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Clinician Article

Cognitive training interventions and depression in mild cognitive impairment and dementia: a systematic review and meta-analysis of randomized controlled trials.



  • Chan JYC
  • Chan TK
  • Kwok TCY
  • Wong SYS
  • Lee ATC
  • Tsoi KKF
Age Ageing. 2020 Aug 24;49(5):738-747. doi: 10.1093/ageing/afaa063. (Review)
PMID: 32378715
Read abstract Read evidence summary
Disciplines
  • Neurology
    Relevance - 6/7
    Newsworthiness - 6/7
  • Physical Medicine and Rehabilitation
    Relevance - 6/7
    Newsworthiness - 6/7
  • Psychiatry
    Relevance - 6/7
    Newsworthiness - 5/7
  • FM/GP/Mental Health
    Relevance - 5/7
    Newsworthiness - 5/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 5/7
    Newsworthiness - 4/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 5/7
    Newsworthiness - 4/7
  • Geriatrics
    Relevance - 5/7
    Newsworthiness - 4/7
  • Internal Medicine
    Relevance - 4/7
    Newsworthiness - 4/7

Abstract

BACKGROUND: Depression is common in people with cognitive impairment but the effect of cognitive training in the reduction of depression is still uncertain.

AIMS: The purpose of this paper is to evaluate the effect of cognitive training interventions in the reduction of depression rating scale score in people with cognitive impairment.

METHODS: Literature searches were conducted via OVID databases. Randomized controlled trials (RCTs) evaluated the effect of cognitive training interventions for the reduction of depression rating scale score in people with mild cognitive impairment (MCI) or dementia were included. Mean difference (MD) with 95% confidence interval (CI) was used to combine the results of Geriatric Depression Scale (GDS). Standardized mean difference (SMD) was used to combine the results of different depression rating scales. Subgroup analyses were conducted according to the types of cognitive training and severity of cognitive impairment, i.e. MCI and dementia.

RESULTS: A total of 2551 people with MCI or dementia were extracted from 36 RCTs. The baseline mean score of GDS-15 was 4.83. Participants received cognitive training interventions had a significant decrease in depression rating scale score than the control group (MD of GDS-15 = -1.30, 95% CI = -2.14--0.47; and SMD of eight depression scales was -0.54 (95% CI = -0.77--0.31). In subgroup analyses, the effect size of computerized cognitive training and cognitive stimulation therapy were medium-to-large and statistically significant in the reduction of depression rating scale score.

CONCLUSIONS: Cognitive training interventions show to be a potential treatment to ameliorate depression in people with cognitive impairment.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

Another “parachute trial”?

FM/GP/Mental Health

The aim of this study is to address an important issue that is often forgotten by most of clinician, namely the effects of mood symptoms in cognitive function. In this sense, it seems clear that the improvement of cognitive functions through cognitive training may reflect, at least in part, an important patient consciousness of better functioning and that reflects an improvement in mood symptoms, i.e. better insight. Nevertheless, more studies are needed to confirm this direct relationship in patients with MCI and Depression.

General Internal Medicine-Primary Care(US)

Sounds kind of positive.

Geriatrics

Antidepressant trials have to deal with the placebo effect that in some cases reaches 40%. That means that 2 out of five depressed participants in the control group reduces 50% of the outcome score. In other words, depressive symptoms are prone to ameliorate acting in some way with the patient and that is the role of these cognitive techniques, and they are always the first step before treating with drugs that always have adverse effects. It is difficult to do non-pharmacologic trials well. The main problem is blinding and the second one may be reaching a large enough sample size to improve the trial's power. Thanks to meta-analyses, the problem of sample size is solved, but not the concealment issue. In any case, this is a good systematic review that backs treating depression without prescribing drugs.

Geriatrics

The data provided are not generalisable because of sources.

Neurology

This is a very welcome analysis in this difficult terrain.

Psychiatry

This is worthwhile information, particularly since the therapy may be administered via computer and has a reasonable effect size.

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