Effectiveness of cognitive interventions on elderly patients with amnestic mild cognitive impairment: A meta-analysis

doi:10.3969/j.issn.1004-583X.2024.01.002

Abstract

Abstract:

Objective To systematically evaluate the effect of cognitive interventions on elderly patients with amnestic mild cognitive impairment (aMCI). Methods Randomized controlled trials (RCTs) reporting the effects of cognitive interventions on patients with aMCI published from 2005 to January 2023 were searched in the PubMed, Embase, Cumulative Index for Nursing and Allied Health Literature (CINAHL), The Cochrane Library, Web of Science, China Biomedical Literature Database, China National Knowledge Internet (CNKI), Wanfang and VIP Database. Two investigators were responsible for literature screening, data collection and quality assessment based on the RCT evaluation criteria in the Cochrane 5.1.0 manual. Meta-analysis was performed using Rev Man 5.4. Results A total of 10 eligible studies involving 671 cases were included. Meta-analysis results showed that after the intervention, patients in the cognitive intervention group had significantly better scores of the Mini-Mental State Examination (MMSE) ( $M D$ =1.99, 95% $C I$ 1.40, 2.58; $P$ <0.01), the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) and the Modified Alzheimer's Disease Assessment Scale-Cognitive Subscale (Modified-ADAS-Cog) ( $M D$ =-3.65, 95% $C I$ -4.89, -2.41; $P$ <0.01), the Contentment Subscale of the Multifactorial Memory Questionnaire (MMQ-Contentment) ( $M D$ =1.68, 95% $C I$ -2.24, 5.60; $P$ =0.40) and the Rivermead Behavioral Memory Test (RBMT) ( $M D$ =4.69, 95% $C I$ 3.41, 5.97; $P$ <0.01) than those of the control group. The Quality of Life in Alzheimer Disease (QOL-AD) score was significantly higher in the cognitive intervention group than that of control group ( $M D$ =1.79, 95% $C I$ 0.60, 2.97; $P$ =0.003). Conclusion The existing evidences have suggested that cognitive interventions may improve memory satisfaction, behavioral memory capacity and quality of survival, and delay the development of Alzheimer's disease in patients with aMCI. The effect of cognitive interventions on improving their cognitive function has been controversial possibly due to the small sample size, high rate of drop-out, and inconsistent baseline levels of cognitive function. Large-scale randomized controlled trials are needed to explore the function of cognitive interventions in Alzheimer's disease patients with aMCI.

Key words: amnestic mild cognitive impairment, cognitive rehabilitation, memory training, alzheimer's disease, meta-analysis

CLC Number:

R741

Xiao Huangyi, Yuan Jiankun, Yan Ziyu, Zeng Wenshu, Lu Lanmo, Wang Jun. Effectiveness of cognitive interventions on elderly patients with amnestic mild cognitive impairment: A meta-analysis[J]. Clinical Focus, 2024, 39(1): 12-19.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.01.002

https://huicui.hebmu.edu.cn/EN/Y2024/V39/I1/12

Figures/Tables 8

Tab.1 Basic characteristics of included studies( n=10)

