The prevalence of individuals living with mild cognitive impairment (MCI), Alzheimer's disease (AD), and other forms of dementia is globally increasing. Four out of nine international clinical guidelines recommend non-pharmacological cognitive interventions to enhance cognition, independence, and wellbeing. However, the effectiveness of cognitive rehabilitation (CR) and cognitive training (CT) for individuals with MCI and AD and other forms of dementia is still debatable, often due to significant heterogeneity among studies.
Objective
This study aims to assess the effectiveness of CT and CR in these populations.
Methods
Following PRISMA guidelines, we conducted a comprehensive literature search across databases including OVID, MEDLINE, EMBASE, and Scopus, identifying randomized controlled trials and non-randomized pre-post intervention studies. The Bayesian meta-analysis focused on pre-post changes in global cognition, quality of life, everyday functioning, and depression, avoiding comparisons with control groups to reduce heterogeneity (PROSPERO: CRD42022365038).
Results
The search yielded 6075 results, with 40 studies meeting inclusion criteria, encompassing 50 independent trials. CT and people with AD and other dementias are the best represented intervention and population, respectively. CT was more effective in improving global cognition in individuals with AD and other dementias, and paper-and-pencil and face-to-face formats yielded greater benefits. The analysis showed a significant susceptibility to bias among the studies.
Conclusions
Limitations in outcome measure (e.g., MMSE) suggest the need for more sensitive assessments, especially for MCI. Future research should explore broader aspects of wellbeing and investigate the potential of CR. Policymakers are encouraged to consider these findings when designing cognitive interventions for this population.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association, 2013.
2.
DeCarliCMungasDHarveyD, et al.Memory impairment, but not cerebrovascular disease, predicts progression of MCI to dementia. Neurology2004; 63: 220–227.
3.
AlbertMSDeKoskySTDicksonD, et al.The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the national institute on aging-Alzheimer's association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement2011; 7: 270–279.
4.
PetersenRCRobertsROKnopmanDS, et al.Mild cognitive impairment: ten years later. Arch Neurol2009; 66: 1447–1455.
5.
PetersenRCLopezOArmstrongMJ, et al.Practice guideline update summary: mild cognitive impairment: report of the guideline development, dissemination, and implementation subcommittee of the American academy of neurology. Neurology2018; 90: 126–135.
6.
BaiWChenPCaiH, et al.Worldwide prevalence of mild cognitive impairment among community dwellers aged 50 years and older: a meta-analysis and systematic review of epidemiology studies. Age Ageing2022; 51: afac173.
7.
KingDFarinaNBurgonC, et al.Factors associated with change over time in quality of life of people with dementia: longitudinal analyses from the MODEM cohort study. BMC Geriatr2022; 22: 469.
8.
MartyrANelisSMQuinnC, et al.Living well with dementia: a systematic review and correlational meta-analysis of factors associated with quality of life, well-being and life satisfaction in people with dementia. Psychol Med2018; 48: 2130–2139.
9.
JekelKDamianMWattmoC, et al.Mild cognitive impairment and deficits in instrumental activities of daily living: a systematic review. Alzheimers Res Ther2015; 7: 17.
10.
DesaiRWhitfieldTSaidG, et al.Affective symptoms and risk of progression to mild cognitive impairment or dementia in subjective cognitive decline: a systematic review and meta-analysis. Ageing Res Rev2021; 71: 101419.
11.
ChenYXLiangNLiXL, et al.Diagnosis and treatment for mild cognitive impairment: a systematic review of clinical practice guidelines and consensus statements. Front Neurol2021; 12: 719849.
12.
ClareLWoodsRT. Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer’s disease: a review. Neuropsychol Rehabil2004; 14: 385–401.
13.
WoodsBRaiHKElliottE, et al.Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev2023; 1: CD005562.
14.
Bahar-FuchsAClareLWoodsB. Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer's disease and vascular dementia. Cochrane Database Syst Rev2013; 2013: CD003260.
15.
Bahar-FuchsAClareLWoodsB. Cognitive training and cognitive rehabilitation for persons with mild to moderate dementia of the Alzheimer's or vascular type: a review. Alzheimers Res Ther2013; 5: 35.
16.
HuntleyJDGouldRLLiuK, et al.Do cognitive interventions improve general cognition in dementia? A meta-analysis and meta-regression. BMJ Open2015; 5: e005247.
17.
