Inadequate evidence for cognitive training in preventing cognitive decline

1. In healthy elderly adults, cognitive training enhanced cognitive performance in the area that was trained, but there did not seem to be any effect on adults with mild cognitive impairment (MCI).

2. There was inadequate evidence regarding prevention of dementia or decline in cognition through cognitive training.

Evidence Rating Level: 1 (Excellent)   

Study Rundown: Concerns about cognitive loss due to dementia has stimulated the growth of cognitive training programs that claim to undo some of the effects of aging on the brain.  There is limited information on the effects of these training programs on the start of dementia or cognitive decline.  Therefore, the authors of this systematic review sought to assess the present literature for the effectiveness of cognitive training for prevention of Alzheimer disease and related dementias (ADRD) or cognitive decline.  The authors evaluated 11 trials with adult participants who had normal cognitive abilities or MCI.  The researchers found that cognitive training enhanced cognitive performance for healthy older adults, but only in the domain that was trained.  For example, if memory was trained, memory improved but not reasoning or processing speed.  Cognitive training did not seem to have any effect on adults with MCI. There was inadequate evidence regarding prevention of dementia or decline in cognition through cognitive training.  Therefore, health care providers cannot currently recommend cognitive training for decreasing the risk of dementia or cognitive decline.

A strength of the study is that it provides an updated report of the evidence regarding the use of cognitive training for prevention of dementia or decline in cognition.  Limitations of the study include varied interventions and measurements of outcome, outcomes that tended to evaluate performance on tests rather than overall function, and the possibility of publication bias.

Click to read the study, published in Annals of Internal Medicine

Relevant Reading: Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer’s disease and vascular dementia

In-Depth [systematic review]: The authors used EMBASE, the Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and PsycINFO to search for pertinent literature that was published from January 2009 to July 2017.  The authors also manually searched the reference lists of certain articles.  To find articles published prior to 2009, the authors used the Agency for Healthcare Research and Quality (AHRQ) review on prevention of decline in cognition and Alzheimer disease.  Qualifying studies were in English, had an intervention of cognitive training with adult participants who had either normal cognitive abilities or MCI, had ≥6 months of follow-up, and gave outcomes of cognitive performance or dementia.  Studies that had a high risk of bias or that included only participants with dementia were excluded.  Of the 11 qualifying trials, 6 had adult participants with normal cognitive abilities, and 5 had adult participants who had MCI.  Most cognitive trainings for healthy elderly adults were computer based, and most trainings for adults with MCI were given in group sessions.  Compared to attention or inactive controls, evidence of moderate strength suggests that training in a certain area may enhance performance in that particular area for adults with normal cognition.  Evidence of low strength suggests that training does not enhance performance for adults with MCI.  The trials for adults with MCI were not as precise as those for adults with normal cognition.  No adverse events were reported.

Image: PD

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