纳入文献		发表年份	国家	研究场所		样本量 (例,试验组/对照组)	年龄 (岁, $x -$ ±s,试验组/对照组)
Troyer等^[8]		2008	加拿大	社区		24/24	76.00±5.60/74.80±7.70
Jean 等^[9]		2010	美国	家庭		11/11	68.55±9.16/68.55±5.91
Buschert 等^[10]		2011	德国	研究所		12/12	71.80±8.60/70.70±5.70
Förster等^[11]		2011	德国	研究所		9/12	74.50±8.60/72.00±7.10
景静^[12]		2013	中国	社区		31/36	73.39±5.57/71.94±6.57
Jeong等^[13]		2016	韩国	诊所		71/76	70.80±6.90/71.60±6.50
Shimada等^[14]		2018	日本	社区		80/79	71.60±5.00/71.60±4.90
Savulich等^[15]		2017	英国	诊所		21/21	75.20±7.40/76.90±8.30
Park等^[16]		2019	韩国	家庭		25/25	70.70±7.50/69.70±8.40
潘利妞^[17]		2019	中国	社区		44/47	75.45±4.87/75.91±5.41
纳入文献	干预措施				随访时间			结局指标	丢失率 (%)
纳入文献	认知干预组			观察组	随访时间			结局指标	丢失率 (%)
Troyer等^[8]	日常记忆训练			健康教育	干预前、干预后、干预后3个月			①	11.11
Jean 等^[9]	认知训练计划			常规护理	干预前、干预后1周、干预后1个月			①②③	9.10
Buschert 等^[10]	多组分认知干预			常规护理	干预前、干预后6个月			②④⑤	5.10
Förster等^[11]	多元认知干预			常规护理	干预前、干预后6个月			②④	9.30
景静^[12]	记忆训练			健康教育	干预前、干预后、干预后2周、干预后2个月			①③⑤	6.94
Jeong等^[13]	小组结合家庭认知训练			健康教育	干预前、干预后、干预后6个月			②⑤⑥	3.60
Shimada等^[14]	运动结合认知训练			健康教育	干预前、干预后10个月			②	4.5
Savulich等^[15]	基于iPad游戏记忆训练			常规护理	干预前、干预后1个月			②	0
Park等^[16]	居家人机交互认知训练			常规护理	干预前、干预后3个月			②⑥	12.28
潘利妞^[17]	基于IMB模型的记忆训练计划			常规护理	干预前、干预后、干预后2个月			②③	12.5

Tab.1 Basic characteristics of included studies( n=10)

纳入文献		发表年份	国家	研究场所		样本量 (例,试验组/对照组)	年龄 (岁, $x -$ ±s,试验组/对照组)
Troyer等^[8]		2008	加拿大	社区		24/24	76.00±5.60/74.80±7.70
Jean 等^[9]		2010	美国	家庭		11/11	68.55±9.16/68.55±5.91
Buschert 等^[10]		2011	德国	研究所		12/12	71.80±8.60/70.70±5.70
Förster等^[11]		2011	德国	研究所		9/12	74.50±8.60/72.00±7.10
景静^[12]		2013	中国	社区		31/36	73.39±5.57/71.94±6.57
Jeong等^[13]		2016	韩国	诊所		71/76	70.80±6.90/71.60±6.50
Shimada等^[14]		2018	日本	社区		80/79	71.60±5.00/71.60±4.90
Savulich等^[15]		2017	英国	诊所		21/21	75.20±7.40/76.90±8.30
Park等^[16]		2019	韩国	家庭		25/25	70.70±7.50/69.70±8.40
潘利妞^[17]		2019	中国	社区		44/47	75.45±4.87/75.91±5.41
纳入文献	干预措施				随访时间			结局指标	丢失率 (%)
纳入文献	认知干预组			观察组	随访时间			结局指标	丢失率 (%)
Troyer等^[8]	日常记忆训练			健康教育	干预前、干预后、干预后3个月			①	11.11
Jean 等^[9]	认知训练计划			常规护理	干预前、干预后1周、干预后1个月			①②③	9.10
Buschert 等^[10]	多组分认知干预			常规护理	干预前、干预后6个月			②④⑤	5.10
Förster等^[11]	多元认知干预			常规护理	干预前、干预后6个月			②④	9.30
景静^[12]	记忆训练			健康教育	干预前、干预后、干预后2周、干预后2个月			①③⑤	6.94
Jeong等^[13]	小组结合家庭认知训练			健康教育	干预前、干预后、干预后6个月			②⑤⑥	3.60
Shimada等^[14]	运动结合认知训练			健康教育	干预前、干预后10个月			②	4.5
Savulich等^[15]	基于iPad游戏记忆训练			常规护理	干预前、干预后1个月			②	0
Park等^[16]	居家人机交互认知训练			常规护理	干预前、干预后3个月			②⑥	12.28
潘利妞^[17]	基于IMB模型的记忆训练计划			常规护理	干预前、干预后、干预后2个月			②③	12.5

