23 to 0.62), and high-quality evidence showing a moderate effect on the secondary outcome of verbal semantic fluency (SMD 0.52, 95% CI 0.23 to 0.81) at end of treatment, with these gains retained in the medium term (3 to 12 months post treatment). In relation to many other outcomes, including our second primary outcome of clinical disease severity in the medium term, the quality of evidence was very low, so we were unable to determine whether CT was associated with any meaningful gains.When compared with an alternative treatment, we found that CT may have little to no effect on our first primary outcome of global cognition at end of treatment (SMD 0.21, 95% CI -0.23 to 0.64), but the quality of evidence was low. No evidence was available to assess our second primary outcome of clinical disease severity in the medium term. We found moderate-quality evidence showing that CT was associated with improved mood of the caregiver at end of treatment, but this was based on a single trial. The quality of evidence in relation to many other outcomes at end of treatment and in the medium term was too low for us to determine whether CT was associated with any gains, but we are moderately confident that CT did not lead to any gains in mood, behavioural and psychological symptoms, or capacity to perform activities of daily living.
Authors' conclusions: Relative to a control intervention, but not to a variety of alternative treatments, CT is probably associated with small to moderate positive effects on global cognition and verbal semantic fluency at end of treatment, and these benefits appear to be maintained in the medium term. Our certainty in relation to many of these findings is low or very low. Future studies should take stronger measures to mitigate well-established risks of bias, and should provide long-term follow-up to improve our understanding of the extent to which observed gains are retained. Future trials should also focus on direct comparison of CT versus alternative treatments rather than passive or active control conditions.
Conflict of interest statement
Alex Bahar‐Fuchs: none known. Anthony Martyr: none known. Anita MY Goh: none known. Linda Clare: none known. Julieta Sabates: none known.
Figures
Study flow diagram.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Forest plot of comparison: 1 Cognitive training vs control immediately post intervention, outcome: 1.1 Change in a global measure of cognition (composite).
Funnel plot of comparison: 1 Cognitive training vs control immediately post intervention, outcome: 1.1 Change in a global measure of cognition (composite).
Forest plot of comparison: 3 Cognitive training vs alternative treatment immediately post intervention, outcome: 3.1 Change in a global measure of cognition (composite).
Forest plot of comparison: 1 Cognitive training vs control immediately post intervention, outcome: 1.3 Change in a global measure of cognition.
Forest plot of comparison: 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), outcome: 2.5 Change in disease progression.
Forest plot of comparison: 1 Cognitive training vs control immediately post intervention, outcome: 1.6 Change in delayed memory.
Forest plot of comparison: 6 Cognitive training vs control immediately post intervention ‐ intervention dose, outcome: 6.9 Change in verbal letter fluency.
Forest plot of comparison: 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), outcome: 9.12 Change in verbal category fluency.
Forest plot of comparison: 1 Cognitive training vs control immediately post intervention, outcome: 1.16 Change in participants' mood.
Forest plot of comparison: 1 Cognitive training vs control immediately post intervention, outcome: 1.17 Change in capacity for activities of daily living.
Forest plot of comparison: 1 Cognitive training vs control immediately post intervention, outcome: 1.20 Participant burden (retention rates).
Forest plot of comparison: 1 Cognitive training vs control immediately post intervention, outcome: 1.23 Change in mood and well‐being (CAREGIVER).
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 1 Change in a global measure of cognition (composite).
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 2 Change in a global measure of cognition (composite)_zero correlation.
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 3 Change in a global measure of cognition.
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 4 Change in a global measure of cognition_zero correlation.
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 5 Change in disease progression.
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 6 Change in delayed memory.
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 7 Change in immediate memory.
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 8 Change in attention and working memory.
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 9 Change in language (naming).
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 10 Change in verbal letter fluency.
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 11 Change in verbal category fluency.
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 12 Change in executive function.
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 13 Change in speed of information processing.
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 14 Change in meta cognition (self‐reported).
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 15 Change in meta cognition (informant‐reported).
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 16 Change in participants' mood.