TullianiNBissettMFaheyP, et al.Efficacy of cognitive remediation on activities of daily living in individuals with mild cognitive impairment or early-stage dementia: a systematic review and meta-analysis. Syst Rev2022; 11: 156.
18.
LivingstonGSommerladAOrgetaV, et al.Dementia prevention, intervention, and care. Lancet2017; 390: 2673–2734.
19.
SikkesSATangYJuttenRJ, et al.Toward a theory-based specification of non-pharmacological treatments in aging and dementia: focused reviews and methodological recommendations. Alzheimers Dement2021; 17: 255–270.
20.
HeWWangMJiangL, et al.Cognitive interventions for mild cognitive impairment and dementia: an overview of systematic reviews. Complement Ther Med2019; 47: 102199.
21.
García-CasalJALoizeauACsipkeE, et al.Computer-based cognitive interventions for people living with dementia: a systematic literature review and meta-analysis. Aging Ment Health2017; 21: 454–467.
22.
KallioELÖhmanHKautiainenH, et al.Cognitive training interventions for patients with Alzheimer’s disease: a systematic review. J Alzheimers Dis2017; 56: 1349–1372.
23.
McDermottOCharlesworthGHogervorstE, et al.Psychosocial interventions for people with dementia: a synthesis of systematic reviews. Aging Ment Health2019; 23: 393–403.
24.
GiraudeauBCailleAEldridgeSM, et al.Heterogeneity in pragmatic randomised trials: sources and management. BMC Med2022; 20: 372.
25.
DomenicucciRFerrandesFSarloM, et al.Efficacy of ICT-based interventions in improving psychological outcomes among older adults with MCI and dementia: a systematic review and meta-analysis. Ageing Res Rev2022; 82: 101781.
26.
FadzilNHMShaharSRajikanR, et al.A scoping review for usage of telerehabilitation among older adults with mild cognitive impairment or cognitive frailty. Int J Environ Res Public Health2022; 19: 4000.
27.
AlaimoCCampanaEStoppelliMR, et al.Cognitive tele-enhancement in healthy older adults and subjects with subjective memory complaints: a review. Front Neurol2021; 12: 650553.
28.
JeongJHNaHRChoiSH, et al.Group-and home-based cognitive intervention for patients with mild cognitive impairment: a randomized controlled trial. Psychother Psychosom2016; 85: 198–207.
29.
CotelliMManentiRBrambillaM, et al.Cognitive telerehabilitation in mild cognitive impairment, Alzheimer’s disease and frontotemporal dementia: a systematic review. J Telemed Telecare2019; 25: 67–79.
30.
PageMJMcKenzieJEBossuytPM, et al.The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ2021; 372: n71.
31.
PageMJMoherDBossuytPM, et al.PRISMA 2020 Explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ2021; 372: n160.
32.
McGowanJSampsonMSalzwedelDM, et al.PRESS Peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol2016; 75: 40–46.
BartošFGronauQFTimmersB, et al.Bayesian model-averaged meta-analysis in medicine. Stat Med2021; 40: 6743–6761.
35.
GronauQFHeckDWBerkhoutSW, et al.A primer on Bayesian model-averaged meta-analysis. Adv Methods Pract Psychol Sci2021; 4: 251524592110312.
36.
AltmanDGBlandJM. Statistics notes: absence of evidence is not evidence of absence. BMJ1995; 311: 485.
37.
KelterR. Bayesian Alternatives to null hypothesis significance testing in biomedical research: a non-technical introduction to Bayesian inference with JASP. BMC Med Res Methodol2020; 20: 142.
38.
CohenJ. Statistical Power Analysis for the Behavioral Sciences. New York: Routledge, 1995.
39.
JASP Team. JASP (Version 0.17.2). 2023.
40.
HeckDWGronauQFWagenmakersEJ. metaBMA: Bayesian Model Averaging for Random and Fixed Effects Meta-Analysis, Version 0.6.7. JASP Team, 2019.
41.
AmievaHRobertPHGrandoulierAS, et al.Group and individual cognitive therapies in Alzheimer’s disease: the ETNA3 randomized trial. Int Psychogeriatr2016; 28: 707–717.
42.
AmjadIToorHNiaziIK, et al.Xbox 360 kinect cognitive games improve slowness, complexity of EEG, and cognitive functions in subjects with mild cognitive impairment: a randomized control trial. Games Health J2019; 8: 144–152.
