The Influence of Eight Cognitive Training Regimes Upon Cognitive Screening Tool Performance in Post-Stroke Survivors: A Network Meta-Analysis

Frontiers in Aging Neuroscience

Zhou, L., Huang, X., et al. (2024).

Frontiers in Aging Neuroscience, 16, 1374546.

<div>This systematic review and meta-analysis investigates the effects of various cognitive interventions on cognition and quality of life (QoL) outcomes in adults with stroke-associated cognitive impairment.&nbsp;</div>

Jiangxi Traditional Chinese Medicine Administration (China); Ganzhou Municipal Science and Technology Bureau (China)

From database inception to September 30, 2023

<div>Randomized controlled trials</div>

50

<div>The following positive treatment effects were reported on overall cognitive function in adults with stroke-associated cognitive impairment:</div> <div> <ul> <li><strong>computer-based cognitive training (CBCT):&nbsp;</strong>MD = 4.3 per the Mini Mental State Examination (MMSE) and 3.87 per the Montreal Cognitive Assessment (MoCA);</li> <li><strong>traditional cognitive training: </strong>MD = 3.59 per the MMSE and 2.38 per the MoCA;</li> <li><strong>virtual reality-based CT (VRCT):</strong> MD = 4.44 per the MoCA;</li> <li><strong>CBCT + traditional cognitive training (tCT): </strong>MD = 7.86 per the MMSE and 6.04 per the MoCA;</li> <li><strong>CBCT + exercise: </strong>MD = 6.68 per the MoCA;</li> <li><strong>tCT + exercise:</strong> MD = 3.98 per the MoCA; and</li> <li><strong>tCT + VRCT: </strong>MD = 8.01 per the MMSE and 5.76 per the MoCA.</li> </ul> <div>Additional findings included:</div> <div> <ul> <li><strong>CBCT + tCT</strong> outperformed tCT alone for both the MMSE and the MoCA.</li> <li><strong>CBCT + tCT</strong> outperformed CBCT alone for the MoCA.&nbsp;</li> <li><strong>CBCT</strong> and <strong>CBCT + exercise</strong> outperformed CT alone for the MoCA.</li> <li><strong>tCT + VRCT</strong> outperformed traditional CT alone for both the MMSE and the MoCA.</li> <li><strong>CBCT + exercise </strong>outperformed exercise only.&nbsp;</li> </ul> <div>No additional differences were noted between treatments.&nbsp;</div> <div>&nbsp;</div> <div>Limitations to this review include heterogeneity between studies, a lack of investigation of baseline characteristics, the exclusion of some studies due to significant pharmacological effects, and the lack of rater blinding.&nbsp;</div> </div> </div>

<div>Cognitive interventions has positive effects on the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) in individuals with stroke-associated cognitive impairment. Of not, the LOTCA&nbsp; measures basic cognitive skills in the context of activities of daily living (ADLs) and instrumental ADLs (iADLs). The following treatment effects on LOTCA were reported:</div> <div> <ul> <li><strong>CBCT:</strong> MD = 23.2;</li> <li><strong>tCT: </strong>MD = 17.33; and</li> <li><strong>CBCT + tCT: </strong>MD = 29.97.</li> </ul> <div>CBCT + tCT demonstrated the highest impact on LOTCA scores, and cumulative probability identified CBCT + tCT (SUCRAs = 92.64%), CBCT (SUCRAs = 67.16%), and VRCT + tCT (SUCRA = 51.00%) as the top three interventions for improved LOTCA scores).&nbsp;</div> <div>&nbsp;</div> </div> <div>Limitations to this review include heterogeneity between studies, a lack of investigation of baseline characteristics, the exclusion of some studies due to significant pharmacological effects, and the lack of rater blinding.</div>

