Comparison of multiple cognitive interventions for dementia-based on Bayesian network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LIANG Jinghong ,  XU Yong , JIA Ruixia , WANG Yingquan

Department of Child Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou, 215123, P.R.China;

Corresponding author：

XU Yong, Email: xuyongchildhealth@163.com

Keywords：

Alzheimer's disease; Cognitive interventions; Bayesian network meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.201710116

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Objectives To systematically review the efficacy of seven types of cognitive interventions for older adults with mild to moderate Alzheimer's Disease (AD).Methods We searched The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data, VIP and CBM databases to collect randomized controlled trials on cognitive interventions for mild to moderate Alzheimer's Disease (AD) from inception to January 2018. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. STATA 14.0 software was then used to perform a meta-analysis.Results A total of 49 randomized controlled trials (RCTs) were included. The results of network meta-analysis revealed that each cognitive intervention had significantly improved the cognitive ability of AD patients. Specifically, nursing intervention (NI) (MD=3.01, 95%CI 1.70 to 4.50, P<0.005) was the most effective enhancer of cognitive ability, followed by music therapy (MT) (MD=2.60, 95%CI 0.96 to 4.30, P<0.001), physical exercise (PE) (MD=2.4, 95%CI 1.0 to 3.9, P<0.001), cognitive rehabilitation (CR) (MD=2.3, 95% CI 0.92 to 3.7, P=0.013), cognitive simulation (CS) (MD=1.7, 95%CI 1.2 to 2.3, P=0.037), computerized cognitive training (CCT) (MD=1.6, 95%CI 0.42 to 2.8, P<0.001), and pharmacological therapies (PT) (MD=1.5, 95%CI 0.24 to 2.8, P=0.041).Conclusions The seven types of cognitive interventions are helpful in improving the cognitive ability of Alzheimer's patients, and nursing intervention is the most effective cognitive intervention. Moreover, non-pharmacological therapies may be better than pharmacological therapies.

Citation： LIANG Jinghong, XU Yong, JIA Ruixia, WANG Yingquan. Comparison of multiple cognitive interventions for dementia-based on Bayesian network meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(1): 18-27. doi: 10.7507/1672-2531.201710116 Copy

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2. 邢秀吉. 老年痴呆症研究现状及中医治疗对策. 康复学报, 2002, 12(1): 58-60.
3. 康宝仁, 庞声航. 中医防治老年痴呆概述. 实用中医药杂志, 2013, 29(4): 327-329.
4. Clare L, Woods RT, Moniz Cook ED, et al. Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia. Cochrane Database Syst Rev, 2003, (4): CD003260.
5. Lumley T. Network meta-analysis for indirect treatment comparisons. Stat Med, 2002, 21(16): 2313-2324.
6. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1.0). Available at: http://handbook.cochrance.org.
7. Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol, 2011, 64(2): 163-171.
8. Lu G, Ades AE. Combination of direct and indirect evidence in mixed treatment comparisons. Stat Med, 2004, 23(20): 3105-3124.
9. Salanti G, Higgins JP, Ades AE, et al. Evaluation of networks of randomized trials. Stat Methods Med Res, 2008, 17(3): 279-301.
10. Caldwell DM, Ades AE, Higgins JP. Simultaneous comparison of multiple treatments: combining direct and indirect evidence. BMJ, 2005, 331(7521): 897-900.
11. Mavridis D, Salanti G. A practical introduction to multivariate meta-analysis. Stat Methods Med Res, 2013, 22(2): 133-158.
12. Brooks SP, Gelman A. General methods for monitoring convergence of iterative simulations. J Comput Graph Stat, 1997, 7(4): 434-455.
13. Dias S, Welton NJ, Caldwell DM, et al. Checking consistency in mixed treatment comparison meta-analysis. Stat Med, 2010, 29(7-8): 932-944.
14. 袁虎, 张俊. 阿尔茨海默病采用中药治疗临床效果观察. 中医临床研究, 2017, 9(7): 93-95.
15. 彭顺兰. 安理申治疗阿尔茨海默病的临床研究. 中国医药指南, 2008, (8): 41-42.
16. 赵瑾, 王琳, 贾晓军, 等. 美金刚治疗阿尔茨海默病的临床研究. 重庆医学, 2008, 37(7): 712-713.
17. 陈美玲, 关素芳, 郑玉娥. 个性化护理对改善老年痴呆患者生活能力的影响. 现代诊断与治疗, 2017, 28(10): 1940-1941.
18. 姜敏. 个性化护理对老年痴呆患者的影响及效果探讨. 中外医疗, 2015, 34(16): 146-147.
19. 李玲. 护理干预对老年痴呆患者生活能力及生活质量的影响. 中外医学研究, 2016, 14(11): 81-82.
20. 来梦, 缪琴华, 袁彩萍, 等. 护理干预在老年血管性痴呆患者中的疗效. 当代护士 (下旬刊), 2015, (6): 43-45.
21. 陈晓飞, 倪姣娜, 林阁. 计算机辅助技术对血管性痴呆患者的认知康复的疗效观察. 心脑血管病防治, 2013, 13(3): 196-199.
22. 周惠嫦, 张盘德, 陈丽珊, 等. 计算机辅助认知训练对血管性认知障碍的疗效观察. 中国康复医学杂志, 2012, 27(6): 551-553.
23. 郭冬梅. 康复训练对老年痴呆患者认知功能、生活质量及抑郁的影响. 齐鲁护理杂志, 2016, 22(1): 26-28.
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