43.
Bahar-FuchsAWebbSBartschL, et al.Tailored and adaptive computerized cognitive training in older adults at risk for dementia: a randomized controlled trial. J Alzheimers Dis2017; 60: 889–911.
44.
BarekatainMAlaviradMTavakoliM, et al.Cognitive rehabilitation in patients with nonamnestic mild cognitive impairment. J Res Med Sci2016; 21: 101.
45.
BarnesDEYaffeKBelforN, et al.Computer-based cognitive training for mild cognitive impairment: results from a pilot randomized, controlled trial. Alzheimer Dis Assoc Disord2009; 23: 205–210.
46.
BergamaschiSArcaraGCalzaA, et al.One-year repeated cycles of cognitive training (CT) for Alzheimer’s disease. Aging Clin Exp Res2013; 25: 421–426.
47.
BrueggenKKasperEOchmannS, et al.Cognitive rehabilitation in Alzheimer’s disease: a controlled intervention trial. J Alzheimers Dis2017; 57: 1315–1324.
48.
ByeonH. The effects of computer-based cognitive rehabilitation program (CoTras) on the verbal fluency of Korean patients with mild dementia. Indian J Public Health Res Dev2018; 9: 1033–1040.
49.
CavalloMHunterEMVan Der HieleK, et al.Computerized structured cognitive training in patients affected by early-stage Alzheimer’s disease is feasible and effective: a randomized controlled study. Arch Clin Neuropsychol2016; 31: 868–876.
50.
CiprianiGBianchettiATrabucchiM. Outcomes of a computer-based cognitive rehabilitation program on Alzheimer’s disease patients compared with those on patients affected by mild cognitive impairment. Arch Gerontol Geriatr2006; 43: 327–335.
51.
ClareLKudlickaAOyebodeJR, et al.Individual goal-oriented cognitive rehabilitation to improve everyday functioning for people with early-stage dementia: a multicentre randomised controlled trial (the GREAT trial). Int J Geriatr Psychiatry2019; 34: 709–721.
52.
De LucaRBramantiADe ColaMC, et al.Cognitive training for patients with dementia living in a Sicilian nursing home: a novel web-based approach. Neurol Sci2016; 37: 1685–1691.
53.
DuffKYingJSuhrieKR, et al.Computerized cognitive training in amnestic mild cognitive impairment: a randomized clinical trial. J Geriatr Psychiatry Neurol2022; 35: 400–409.
54.
GermainSWojtasikVLekeuF, et al.Efficacy of cognitive rehabilitation in Alzheimer disease: a 1-year follow-up study. J Geriatr Psychiatry Neurol2019; 32: 16–23.
55.
GriffinAO’GormanARobinsonD, et al.The impact of an occupational therapy group cognitive rehabilitation program for people with dementia. Aust Occup Ther J2022; 69: 331–340.
56.
HanJWSonKLByunHJ, et al.Efficacy of the ubiquitous spaced retrieval-based memory advancement and rehabilitation training (USMART) program among patients with mild cognitive impairment: a randomized controlled crossover trial. Alzheimers Res Ther2017; 9: 39.
57.
HuntleyJDHampshireABorD, et al.Adaptive working memory strategy training in early Alzheimer’s disease: randomised controlled trial. Br J Psychiatry2017; 210: 61–66.
58.
HwangJ-HChaH-GChoY-S, et al.The effects of computer-assisted cognitive rehabilitation on Alzheimer’s dementia patients’ memories. J Phys Ther Sci2015; 27: 2921–2923.
59.
HyerLScottCAtkinsonMM, et al.Cognitive training program to improve working memory in older adults with MCI. Clin Gerontol2016; 39: 410–427.
60.
JelcicNCagninAMeneghelloF, et al.Effects of lexical-semantic treatment on memory in early Alzheimer disease: an observer-blinded randomized controlled trial. Neurorehabil Neural Repair2012; 26: 949–956.
61.
JelcicNAgostiniMMeneghelloF, et al.Feasibility and efficacy of cognitive telerehabilitation in early Alzheimer’s disease: a pilot study. Clin Interv Aging2014; 9: 1605–1611.
62.
KallioELÖhmanHHietanenM, et al.Effects of cognitive training on cognition and quality of life of older persons with dementia. J Am Geriatr Soc2018; 66: 664–670.
63.
