Do cognitive interventions improve general cognition in dementia? A meta-analysis and meta-regression
Resource type
Journal Article
Authors/contributors
- Huntley, J. D. (Author)
- Gould, R. L. (Author)
- Liu, K. (Author)
- Smith, M. (Author)
- Howard, R. J. (Author)
Title
Do cognitive interventions improve general cognition in dementia? A meta-analysis and meta-regression
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 0.29 to 0.69; p<0.001) compared to non-active controls and (g=0.35, 95% CI 0.06 to 0.65; 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.
Publication
BMJ Open
Volume
5
Issue
4
Pages
e005247
Date
2015/04/01
Language
en
ISSN
2044-6055, 2044-6055
Short Title
Do cognitive interventions improve general cognition in dementia?
Accessed
02/11/2023, 22:10
Library Catalogue
Rights
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Extra
Publisher: British Medical Journal Publishing Group
Section: Mental health
PMID: 25838501
Citation
Huntley, J. D., Gould, R. L., Liu, K., Smith, M., & Howard, R. J. (2015). Do cognitive interventions improve general cognition in dementia? A meta-analysis and meta-regression. BMJ Open, 5(4), e005247. https://doi.org/10.1136/bmjopen-2014-005247
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