Treatment for mild cognitive impairment: a systematic review and meta-analysis

Fitzpatrick‐Lewis, Donna; Warren, Rachel; Ali, Muhammad Usman; Sherifali, Diana; Raina, Parminder

doi:10.9778/cmajo.20150057

Cited by 62 publications

(63 citation statements)

References 30 publications

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“…14 These outcomes included cognition ( 10 The harms for treatment were identified by the guideline working group, which included serious adverse events (i.e., hospital admission or death) and psychosocial harms (e.g., lack of independence, stress, depression).…”

Section: Methodsmentioning

confidence: 99%

“…A clinical expert was consulted throughout the process. The task force workgroup selected outcomes important to patients and the scales used to measure such outcomes from those selected and prioritized by Canadian clinicians and policy-makers.14 These outcomes included cognition ( 10 The harms for treatment were identified by the guideline working group, which included serious adverse events (i.e., hospital admission or death) and psychosocial harms (e.g., lack of independence, stress, depression). …”

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confidence: 99%

“…10 Provincial payment for the medications used in primary care practice is often linked to cognitive assessment scores measured by the screening instruments.…”

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confidence: 99%

“…[6][7][8] Cognitive impairment is commonly assessed using screening tools such as the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA) and the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog). [9][10][11] The MMSE has a raw score range of 0 to 30 and typically uses a cut-off of scores below 23 to suggest likely cognitive impairment, 12 although the specific cut-off that is recommended varies based on age and education level. 11 Clinical significance is considered to be a change in score of 1.4 to 3 points.…”

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confidence: 99%

“…14 Treatments include medications such as cholinesterase inhibitors (i.e., donepezil, rivastigmine and galantamine), dietary supplements and vitamins, and nonpharmacologic interventions such as exercise, and cognitive training and rehabilitation. 10 Provincial payment for the medications used in primary care practice is often linked to cognitive assessment scores measured by the screening instruments.…”

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confidence: 99%

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Recommendations on screening for cognitive impairment in older adults

Pottie

Rahal

Jaramillo

et al. 2015

CMAJ

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• Practitioners should consider cognitive assessment for patients with signs and symptoms of impairment or when family members or patients express concerns about potential cognitive decline. cognitive impairment (scores of 10-17) and severe impairment (scores less than 10). Key points 13The ADAS-cog is a cognitive testing instrument not normally used in practice but often used in research studies. It consists of 11 tasks measuring disturbances of memory, language, praxis (i.e., application or use of specific knowledge or skills such as drawing geometric figures or fitting a page into an envelope), attention and other cognitive abilities. 9 A change in the ADAS-cog score of 4 points is considered by many clinical experts to represent a clinically important change. The MMSE and the MoCA tools are commonly used by Canadian clinicians in clinical practice.14 Treatments include medications such as cholinesterase inhibitors (i.e., donepezil, rivastigmine and galantamine), dietary supplements and vitamins, and nonpharmacologic interventions such as exercise, and cognitive training and rehabilitation. 10 Provincial payment for the medications used in primary care practice is often linked to cognitive assessment scores measured by the screening instruments.The objective of this guideline, which updates the 2001 Canadian Task Force on Preventive Health Care recommendations, 15 is to provide evidence-based recommendations on screening for cognitive impairment in adults. The guideline focuses on screening asymptomatic adults. This recommendation does not apply to men and women who are concerned about their own cognitive performance (i.e., patients who report cognitive changes to their clinician or others) or who are suspected of having mild cognitive impairment or dementia by clinicians or nonclinicians (i.e., caregivers, family or friends) and who have symptoms suggestive of mild cognitive impairment or dementia (e.g., loss of memory, language, attention, visuospatial or executive functioning, or behavioural or psychological symptoms that may mildly or substantially affect a patient's day-to-day life or usual activities). MethodsThe Canadian Task Force on Preventive Health Care is an independent panel of volunteer clinicians and methodologists that makes recommendations about clinical manoeuvres aimed at primary and secondary prevention (www.canadian taskforce.ca). The development of these recommendations was led by a workgroup of eight members of the task force and scientific staff at the Public Health Agency of Canada. The task force established this topic as a priority based on the potential to decrease inconsistencies in screening in primary care practice and a need to determine whether benefits of screening outweigh harms.The US Preventive Services Task Force recently published a systematic review on screening and treatment for cognitive impairment.11 Initially, the Canadian task force updated the US task force review, assessing the effects of screening for cognitive impairment on health outcomes. 9 The Evidence Revie...