KimS. Cognitive rehabilitation for elderly people with early-stage Alzheimer’s disease. J Phys Ther Sci2015; 27: 543–546.
64.
KurthSWojtasikVLekeuF, et al.Efficacy of cognitive rehabilitation versus usual treatment at home in patients with early stages of Alzheimer disease. J Geriatr Psychiatry Neurol2021; 34: 209–215.
65.
KurzAThöne-OttoACramerB, et al.CORDIAL: cognitive rehabilitation and cognitive-behavioral treatment for early dementia in Alzheimer disease. Alzheimer Dis Assoc Disord2012; 26: 246–253.
66.
LeeGYYipCCKYuECS, et al.Evaluation of a computer-assisted errorless learning-based memory training program for patients with early Alzheimer’s disease in Hong Kong: a pilot study. Clin Interv Aging2013; 8: 623–633.
67.
LiBYHeNYQiaoY, et al.Computerized cognitive training for Chinese mild cognitive impairment patients: a neuropsychological and fMRI study. Neuroimage Clin2019; 22: 101691.
68.
MaengSHongJPKimWH, et al.Effects of virtual reality-based cognitive training in the elderly with and without mild cognitive impairment. Psychiatry Investig2021; 18: 619–627.
69.
ManentiRGobbiEBaglioF, et al.Effectiveness of an innovative cognitive treatment and telerehabilitation on subjects with mild cognitive impairment: a multicenter, randomized, active-controlled study. Front Aging Neurosci2020; 12: 585988.
70.
MansbachWEMaceRAClarkKM. The efficacy of a computer-assisted cognitive rehabilitation program for patients with mild cognitive deficits: a pilot study. Exp Aging Res2017; 43: 94–104.
71.
ParkJHParkJH. Does cognition-specific computer training have better clinical outcomes than non-specific computer training? A single-blind, randomized controlled trial. Clin Rehabil2018; 32: 213–222.
72.
ParkJKimSEKimEJ, et al.Effect of 12-week home-based cognitive training on cognitive function and brain metabolism in patients with amnestic mild cognitive impairment. Clin Interv Aging2019; 14: 1167–1175.
73.
Arıca PolatBSKaradaO. Evaluation of a computer-based cognitive training program for early-stage Alzheimer’s disease. Ann Clin Anal Med2022; 13: 175–179.
74.
RojasGJVillarVIturryM, et al.Efficacy of a cognitive intervention program in patients with mild cognitive impairment. Int Psychogeriatr2013; 25: 825–831.
75.
ThapaNParkHJYangJG, et al.The effect of a virtual reality-based intervention program on cognition in older adults with mild cognitive impairment: a randomized control trial. J Clin Med2020; 9: 1283.
76.
TsantaliEEconomidisDRigopoulouS. Testing the benefits of cognitive training vs. Cognitive stimulation in mild Alzheimer’s disease: a randomised controlled trial. Brain Impairment2017; 18: 188–196.
77.
VaiaSIavaroneAMoschianoF, et al.Computer-aided cognitive training in patients with neurocognitive vascular impairment: effects on cognition, depression and behavior. J Gerontol Geriatr2022; 70: 99–104.
78.
VidovichMRLautenschlagerNTFlickerL, et al.The PACE study: a randomized clinical trial of cognitive activity strategy training for older people with mild cognitive impairment. Am J Geriatr Psychiatry2015; 23: 360–372.
79.
YangYKwakYT. Improvement of cognitive function after computer-based cognitive training in early stage of Alzheimer’s dementia. Dement Neurocogn Disord2017; 16: 7.
80.
McKhannGDrachmanDFolsteinM, et al.Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA working group under the auspices of department of health and human services task force on Alzheimer’ disease. Neurology1984; 34: 939–944.
81.
WinbladBPalmerKKivipeltoM, et al.Mild cognitive impairment beyond controversies, towards a consensus: report of the international working group on mild cognitive impairment. J Intern Med2004; 256: 240–246.
82.
American Psychiatric Association. The diagnostic and statistical manual of mental disorders. 4th edn. Washington, DC: American Psychiatric Association, 1994.
83.
World Health Association. International Classification of Diseases, Tenth Revision (ICD-10). Geneva: WHO, 1992.
84.
McKhannGMKnopmanDSChertkowH, et al.The diagnosis of dementia due to Alzheimer’s disease: recommendations from the national institute on aging-Alzheimer’s association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement2011; 7: 263–269.