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 17 Change in capacity for activities of daily living.
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 18 Change in general health and quality of life.
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 19 Change in behavioural and psychological symptoms of dementia (BPSD).
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 20 Participant burden (retention rates).
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 21 Change in burden of care (CAREGIVER).
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 22 Change in quality of life (CAREGIVER).
Comparison 1 Cognitive training vs control immediately post intervention, Outcome 23 Change in mood and well‐being (CAREGIVER).
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 1 Change in a global measure of cognition (composite).
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 2 Change in a global measure of cognition (composite)_zero correlation.
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 3 Change in a global measure of cognition.
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 4 Change in a global measure of cognition (zero correlation).
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 5 Change in disease progression.
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 6 Change in disease progression (zero correlation).
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 7 Change in delayed memory.
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 8 Change in immediate memory.
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 9 Change in attention and working memory.
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 10 Change in language (naming).
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 11 Change in verbal letter fluency.
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 12 Change in verbal category fluency.
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 13 Change in executive function.
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 14 Change in speed of information processing.
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 15 Change in meta cognition (self‐reported).
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 16 Change in meta cognition (informant‐reported).
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 17 Change in participants' mood.
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 18 Change in capacity for activities of daily living.
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 19 Change in general health and quality of life.
Comparison 2 Cognitive training vs control in the medium term (3 to 12 months post intervention), Outcome 20 Change in behavioural and psychological symptoms of dementia (BPSD).
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 1 Change in a global measure of cognition (composite).
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 2 Change in a global measure of cognition (composite)_zero correlation.
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 3 Change in a global measure of cognition.
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 4 Change in a global measure of cognition_zero correlation.
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 5 Change in disease progression.
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 6 Change in delayed memory.
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 7 Change in immediate memory.
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 8 Change in attention and working memory.
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 9 Change in language (naming).
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 10 Change in verbal letter fluency.
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 11 Change in verbal category fluency.
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 12 Change in executive function.
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 13 Change in speed of information processing.
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 16 Change in participants' mood.
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 17 Change in capacity for activities of daily living.
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 18 Change in general health and quality of life.
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 19 Change in behavioural and psychological symptoms of dementia (BPSD).
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 20 Participant burden (retention rates).
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 21 Change in burden of care (CAREGIVER).
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 22 Change in quality of life (CAREGIVER).
Comparison 3 Cognitive training vs alternative treatment immediately post intervention, Outcome 23 Change in mood and well‐being (CAREGIVER).
Comparison 4 Cognitive training vs alternative treatment in the medium term (3 to 12 months post intervention), Outcome 1 Change in a global measure of cognition (composite).
Comparison 4 Cognitive training vs alternative treatment in the medium term (3 to 12 months post intervention), Outcome 2 Change in a global measure of cognition (composite)_zero correlation.
Comparison 4 Cognitive training vs alternative treatment in the medium term (3 to 12 months post intervention), Outcome 3 Change in a global measure of cognition.
Comparison 4 Cognitive training vs alternative treatment in the medium term (3 to 12 months post intervention), Outcome 6 Change in delayed memory.
Comparison 4 Cognitive training vs alternative treatment in the medium term (3 to 12 months post intervention), Outcome 7 Change in immediate memory.
Comparison 4 Cognitive training vs alternative treatment in the medium term (3 to 12 months post intervention), Outcome 8 Change in attention and working memory.
Comparison 4 Cognitive training vs alternative treatment in the medium term (3 to 12 months post intervention), Outcome 9 Change in language (naming).
Comparison 4 Cognitive training vs alternative treatment in the medium term (3 to 12 months post intervention), Outcome 10 Change in verbal letter fluency.
Comparison 4 Cognitive training vs alternative treatment in the medium term (3 to 12 months post intervention), Outcome 11 Change in verbal category fluency.
Comparison 4 Cognitive training vs alternative treatment in the medium term (3 to 12 months post intervention), Outcome 12 Change in executive function.
Comparison 4 Cognitive training vs alternative treatment in the medium term (3 to 12 months post intervention), Outcome 13 Change in speed of information processing.