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

“…10 Provincial payment for the medications used in primary care practice is often linked to cognitive assessment scores measured by the screening instruments.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Recommendations on screening for cognitive impairment in older adults

Pottie

Rahal

Jaramillo

et al. 2015

CMAJ

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A meta‐analysis of randomised controlled trials of physical activity in people with Alzheimer's disease and mild cognitive impairment with a comparison to donepezil

Pisani

Mueller

Huntley

et al. 2021

Int J Geriat Psychiatry

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Objectives Physical exercise may benefit people with Alzheimer's disease (AD) and mild cognitive impairment (MCI). However, randomised controlled trials (RCTs) of exercise have shown conflicting findings and it is unclear if positive outcomes are comparable to a commonly used cholinesterase inhibitor, donepezil. Methods Embase, Medline, PsycINFO, PsycARTICLES, SCOPUS were searched for RCTs of physical activity compared to a control condition, and donepezil compared to placebo in people with AD and MCI. Effect sizes were calculated from pre‐ and post‐MMSE and ADAS‐Cog scores and pooled using a random effects meta‐analysis. Results Ninteen RCTs were included in the exercise meta‐analysis (AD, N = 524; MCI, N = 1269). Physical exercise improved MMSE scores in AD (Hedges' g = 0.46) and MCI groups (g = 0.63). For the MCI group, exercise appeared to have a stronger effect for those with lower MMSE scores at baseline (p = 0.022). 18 RCTs were included in the donepezil meta‐analysis (AD, N = 2984, MCI, N = 1559). In people with AD, donepezil improved cognition (MMSE g = 0.23; ADAS‐Cog, g = −0.17) but there was no evidence of improved cognition in MCI. Conclusions Physical exercise improved cognition in both AD and MCI groups. Where comparisons were possible, the effect size for physical exercise was generally comparable to donepezil. These results strengthen the evidence base for exercise as an effective intervention in AD and MCI, and future clinical trials should examine exercise type, intensity and frequency, in addition to cholinesterase inhibitors to determine the most effective interventions for AD and MCI.

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Does repetitive transcranial magnetic stimulation improve cognitive function in age‐related neurodegenerative diseases? A systematic review and meta‐analysis

Miller

Allen

Juma

et al. 2023

Int J Geriat Psychiatry

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ObjectiveHigh‐frequency, repetitive transcranial magnetic stimulation (rTMS) targeted over the dorsolateral prefrontal cortex (DLPFC) is widely used in research to promote neuroplasticity and cognitive enhancement. RTMS is a promising intervention to tackle cognitive decline in people with age‐related neurodegenerative diseases. However, there is currently no systematic evidence examining the effects of DLPFC‐targeted, high‐frequency rTMS on cognitive function in this population. The aim of this systematic review was to evaluate the efficacy and moderators of this treatment intervention.MethodsA comprehensive literature search of five electronic databases was performed to identify articles published before October, 2022. Following PRISMA guidelines, the identified articles were screened, data was extracted, and the methodological quality was assessed using the Cochrane tool, Risk of Bias 2. Meta‐analyses were performed using R Studio (v.4.1.2).ResultsSixteen studies involving 474 participants met the inclusion criteria, of which 8 studies measured global cognitive function. The results from the random‐effects meta‐analysis showed rTMS significantly improved global cognitive function relative to control groups shown by a large, significant effect size (g = 1.39, 95% CI, 0.34–2.43; p = 0.017). No significant effects were found between subgroups or for individual cognitive domains.ConclusionsHigh‐frequency rTMS, targeted over the DLPFC, appears to improve global cognitive function in people with age‐related neurodegenerative diseases. However, these results should be interpreted with caution due to the small number of studies included, and high between‐study heterogeneity.

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Treatment for mild cognitive impairment: a systematic review and meta-analysis

Cited by 62 publications

References 30 publications

Recommendations on screening for cognitive impairment in older adults

Recommendations on screening for cognitive impairment in older adults

A meta‐analysis of randomised controlled trials of physical activity in people with Alzheimer's disease and mild cognitive impairment with a comparison to donepezil

Does repetitive transcranial magnetic stimulation improve cognitive function in age‐related neurodegenerative diseases? A systematic review and meta‐analysis

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