Computerized Cognitive Training in People with Depression: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Abstract

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.

Treatment response following adaptive PASAT training for depression vulnerability: A systematic review and meta-analysis

“…The effects from this meta-analysis are similar in size compared with previous metaanalyses examining the effects of cognitive training (e.g. Launder et al, 2021;Motter et al, 2016), resulting in small to medium effect sizes for the effects of CCT. This leads to several interesting conclusions.…”

Augmenting neurocognitive remediation therapy to Preventive Cognitive Therapy for partially remitted depressed patients: protocol of a pragmatic multicentre randomised controlled trial

“…[47][48][49] Cognitive functioning of patients with (remitted) MDD can be improved by NCRT. [52][53][54][55][56] Therefore, this study will examine the effectiveness of a multimodal approach, that is, adding oNCRT to PCT in a pragmatic RCT. To our knowledge, the current study is the first to assess if augmenting oNCRT to PCT further reduces depressive symptoms in partially remitted depressed patients.…”

“…Recent meta-analyses demonstrated that NCRT enhances attention, processing speed, executive functioning, working memory and verbal memory in (remitted) depressed patients. [52][53][54][55][56] For patients in partial remission specifically, NCRT improved attention. 57 NCRT also decreased depressive symptomatology in patients with (remitted) MDD, 52 54-56 although the robustness of the effect on depressive symptomatology is questionable as the beneficial effect disappeared when only high-quality studies were included.…”

Computerized Working Memory Training in Remission From Major Depressive Disorder: Effects on Emotional Working Memory, Processing Speed, Executive Functions, and Associations With Symptoms

“…WM has been suggested as a target for enhancing cognition through CWMT (Webb et al, 2018 ; Motter et al, 2019 ). Recent studies indicate that the improvements appear in depressive symptoms, EF, and PS, following training (Barkus, 2020 ; Launder et al, 2021 ; Woolf et al, 2021 ), but results are mixed with studies including higher symptom levels showing most symptom improvement (Legemaat et al, 2021 ), and the underlying mechanisms in improvements are largely unknown (Webb et al, 2018 ; Motter et al, 2019 ; Ferrari et al, 2021 ). Given these mixed results (Lengvenyte et al, 2020 ; Legemaat et al, 2021 ), investigating depressive symptoms following CWMT with particular focus on subjective cognition seem important.…”