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F5‐02‐03: COGNITIVE TRAINING FOR OLDER ADULTS WITH DEMENTIA: AN UPDATED COCHRANE REVIEW
Author(s) -
Bahar-Fuchs Alex,
Martyr Anthony,
Goh Anita,
Clare Linda
Publication year - 2018
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2018.06.2974
Subject(s) - meta analysis , cognition , forest plot , medicine , randomized controlled trial , dementia , cognitive training , clinical trial , cognitive impairment , clinical psychology , psychiatry , disease
to compare training efficacy across methods, cognitive domains and populations. Methods: We performed four meta-analyses investigating the effects of CCT in healthy older adults, mild cognitive impairment (MCI), dementia and Parkinson’s disease. Analyses were performed for overall as well as domain-specific cognitive outcomes. A series of subgroup analyses and metaregression investigated heterogeneity across studies to examine the association between key design factors and effect sizes across populations, as well as within intervention and control groups. Results: Overall, 92 randomised controlled trials were included in the analyses. Overall efficacy was the greatest in MCI, driven by null effects within control groups. Control group effect sizes in other populations were small. Across all populations, effect sizes and their precision were comparable across active and passive-controlled studies. Supervised training and frequency not exceeding 3 times per week were associated with greater efficacy. Multidomain training was more efficacious on overall cognition than single-domain programs (e.g. working memory training). Combination of CCT with physical exercise was associated with greater effect sizes than CCT alone, but only when done simultaneously (e.g. exergaming) than consecutively. In contrast to moderate effect sizes on learning and memory, the effects on executive domains were small overall and mostly pronounced in trials of videogames and virtual reality. As expected, gains largely diminish after stopping training. Conclusions:The aggregate evidence makes a case for examining the long-term effectiveness of CCT on slowing cognitive decline, especially in MCI. Training appears to work best when based on combining drill-and-practice exercises with more novel approaches and targeting multiple domains simultaneously. Long-term head-to-head comparisons of combined intervention designs are key to guide clinical implementation in people at high dementia risk.