Cognitive rehabilitation and cognitive training for early‐stage Alzheimer's disease and vascular dementia

Linda Clare; Bob Woods

doi:10.1002/14651858.CD003260

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Analysis 1.1

Comparison 1 Cognitive training vs control ‐ impact on global measures of dementia severity at post‐treatment assessment, Outcome 1 Change in MMSE scores at post‐treatment.

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Analysis 2.1

Comparison 2 Cognitive training vs control ‐ impact on neuropsychological test performance at post‐treatment assessment, Outcome 1 Change in immediate verbal memory scores.

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Analysis 2.2

Comparison 2 Cognitive training vs control ‐ impact on neuropsychological test performance at post‐treatment assessment, Outcome 2 Change in delayed verbal memory scores.

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Analysis 2.3

Comparison 2 Cognitive training vs control ‐ impact on neuropsychological test performance at post‐treatment assessment, Outcome 3 Change in verbal letter fluency scores.

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Analysis 2.4

Comparison 2 Cognitive training vs control ‐ impact on neuropsychological test performance at post‐treatment assessment, Outcome 4 Change in verbal category fluency scores.

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Analysis 2.5

Comparison 2 Cognitive training vs control ‐ impact on neuropsychological test performance at post‐treatment assessment, Outcome 5 Change in executive function (sequencing) scores.

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Analysis 3.1

Comparison 3 Cognitive training vs control ‐ impact on participant self‐report of functioning at post‐treatment assessment, Outcome 1 Change in self‐report of memory functioning.

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Analysis 3.2

Comparison 3 Cognitive training vs control ‐ impact on participant self‐report of functioning at post‐treatment assessment, Outcome 2 Change in participant self‐report of mood (depression).

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Analysis 4.1

Comparison 4 Cognitive training vs control ‐ impact on informant report of participant functioning at post‐treatment asst., Outcome 1 Change in informant report of participant memory functioning.

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Analysis 4.2

Comparison 4 Cognitive training vs control ‐ impact on informant report of participant functioning at post‐treatment asst., Outcome 2 Change in informant report of participant mood (depression).

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Analysis 4.3

Comparison 4 Cognitive training vs control ‐ impact on informant report of participant functioning at post‐treatment asst., Outcome 3 Change in informant report of participant functional ability (activities of daily living).

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Analysis 5.1

Comparison 5 Cognitive training vs control ‐ impact on informant reactions at post‐treatment assessment, Outcome 1 Change in informant report of informant reaction to participant memory and behaviour problems.

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Analysis 6.1

Comparison 6 Cognitive training vs control ‐ impact on neuropsychological test scores at follow‐up assessment, Outcome 1 Change in imediate verbal memory scores.

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Analysis 6.2

Comparison 6 Cognitive training vs control ‐ impact on neuropsychological test scores at follow‐up assessment, Outcome 2 Change in executive function (sequencing) scores.

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Analysis 7.1

Comparison 7 Cognitive training vs control ‐ impact on informant report of participant functioning at follow‐up assessment., Outcome 1 Change in informant report of participant memory functioning.

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Analysis 7.2

Comparison 7 Cognitive training vs control ‐ impact on informant report of participant functioning at follow‐up assessment., Outcome 2 Change in informant report of participant functional ability (activities of daily living).

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Table 1. Characteristics of participants in cognitive training and control groups

Study	Condition	n	Age	Gender balance (m:f)	Years of education	Number taking AChEI	Baseline MMSEscore
Cahn‐Weiner 2003	Cognitive training	17	77. 8 (6.9)	9:8	12.7 (2.1)	all	24.3 (2.2)
	Control	17	76.0 (7.7)	5:12	13.1 (3.5)	all	25.1 (1.7)
Davis 2001	Cognitive training	19	68.67 (3.86)	10:9	15.06 (3.86)	5	21.84(4.03)
	Control	18	72.56 (7.62)	6:12	12.97 (2.56)	4	22.78 (4.45)
De Vreese 1998	Cognitive training	9				all	17.33 (3.39)
	Control	9				all	17 (3.2)
Heiss 1994	Cognitive training	18	65.95 (6.28)	9:9		none
	Control	17	66.63 (10.17)	10:7		none
Koltai 2001	Cognitive training	14	72.9 (6.7)		15.0 (4.0)		22.9 (3.6)
	Control	8	73.9 (7.2)		15.0 (4.0)		26.6 (2.5)
Lowenstein 2004	Cognitive training	25	78.12 (4.3)	15:10	13.08 (4.1)	all	23.4 (2.9)
	Control	19	74.74 (7.5)	11:8	14.37 (3.0)	all	24.53 (4.5)
Beck 1988	Cognitive training	10	74 (range 68‐75)	5:5		none
	Control	10	76 (range 70‐93)	3:7		none

Table 1. Characteristics of participants in cognitive training and control groups

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Table 2. Summary of duration of interventions and timing of assessments

