Cognitive rehabilitation for people with mild to moderate dementia

Kudlicka, Aleksandra; Martyr, Anthony; Bahar‐Fuchs, Alex; Woods, Bob; Clare, Linda

doi:10.1002/14651858.cd013388

Cited by 34 publications

(43 citation statements)

References 56 publications

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“…Sherman et al (2017) included cognitive stimulation in their review of cognitive interventions in MCI but did not identify any eligible trials. Finally, although a protocol for a meta-analysis of cognitive rehabilitation for people with dementia was recently published (Kudlicka et al, 2019), no current reviews were identified that reported meta-analytic results for cognitive rehabilitation, and it was recently concluded that the number of cognitive rehabilitation trials for Alzheimer's disease (Oltra-Cucarella et al, 2018) and other progressive neurodegenerative disorders (Clare et al, 2018) is still limited. Since cognitive rehabilitation is the cognition-oriented treatment approach that is most directly targeted towards producing functional change , future trials exploring the effects of cognitive rehabilitation on functional abilities is an important area of investigation, especially considering the weak evidence for functional improvement following cognitive training and cognitive stimulation.…”

Section: Overall Completeness Of the Evidencementioning

confidence: 99%

“…Since we only identified meta-analyses on cognitive stimulation for people with dementia, a future direction for primary trials and subsequent evidence synthesis is to explore the efficacy of cognitive stimulation in other age-related conditions associated with cognitive decline. The effects of cognitive rehabilitation remains largely unexplored, however, a Cochrane review on cognitive rehabilitation in dementia is underway (Kudlicka et al, 2019). Future research on cognitive rehabilitation in other conditions, such as PD and MCI, could also be of value.…”

Section: Implications For Researchmentioning

confidence: 99%

“…Cognitive stimulation consists of nonspecific engagement in a variety of activities aimed at general enhancement of cognitive and social functioning, usually carried out in group settings at clinics or residential care facilities (Woods, Aguirre, Spector, & Orrell, 2012). Cognitive rehabilitation is an individualized approach with a functional emphasis, aimed at achieving or maintaining optimal levels of functioning in everyday life (Clare & Woods, 2004;Kudlicka, Martyr, Bahar-Fuchs, Woods, & Clare, 2019). Core elements of cognitive rehabilitation include identifying personallyrelevant goals and devising strategies for goal achievement in collaboration with the patients and their families .…”

Section: Introductionmentioning

confidence: 99%

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Cognition-Oriented Treatments for Older Adults: a Systematic Overview of Systematic Reviews

et al. 2020

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Cognition-oriented treatmentscommonly categorized as cognitive training, cognitive rehabilitation and cognitive stimulationare 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.

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Section: Overall Completeness Of the Evidencementioning

confidence: 99%

Section: Implications For Researchmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cognition-Oriented Treatments for Older Adults: a Systematic Overview of Systematic Reviews

et al. 2020

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“…included CS in their review of cognitive interventions in MCI but did not identify any eligible trials. Finally, although a protocol for a meta-analysis of CR for people with dementia was recently published(Kudlicka et al, 2019), no current reviews were identified that reported meta-analytical results for CR, and it was recently concluded that the number of CR trials for Alzheimer's disease(Oltra-Cucarella et al, 2018) and other progressive neurodegenerative disorders(Clare et al, 2018) is still limited. Since CR is the COT approach that is most directly targeted towards producing functional change, future trials exploring the effects of CR on functional abilities is an important area of investigation, especially considering the weak evidence for functional improvement following CT and CS.…”

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confidence: 99%

Cognition-oriented treatments for older adults: A systematic overview of systematic reviews

Gavelin¹,

Lampit²,

Hallock³

et al. 2019

Preprint

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Cognition-oriented treatments (COTs) -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 COTs on cognitive and non-cognitive outcomes in older adults with or without cognitive impairment. Review quality was assessed by AMSTAR 2. 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 (Hedge's g 0.32, range 0.13-0.64, 19 reviews), mild cognitive impairment (Hedge's g 0.40, range 0.32-0.60, five reviews), and dementia (Hedge's g 0.38, range 0.09-1.16, seven reviews), and small for cognitive stimulation in dementia (Hedge's 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 COTs 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.

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“…This theoretical notion, combined with experimental study designs, has been the basis for most studies on learning involving people living with dementia, resulting in learning of low ecological validity (Ingebrand et al, 2020). Moreover, most studies on learning and dementia to date have had an outspoken focus on how rehabilitative interventions can be implemented in order for people living with dementia to relearn information or abilities that they once knew (Clare, 2008;Kudlicka et al, 2019). Quinn and Blandon (2017) argue that research on learning and dementia has been occupied with containment rather than expansion.…”

Section: Introductionmentioning

confidence: 99%