Efficacy of lifestyle and psychosocial interventions in reducing cognitive decline in older people: Systematic review

Marina Palomo,Kate Walters,Georgina Charlesworth,Anne‐Marie Minihane ,Karen Ritchie,Samuel R Nyman,Sarah Morgan‐Trimmer ,Michaela Poppe,Emma Whitty,Zuzana Walker,Jennifer Wenborn,Jonathan Huntley,Elisa Aguirre,Henry Brodaty,Hassan Mansour,Iain Lang,Helen C Kales,Irene Petersen,Claudia Cooper,Serena Ramjee

doi:10.1016/j.arr.2020.101113

Abstract

It is unclear what non-pharmacological interventions to prevent cognitive decline should comprise. We systematically reviewed lifestyle and psychosocial interventions that aimed to reduce cognitive decline in healthy people aged 50+, and people of any age with Subjective Cognitive Decline or Mild Cognitive Impairment. We narratively synthesised evidence, prioritising results from studies rated as at lower Risk of Bias (ROB) and assigning Centre for Evidence Based Medicine grades. We included 64 papers, describing: psychosocial (n = 12), multi-domain (n = 10), exercise (n = 36), and dietary (n = 6) interventions. We found Grade A evidence that over 4+ months: aerobic exercise twice weekly had a moderate effect on global cognition in people with/ without MCI; and interventions that integrate cognitive and motor challenges (e.g. dance, dumb bell training) had small to moderate effects on memory or global cognition in people with MCI. We found Grade B evidence that 4+ months of creative art or story-telling groups in people with MCI; 6 months of resistance training in people with MCI and a two-year, dietary, exercise, cognitive training and social intervention in people with or without MCI had small, positive effects on global cognition. Effects for some intervention remained up to a year beyond facilitated sessions.

Highlights

Dementia is one of the greatest health and social challenges of our time
We found Grade B evidence that creative art or art and story-telling groups led by trained therapists delivered over 16–26 weeks had a small effect on global cognition or memory in people with Mild Cognitive Impairment (MCI), relative to treatment as usual in one study and to a socially active control in the second study
We found Grade C evidence that inhome reminiscence was ineffective at improving global cognition and that 6 months of weekly piano lessons was effective at improving executive functioning, in populations including people with and without MCI

Summary

Introduction

Dementia is one of the greatest health and social challenges of our time. Robust, observational study evidence indicates that it can be predicted, delayed and perhaps even prevented. A third of dementia cases have been attributable to nine risk factors (education, midlife hypertension, midlife obesity, hearing loss, late-life depression, diabetes, physical inactivity, smoking, and social isolation) (Livingston et al, 2017). These attributions do not necessarily imply that mitigation of these risk factors will prevent dementia, but recent research provides grounds for optimism. There is less clear evidence from trials regarding whether interventions targeting modifiable risk factors can reduce cognitive decline or prevent dementia. There is a counter-argument, that these lifestyle factors require a societal rather than individual response (Leibing, 2018), but in the light of the burgeoning literature describing interventions designed to reduce dementia risk, we think this broad synthesis of the evidence in this area is timely

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