85.
AndreescuCTeverovskyEFuB, et al.Old worries and new anxieties: behavioral symptoms and mild cognitive impairment in a population study. Am J Geriatr Psychiatry2014; 22: 274–284.
86.
PetersenRCDoodyRKurzA, et al.Current concepts in mild cognitive impairment. Arch Neurol2001; 58: 1985–1992.
87.
PetersenRC. Mild cognitive impairment as a diagnostic entity. J Intern Med2004; 256: 183–194.
PetersenRCAisenPBoeveBF, et al.Mild cognitive impairment due to Alzheimer disease in the community. Ann Neurol2013; 74: 199–208.
90.
BacigalupoIGiaquintoFSalviE, et al.A new national survey of centers for cognitive disorders and dementias in Italy. Neurol Sci2024; 45: 525–538.
91.
HuckansMHutsonLTwamleyE, et al.Efficacy of cognitive rehabilitation therapies for mild cognitive impairment (MCI) in older adults: working toward a theoretical model and evidence-based interventions. Neuropsychol Rev2013; 23: 63–80.
92.
JayadevappaRCookRChhatreS. Minimal important difference to infer changes in health-related quality of life—A systematic review. J Clin Epidemiol2017; 89: 188–198.
93.
GargDGuptaAAgarwalA, et al.Latest trends in outcome measures in dementia and mild cognitive impairment trials. Brain Sci2022; 12: 922.
94.
O’BryantSELacritzLHHallJ, et al.Validation of the new interpretive guidelines for the clinical dementia rating scale sum of boxes score in the national Alzheimer’s coordinating center database. Arch Neurol2010; 67: 746–749.
95.
ZhaoCSGaoLMengFM. The effect of cognitive training on cognitive function of elderly patients with mild cognitive impairment: a meta-analysis. Chin J Gerontol2018; 38: 5487–5492.
96.
MondiniSMadellaIZangrossiA, et al.Cognitive reserve in dementia: implications for cognitive training. Front Aging Neurosci2016; 8: 84.
97.
GiaquintoFTosiGAbbatantuonoC, et al.The indirect effect of cognitive reserve on the relationship between age and cognition in pathological ageing: a cross-sectional retrospective study in an unselected and consecutively enrolled sample. J Neuropsychol2023; 17: 477–490.
98.
KishitaNBackhouseTMioshiE. Nonpharmacological interventions to improve depression, anxiety, and quality of life (QoL) in people with dementia: an overview of systematic reviews. J Geriatr Psychiatry Neurol2023; 33: 28–41.
99.
KudlickaAMartyrABahar-FuchsA, et al.Cognitive rehabilitation for people with mild to moderate dementia. Cochrane Database Syst Rev2023; 6: CD013388.
100.
ChanJYChanTKKwokTC, et al.Cognitive training interventions and depression in mild cognitive impairment and dementia: a systematic review and meta-analysis of randomized controlled trials. Age Ageing2020; 49: 738–747.
101.
MajorGBagnallAMBharS, et al.A scoping review of the measurement of depression in older adults with cognitive impairment. Clin Gerontol2023; 46: 498–510.
102.
KokRMReynoldsCF. Management of depression in older adults: a review. JAMA2017; 317: 2114–2122.
103.
IrazokiEContreras-SomozaLMToribio-GuzmánJM, et al.Technologies for cognitive training and cognitive rehabilitation for people with mild cognitive impairment and dementia. A systematic review. Front Psychol2020; 11: 648.
104.
CaoQTanCCXuW, et al.The prevalence of dementia: a systematic review and meta-analysis. J Alzheimers Dis2020; 73: 1157–1166.
105.
WagenmakersEJMarsmanMJamilT, et al.Bayesian Inference for psychology. Part I: theoretical advantages and practical ramifications. Psychon Bull Rev2018; 25: 35–57.
106.
TosiGMentesanaBRomanoD. The correlation between proprioceptive drift and subjective embodiment during the rubber hand illusion: a meta-analytic approach. Q J Exp Psychol (Hove)2023; 76: 2197–2207.
107.
GiaquintoFBattistaPAngelelliP. Touchscreen cognitive tools for mild cognitive impairment and dementia used in primary care across diverse cultural and literacy populations: a systematic review. J Alzheimers Dis2022; 90: 1359–1380.
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