Cognitive rehabilitation and cognitive training for early-stage

Alzheimer’s disease and vascular dementia (Review)

Clare L, Woods B

This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2003, Issue 4
http://www.thecochranelibrary.com

Cognitive rehabilitation and cognitive training for early-stage Alzheimer’s disease and vascular dementia (Review)
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
[Intervention Review]

Cognitive rehabilitation and cognitive training for early-stage

Alzheimer’s disease and vascular dementia

Linda Clare1 , Bob Woods2

1 Schoolof Psychology, University of Wales Bangor, Bangor, UK. 2 Dementia Services Development Centre Wales, University of Wales,
Bangor, UK

Contact address: Linda Clare, School of Psychology, University of Wales Bangor, Bangor, Gwynedd, Wales, LL57 2AS, UK.
l.clare@bangor.ac.uk.

Editorial group: Cochrane Dementia and Cognitive Improvement Group.

Publication status and date: Edited (no change to conclusions), published in Issue 4, 2008.
Review content assessed as up-to-date: 17 September 2006.

Citation: Clare L, Woods B. Cognitive rehabilitation and cognitive training for early-stage Alzheimer’s disease and vascular dementia.
Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD003260. DOI: 10.1002/14651858.CD003260.

Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

ABSTRACT
Background
Cognitive impairments, and particularly memory problems, are a defining feature of the early stages of Alzheimer’s disease (AD) and
vascular dementia. Cognitive training and cognitive rehabilitation are specific approaches designed to address difficulties with memory
and other aspects of cognitive functioning.
Objectives
The main aim was to evaluate the effectiveness and impact of cognitive training and cognitive rehabilitation interventions aimed at
improving memory and other aspects of cognitive functioning for people in the early stages of Alzheimer’s disease or vascular dementia.
Search methods
The CDCIG Specialized Register, which contains records from MEDLINE, EMBASE, CINAHL, PsycINFO and many other databases,
was searched on 28 September 2001 for the original review. For this updated review, the CDCIG Specialized Register was searched on
7 April 2006 and 18 September 2006.
Selection criteria
RCTs comparing cognitive rehabilitation or cognitive training interventions with control conditions, and reporting outcomes for the
person with dementia and/or the family caregiver, were considered for inclusion.
Data collection and analysis
Nine RCTs reporting cognitive training interventions were included in the review. No RCTs of cognitive rehabilitation were identified.
Statistical analyses were conducted to provide an indication of intervention effect sizes. Overall estimates of the treatment effect were
calculated using a fixed-effects model, with a test for heterogeneity using a standard chi-square statistic. The diversity of outcome
measures used in the studies constrained the possibilities for meta-analysis, but 8 of the 9 studies contributed at least one measure.
Main results
No significant positive effects of cognitive training were observed. There were also no significant negative effects.
Cognitive rehabilitation and cognitive training for early-stage Alzheimer’s disease and vascular dementia (Review)
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Authors’ conclusions
The available evidence remains limited, but there is still no indication of any significant benefits from cognitive training. Trial reports
indicate that some gains resulting from intervention may not be captured adequately by available standardized outcome measures.
It is not possible at present to draw conclusions about the efficacy of individualised cognitive rehabilitation interventions for people
with early-stage dementia, due to the lack of any RCTs in this area. Further, well-designed studies of cognitive training and cognitive
rehabilitation are required to provide more definitive evidence.

PLAIN LANGUAGE SUMMARY

No evidence for the efficacy of cognitive training, and insufficient evidence to evaluate individualised cognitive rehabilitation,
in improving cognitive functioning for people with mild to moderate Alzheimer’s disease or vascular dementia
Cognitive training and cognitive rehabilitation are methods that aim to help people with early-stage dementia make the most of their
memory and cognitive functioning despite the difficulties they are experiencing. Cognitive training involves guided practice on a set
of tasks that reflect particular cognitive functions, such as memory, attention, or problem-solving, which can be done in a variety
of settings and formats. Cognitive rehabilitation involves identifying and addressing individual needs and goals, which may require
strategies for taking in new information or methods of compensating such as using memory aids.

Cognitive rehabilitation and cognitive training for early-stage Alzheimer’s disease and vascular dementia (Review)
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.