Original Title: Efectividad del entrenamiento cognitivo en pacientes con demencia moderada y grave

Authors' objectives: To assess the effectiveness of cognitive training in adult patients with a diagnosis of dementia and a mild-moderate level of severity.

Authors' results and conclusions: 18 trials were included with a total of 1483 patients, published between 1993 and 2018 and conducted in 11 countries in the world. With the exception of 1 cross-over trial, the rest of the trials were designed in parallel-groups. The mean age of participants was between 65.9 and 86.0 years and had received a mean between 4.3 and 12.5 years of education. The duration of the cognitive training sessions ranged from 4 to 96 weeks. As a result, we found that cognitive training compared to a control group, at end of treatment, may have large positive effects on global cognitive ability (Standardised mean difference-SMD-: 0.92; 95% CI 95% 0.35 to 1.48) and on specific subdomains such as delayed memory and language, as well as a more discrete positive effect on semantic fluency of patients with mild-moderate dementia (low-quality evidence). Likewise, we found moderate-quality evidence showing that cognitive training probably has a moderate positive effect on the immediate memory of these patients (SMD: 0.69, 95% CI 0.42 to 0.97). This positive effect seems to be maintained in the medium term (3 to 12 months post treatment) for domains such as verbal fluency (moderate-quality evidence). Cognitive training may also be associated with a significant slower clinical progression of dementia and a more discrete decrease in the caregiver's burden immediately after treatment (low-quality evidence). We found no evidence of a significant effect of cognitive training on functional capacity, quality of life or behavioural symptoms at end of treatment or in the medium term. Future studies with rigorous methods that minimize the risks of bias and provide longer-term follow-up are needed.

Authors' methods: To identify relevant studies, we developed specific search strategies and consulted the following electronic databases: Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform and ClinicalTrials.gov. We included randomized controlled trials, published in any language, which analyzed the effect of cognitive training on cognitive and non-cognitive outcomes in people diagnosed with mild-moderate dementia versus a control intervention. Two independent reviewers carried out the study selection and the extraction of the relevant data and assessed the risk of bias using the Cochrane Collaboration's Risk of Bias tool for clinical trials. We performed a meta-analysis of the effects of treatment using a random-effects model, estimated statistical heterogeneity and performed subgroup analyses to explore possible factors that could explain it. The GradePro tool was used to assess the quality of the evidence.

Project Status: Completed

Year Published: 2020

URL for published report: https://www.aetsa.org/publicacion/efectividad-del-entrenamiento-cognitivo-en-pacientes-con-demencia-moderada-y-grave/

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Spain

Organisation Name: Andalusian Health Technology Assessment Area

Contact Address: Area de Evaluacion de Tecnologias Sanitarias Sanitarias de Andalucia (AETSA) Avda. Innovación, s/n Edificio Arena 1. Sevilla (Spain) Tel. +34 955 006 309

Contact Name: aetsa.csalud@juntadeandalucia.es

Contact Email: aetsa.csalud@juntadeandalucia.es

Copyright: Andalusian Agency for Health Technology Assessment (AETSA)