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Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia

  • Review
  • Intervention

Authors


Abstract

Background

Cognitive impairments, and particularly memory problems, are a defining feature of the early stages of Alzheimer's disease (AD) and vascular dementia. Cognitive training and cognitive rehabilitation are specific approaches designed to address difficulties with memory and other aspects of cognitive functioning.

Objectives

The main aim was to evaluate the effectiveness and impact of cognitive training and cognitive rehabilitation interventions aimed at improving memory and other aspects of cognitive functioning for people in the early stages of Alzheimer's disease or vascular dementia.

Search methods

The CDCIG Specialized Register, which contains records from MEDLINE, EMBASE, CINAHL, PsycINFO and many other databases, was searched on 28 September 2001 for the original review. For this updated review, the CDCIG Specialized Register was searched on 7 April 2006 and 18 September 2006.

Selection criteria

RCTs comparing cognitive rehabilitation or cognitive training interventions with control conditions, and reporting outcomes for the person with dementia and/or the family caregiver, were considered for inclusion.

Data collection and analysis

Nine RCTs reporting cognitive training interventions were included in the review. No RCTs of cognitive rehabilitation were identified. Statistical analyses were conducted to provide an indication of intervention effect sizes. Overall estimates of the treatment effect were calculated using a fixed-effects model, with a test for heterogeneity using a standard chi-square statistic. The diversity of outcome measures used in the studies constrained the possibilities for meta-analysis, but 8 of the 9 studies contributed at least one measure.

Main results

No significant positive effects of cognitive training were observed. There were also no significant negative effects.

Authors' conclusions

The available evidence remains limited, but there is still no indication of any significant benefits from cognitive training. Trial reports indicate that some gains resulting from intervention may not be captured adequately by available standardized outcome measures. It is not possible at present to draw conclusions about the efficacy of individualised cognitive rehabilitation interventions for people with early-stage dementia, due to the lack of any RCTs in this area. Further, well-designed studies of cognitive training and cognitive rehabilitation are required to provide more definitive evidence.

摘要

背景

對於患有早期阿茲海默症和血管型失智症的患者進行認知重建和認知訓練

認知障礙,特別是記憶問題,是早期阿茲海默症(AD)和血管型失智症的主要特徵,認知訓練和認知重建都是被用來治療記憶障礙和其他認知功能問題的特別方法。

目標

本研究的主要目的在評估認知訓練和認知重建對於改善患有早期阿茲海默症或血管型失智症患者的記憶和其他認知功能方面問題的療效和影響。

搜尋策略

先前的回顧性文章是在2001年9月28日針對CDCIG Specialized Register資料庫,其中包含來自MEDLINE, EMBASE, CINAHL, PsycINFO和其他許多資料庫的資料,進行審查。在這一次更新審查中,則是於2006年4月7日和2006年9月18日針對CDCIG Specialized Register資料庫進行檢索。

選擇標準

針對認知重建或認知訓練與對照組進行比較的RCT試驗,而且有報告提及對於失智症患者的治療成果和/或家庭照護者的評估都可能被列入研究中。

資料收集與分析

有9個提到認知訓練的RCT試驗被納入本研究中,並沒有有關於認知重建的RCT試驗被確認。執行統計分析來提供介入性治療需要的規模大小。針對治療效果的整體評估也會利用固定效應模式進行計算,利用標準卡方統計(chisquare statistic)來計算試驗的異質性。納入本研究中治療結果的變異性限制了metaanalysis的分析,但是9個試驗中有8個試驗都有針對至少一個以上的治療成果進行檢測。

主要結論

並沒有發現進行認知訓練有得到任何明顯的正面效應,但是也沒有出現任何負面效應。

作者結論

本研究中可用的數據仍十分有限,也沒有證據顯示進行認知訓練可以得到任何明顯的好處,試驗報告的結果暗示有些由介入性治療試驗得到正面幫助可能是因為成果測量沒有標準化。在缺乏相關領域的RCT試驗數據下,根據現有的數據很難定論說明,對於患有早期失智症的患者施以個別認知重建治療有任何好處,此外,需要提供良好的試驗設計來瞭解認知訓練和認知重建的明確功效。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

並沒有證據可以證明認知訓練的功效,也沒有足夠的證據個別評估認知重建對於改善輕度至中度阿茲海默氏症患者和血管型失智症患者認知功能的效果,認知訓練和認知重建都是用來幫助患有早期失智症患者保持大部分記憶和認知功能的方法,儘管在這過程中他們要經歷許多困難。認知訓練涉及了一系列針對特殊認知功能(例如記憶、注意力或是問題解決)所設計的標準化練習,有許多設計和模式可以達到這樣的目的。認知重建則涉及辨識和說出個人需要及目標,在這過程中也許需要不斷策略性的使用新資訊或提醒的方法,例如使用輔助記憶資訊。

Plain language summary

No evidence for the efficacy of cognitive training, and insufficient evidence to evaluate individualised cognitive rehabilitation, in improving cognitive functioning for people with mild to moderate Alzheimer's disease or vascular dementia

Cognitive training and cognitive rehabilitation are methods that aim to help people with early-stage dementia make the most of their memory and cognitive functioning despite the difficulties they are experiencing. Cognitive training involves guided practice on a set of tasks that reflect particular cognitive functions, such as memory, attention, or problem-solving, which can be done in a variety of settings and formats. Cognitive rehabilitation involves identifying and addressing individual needs and goals, which may require strategies for taking in new information or methods of compensating such as using memory aids.

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