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

Video：

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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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1. 肖聞宇, 鄭舒華, 何小珍. 社區護理干預對老年癡呆患者及照料者生活質量影響的研究. 中華全科醫學, 2016, 14(1): 150-152.
2. 邢秀吉. 老年癡呆癥研究現狀及中醫治療對策. 康復學報, 2002, 12(1): 58-60.
3. 康寶仁, 龐聲航. 中醫防治老年癡呆概述. 實用中醫藥雜志, 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, 張俊. 阿爾茨海默病采用中藥治療臨床效果觀察. 中醫臨床研究, 2017, 9(7): 93-95.
15. 彭順蘭. 安理申治療阿爾茨海默病的臨床研究. 中國醫藥指南, 2008, (8): 41-42.
16. 趙瑾, 王琳, 賈曉軍, 等. 美金剛治療阿爾茨海默病的臨床研究. 重慶醫學, 2008, 37(7): 712-713.
17. 陳美玲, 關素芳, 鄭玉娥. 個性化護理對改善老年癡呆患者生活能力的影響. 現代診斷與治療, 2017, 28(10): 1940-1941.
18. 姜敏. 個性化護理對老年癡呆患者的影響及效果探討. 中外醫療, 2015, 34(16): 146-147.
19. 李玲. 護理干預對老年癡呆患者生活能力及生活質量的影響. 中外醫學研究, 2016, 14(11): 81-82.
20. 來夢, 繆琴華, 袁彩萍, 等. 護理干預在老年血管性癡呆患者中的療效. 當代護士 (下旬刊), 2015, (6): 43-45.
21. 陳曉飛, 倪姣娜, 林閣. 計算機輔助技術對血管性癡呆患者的認知康復的療效觀察. 心腦血管病防治, 2013, 13(3): 196-199.
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Chinese Journal of Evidence-Based Medicine

Comparison of multiple cognitive interventions for dementia-based on Bayesian network meta-analysis

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