Mary Butler, PhD, MBA; Ellen McCreedy, PhD; Victoria A. Nelson, MSc; Priyanka Desai, MSPH; Edward Ratner, MD; Howard A. Fink, MD; Laura S. Hemmy, PhD; J. Riley McCarten, MD; Terry R. Barclay, PhD; Michelle Brasure, PhD, MSPH, MLIS; Heather Davila, MPA; Robert L. Kane, MD †
Disclaimer: Findings and conclusions are those of the authors, who are responsible for the article's contents; findings and conclusions do not necessarily represent views of AHRQ. No statement in this report should be construed as an official position of AHRQ or the U.S. Department of Health and Human Services.
Financial Support: This manuscript is based on research conducted by the Minnesota Evidence-based Practice Center under AHRQ contract 290-2015-00008-I.
Disclosures: Drs. Hemmy and Barclay report grant support from AHRQ during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1531.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Available at https://effectivehealthcare.ahrq.gov. Statistical code: Not applicable. Data set: See Systematic Review Data Repository at https://srdr.ahrq.gov/.
Requests for Single Reprints: Mary Butler, PhD, MBA, Division of Health Policy and Management, University of Minnesota, 420 Delaware Street Southeast, Mayo Memorial Building D351, Minneapolis, MN 55455; e-mail, email@example.com.
Current Author Addresses: Drs. Butler and Brasure, Ms. Nelson, Ms. Desai, and Ms. Davila: Division of Health Policy and Management, University of Minnesota, 420 Delaware Street Southeast, Mayo Memorial Building D351, Minneapolis, MN 55455.
Dr. McCreedy: Center for Gerontology and Healthcare Research, Brown University, School of Public Health, 121 South Main Street, Suite 6, Providence, RI 02903.
Drs. Ratner, Fink, Hemmy, and McCarten: Geriatric Research Education and Clinical Center, VA Health Care System, One Veterans Drive, 11-G, Minneapolis, MN 55417.
Dr. Barclay: Department of Neurology, University of Minnesota, 295 Phalen Boulevard, Mailstop 41203C, St. Paul, MN 55130.
Author Contributions: Conception and design: M. Butler, H.A. Fink, L.S. Hemmy, J.R. McCarten, M. Brasure, R.L. Kane.
Analysis and interpretation of the data: M. Butler, E. McCreedy, V.A. Nelson, P. Desai, E. Ratner, H.A. Fink, L.S. Hemmy, J.R. McCarten, T.R. Barclay, M. Brasure, R.L. Kane.
Drafting of the article: M. Butler, E. McCreedy, V.A. Nelson, P. Desai, T.R. Barclay, M. Brasure, R.L. Kane.
Critical revision for important intellectual content: M. Butler, E. Ratner, H.A. Fink, L.S. Hemmy, J.R. McCarten, T.R. Barclay, B. Brasure.
Final approval of the article: M. Butler, E. McCreedy, V.A. Nelson, P. Desai, E. Ratner, H.A. Fink, L.S. Hemmy, J.R. McCarten, T.R. Barclay, M. Brasure, H. Davila.
Provision of study materials or patients: M. Brasure.
Obtaining of funding: M. Butler, H.A. Fink, M. Brasure, R.L. Kane.
Administrative, technical, or logistic support: V.A. Nelson, P. Desai, M. Brasure, H. Davila.
Collection and assembly of data: M. Butler, E. McCreedy, V.A. Nelson, P. Desai, M. Brasure, H. Davila.
Structured activities to stimulate brain function—that is, cognitive training exercises—are promoted to slow or prevent cognitive decline, including dementia, but their effectiveness is highly debated.
To summarize evidence on the effects of cognitive training on cognitive performance and incident dementia outcomes for adults with normal cognition or mild cognitive impairment (MCI).
Ovid MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and PsycINFO through July 2017, supplemented by hand-searches.
Trials (published in English) lasting at least 6 months that compared cognitive training with usual care, waitlist, information, or attention controls in adults without dementia.
Single-reviewer extraction of study characteristics confirmed by a second reviewer; dual-reviewer risk-of-bias assessment; consensus determination of strength of evidence. Only studies with low or medium risk of bias were analyzed.
Of 11 trials with low or medium risk of bias, 6 enrolled healthy adults with normal cognition and 5 enrolled adults with MCI. Trainings for healthy older adults were mostly computer based; those for adults with MCI were mostly held in group sessions. The MCI trials used attention controls more often than trials with healthy populations. For healthy older adults, training improved cognitive performance in the domain trained but not in other domains (moderate-strength evidence). Results for populations with MCI suggested no effect of training on performance (low-strength and insufficient evidence). Evidence for prevention of cognitive decline or dementia was insufficient. Adverse events were not reported.
Heterogeneous interventions and outcome measures; outcomes that mostly assessed test performance rather than global function or dementia diagnosis; potential publication bias.
In older adults with normal cognition, training improves cognitive performance in the domain trained. Evidence regarding prevention or delay of cognitive decline or dementia is insufficient.
Agency for Healthcare Research and Quality.
Butler M, McCreedy E, Nelson VA, et al. Does Cognitive Training Prevent Cognitive Decline?: A Systematic Review. Ann Intern Med. 2018;168:63–68. [Epub ahead of print 19 December 2017]. doi: https://doi.org/10.7326/M17-1531
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Published: Ann Intern Med. 2018;168(1):63-68.
Published at www.annals.org on 19 December 2017
Dementia, Geriatric Medicine, Neurology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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