Cognitive rehabilitation and cognitive training for early‐stage Alzheimer's disease and vascular dementia
Abstract
Background
Cognitive impairments, and particularly memory problems, are a defining feature of the early stages of Alzheimer's disease (AD) and vascular dementia. Cognitive training and cognitive rehabilitation are specific approaches designed to address difficulties with memory and other aspects of cognitive functioning.
Objectives
The main aim was to evaluate the effectiveness and impact of cognitive training and cognitive rehabilitation interventions aimed at improving memory and other aspects of cognitive functioning for people in the early stages of Alzheimer's disease or vascular dementia.
Search methods
The CDCIG Specialized Register, which contains records from MEDLINE, EMBASE, CINAHL, PsycINFO and many other databases, was searched on 28 September 2001 for the original review. For this updated review, the CDCIG Specialized Register was searched on 7 April 2006 and 18 September 2006.
Selection criteria
RCTs comparing cognitive rehabilitation or cognitive training interventions with control conditions, and reporting outcomes for the person with dementia and/or the family caregiver, were considered for inclusion.
Data collection and analysis
Nine RCTs reporting cognitive training interventions were included in the review. No RCTs of cognitive rehabilitation were identified. Statistical analyses were conducted to provide an indication of intervention effect sizes. Overall estimates of the treatment effect were calculated using a fixed‐effects model, with a test for heterogeneity using a standard chi‐square statistic. The diversity of outcome measures used in the studies constrained the possibilities for meta‐analysis, but 8 of the 9 studies contributed at least one measure.
Main results
No significant positive effects of cognitive training were observed. There were also no significant negative effects.
Authors' conclusions
The available evidence remains limited, but there is still no indication of any significant benefits from cognitive training. Trial reports indicate that some gains resulting from intervention may not be captured adequately by available standardized outcome measures. It is not possible at present to draw conclusions about the efficacy of individualised cognitive rehabilitation interventions for people with early‐stage dementia, due to the lack of any RCTs in this area. Further, well‐designed studies of cognitive training and cognitive rehabilitation are required to provide more definitive evidence.
PICOs
Plain language summary
No evidence for the efficacy of cognitive training, and insufficient evidence to evaluate individualised cognitive rehabilitation, in improving cognitive functioning for people with mild to moderate Alzheimer's disease or vascular dementia
Cognitive training and cognitive rehabilitation are methods that aim to help people with early‐stage dementia make the most of their memory and cognitive functioning despite the difficulties they are experiencing. Cognitive training involves guided practice on a set of tasks that reflect particular cognitive functions, such as memory, attention, or problem‐solving, which can be done in a variety of settings and formats. Cognitive rehabilitation involves identifying and addressing individual needs and goals, which may require strategies for taking in new information or methods of compensating such as using memory aids.
