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The clinical significance of cognition-focused interventions for cognitively impaired older adults: a systematic review of randomized controlled trials

Published online by Cambridge University Press:  11 July 2011

Alexander F. Kurz ,
Stefan Leucht  and
Nicola T. Lautenschlager
Alexander F. Kurz*
Affiliation:
Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
Stefan Leucht
Affiliation:
Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
Nicola T. Lautenschlager
Affiliation:
Academic Unit for Psychiatry of Old Age, St. Vincent's Health, Department of Psychiatry, The University of Melbourne, St. George's Hospital, Melbourne, Australia School of Psychiatry and Clinical Neurosciences and WA Centre for Health & Ageing, The University of Western Australia, Perth, Australia
*
Correspondence should be addressed to: Alexander F. Kurz, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Moehlstrasse 26, D-81675, Munich, Germany. Phone: +49-89-4140-4285; Fax: +49-89-4140-4923. Email: [email protected].
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Abstract

Background: Cognitive stimulation, training or rehabilitation can achieve modest, skill-specific gains in cognitively healthy older adults. With regard to the limited efficacy of currently available anti-dementia drugs it is crucial to investigate whether such treatments also provide clinically meaningful benefits to cognitively impaired older individuals.

Methods: We conducted a systematic review of randomized controlled trials evaluating cognition-focused interventions in participants with mild cognitive impairment or dementia. Meta-analytic strategies were used to calculate effect sizes.

Results: Cognition-focused interventions confer small and inconsistent effects on trained cognitive skills which, according to some studies, translate into gains on general cognitive ability. Instruments measuring such effects such as the Mini-Mental State Examination (MMSE) or the Alzheimer's Disease Assessment Scale, cognitive part (ADAS-Cog) show standardized mean differences of 0.20 and 0.30, respectively, which are comparable with those of current antidementia drug treatments. However, convincing evidence of clinical significance was only obtained from single trials in terms of delay of cognitive decline, improvement in activities of daily living, or enhanced attainment of personally relevant goals.

Conclusions: The potential of cognition-focused interventions has probably been obscured by the methodological inconsistencies and limitations of the clinical studies conducted thus far. Further randomized controlled trials on the efficacy of these treatment modalities are required using optimized and consistent methods. Emphasis should be placed on tailoring interventions to individual needs and resources while maintaining a high level of standardization, on implementing newly acquired skills and strategies in the everyday context, on appropriate treatment duration, and on including person-centered outcomes.

Keywords

Alzheimer's diseasedementiamild cognitive impairmentcognitive stimulationcognitive trainingcognitive rehabilitationsystematic review
Type
Review Article
Information
International Psychogeriatrics , Volume 23 , Issue 9 , November 2011 , pp. 1364 - 1375
Copyright
Copyright © International Psychogeriatric Association 2011

