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Importance: Cognitive impairment is a common feature of both symptomatic and remitted states of depression that is associated with poorer psychosocial outcomes and treatment non-response. As such, finding treatments to maintain or enhance cognition in people with depression is imperative. Objective: To investigate the efficacy of computerized cognitive training (CCT) on cognitive and functional outcomes in people with depression. Data Sources: MEDLINE, EMBASE and PsycINFO databases were screened through the Ovid interface for eligible studies from inception to 29 June 2020, with no language or publication type restrictions. Study Selection: Two independent reviewers conducted duplicate study screening and assessed against the following inclusion criteria: (1) adults with depression, (2) CCT with minimum three hours practice, (3) active or passive control group, (4) cognitive and/or functional outcomes measured at baseline and post-intervention, (5) randomized controlled trials. Of 3666 identified studies, 24 met selection criteria. Data Extraction and Synthesis: The methods used followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data extraction and risk of bias assessment using the revised Cochrane Risk of Bias Tool (RoB2) was conducted independently by two reviewers. Analysis of the pooled results was conducted using robust variance estimation (RVE) based on a correlational dependence model. Main Outcomes and Measures: The primary outcome was change from baseline to post-intervention in overall cognition. Secondary outcomes were depressive symptoms, psychiatric symptoms, psychosocial functioning, daily functioning, subjective cognition, global cognition and domain-specific cognitive function. Results: Twenty-four studies encompassing 28 comparisons and 1,141 unique participants met inclusion criteria. The pooled effect size of CCT for overall cognition was small and significant (g=0.26; 95% CI 0.15 to 0.36; P<.001; τ2=0.057; I2=37%; prediction interval -0.25 to 0.76) and for depressive symptoms was small and significant (g=0.24; 95% CI 0.04 to 0.45; P=.02; τ2=0.075; I2=46%; prediction interval -0.37 to 0.86). Evidence of small-study effect was found for both overall cognition and depressive symptoms, with trim-and-fill analysis imputing two studies for each. Sensitivity analyses of overall cognition and depressive symptoms revealed the main analyses to be robust. Benefits of CCT were also found for psychosocial functioning and domain-specific cognitive function in abstract reasoning, learning/encoding efficiency, retrieval fluency, high working memory, low working memory, inhibition and processing speed. No significant effect was found for psychiatric symptoms, subjective cognition, global cognition or domain-specific cognitive function in short-term memory and shifting. No separate pooled analyses were conducted for daily functioning or verbal reasoning, updating and visual processing domains due to two or less studies reporting outcomes for each. A moderating effect of dose was found for overall cognition, with larger doses of CCT associated with greater effect size estimates. Conclusions and Relevance: This systematic review and meta-analysis indicates that CCT is an efficacious intervention for overall cognition, depressive symptoms, psychosocial functioning and domain-specific cognitive function for people with depression.

