Positive effects of cognitive training in healthy elderly people have been reported, but data regarding its effects in patients with dementia remains unclear, found a Finnish review of 31 trials.
"The effects of cognitive training in dementia patients have been studied actively during recent decades but the quality and reliability of the studies varies," says licensed neuro-psychologist Eeva-Liisa Kallio. She reviewed 31 randomised controlled trials on cognitive training in dementia patients.
Some of the studies in the review focused primarily on cognitive training and in others cognitive training was part of broader cognitive or multi-component intervention. "Many of the studies reported effects on cognitive functions immediately after the intervention but only few studies included follow-up of the patients or showed improvement in cognitive functions that were not directly linked to the skills trained in the intervention," Kallio says.
In the studies, cognitive functioning was measured before and after the intervention. Also questionnaires on psychological wellbeing, quality of life and activities of daily living were used.
According to Kallio's review, the data from the previous studies is not adequate to give any recommendations on the use of cognitive training in the treatment of dementia patients. Even though the scientific evidence remains scarce, the studies do suggest that the training should be intensive or focus primarily on a particular aspect of cognitive functions.
"Healthy adults can get limited benefits from cognitive training but we need more high quality trials to confirm cognitive training as an effective treatment option in dementia," Kallio says.
She belongs to the University of Helsinki's FINCOG research group, led by professor Kaisu Pitkälä. The next step in the project is to study the effects of intensive, three-month cognitive training on the community-dwelling older persons with dementia participating in adult day care activities organised by the City of Helsinki.
In this randomised controlled trial, part of the participants attend systematic cognitive training while their control group participates in the normal day care activities.
In addition to cognitive functions, also indicators of quality of life and activities of daily living are used and the measurements are repeated six months after the intervention. The research also includes a 24-month health register follow-up.
"Cognitive training is quite easy to implement. If our research suggests that the participants benefit from it, cognitive training can be easily included in the adult day care activities," Kallio says.
Abstract
Background: Cognitive training (CT) refers to guided cognitive exercises designed to improve specific cognitive functions, as well as enhance performance in untrained cognitive tasks. Positive effects of CT on cognitive functions in healthy elderly people and persons with mild cognitive impairment have been reported, but data regarding the effects of CT in patients with dementia is unclear.
Objective: We systematically reviewed the current evidence from randomized controlled trials (RCTs) to find out if CT improves or stabilizes cognition and/or everyday functioning in patients with mild and moderate Alzheimer’s disease.
Results: Altogether, 31 RCTs with CT as either the primary intervention or part of a broader cognitive or multi-component intervention were found. A positive effect was reported in 24 trials, mainly on global cognition and training-specific tasks, particularly when more intensive or more specific CT programs were used. Little evidence of improved everyday functioning was found.
Conclusions: Despite some positive findings, the inaccurate definitions of CT, inadequate sample sizes, unclear randomization methods, incomplete datasets at follow-up and multiple testing may have inflated the results in many trials. Future high quality RCTs with appropriate classification and specification of cognitive interventions are necessary to confirm CT as an effective treatment option in Alzheimer’s disease.
Authors
Eeva-Liisa Kallio, Hanna Öhman, Hannu Kautiainen, Marja Hietanen, Kaisu Pitkälä
[link url="https://www.sciencedaily.com/releases/2017/02/170222101634.htm"]University of Helsinki material[/link]
[link url="http://content.iospress.com/articles/journal-of-alzheimers-disease/jad160810"]Journal of Alzheimer’s Disease abstract[/link]