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References

Acevedo, A. and Loewenstein, D. A. (2007). Nonpharmacological cognitive interventions in aging and dementia. Journal of Geriatric Psychiatry and Neurology, 20, 239–249.CrossRefGoogle ScholarPubMed
Bach, D., Bach, M., Böhmer, F., Frühwald, T. and Grilc, B. (1995). Reactivating occupational therapy: a method to improve cognitive performance in geriatric patients. Age and Ageing, 24, 222–226.CrossRefGoogle ScholarPubMed
Barnes, D. E. et al. (2009). Computer-based cognitive training for mild cognitive impairment: results from a pilot randomized, controlled trial. Alzheimer Disease and Associated Disorders, 23, 205–210.CrossRefGoogle ScholarPubMed
Blankevoort, C. G., van Heuvelen, M. J., Boersma, F., Luning, H., de Jong, J. and Scherder, E. J. (2010). Review of the effects of physical activity on strength, balance, mobility and ADL performance in elderly subjects with dementia. Dementia and Geriatric Cognitive Disorders, 30, 392–402.CrossRefGoogle ScholarPubMed
Borenstein, M., Hedges, L., Higgins, J. and Rothstein, H. (2006). Comprehensive Meta-analysis Version 2. Englewood NJ: Biostat Inc.Google Scholar
Bottino, C. M. C. et al. (2005). Cognitive rehabilitation combined with drug treatment in Alzheimer's disease patients: a pilot study. Clinical Rehabilitation, 19, 861–869.CrossRefGoogle ScholarPubMed
Buschert, V., Bokde, A. L. W. and Hampel, H. (2010). Cognitive intervention in Alzheimer disease. Nature Reviews Neurology, 6, 508–517.CrossRefGoogle ScholarPubMed
Cahn-Weiner, D. A., Malloy, P. F., Rebok, G. W. and Ott, B. R. (2003). Results of a randomized placebo-controlled study of memory training for mildly impaired Alzheimer's disease patients. Applied Neuropsychology, 10, 215–223.CrossRefGoogle ScholarPubMed
Chapman, S. B., Weiner, M. F., Rackley, A., Hynan, L. S. and Zientz, J. (2004). Effects of cognitive-communication stimulation for Alzheimer's disease patients treated with donepezil. Journal of Speech, Language and Hearing Research, 47, 1149–1163.CrossRefGoogle ScholarPubMed
Chin, J. J. (2008). Alzheimer's disease: towards more patient-centred and meaningful clinical outcomes. Annals of the Academy of Medicine Singapore, 37, 535–537.CrossRefGoogle ScholarPubMed
Clare, L. and Jones, R. S. P. (2008). Errorless learning in the rehabilitation of memory impairment: a critical review. Neuropsychology Review, 18, 1–23.CrossRefGoogle ScholarPubMed
Clare, L., Woods, R. T., Moniz-Cook, E. D., Orrell, M. and Spector, A. (2008). Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia. Cochrane Database Systematic Review, 4, CD003260.Google Scholar
Clare, L. et al. (2010). Goal-oriented cognitive rehabilitation for people with early-stage Alzheimer disease: a single-blind randomized controlled trial of clinical efficacy. American Journal of Geriatric Psychiatry, 18, 928–939.CrossRefGoogle ScholarPubMed
Cott, C. A., Dawson, P., Sidani, S. and Wells, D. (2002). The effects of a walking/talking program on communication, ambulation, and functional status in residents with Alzheimer disease. Alzheimer Disease and Associated Disorders, 16, 81–87.CrossRefGoogle ScholarPubMed
Davis, R. N., Massman, P. J. and Doody, R. S. (2001). Cognitive intervention in Alzheimer disease: a randomized placebo-controlled trial. Alzheimer Disease and Associated Disorders, 15, 1–9.CrossRefGoogle Scholar
De Vreese, L. P., Neri, M., Floravanti, M., Belloi, L. and Zanetti, O. (2001). Memory rehabilitation in Alzheimer's disease: a review of progress. Internationa Journal of Geriatric Psychiatry, 16, 794–809.CrossRefGoogle ScholarPubMed
DerSimonian, R. and Laird, N. (1986). Meta-analysis in clinical trials. Controlled Clinical Trials, 7, 177–188.CrossRefGoogle ScholarPubMed
Forbes, D., Forbes, S., Morgan, D. G., Markle-Reid, M., Wood, J. and Culum, L. (2008). Physical activity programs for persons with dementia. Cochrane Database Systematic Review, Issue 3. Art. No. CD006489.CrossRefGoogle Scholar
Galante, E., Venturini, G. and Fiaccadori, C. (2007). Computer-based cognitive intervention for dementia: preliminary results of a randomized clinical trial. Giornale Italiano di Medicina del Lavoro ed Ergonomia, 29, B26–32.Google ScholarPubMed
Gitlin, L. N., Winter, L., Burke, J., Chernett, N., Dennis, M. P. and Hauck, W. W. (2008). Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden: a randomized pilot study. American Journal of Geriatric Psychiatry, 16, 229–239.CrossRefGoogle ScholarPubMed
