Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Nov 1;25(6):727-736.
doi: 10.5152/alphapsychiatry.2024.241731. eCollection 2024 Nov.

Effectiveness of Cognitive Rehabilitation in Improving Symptoms and Restoring Cognitive Functions in Patients with Depression: An Updated Meta-Analysis of Randomized Controlled Trials

Lijun Liu  1 , Keqiang Wang  2 , Dongmei Xu  1 , Yuhong Wang  2 , Xiaomei Xu  2 , Qian Wang  1 , Xinfu Wang  2
Affiliations
Review

Effectiveness of Cognitive Rehabilitation in Improving Symptoms and Restoring Cognitive Functions in Patients with Depression: An Updated Meta-Analysis of Randomized Controlled Trials

Lijun Liu et al. Alpha Psychiatry. .

Abstract

Objective: Patients with depression often experience cognitive impairments. Cognitive rehabilitation, as an adjunctive intervention, may help to improve symptoms and restore functions in these patients. This study explores the effectiveness of cognitive rehabilitation in improving symptoms and restoring cognitive functions in patients with depression.

Methods: The following databases were systematically searched for relevant randomized controlled trials (RCTs): PubMed, Embase, and the Cochrane Central Register of Controlled Trials. Two reviewers independently screened the studies. The search was conducted from the inception of the databases to April 10, 2024. Standardized mean differences (SMDs) with 95% CIs, confidence interval were calculated using RevMan v. 5.3 software, and heterogeneity was assessed using Cochran's Q test and the I 2 statistic.

Results: A total of 14 RCTs involving 700 patients were included in this meta-analysis. Compared with the control group, there was no significant difference in the severity of depression after cognitive rehabilitation intervention, with a pooled SMD of -0.14 (95% CI: -0.32 to 0.05; P = .15; I2 = 30%). Among the 4 studies reporting attention-related data, cognitive rehabilitation significantly improved attention function in patients with depression compared with the control group, with an SMD of -0.63 (95% CI: -0.99 to -0.27; P < .001; I2 = 0%). In 6 studies, data showed significant improvement in verbal learning ability in patients with depression after cognitive rehabilitation intervention, with an SMD of -0.33 (95% CI: -0.60 to -0.05; P = .02; I2 = 48%). Executive function outcomes were reported in 6 studies, whereas working memory outcomes were reported in 7 studies, both before and after the intervention. No significant differences were observed between the groups, with SMDs of -0.45 (95% CI: -1.09 to 0.19; P = .17; I2 = 78%) in executive function and -0.38 (95% CI: -0.82 to 0.07; P = .10; I2 = 67%) in working memory post-intervention. Subgroup analysis suggested that cognitive rehabilitation training had a close to statistically significant improvement effect on depression severity in European regions, whereas no significant impact was observed in other regions.

Conclusion: Cognitive rehabilitation shows certain value in improving attention and verbal learning in patients with depression as an adjunctive treatment, but its effectiveness in improving depressive symptoms, executive function, and working memory remains inconclusive. Future large-sample RCTs are needed to further explore this aspect.

Keywords: Depression; cognitive function; executive function; meta-analysis.

PubMed Disclaimer

Conflict of interest statement

Declaration of Interests: The authors have no conflict of interest to declare.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram outlining the study selection procedure.
Figure 2.
Figure 2.
Evaluation of risk of bias of the included studies.
Figure 3.
Figure 3.
Forest plot of depressive symptom after cognitive rehabilitation. SD, Standard Deviation; CI, Confidence Interval.
Figure 4.
Figure 4.
Funnel plot of analyses of depressive symptoms.
Figure 5.
Figure 5.
Forest plots of secondary outcomes after cognitive rehabilitation. (A) attention; (B) executive function; (C) verbal learning; (D) working memory.
Figure 6.
Figure 6.
Funnel plots of analyses of secondary outcomes. (A) attention; (B) executive function; (C) verbal learning; (D) working memory.
Supplementary Figure 1.
Supplementary Figure 1.
The forest plots of secondary outcomes after cognitive rehabilitation. SMD, Standard mean difference.
See this image and copyright information in PMC

References

    1. COVID-19 Mental Disorders Collaborators. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet. 2021;398(10312):1700 1712. (10.1016/S0140-6736(21)02143-7) - DOI - PMC - PubMed
    1. Lu J, Xu X, Huang Y, et al. Prevalence of depressive disorders and treatment in China: a cross-sectional epidemiological study. Lancet Psychiatry. 2021;8(11):981 990. (10.1016/S2215-0366(21)00251-0) - DOI - PubMed
    1. McIntyre RS, Zimmerman M, Goldberg JF, First MB. Differential diagnosis of major depressive disorder versus bipolar disorder: current status and best clinical practices. J Clin Psychiatry. 2019;80(3):ot18043ah2. (10.4088/JCP.ot18043ah2) - DOI - PubMed
    1. Pan Z, Park C, Brietzke E, et al. Cognitive impairment in major depressive disorder. CNS Spectr. 2019;24(1):22 29. (10.1017/S1092852918001207) - DOI - PubMed
    1. Li Z, Ruan M, Chen J, Fang Y. Major depressive disorder: advances in neuroscience research and translational applications. Neurosci Bull. 2021;37(6):863 880. (10.1007/s12264-021-00638-3) - DOI - PMC - PubMed

LinkOut - more resources