Abstract
Cognition-oriented treatments – commonly categorized as cognitive training, cognitive rehabilitation and cognitive stimulation – are promising approaches for the prevention of cognitive and functional decline in older adults. We conducted a systematic overview of meta-analyses investigating the efficacy of cognition-oriented treatments on cognitive and non-cognitive outcomes in older adults with or without cognitive impairment. Review quality was assessed by A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR). We identified 51 eligible reviews, 46 of which were included in the quantitative synthesis. The confidence ratings were “moderate” for 9 (20%), “low” for 13 (28%) and “critically low” for 24 (52%) of the 46 reviews. While most reviews provided pooled effect estimates for objective cognition, non-cognitive outcomes of potential relevance were more sparsely reported. The mean effect estimate on cognition was small for cognitive training in healthy older adults (mean Hedges’ g = 0.32, range 0.13–0.64, 19 reviews), mild cognitive impairment (mean Hedges’ g = 0.40, range 0.32–0.60, five reviews), and dementia (mean Hedges’ g = 0.38, range 0.09–1.16, seven reviews), and small for cognitive stimulation in dementia (mean Hedges’ g = 0.36, range 0.26–0.44, five reviews). Meta-regression revealed that higher AMSTAR score was associated with larger effect estimates for cognitive outcomes. The available evidence supports the efficacy of cognition-oriented treatments improving cognitive performance in older adults. The extent to which such effects are of clinical value remains unclear, due to the scarcity of high-quality evidence and heterogeneity in reported findings. An important avenue for future trials is to include relevant non-cognitive outcomes in a more consistent way and, for meta-analyses in the field, there is a need for better adherence to methodological standards. PROSPERO registration number: CRD42018084490.
Highlights
As a larger proportion of the population reaches more advanced age, more people will be affected by cognitive aging.Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Melbourne, Australia 3 Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany 4 Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, GermanySome cognitive decline occurs in what is usually considered normal ageing (Deary et al, 2009; Nyberg, Lovden, Riklund, Lindenberger, & Backman, 2012), and it is a prominent feature in several predominantly age-related pathological conditions, including neurodegenerative and neurovascular diseases (Aarsland et al, 2017; Cumming, Marshall, & Lazar, 2013; Weintraub, Wicklund, & Salmon, 2012)
An electronic database search of MEDLINE, EMBASE, PsychINFO and Cochrane Database of Systematic Reviews was conducted from inception to April 2019 to identify systematic reviews with meta-analysis examining the effects of cognition-oriented treatments on cognitive or non-cognitive outcomes for older adults with or without cognitive decline
Results are presented based on the 46 meta-analyses that provided sufficient information to be included in the quantitative synthesis
Summary
As a larger proportion of the population reaches more advanced age, more people will be affected by cognitive aging. Some cognitive decline occurs in what is usually considered normal ageing (Deary et al, 2009; Nyberg, Lovden, Riklund, Lindenberger, & Backman, 2012), and it is a prominent feature in several predominantly age-related pathological conditions, including neurodegenerative and neurovascular diseases (Aarsland et al, 2017; Cumming, Marshall, & Lazar, 2013; Weintraub, Wicklund, & Salmon, 2012). Given the functional consequences of cognitive impairment in aging, and the subsequent personal, societal and financial costs, development of effective interventions that could maintain levels of cognitive functioning and delay cognitive and functional decline is a key priority in the field. Unlike treatments that are primarily oriented towards outcomes that are behavioural (e.g. wandering), emotional (e.g. anxiety), or physical (e.g. sedentary lifestyle), in cognition-oriented
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