Grandmaison, E. and Simard, M. (2003). A critical review of memory stimulation programs in Alzheimer's disease. Journal of Neuropsychiatry and Clinical Neurosciences, 15, 130–144.CrossRefGoogle ScholarPubMed
Haight, B. K., Gibson, F. and Michel, Y. (2006). The Northern Ireland life review/life storybook project for people with dementia. Alzheimer's and Dementia, 2, 56–58.CrossRefGoogle ScholarPubMed
Hawley, K. S., Charry, K. E., Boudreaux, E. O. and Jackson, E. M. (2008). A comparison of adjusted spaced retrieval versus a uniform expanded retrieval schedule for learning a name-face association in older adults with probable Alzheimer's disease. Journal of Clinical and Experimental Neuropsychology, 30, 639–649.CrossRefGoogle ScholarPubMed
Heiss, W. D., Kessler, J., Mielke, R., Szelies, B. and Herholz, K. (1994). Long-term effects of phosphatidylserine, pyritinol and cognitive training in Alzheimer's disease: a neuropsychological, EEG, and PET investigation. Dementia, 5, 88–98.Google ScholarPubMed
Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (2009). Non-pharmacological Treatment of Alzheimer's Dementia. Report A05–19D. Cologne: Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen.Google Scholar
Jean, L., Bergeron, M. E., Thivierge, S. and Simard, M. (2010a). Cognitive intervention programs for individuals with mild cognitive impairment: systematic review of the literature. American Journal of Geriatric Psychiatry, 18, 281–296.CrossRefGoogle ScholarPubMed
Jean, L. et al. (2010b). Efficacy of a cognitive training programme for mild cognitive impairment: results of a randomised controlled study. Neuropsychological Rehabilitation, 20, 377–405.CrossRefGoogle ScholarPubMed
Kinsella, G. J. et al. (2009). Early intervention for mild cognitive impairment: A randomised controlled trial. Journal of Neurology, Neurosurgery and Psychiatry, 80, 730–736.CrossRefGoogle ScholarPubMed
Koltai, D. C., Welsh-Bohmer, K. A. and Schmechel, D. E. (2001). Influence of anosognosia on treatment outcome among dementia patients. Neuropsychological Rehabilitation, 11, 455–475.CrossRefGoogle Scholar
Lai, C. K. Y., Chi, I. and Kayser-Jones, J. (2004). A randomized controlled trial of a specific reminiscence approach to promote the well-being of nursing home residents with dementia. International Psychogeriatrics, 16, 33–49.CrossRefGoogle ScholarPubMed
Livingston, G., Johnson, K., Katona, C., Paton, J. and Lyketsos, C. G. (2005). Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia. American Journal of Psychiatry, 162, 1996–2021.CrossRefGoogle Scholar
Loewenstein, D. A., Acevedo, A., Czaja, S. J. and Duara, R. (2004). Cognitive rehabilitation of mildly impaired Alzheimer disease patients on cholinesterase inhibitors. American Journal of Geriatric Psychiatry, 12, 395–402.CrossRefGoogle ScholarPubMed
Molnar, F. J., Man Son Hing, M. and Fergusson, D. (2009). Systematic review of measures of clinical significance employed in randomized controlled trials of drugs for dementia. Journal of the American Geriatrics Society, 57, 536–546.CrossRefGoogle ScholarPubMed
Niu, Y. X., Tan, J. P., Guan, J. Q., Zhang, Z. Q. and Wang, L. N. (2010). Cognitive stimulation therapy in the treatment of neuropsychiatric symptoms in Alzheimer's disease: a randomized controlled trial. Clinical Rehabilitation, 24, 1102–1111.CrossRefGoogle ScholarPubMed
Olazarán, J. et al. (2004). Benefits of cognitive-motor intervention in MCI and mild to moderate Alzheimer disease. Neurology, 63, 2348–2353.CrossRefGoogle ScholarPubMed
Olazarán, J. et al. (2010). Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy. Dementia and Geriatric Cognitive Disorders, 30, 161–178.CrossRefGoogle ScholarPubMed
Onder, G. et al. (2005). Reality orientation therapy combined with cholinesterase inhibitors in Alzheimer's disease: randomised controlled trial. British Journal of Psychiatry, 187, 450–455.CrossRefGoogle ScholarPubMed
Onor, M. L., Trevisiol, M., Negro, C., Signorini, A., Saina, M. and Aguglia, E. (2007). Impact of a multimodal rehabilitative intervention on demented patients and their caregivers. American Journal of Alzheimer's Disease and Other Dementias, 22, 261–272.CrossRefGoogle ScholarPubMed
Qaseem, A. et al. (2008). Current pharmacologic treatment of dementia: a clinical pracice guideline from the American College of Physicians and the American Academy of Family Physicians. Annals of Internal Medicine, 148, 370–378.CrossRefGoogle Scholar
Quayhagen, M. P., Quayhagen, M., Corbeil, R. R., Roth, P. A. and Rodgers, J. A. (1995). A dyadic remediation program for care recipients with dementia. Nursing Research, 44, 153–159.CrossRefGoogle ScholarPubMed