Tab. 2 Methodological quality assessment for included studies

纳入文献	随机方法	分配隐藏	受试者和研究人员盲法	结局评估盲法	结果数据完整性	选择性报告研究结果	其他偏倚来源	文献质量等级
Troyer等^[8]	低风险	低风险	不清楚	不清楚	低风险	低风险	低风险	A
Jean 等^[9]	低风险	低风险	低风险	低风险	低风险	低风险	低风险	A
Buschert 等^[10]	低风险	低风险	低风险	低风险	低风险	低风险	低风险	A
Förster等^[11]	低风险	不清楚	低风险	不清楚	低风险	低风险	低风险	A
景静^[12]	低风险	低风险	高风险	低风险	低风险	低风险	低风险	B
Jeong 等^[13]	低风险	不清楚	不清楚	低风险	低风险	低风险	低风险	A
Shimada等^[14]	低风险	低风险	低风险	低风险	低风险	低风险	低风险	A
Savulich等^[15]	低风险	不清楚	高风险	低风险	低风险	低风险	低风险	B
Park等^[16]	低风险	低风险	高风险	低风险	低风险	低风险	低风险	B
潘利妞^[17]	低风险	不清楚	高风险	低风险	低风险	低风险	低风险	B

Fig. 1 Effect of cognitive intervention on cognitive function in elderly patients with aMCI

Fig. 2 Effect of cognitive intervention on memory satisfaction in elderly patients with aMCI

Fig. 3 Effect of cognitive intervention on behavioral memory ability of elderly patients with aMCI

Fig. 4 Effect of cognitive intervention on progressive Alzheimer's disease in patients with aMCI

Fig. 5 Effect of cognitive intervention on the quality of survival in patients with aMCI

