Abstract
BackgroundAlzheimer disease (AD) is the most common type of dementia with cognitive decline as one of the core symptoms in older adults. Numerous studies have suggested the value of psychosocial interventions to improve cognition in this population, but which one should be preferred are still matters of controversy. Consequently, we aim to compare and rank different psychosocial interventions in the management of mild to moderate AD with cognitive symptoms.MethodsWe did a network meta-analysis to identify both direct and indirect evidence in relevant studies. We searched MEDLINE, EMBASE, PsycINFO through the OVID database, CENTRAL through the Cochrane Library for clinical randomized controlled trials investigating psychosocial interventions of cognitive symptoms in patients with Alzheimer disease, published up to August 31, 2017. We included trials of home-based exercise(HE), group exercise(GE), walking program(WP), reminiscence therapy(RT), art therapy(AT) or the combination of psychosocial interventions and acetylcholinesterase inhibitor (ChEIs). We extracted the relevant information from these trials with a predefined data extraction sheet and assessed the risk of bias with the Cochrane risk of bias tool. The outcomes investigated were Mini–Mental State Examination (MMSE) and compliance. We did a pair-wise meta-analysis using the fixed-effects model and then did a random-effects network meta-analysis within a Bayesian framework.ResultsWe deemed 10 trials eligible, including 682 patients and 11 treatments. The quality of included study was rated as low in most comparison with Cochrane tools. Treatment effects from the network meta-analysis showed WP was better than control (SMD 4.89, 95% CI -0.07 to 10.00) while cognitive training and acetylcholinesterase inhibitor (CT + ChEIs) was significantly better than the other treatments, when compared with simple ChEIs treatment, assessed by MMSE. In terms of compliance, the pair-wise meta-analysis indicated that WP and HE are better than GE and AT, while CT + ChEIs, CST + ChEIs are better than other combined interventions.ConclusionOur study confirmed the effectiveness of psychosocial interventions for improving cognition or slowing down the progression of cognitive impairment in AD patients and recommended several interventions for clinical practice.
Highlights
Alzheimer disease (AD) is the most common type of dementia with cognitive decline as one of the core symptoms in older adults
Quality assessment of included studies We evaluated the quality of included studies with the Cochrane Collaboration Recommendations assessment tools [12]
9 studies were deemed to have low-risk outcome data. 1 study did not provide adequate information to judge the risk of missing data
Summary
Alzheimer disease (AD) is the most common type of dementia with cognitive decline as one of the core symptoms in older adults. We aim to compare and rank different psychosocial interventions in the management of mild to moderate AD with cognitive symptoms. Et al have concluded that cognitive stimulation programs benefit the maintenance of cognitive function and improve self-reported quality of life in patients with mild to moderate Alzheimer’s disease [5]. The 2014 American Psychiatric Association’s practice guidelines indicate that the available research has not conclusively determined whether any one intervention is more effective than any other. It has not conclusively determined which intervention works best for which service setting, specific behavior, disease stage, or caregiver and patient profile [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