Comparison 4 Cognitive training vs alternative treatment in the medium term (3 to 12 months post intervention), Outcome 16 Change in participants' mood.
Comparison 4 Cognitive training vs alternative treatment in the medium term (3 to 12 months post intervention), Outcome 18 Change in general health and quality of life.
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 1 Change in a global measure of cognition.
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 2 Change in a global measure of cognition_zero correlation.
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 3 Change in a global measure of cognition (composite).
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 4 Change in a global measure of cognition (composite)_zero correlation.
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 5 Change in immediate memory.
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 6 Change in delayed memory.
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 7 Change in attention and working memory.
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 8 Change in language (naming).
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 9 Change in verbal letter fluency.
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 10 Change in speed of information processing.
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 11 Change in executive function.
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 12 Change in verbal category fluency.
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 13 Change in meta cognition (self‐reported).
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 14 Change in meta cognition (informant‐reported).
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 15 Change in participants' mood.
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 16 Change in capacity for activities of daily living.
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 17 Change in general health and quality of life.
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 18 Change in behavioural and psychological symptoms of dementia (BPSD).
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 19 Change in disease progression.
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 20 Change in burden of care (CAREGIVER).
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 21 Change in quality of life (CAREGIVER).
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 22 Change in mood and well‐being (CAREGIVER).
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 23 Participant burden (retention rates).
Comparison 5 Cognitive training vs control immediately post intervention ‐ risk of bias, Outcome 24 Change in general health and quality of life.
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 1 Change in a global measure of cognition.
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 2 Change in a global measure of cognition_zero correlation.
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 3 Change in a global measure of cognition (composite).
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 4 Change in a global measure of cognition (composite)_zero correlation.
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 5 Change in immediate memory.
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 6 Change in delayed memory.
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 7 Change in attention and working memory.
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 8 Change in language (naming).
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 9 Change in verbal letter fluency.
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 10 Change in speed of information processing.
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 11 Change in executive function.
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 12 Change in verbal category fluency.
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 13 Change in meta cognition (self‐reported).
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 14 Change in meta cognition (informant‐reported).
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 15 Change in participants' mood.
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 16 Change in capacity for activities of daily living.
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 17 Change in disease progression.
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 18 Change in behavioural and psychological symptoms of dementia (BPSD).
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 19 Change in attention and working memory.
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 20 Change in burden of care (CAREGIVER).
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 21 Change in quality of life (CAREGIVER).
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 22 Change in mood and well‐being (CAREGIVER).
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 23 Participant burden (retention rates).
Comparison 6 Cognitive training vs control immediately post intervention ‐ intervention dose, Outcome 24 Change in general health and quality of life.
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 1 Change in a global measure of cognition.
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 2 Change in a global measure of cognition_zero correlation.
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 3 Change in a global measure of cognition (composite).
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 4 Change in a global measure of cognition (composite)_zero correlation.
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 5 Change in immediate memory.
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 6 Change in delayed memory.
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 7 Change in attention and working memory.
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 8 Change in language (naming).
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 9 Change in verbal letter fluency.
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 10 Change in speed of information processing.
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 11 Change in executive function.
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 12 Change in verbal category fluency.
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 13 Change in meta cognition (self‐reported).
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 14 Change in meta cognition (informant‐reported).
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 15 Change in participants' mood.
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 16 Change in capacity for activities of daily living.
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 17 Change in disease progression.
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 18 Change in behavioural and psychological symptoms of dementia (BPSD).
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 19 Participant burden (retention rates).
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 20 Change in burden of care (CAREGIVER).
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 21 Change in quality of life (CAREGIVER).
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 22 Change in mood and well‐being (CAREGIVER).
Comparison 7 Cognitive training vs control immediately post intervention ‐ intervention duration, Outcome 23 Change in general health and quality of life.
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 1 Change in a global measure of cognition.
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 2 Change in a global measure of cognition_zero correlation.
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 3 Change in a global measure of cognition (composite).
