Computerised cognitive training for preventing dementia in people with mild cognitive impairment.
Level 1 - systematic review of randomized trials
Systematic review of randomized controlled trials
PubMed 30864747 · doi:10.1002/14651858.CD012279.pub2
What was done
Authors conducted a Cochrane systematic review searching ALOIS, MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov, and WHO ICTRP through May 31, 2018. They included randomized and quasi-randomized controlled trials evaluating at least 12 weeks of interactive computerized cognitive training (CCT) compared with active or inactive control interventions in adults with mild cognitive impairment, mild neurocognitive disorder, or at high risk of cognitive decline. Primary outcomes were incident dementia and global cognitive function immediately post-intervention. Evidence quality was assessed using the GRADE approach.
What was found
Eight RCTs with a total of 660 participants were included (durations from 12 weeks to 18 months). No included trial evaluated incident dementia. For global cognitive function post-intervention, the quality of evidence was very low for comparisons with both active and inactive controls. Comparing CCT with active control, low-quality evidence suggested no clear effect on speed of processing (SMD 0.20, 95% CI -0.16 to 0.56; 2 studies; 119 participants), verbal fluency (SMD -0.16, 95% CI -0.76 to 0.44; 3 studies; 150 participants), or quality of life (MD 0.40, 95% CI -1.85 to 2.65; 1 study; 19 participants). Evidence was very low quality for episodic memory, working memory, executive function, depression, functional performance, and mortality.
Why it matters
Current clinical trial evidence is insufficient to determine whether computerized cognitive training prevents dementia or improves cognitive performance in people with mild cognitive impairment. It underscores that commercial or therapeutic CCT interventions cannot yet be recommended on the basis of robust clinical evidence.
Limits
The total evidence base was small (8 trials, 660 total participants) and highly imprecise. Most studies had unclear or high risk of bias across multiple domains. Only one trial utilized an inactive control, none assessed progression to incident dementia, and studies showed inconsistency and indirectness.
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- supports Studies testing cognitive and mental exercises in patients who already have cognitive impairment generally show little clinical benefit.