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Article pour les cliniciens

La formation cognitive informatisée chez les personnes âgées ayant une déficience cognitive ou une démence légère: une revue systématique et méta-analyse.



  • Hill NT
  • Mowszowski L
  • Naismith SL
  • Chadwick VL
  • Valenzuela M
  • Lampit A
Am J Psychiatry. 2017 Apr 1;174(4):329-340. doi: 10.1176/appi.ajp.2016.16030360. Epub 2016 Nov 14. (Review)
PMID: 27838936
Lire le résumé Lire résumé des données probantes Lire le texte intégral
Disciplines
  • - Neurologie
    Relevance - 6/7
    Intérêt médiatique  - 6/7
  • Médecine interne (voir sous-spécialités ci-dessous)
    Relevance - 6/7
    Intérêt médiatique  - 5/7
  • Psychiatrie
    Relevance - 6/7
    Intérêt médiatique  - 5/7
  • - Gériatrie
    Relevance - 6/7
    Intérêt médiatique  - 4/7
  • - MF/MG/Santé mentale
    Relevance - 5/7
    Intérêt médiatique  - 6/7
  • Médecine familiale (MF)/Médecine générale (MG)
    Relevance - 5/7
    Intérêt médiatique  - 5/7
  • Médecine interne générale - Soins primaires
    Relevance - 5/7
    Intérêt médiatique  - 5/7

Résumé (en anglais)

OBJECTIVE: Previous meta-analyses indicate that computerized cognitive training (CCT) is a safe and efficacious intervention for cognition in older adults. However, efficacy varies across populations and cognitive domains, and little is known about the efficacy of CCT in people with mild cognitive impairment or dementia.

METHOD: The authors searched Medline, Embase, PsychINFO, CINAHL, and CENTRAL through July 1, 2016, for randomized controlled trials of CCT in older adults with mild cognitive impairment or dementia. Overall cognition, individual cognitive domains, psychosocial function, and activities of daily living were pooled separately for mild cognitive impairment and dementia trials.

RESULTS: The overall effect on cognition in mild cognitive impairment across 17 trials was moderate (Hedges' g=0.35, 95% CI=0.20-0.51). There was no evidence of publication bias or difference between active- and passive-controlled trials. Small to moderate effects were found for global cognition, attention, working memory, learning, and memory, with the exception of nonverbal memory, and for psychosocial functioning, including depressive symptoms. In dementia, statistically significant effects were found on overall cognition (k=11, g=0.26, 95% CI=0.01-0.52) and visuospatial skills, but these were driven by three trials of virtual reality or Nintendo Wii.

CONCLUSIONS: CCT is efficacious on global cognition, select cognitive domains, and psychosocial functioning in people with mild cognitive impairment. This intervention therefore warrants longer-term and larger-scale trials to examine effects on conversion to dementia. Conversely, evidence for efficacy in people with dementia is weak and limited to trials of immersive technologies.


Commentaires cliniques (en anglais)

Family Medicine (FM)/General Practice (GP)

The headline is impressive, but I can`t work out whether the effect size (deemed up to `moderate` using Hedges` g, which is a new one to me) is really worthwhile. I wonder how, if confirmed, we could put this into clinical practice? (Perhaps my mild cognitive impairment is obscuring something more obvious to me.)

FM/GP/Mental Health

As a general practitioner, it is relevant to learn that results from 17 RCTs of moderate quality conclude that CCT is possibly a viable intervention for enhancing cognition in people with mild cognitive impairment.

General Internal Medicine-Primary Care(US)

This sort of computerized cognitive training has hit big time in American cultural offerings. There is nothing new here.

General Internal Medicine-Primary Care(US)

I enrolled in Luminosity and realized I was much better at memory on the memory tests. However, the question is: Does this generalize to everyday life? I know where the 8 tiles are when flashed in front of me, but I still can't remember the name of a new employee, etc. So I agree that more work is needed and that's it's good to be able to use this info to counsel patients, but there is a cost in many cases. It is fun, though!!!

Neurology

This study confirmed that, in people with dementia, it is not straightforward to translate the results from other RCTs/meta-analyses. The main limitation of this study is the absence of meta-regression analyses that might clarify the huge heterogeneity in the effect size in the population with dementia. The results on MCI were well-known; although, the best technique to use in the population is still a matter of debate. Again, I would be happy to get meta-regression analyses for this outcome too.

Neurology

As a neurologist, I would have expected these results. The benefit of this article to me is that it provides evidence when I am asked to give an opinion or advice to my colleagues.

Psychiatry

Although the results are statistically significant, the magnitude of benefit is modest and the clinical meaningfulness of the finding is uncertain. As a practical matter, however, patients of all age groups should always be counseled to engage in mentally challenging activities throughout their life.

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