Background Large systematic reviews have pointed to the efficacy of cognitive training and physical exercise on cognitive performance in older adults, making them the most common interventions in multidomain dementia prevention trials. However, it remains unclear to which extent combinations of these interventions yield additive effects beyond their individual components and what combination strategies are most beneficial. Our aim therefore was to synthesize the evidence from randomized controlled trials of combined cognitive and physical training on cognitive, physical, psychosocial and functional outcomes in older adults with or without cognitive impairment, and to compare and rank the efficacy of the three main types of combined intervention delivery formats (simultaneous, sequential or exergaming) relative to either intervention alone or control conditions. Methods and Findings We systematically searched MEDLINE, Embase and PsycINFO from inception to 23 July 2019. Change from baseline to post-intervention were extracted for each outcome and results were analyzed using random-effects models. The overall efficacy of combined interventions was assessed using multivariate pairwise meta-analysis and the comparative efficacy across different intervention delivery formats and control conditions was investigated using network meta-analysis. A total of 47 trials encompassing 4052 participants were eligible, including cognitively healthy older adults (k=30), mild cognitive impairment (k=13), dementia (k=2) and Parkinson disease (k=2). Due to the small number of identified studies in dementia and Parkinson disease, these were excluded from the pooled analyses and instead summarized narratively. Relative to any control condition, combined interventions were associated with small and heterogeneous effects on overall cognitive (k=41, Hedges g = 0.22, 95% CI 0.14 to 0.30, prediction interval -0.34 to 0.78) and physical function (k=32, g = 0.25, 95% CI 0.13 to 0.37, prediction interval -0.46 to 0.96). Cognitive and physical effects were similar for cognitively healthy older adults and those with mild cognitive impairment. No robust evidence for benefit on psychosocial function (k=9) or functional abilities (k=2) was found. The efficacy of simultaneous and sequential training for cognition exceeded all control conditions apart from cognitive training alone, with small to moderate effect estimates and moderate certainty of the evidence. The efficacy of simultaneous and sequential training on physical outcomes was comparable but not significantly greater than physical exercise alone. Exergaming was ranked low for both outcomes and superior only to passive control. The certainty of the evidence was low for physical outcomes, and we were not able to compare interventions in Parkinson disease and dementia. Conclusion Combined cognitive and physical training, delivered either simultaneously or sequentially, is efficacious for cognitive and physical outcomes in cognitively healthy and mildly impaired older adults, but not superior to cognitive or physical exercise alone in each domain. There is little systematic evidence to support potential additive effects of combined interventions or the use of exergaming in older adults. Given simultaneous training is as efficacious but less burdensome than sequential design, the former may be better suited for practical implementation to promote cognitive alongside physical health in late life. More research is needed to establish the effects of combined interventions on everyday function and well-being.

Background People with depression often present with concurrent cognitive impairment. Computerized cognitive training (CCT) is a safe and efficacious strategy to maintain or enhance cognitive performance in a range of clinical populations. However, its efficacy in people with depression and how it varies across populations and design factors are currently unclear. Methods We searched MEDLINE, EMBASE, and PsycINFO from inception to 13 July 2021 for randomised controlled trials examining the efficacy of CCT vs any control condition on cognitive, mood, psychiatric symptoms, psychosocial, and daily functioning in adults with depression. Eligible samples include studies specifically targeting people with major depressive disorder as well as those with other diagnoses where at least 50% of the sample meets the clinical criteria for depression, with the exception of major psychiatric disorders or dementia. The primary outcome is change in the overall cognitive performance. Multivariate analyses will be used to examine the effect sizes on each outcome category as well as possible effect modifiers and correlations between categories. The risk of bias will be assessed using the Cochrane risk of bias tool version 2. Discussion To the best of our knowledge, this will be the first systematic review and meta-analysis of narrowly defined CCT across clinical populations with depression. We aim to investigate not only whether CCT is efficacious for cognition, but also how such effects vary across design factors, what other clinically relevant outcomes might respond to CCT, and the extent to which they differ across populations. Systematic review registration PROSPERO CRD42020204209

Background People with depression often present with concurrent cognitive impairment. Computerized cognitive training (CCT) is safe and efficacious strategy to maintain or enhance cognitive performance in a range of clinical populations. However, its efficacy in people with depression and how it varies across populations and design factors is currently unclear. Methods We searched MEDLINE, EMBASE and PsycINFO from inception to 29 June 2020 for randomised controlled trials examining the efficacy of CCT vs any control condition on cognitive, mood, psychiatric symptoms, psychosocial functioning and daily function in adults with depression. Eligible samples include studies specifically targeting people with major depressive disorder as well as those with other diagnoses where at least 50% of the sample meets clinical criteria for depression, with the exception of major psychiatric disorders or dementia. The primary outcome is change in overall cognitive performance. Multivariate analyses will be used to examine effect sizes on each outcome category as well as possible effect modifiers and correlations between categories. Risk of bias will be assessed using the Cochrane risk of bias tool version 2. Discussion To the best of our knowledge, this will be the first systematic review and meta-analysis of narrowly-defined CCT across clinical populations with depression. We aim to investigate not only whether CCT is efficacious for cognition, but also how such effects vary across design factors, what other clinically relevant outcomes might respond to CCT and the extent to which they differ across populations. Systematic review registration: Submitted and pending evaluation with PROSPERO.