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 4 Change in a global measure of cognition (composite)_zero correlation.
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 5 Change in immediate memory.
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 6 Change in delayed memory.
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 7 Change in attention and working memory.
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 8 Change in language (naming).
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 9 Change in verbal letter fluency.
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 10 Change in speed of information processing.
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 11 Change in executive function.
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 12 Change in verbal category fluency.
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 13 Change in meta cognition (self‐reported).
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 14 Change in meta cognition (informant‐reported).
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 15 Change in participants' mood.
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 16 Change in capacity for activities of daily living.
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 17 Change in disease progression.
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 18 Change in behavioural and psychological symptoms of dementia (BPSD).
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 19 Participant burden (retention rates).
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 20 Change in burden of care (CAREGIVER).
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 21 Change in quality of life (CAREGIVER).
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 22 Change in mood and well‐being (CAREGIVER).
Comparison 8 Cognitive training vs control immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 23 Change in general health and quality of life.
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 1 Change in a global measure of cognition.
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 2 Change in a global measure of cognition_zero correlation.
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 3 Change in a global measure of cognition (composite).
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 4 Change in a global measure of cognition (composite)_zero correlation.
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 5 Change in immediate memory.
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 6 Change in delayed memory.
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 7 Change in attention and working memory.
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 8 Change in language (naming).
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 9 Change in verbal letter fluency.
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 10 Change in speed of information processing.
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 11 Change in executive function.
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 12 Change in verbal category fluency.
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 13 Change in meta cognition (self‐reported).
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 14 Change in meta cognition (informant‐reported).
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 15 Change in participants' mood.
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 16 Change in capacity for activities of daily living.
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 17 Change in disease progression.
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 18 Change in behavioural and psychological symptoms of dementia (BPSD).
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 19 Participant burden (retention rates).
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 20 Change in burden of care (CAREGIVER).
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 21 Change in quality of life (CAREGIVER).
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 22 Change in mood and well‐being (CAREGIVER).
Comparison 9 Cognitive training vs control immediately post intervention ‐ type of CT (multi‐domain vs single domain), Outcome 23 Change in general health and quality of life.
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 1 Change in a global measure of cognition.
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 2 Change in a global measure of cognition_zero correlation.
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 3 Change in a global measure of cognition (composite).
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 4 Change in a global measure of cognition (composite)_zero correlation.
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 5 Change in immediate memory.
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 6 Change in delayed memory.
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 7 Change in attention and working memory.
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 8 Change in language (naming).
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 9 Change in verbal letter fluency.
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 10 Change in speed of information processing.
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 11 Change in executive function.
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 12 Change in verbal category fluency.
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 13 Change in meta cognition (self‐reported).
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 14 Change in meta cognition (informant‐reported).
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 15 Change in participants' mood.
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 16 Change in capacity for activities of daily living.
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 17 Change in disease progression.
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 18 Change in behavioural and psychological symptoms of dementia (BPSD).
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 19 Participant burden (retention rates).
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 20 Change in burden of care (CAREGIVER).
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 21 Change in quality of life (CAREGIVER).
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 22 Change in mood and well‐being (CAREGIVER).
Comparison 10 Cognitive training vs control immediately post intervention ‐ type of control (passive vs active), Outcome 23 Change in general health and quality of life.
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 1 Change in a global measure of cognition.
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 2 Change in a global measure of cognition_zero correlation.
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 3 Change in a global measure of cognition (composite).
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 4 Change in a global measure of cognition (composite)_zero correlation.
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 5 Change in immediate memory.
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 6 Change in delayed memory.
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 7 Change in attention and working memory.
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 8 Change in language (naming).
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 9 Change in verbal letter fluency.
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 10 Change in verbal category fluency.
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 11 Change in executive function.
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 14 Change in participants' mood.
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 15 Change in capacity for activities of daily living.
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 16 Change in behavioural and psychological symptoms of dementia (BPSD).
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 17 Change in disease progression.
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 18 Participant burden (retention rates).
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 19 Change in mood and well‐being (CAREGIVER).
