Abstract
Background: Mild cognitive impairment (MCI) is the early phase of Alzheimer's disease (AD). The aim of early intervention for MCI is to decrease the rate of conversion from MCI to AD. However, the efficacy of multiple interventions in MCI, and the optimal methods of delivery, remain controversial. We aimed to compare and rank the treatment methods for MCI in AD, in order to find an optimal intervention for MCI and a way to prevent or delay the occurrence of AD.Methods: Pair-wise and network meta-analysis were conducted to integrate the treatment effectiveness through direct and indirect evidence. Four English databases and three Chinese databases were searched for international registers of eligible published, single or double blind, randomized controlled trials up to September 31st 2019. We included nine comparative interventions: pharmacological therapies which incorporated cholinesterase inhibitors (ChEI), ginkgo, nimodipine, and Chinese medicine; non-pharmacological therapies comprising of acupuncture, music therapy, exercise therapy, and nutrition therapy; and a placebo group. The primary outcome was the Mini-Mental State Examination (MMSE) score. The secondary outcome was the AD Assessment Scale-cognitive subscale (ADAS-cog).Results: Twenty-eight trials were eligible, including 6,863 participants. In the direct meta-analysis, as for the Mini-Mental State Examination scale, the ChEIs (MD: −0.38; 95% CI: −0.74, −0.01), Chinese medicine (MD: −0.31; 95% CI: −0.75, 0.13), exercise therapy (MD: −0.50; 95% CI: −0.65, −0.35), music therapy (MD: −1.71; 95% CI: −4.49, 1.07), were statistically more efficient than placebo. For AD Assessment Scalecognitive subscale outcome, ChEIs (MD: 1.20; 95% CI: 0.73, 1.68), Acupuncture (MD: 1.36; 95% CI: 1.28, 1.44), Chinese medicine (MD: 0.61; 95% CI: 0.49, 0.73) and exercise (MD: 0.61; 95% CI: 0.49, 0.73) were better than placebo. In the network meta-analysis, the MMSE outcome ranked music therapy (59%) as the best and Acupuncture (26%) as second. Nutrition and Ginkgo treatment had the lowest rank among all interventions. For ADAS-cog outcome, acupuncture (52) ranked the best.Conclusion: Among the nine treatments studied, music therapy appears to be the best treatment for MCI, followed by acupuncture. Our study provides new insights into potential clinical treatments for MCI due to AD, and may aid the development of guidelines for MCI in AD.
Highlights
Mild cognitive impairment (MCI) has been defined as a “transitional” state to describe individuals who are not cognitively “active” for their age, but who would not meet a clinical diagnosis of early dementia (Brendan and Kelley, 2015)
Acupuncture, music therapy, and exercise therapy are non-pharmacologic therapies, some participants and researchers involved in these studies were not able to be blinded
We have excluded some drug interventions because of our selection criterion of outcome measures, which may influence the strength of evidence. The findings of this comprehensive network meta-analysis provide some evidence that music therapy and acupuncture might improve the cognitive function of patients with MCI
Summary
Mild cognitive impairment (MCI) has been defined as a “transitional” state to describe individuals who are not cognitively “active” for their age, but who would not meet a clinical diagnosis of early dementia (Brendan and Kelley, 2015). It is an intermediate clinical condition with a number of sub-types and multiple pathologies (Petersen, 2004; Rountree et al, 2007). We aimed to compare and rank the treatment methods for MCI in AD, in order to find an optimal intervention for MCI and a way to prevent or delay the occurrence of AD
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