Study	Intervention length	Initial assessment	Interim assessment	Post‐interv assesst	Follow up assessment	Details of sessions	Format of sessions
Cahn‐Weiner 2003	6 weeks	week 0	n/a	weeks 8 ‐9 (mean 59 days post baseline)	week 16 (mean 114. 5 days post baseline)	6 x 45 minute sessions	Group
Davis 2001	5 weeks	week 0	n/a	week 6	week 12	5 x 1 hour sessions	Individual
De Vreese 1998	12 weeks (after 12 weeks on drug)	weeks 0 and 13	n/a	week 26	n/a	24 x 45 minute sessions	Individual
Heiss 1994	24 weeks	week 0	weeks 8 and 16 (plus monthly physician appointments)	week 25	n/a	48 x 1 hour sessions	Individual
Koltai 2001	5 ‐ 6 weeks	weeks 0 ‐ 2	n/a	weeks 6 ‐ 8	n/a	5 x 1 hour sessions (group) or mean of 6 x 1 hour sessions (group)	Group or individual
Loewenstein 2004	12 ‐ 16 weeks	week 0	n/a	weeks 13 ‐ 18	weeks 25 ‐ 31	24 x 45 minute sessions	Individual
Quayhagen 1995	12 weeks	week 0	n/a	week 13	week 38	72 x 1 hour caregiver‐facilitated sessions	Individual
Quayhagen 2000	8 weeks	week 0	n/a	week 12	n/a	40 x 1 hour caregiver‐facilitated sessions	Individual
Beck 1988	6 weeks	week 0	n/a	week 6	n/a	18 x 30 to 40 minute sessions	Individual

Table 2. Summary of duration of interventions and timing of assessments

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Comparison 1. Cognitive training vs control ‐ impact on global measures of dementia severity at post‐treatment assessment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change in MMSE scores at post‐treatment Show forest plot	4	112	Mean Difference (IV, Fixed, 95% CI)	‐0.06 [‐1.75, 1.64]

Comparison 1. Cognitive training vs control ‐ impact on global measures of dementia severity at post‐treatment assessment

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Comparison 2. Cognitive training vs control ‐ impact on neuropsychological test performance at post‐treatment assessment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change in immediate verbal memory scores Show forest plot	4	137	Std. Mean Difference (IV, Fixed, 95% CI)	0.07 [‐0.26, 0.41]

2 Change in delayed verbal memory scores Show forest plot	2	81	Mean Difference (IV, Fixed, 95% CI)	‐0.05 [‐3.47, 3.38]

3 Change in verbal letter fluency scores Show forest plot	1	37	Mean Difference (IV, Fixed, 95% CI)	‐1.11 [‐13.08, 10.86]

4 Change in verbal category fluency scores Show forest plot	3	115	Mean Difference (IV, Fixed, 95% CI)	1.27 [‐1.94, 4.47]

5 Change in executive function (sequencing) scores Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

5.1 Change in scores on Trails A	1	43	Mean Difference (IV, Fixed, 95% CI)	14.26 [‐19.50, 48.02]
5.2 Change in scores on Trails B	1	42	Mean Difference (IV, Fixed, 95% CI)	‐23.04 [‐97.33, 51.25]

Comparison 2. Cognitive training vs control ‐ impact on neuropsychological test performance at post‐treatment assessment

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Comparison 3. Cognitive training vs control ‐ impact on participant self‐report of functioning at post‐treatment assessment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change in self‐report of memory functioning Show forest plot	2	66	Std. Mean Difference (IV, Fixed, 95% CI)	0.25 [‐0.24, 0.74]

2 Change in participant self‐report of mood (depression) Show forest plot	3	103	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.00 [‐0.40, 0.39]

Comparison 3. Cognitive training vs control ‐ impact on participant self‐report of functioning at post‐treatment assessment

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Comparison 4. Cognitive training vs control ‐ impact on informant report of participant functioning at post‐treatment asst.

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change in informant report of participant memory functioning Show forest plot	2	66	Std. Mean Difference (IV, Fixed, 95% CI)	0.52 [0.02, 1.02]

2 Change in informant report of participant mood (depression) Show forest plot	2	66	Std. Mean Difference (IV, Fixed, 95% CI)	0.11 [‐0.38, 0.61]

3 Change in informant report of participant functional ability (activities of daily living) Show forest plot	2	62	Std. Mean Difference (IV, Fixed, 95% CI)	0.05 [‐0.45, 0.55]

Comparison 4. Cognitive training vs control ‐ impact on informant report of participant functioning at post‐treatment asst.

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Comparison 5. Cognitive training vs control ‐ impact on informant reactions at post‐treatment assessment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change in informant report of informant reaction to participant memory and behaviour problems Show forest plot	2	80	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.06 [‐0.50, 0.39]

Comparison 5. Cognitive training vs control ‐ impact on informant reactions at post‐treatment assessment

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Comparison 6. Cognitive training vs control ‐ impact on neuropsychological test scores at follow‐up assessment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change in imediate verbal memory scores Show forest plot	1	44	Std. Mean Difference (IV, Fixed, 95% CI)	0.07 [‐0.53, 0.67]

2 Change in executive function (sequencing) scores Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

2.1 Change in Trails A scores	1	43	Mean Difference (IV, Fixed, 95% CI)	12.19 [‐16.27, 40.65]
2.2 Change in Trails B scores	1	42	Mean Difference (IV, Fixed, 95% CI)	‐1.72 [‐110.17, 106.73]

Comparison 6. Cognitive training vs control ‐ impact on neuropsychological test scores at follow‐up assessment

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Comparison 7. Cognitive training vs control ‐ impact on informant report of participant functioning at follow‐up assessment.

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change in informant report of participant memory functioning Show forest plot	1	44	Std. Mean Difference (IV, Fixed, 95% CI)	0.02 [‐0.57, 0.62]

2 Change in informant report of participant functional ability (activities of daily living) Show forest plot	1	44	Std. Mean Difference (IV, Fixed, 95% CI)	0.11 [‐0.49, 0.71]

Comparison 7. Cognitive training vs control ‐ impact on informant report of participant functioning at follow‐up assessment.

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