Fig. 6 Funnel plot of publication bias of cognitive function status

References 37

[1]	谢冰, 许顺江, 王学义, 等. 轻度认知障碍和阿尔茨海默病血、尿β2-MG及尿mALB水平观察[J]. 中国神经精神疾病杂志, 2015, 41(1):54-56.
[2]	Mioni G, Román-Caballero R, Clerici J, et al. Prospective and retrospective timing in mild cognitive impairment and Alzheimer's disease patients: A systematic review and meta-analysis[J]. Behav Brain Res, 2021, 410:113-354.
[3]	Hu Z, Wu L, Jia J, et al. Advances in longitudinal studies of amnestic mild cognitive impairment and Alzheimer's disease based on multi-modal MRI techniques[J]. Neurosci Bull, 2014, 30(2):198-206. doi: 10.1007/s12264-013-1407-y pmid: 24574084
[4]	Zhang J, Kuang X, Tang C, et al. Acupuncture for amnestic mild cognitive impairment: A pilot multicenter, randomized, parallel controlled trial[J]. Medicine (Baltimore), 2021, 100(46):e27686. doi: 10.1097/MD.0000000000027686 URL
[5]	Liang JH, Xu Y, Lin L, et al. Comparison of multiple interventions for older adults with Alzheimer disease or mild cognitive impairment: A PRISMA-compliant network meta-analysis[J]. Medicine (Baltimore), 2018, 97(20):e10744. doi: 10.1097/MD.0000000000010744 URL
[6]	Simon SS, Yokomizo JE, Bottino CM. Cognitive intervention in amnestic Mild Cognitive Impairment: A systematic review[J]. Neurosci Biobehav Rev, 2012, 36(4):1163-1178. doi: 10.1016/j.neubiorev.2012.01.007 pmid: 22322184
[7]	刘津池, 刘畅, 华成舸. 随机对照试验偏倚风险评价工具RoB2(2019修订版)解读[J]. 中国循证医学杂志, 2021, 21(6):737-744.
[8]	Troyer AK, Murphy KJ, Anderson ND, et al. Changing everyday memory behaviour in amnestic mild cognitive impairment: A randomised controlled trial[J]. Neuropsychol Rehabil, 2008, 18(1):65-88. doi: 10.1080/09602010701409684 pmid: 17943615
[9]	Jean L, Simard M, Wiederkehr S, et al. Efficacy of a cognitive training programme for mild cognitive impairment: Results of a randomised controlled study[J]. Neuropsychol Rehabil, 2010, 20(3):377-405. doi: 10.1080/09602010903343012 pmid: 20029715
[10]	Buschert VC, Friese U, Teipel SJ, et al. Effects of a newly developed cognitive intervention in amnestic mild cognitive impairment and mild Alzheimer's disease: A pilot study[J]. J Alzheimers Dis, 2011, 25(4):679-694. doi: 10.3233/JAD-2011-100999 pmid: 21483095
[11]	Förster S, Buschert VC, Buchholz HG, et al. Effects of a 6-month cognitive intervention program on brain metabolism in amnestic mild cognitive impairment and mild Alzheimer's disease[J]. J Alzheimers Dis, 2011, 25(4):695-706. doi: 10.3233/JAD-2011-100996 pmid: 21498904
[12]	景静. 记忆训练对遗忘型轻度认知障碍老年人记忆力的影响[D]. 北京协和医学院, 2013.
[13]	Jeong JH, Na HR, Choi SH, et al. Group- and home-based cognitive intervention for patients with mild cognitive impairment: A randomized controlled trial[J]. Psychother Psychosom, 2016, 85(4):198-207. doi: 10.1159/000442261 pmid: 27230861
[14]	Shimada H, Makizako H, Doi T, et al. Effects of combined physical and cognitive exercises on cognition and mobility in patients with mild cognitive impairment: A randomized clinical trial[J]. J Am Med Dir Assoc, 2018, 19(7):584-591. doi: 10.1016/j.jamda.2017.09.019 URL
[15]	Savulich G, Piercy T, Fox C, et al. Cognitive training using a novel memory game on an ipad in patients with amnestic mild cognitive impairment (aMCI)[J]. Int J Neuropsychopharmacol, 2017, 20(8):624-633. doi: 10.1093/ijnp/pyx040 pmid: 28898959
[16]	Park J, Kim SE, Kim EJ, et al. Effect of 12-week home-based cognitive training on cognitive function and brain metabolism in patients with amnestic mild cognitive impairment[J]. Clin Interv Aging, 2019, 14:1167-1175. doi: 10.2147/CIA.S200269 pmid: 31303750
[17]	潘利妞. 基于IMB模型的遗忘型轻度认知障碍患者记忆功能干预研究[D]. 郑州大学, 2019.