<div>Based on MoCA scores, the following treatment effects were reported on specific cognitive domains in adults with stroke-associated cognitive impairment:</div> <div> <ul> <li><strong>Abstract reasoning</strong>: tCT (MD = 0.45) outperformed controls. CBCT + tCT (MD = 1.19) and tCT (MD = 1.01) outperformed VRCT.&nbsp;</li> <li><strong>Attention: </strong>CBCT + tCT (MD = 2.53), CBCT alone (MD = 1.2) and VRCT (MD = 2.69) outperformed controls. Cumulative probability demonstrated that CBCT + tCT (SUCRAs = 84.17%) and VRCT (SUCRAs = 83.46%) might be the most effective treatments to improve attention in this population.&nbsp;</li> <li><strong>Delayed recall:&nbsp;</strong>CBCT + tCT outperformed controls and tCT (MD = 2.16 to controls, MD = 1.38 to tCT).</li> <li><strong>Naming and language function: </strong>No intervention demonstrated a significant impact on these skills.&nbsp;</li> <li><strong>Orientation:&nbsp;</strong>CBCT + tCT (MD = 2.34), CBCT (MD = 1.15), and tCT (MD -1.15) outperformed controls. CBCT + tCT outperformed tCT alone (MD= 1.17)&nbsp;</li> <li><strong>Visuospatial skills and executive function:</strong> CBCT (MD = 1.09) outperformed controls.</li> </ul> <div>Overall, CBCT + tCT was found to be the leading intervention for enhancing attention, abstract reasoning, delayed recall, and orientation as measured by the MoCA.&nbsp;</div> <div>&nbsp;</div> </div> <div>Limitations to this review include heterogeneity between studies, a lack of investigation of baseline characteristics, the exclusion of some studies due to significant pharmacological effects, and the lack of rater blinding.</div>

<div>Cognitive interventions had the following effects on neuropsychological tests in individuals with stroke-associated cognitive impairment:</div> <div> <ul> <li><strong>digit span tests:</strong> positive results in 6 out of 8 studies; and</li> <li><strong>Trail-Making Test part A: </strong>no significant improvement.</li> </ul> <div>These findings are based on limited research with small sample sizes.&nbsp;</div> <div>&nbsp;</div> </div> <div>Limitations to this review include heterogeneity between studies, a lack of investigation of baseline characteristics, the exclusion of some studies due to significant pharmacological effects, and the lack of rater blinding.</div>

<div>When compared to controls, the following positive treatment effects were reported on function in daily living in adults with stroke-associated cognitive impairment:</div> <div> <ul> <li><strong>CBCT:</strong> MD = 11.32;</li> <li><strong>tCT: </strong>MD = 11.18;</li> <li><strong>CBCT + tCT: </strong>MD =18.66; and</li> <li><strong>VRCT + tCT: </strong>MD = 14.68.</li> </ul> <div>Cumulative probability demonstrated that CBCT + tCT (SUCRAs = 90.19%), VRCT + tCT (SUCRAs =69.36), and CBCT (SUCRAS = 49.59% were the top three interventions in improving function in daily living.&nbsp;</div> <div>&nbsp;</div> </div> <div>Limitations to this review include heterogeneity between studies, a lack of investigation of baseline characteristics, the exclusion of some studies due to significant pharmacological effects, and the lack of rater blinding.</div>

<div>Cognitive interventions had the following effects on motor function, as measured by the Fugl-Meyer Assessment (FMA), in individuals with stroke-associated cognitive impairment:</div> <div> <ul> <li><strong>tCT</strong> (MD = 11.21) outperformed controls.</li> <li><strong>CBCT + tCT </strong>(MD = 28.76) outperformed controls.</li> </ul> <div>CBCT + CBT ranked as the most effective cognitive intervention in improving motor functioning in this population.</div> <div>&nbsp;</div> </div> <div>Limitations to this review include heterogeneity between studies, a lack of investigation of baseline characteristics, the exclusion of some studies due to significant pharmacological effects, and the lack of rater blinding.</div>

<div>Cognitive interventions had the following effects on functional independence, as measured by the Functional Independence Measure (FIM) scale, in individuals with stroke-associated cognitive impairment:</div> <div> <ul> <li><strong>tCT </strong>(MD 22.45) outperformed controls.&nbsp;</li> <li><strong>CBCT + tCT </strong>(MD = 42.4) outperformed controls.</li> </ul> <div>CBCT was found to likely be the most effective cognitive treatment in improving functional independence in this population (SUPRAs = 92.16%).&nbsp;</div> <div>&nbsp;</div> <div>Limitations to this review include heterogeneity between studies, a lack of investigation of baseline characteristics, the exclusion of some studies due to significant pharmacological effects, and the lack of rater blinding.</div> </div>