Cognitive Interventions in Patients With Dementia Living in Long-Term Care Facilities: Systematic Review and Meta-Analysis

Archives of Gerontology and Geriatrics

Folkerts, A. K., Roheger, M., et al. (2017).

Archives of Gerontology and Geriatrics, 73, 204-221.

This systematic review investigates cognitive treatments (e.g., reminiscence therapy, cognitive training, cognitive rehabilitation) in adults with dementia residing in a long-term care facility. An additional meta-analysis on a subset of studies examines the effects by specific intervention approach and outcome (e.g., global cognition, quality of life, depression).

No funding received

The data in this systematic review are included in another document which can be found in the Associated Article section below.

Up to December 2015

Randomized controlled trials; quasi-randomized controlled trials; controlled studies

27 systematic review; 15 meta-analysis

Nine studies examined the efficacy of cognitive stimulation/reality orientation for long term care residents with dementia. Three studies included in the meta-analysis examined global cognitive outcomes and reported small effects in favor of the intervention group (SMD: 0.43) compared to the passive control group. Small effects were also noted for quality of life and well-being outcomes (SMD: 0.33). Limitations to this review includes an overall paucity of research for each investigated therapy and outcome, varying definitions of long-term care facilities, and variable quality of included studies.

Reminiscence treatment was found to have a moderate effect on autobiographic memory in long-term care patients (SMD: 0.67), small effects on quality of life (SMD: 0.37), and moderate effects on BPSD apart from depression (SMD: 0.71). No significant effect was noted for depression symptoms when compared to passive controls, however there was a moderate effect for depression when compared to active controls (SMD:0.64). There was no significant effect on activities of daily living. Limitations to this review includes an overall paucity of research for each investigated therapy and outcome, varying definitions of long-term care facilities, and variable quality of included studies.

Findings regarding the impact of cognitive interventions as a whole for people with dementia living in long-term care facilities were as follows:<br /> <ul> <li><span style="color: #333333;">moderate significant effects on global cognition (Standard Mean Difference [SMD]: 0.47 in comparison to passive controls, SMD: 0.55 for active controls) favoring cognitive interventions;</span></li> <li><span style="color: #333333;">moderate effects on autobiographical memory (SMD: 0.67) and behavioral and psychological symptoms of dementia (BPSD; SMD: 0.71, 95% CI: 0.06, 1.36) compared to passive control groups;</span></li> <li><span style="color: #333333;">small, significant effects for quality of life (SMD: 0.37);</span></li> <li><span style="color: #333333;">a large effect for frontal and executive functions (SMD: 2.18) in one study when compared to passive controls;</span></li> <li><span style="color: #333333;">no significant effect on memory, executive functioning, visuoconstruction, QoL, and well-being were noted when compared to active controls; and</span></li> <li><span style="color: #333333;">no significant correlation between the number of minutes of treatment and the effect size of cognitive therapy.&nbsp;</span></li> </ul> <span style="color: #333333;">Limitations to this review includes an overall paucity of research for each investigated therapy and outcome, varying definitions of long-term care facilities, and variable quality of included studies.&nbsp;</span>

Six studies examined the efficacy of cognitive training (e.g., paper/pencil tasks, spaced retrieval, errorless learning strategy training) for long term care residents with dementia. Of these, two were included in the meta-analyses and reported large effects (SMD=1.16) for improved global cognition after cognitive training. No treatment effects were noted on other cognitive outcomes. Limitations to this review includes an overall paucity of research for each investigated therapy and outcome, varying definitions of long-term care facilities, and variable quality of included studies.