Cognitive interventions in patients with dementia living in long-term care facilities: Systematic review and meta-analysis

Ann-Kristin Folkerts; Mandy Roheger; Jeremy Franklin; Jennifer Middelstädt; Elke Kalbe

doi:10.1016/j.archger.2017.07.017

Cognitive interventions in patients with dementia living in long-term care facilities: Systematic review and meta-analysis

Arch Gerontol Geriatr. 2017 Nov:73:204-221. doi: 10.1016/j.archger.2017.07.017. Epub 2017 Jul 29.

Authors

Ann-Kristin Folkerts¹, Mandy Roheger¹, Jeremy Franklin², Jennifer Middelstädt³, Elke Kalbe⁴

Affiliations

¹ Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Kerpenerstraße 62, 50937 Cologne, Germany.
² Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Albertus-Magnus-Platz, 50923 Cologne, Germany.
³ Institute of Gerontology, University of Vechta, Driverstraße 22, 49377 Vechta, Germany.
⁴ Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Kerpenerstraße 62, 50937 Cologne, Germany. Electronic address: elke.kalbe@uk-koeln.de.

PMID: 28843172
DOI: 10.1016/j.archger.2017.07.017

Abstract

Background: Previous reviews and meta-analyses demonstrated effects of cognitive interventions in dementia, but none specifically considered residents with dementia in long-term care (LTC) facilities.

Objective: To analyse the efficacy of cognitive interventions in institutionalised individuals with dementia.

Methods: After identifying 27 articles, a systematic review was performed. A meta-analysis was calculated for 15 studies of the randomized controlled trials regarding effects on relevant outcomes. Fixed-effects meta-analyses were conducted using standardized mean differences (SMD) of changes from baseline pooled using the inverse variance method.

Results: When comparing cognitive interventions to passive control groups, the meta-analysis revealed significant moderate effects on global cognition (SMD=0.47, 95% CI 0.27-0.67), autobiographical memory (0.67, 0.02-1.31), and behavioral and psychological symptoms in dementia (BPSD; 0.71, 0.06-1.36). Significant small effects were detected for quality of life (QoL; 0.37, 0.05-0.70). Moderate effects on activities of daily living (0.28; -0.02 to 0.58) failed to reach significance; no effects were found on depression (0.22; -0.08 to 0.51). Significant moderate effects of global cognition (0.55; 0.22-0.89) and depression (0.64; 0.21-1.07) were also found for cognitive interventions contrasting active control groups. No harmful events related to the participation in the interventions were observed.

Conclusion: Cognitive interventions are safe and effective for residents with dementia in LTC. However, while it seems clear that cognitive benefits can specifially be assigned to these forms of intervention, further research is necessary to clarify whether the effects on BPSD and QoL reflect unspecific changes due to additional attention. Furthermore, future studies will have to determine which intervention type yields the largest benefits.

Keywords: Alzheimer disease; Cognition; Dementia; Meta-analysis; Nursing homes; Therapy.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Activities of Daily Living
Cognitive Behavioral Therapy*
Dementia / psychology
Dementia / therapy*
Humans
Long-Term Care*
Quality of Life