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 20 Change in burden of care (CAREGIVER).
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 21 Change in quality of life (CAREGIVER).
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 22 Change in speed of information processing.
Comparison 11 Cognitive training vs alternative treatment immediately post intervention ‐ intervention dose, Outcome 23 Change in general health and quality of life.
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 1 Change in a global measure of cognition.
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 2 Change in a global measure of cognition_zero correlation.
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 3 Change in a global measure of cognition (composite).
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 4 Change in a global measure of cognition (composite)_zero correlation.
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 5 Change in immediate memory.
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 6 Change in delayed memory.
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 7 Change in attention and working memory.
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 8 Change in language (naming).
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 9 Change in verbal letter fluency.
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 10 Change in verbal category fluency.
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 11 Change in executive function.
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 14 Change in participants' mood.
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 15 Change in capacity for activities of daily living.
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 16 Change in behavioural and psychological symptoms of dementia (BPSD).
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 17 Change in disease progression.
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 18 Participant burden (retention rates).
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 19 Change in mood and well‐being (CAREGIVER).
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 20 Change in burden of care (CAREGIVER).
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 21 Change in quality of life (CAREGIVER).
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 22 Change in speed of information processing.
Comparison 12 Cognitive training vs alternative treatment immediately post intervention ‐ type of CT (traditional vs augmented), Outcome 23 Change in general health and quality of life.
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 1 Change in a global measure of cognition.
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 2 Change in a global measure of cognition (zero correlation).
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 3 Change in a global measure of cognition (composite).
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 4 Change in a global measure of cognition (composite)_zero correlation.
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 5 Change in disease progression (zero correlation).
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 6 Change in disease progression.
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 7 Change in immediate memory.
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 8 Change in delayed memory.
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 9 Change in language (naming).
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 10 Change in verbal letter fluency.
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 11 Change in verbal category fluency.
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 12 Change in attention and working memory.
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 13 Change in speed of information processing.
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 14 Change in meta cognition (self‐reported).
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 15 Change in meta cognition (informant‐reported).
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 16 Change in capacity for activities of daily living.
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 17 Change in behavioural and psychological symptoms of dementia (BPSD).
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 18 Change in general health and quality of life.
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 19 Change in participants' mood.
Comparison 13 Cognitive training vs control in the medium term (3 to 12 months post intervention) ‐ follow‐up period, Outcome 23 Change in executive function.
Update of
- doi: 10.1002/14651858.CD013069
References
References to studies included in this review
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Beck 1988 {published data only}
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Kallio 2018 {published and unpublished data}
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Kao 2016 {published data only (unpublished sought but not used)}
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Lee 2013 {published data only}
Mapelli 2013 {published data only (unpublished sought but not used)}
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Burgener 2009 {published data only}
Buschert 2011 {published data only}
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Ceccato 2012 {published data only}
Chapman 2004 {published data only}
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Choi 2012 {published data only}
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Cipriani 2006 {published data only}
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Clare 2013 {published data only}
Contador 2016 {published data only}
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Costa 2015 {published data only}
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Danassi 2015 {published data only}
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Dwolatzky 2014 {published data only}
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Eckroth‐Bucher 2009 {published data only}
Edwards 2013 {published data only}
Faggian 2007 {published data only}
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Fane 2013 {published data only}
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Farina 2002 {published data only}
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Farina 2006 {published data only}
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Fernández‐Calvo 2015 {published data only}
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Fisher 2016 {published data only}
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Gaitan 2013 {published data only}
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- Gaitan A, Garolera M, Cerulla N, Chico G, Rodriguez‐Querol, Canela‐Soler J. Efficacy of an adjunctive computer‐based cognitive training program in amnestic mild cognitive impairment and Alzheimer's disease: a single‐blind, randomized clinical trial. International Journal of Geriatric Psychiatry 2013;28(1):91‐9. - PubMed
Giordano 2010 {published data only}
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Graessel 2011 {published data only}
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Han 2017 {published data only}
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Helcer 2012 {published data only}
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Hochhalter 2004 {published data only}
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