[18]	Philipps V, Amieva H, Andrieu S, et al. Normalized mini mental state examination for assessing cognitive change in population- based brain aging studies[J]. Neuroepidemiology, 2014, 43(1):15-25. doi: 10.1159/000365637 pmid: 25248074
[19]	Troyer AK, Rich JB. Psychometric properties of a new metamemory questionnaire for older adults[J]. J Gerontol B Psychol Sci Soc Sci, 2002, 57(1):19-27.
[20]	Kinsella GJ, Mullaly E, Rand E, et al. Early intervention for mild cognitive impairment: a randomised controlled trial[J]. J Neurol Neurosurg Psychiatry, 2009, 80(7):730-736. doi: 10.1136/jnnp.2008.148346 pmid: 19332424
[21]	尤春景, 韩韶华, 许涛. Rivermead行为记忆测验的信度和效度[J]. 中国康复, 2003, 18(6):344-347.
[22]	齐善夫, 郑成应, 周东升, 等. 老年痴呆患者生活质量与社会支持的关系[J]. 中国康复理论与实践, 2013, 19(2):164-166.
[23]	Opara JA. Activities of daily living and quality of life in Alzheimer disease[J]. J Med Life. 2012, 5(2):162-167. pmid: 22802883
[24]	Valenzuela M, Sachdev P. Can cognitive exercise prevent the onset of dementia? Systematic review of randomized clinical trials with longitudinal follow-up[J]. Am J Geriatr Psychiatry, 2009, 17(3):179-187. doi: 10.1097/JGP.0b013e3181953b57 pmid: 19225276
[25]	Sherman DS, Mauser J, Nuno M, et al. The efficacy of cognitive intervention in mild cognitive impairment (MCI): A meta analysis of outcomes on neuropsychological measures[J]. Neuropsychol Rev, 2017, 27(4): 440-484. doi: 10.1007/s11065-017-9363-3 pmid: 29282641
[26]	Train the Brain Consortium. Randomized trial on the effects of a combined physical/cognitive training in aged MCI subjects: The train the brain study[J]. Sci Rep, 2017, 7:39471. doi: 10.1038/srep39471 pmid: 28045051
[27]	Petersen RC, Lopez O, Armstrong MJ, et al. Practice guideline update summary: Mild cognitive impairment: Report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology[J]. Neurology, 2018, 90(3):126-135. doi: 10.1212/WNL.0000000000004826 pmid: 29282327
[28]	Corbetta M, Ramsey L, Callejas A, et al. Common behavioral clusters and subcortical anatomy in stroke[J]. Neuron, 2015, 85(5):927-941. doi: 10.1016/j.neuron.2015.02.027 pmid: 25741721
[29]	Fernández-Ballesteros R, Zamarrón MD, Tàrraga L. Learning potential: A new method for assessing cognitive impairment[J]. Int Psychogeriatr, 2005, 17(1):119-128. pmid: 15945596
[30]	刘智岚, 贾杰. 基于计算机认知训练技术在改善老年认知功能中的应用与展望[J]. 中国卒中杂志, 2021, 16(3):246-250.
[31]	Gómez-Soria I, Peralta-Marrupe P, Calatayud-Sanz E, et al. Efficacy of cognitive intervention programs in amnesic mild cognitive impairment: A systematic review[J]. Arch Gerontol Geriatr, 2021, 94:104332. doi: 10.1016/j.archger.2020.104332 URL
[32]	认知训练中国专家共识写作组, 中国医师协会神经内科医师分会认知障碍疾病专业委员会. 认知训练中国专家共识[J]. 中华医学杂志, 2019, 99(1):4-8.
[33]	Petersen RC, Smith GE, Waring SC, et al. Mild cognitive impairment: clinical characterization and outcome[J]. Arch Neurol, 1999, 56(3):303-308. doi: 10.1001/archneur.56.3.303 URL
[34]	Emsaki G, NeshatDoost HT, Tavakoli M, et al. Memory specificity training can improve working and prospective memory in amnestic mild cognitive impairment[J]. Dement Neuropsychol, 2017, 11(3):255-261. doi: 10.1590/1980-57642016dn11-030007 URL
[35]	Belleville S. Cognitive training for persons with mild cognitive impairment[J]. Int Psychogeriatr, 2008, 20(1):57-66. doi: 10.1017/S104161020700631X pmid: 17958927
[36]	Estoque RC, Togawa T, Ooba M, et al. A review of quality of life (QOL) assessments and indicators: Towards a “QOL-Climate” assessment framework[J]. Ambio, 2019, 48(6):619-638. doi: 10.1007/s13280-018-1090-3 pmid: 30206898
[37]	Londos E, Boschian K, Lindén A, et al. Effects of a goal-oriented rehabilitation program in mild cognitive impairment: a pilot study[J]. Am J Alzheimers Dis Other Demen, 2008, 23(2):177-183. doi: 10.1177/1533317507312622 URL