Quayhagen, M. P. et al. (2000). Coping with dementia: evaluation of four nonpharmacologic interventions. International Psychogeriatrics, 12, 249–265.CrossRefGoogle ScholarPubMed
Rapp, S., Brenes, G. and Marsh, A. P. (2002). Memory enhancement training for older adults with mild cognitive impairment: a preliminary study. Aging and Mental Health, 6, 5–11.CrossRefGoogle ScholarPubMed
Raschetti, R., Albanese, E., Vanacore, N. and Maggini, M. (2007). Cholinesterase inhibitors in mild cognitive impairment: a systematic review of randomised trials. PLoS Medicine, 4, 1818–1828.CrossRefGoogle ScholarPubMed
Rockwood, K. (2004). Size of the treatment effect on cognition of cholinesterase inhibition in Alzheimer's disease. Journal of Neurology, Neurosurgery and Psychiatry, 75, 677–685.CrossRefGoogle ScholarPubMed
Royall, D. R., Lauterbach, E. C., Kaufer, D., Malloy, P., Coburn, K. L. and Black, K. J. (2007). The cognitive correlates of functional status: a review from the Committee on Research of the American Neuropsychiatric Association. Journal of Neuropsychiatry and Clinical Neuroscience, 19, 249–265.CrossRefGoogle Scholar
Rozzini, L., Costardi, D., Vicini-Chilovi, B., Franzoni, S., Trabucchi, M. and Padovani, A. (2006). Efficacy of cognitive rehabilitation in patients with mild cognitive impairment treated with cholinesterase inhibitors. International Journal of Geriatric Psychiatry, 21, 550–555.CrossRefGoogle Scholar
Sitzer, D. I., Twamley, E. W. and Jeste, D. V. (2006). Cognitive training in Alzheimer's disease: a meta-analysis of the literature. Acta Psychiatrica Scandinavica, 114, 75–90.CrossRefGoogle ScholarPubMed
Spector, A. et al. (2003). Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial. British Journal of Psychiatry, 183, 248–254.CrossRefGoogle ScholarPubMed
Tadaka, E. and Kanagawa, K. (2007). Effects of reminiscence group in elderly people with Alzheimer disease and vascular dementia in a community setting. Geriatrics and Gerontology International, 7, 167–173.CrossRefGoogle Scholar
Tappen, R. M., Roach, K. E., Brooks-Applegate, E. and Stowell, P. (2000). Effect of a combined walking and conversation intervention on functional mobility of nursing home residents with Alzheimer's disease. Alzheimer Disease and Associated Disorders, 14, 196–201.CrossRefGoogle Scholar
Tappen, R. M., Willians, C. L., Barry, C. and DiSesa, D. (2002). Conversation intervention with Alzheimer's patients: increasing the relevance of communication. Clinical Gerontology, 24, 63–75.CrossRefGoogle ScholarPubMed
Tárraga, L. et al. (2006). A randomised pilot study to assess the efficacy of an interative, multimedia tool of cognitive stimulation in Alzheimer's disease. Journal of Neurology, Neurosurgery and Psychiatry, 77, 1116–1121.CrossRefGoogle Scholar
Troyer, A. K., Murphy, K. J., Anderson, N. D., Moscovitch, M. and Craik, F. I. M. (2008). Changing everyday memory behaviour in amnestic mild cognitive impairment: A randomised controlled trial. Neuropsychological Rehabilitation, 18, 65–88.CrossRefGoogle ScholarPubMed
Tsolaki, M. et al. (2011). Effectiveness of nonpharmacological approaches in patients with mld cognitive impairment. Neurodegenerative Disorders, 8, 138–145.CrossRefGoogle Scholar
Wang, J. J. (2007). Group reminiscence therapy for cognitive and affective function of demented elderly in Taiwan. International Journal of Geriatric Psychiatry, 22, 1235–1240.CrossRefGoogle ScholarPubMed
Wang, J. J., Yen, M. and OuYang, W. C. (2008). Group reminiscence intervention in Taiwanese elders with dementia. Archives of Gerontology and Geriatrics, 49, 227–232.CrossRefGoogle ScholarPubMed
Werheid, K. and Thöne-Otto, A. (2006). Cognitive training in Alzheimer's dementia. Der Nervenarzt, 77, 549–557.CrossRefGoogle ScholarPubMed
Wilson, B. (2002). Toward a comprehensive model of cognitive rehabilitation.Neuropsychological Rehabilitation, 12, 92–110.CrossRefGoogle Scholar
Winblad, B. et al. (2004). Mild cognitive impairment: beyond controversies, towards a consensus. Report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240–246.CrossRefGoogle Scholar
Wolinsky, F. D. et al. (2010). Speed of processing training protects self-rated health in older adults: enduring effects observed in the multi-site ACTIVE randomized controlled trial. International Psychogeriatrics, 22, 470–478.CrossRefGoogle ScholarPubMed
Zarit, S. H., Zarit, J. M. and Reever, K. E. (1982). Memory training for severe memory loss: effects on senile dementia patients and their families. Gerontologist, 22, 373–377.CrossRefGoogle ScholarPubMed