TY - JOUR
T1 - Efficacy of cognitive rehabilitation therapies for mild cognitive impairment (MCI) in older adults
T2 - Working toward a theoretical model and evidence-based interventions
AU - Huckans, Marilyn
AU - Hutson, Lee
AU - Twamley, Elizabeth
AU - Jak, Amy
AU - Kaye, Jeffrey
AU - Storzbach, Daniel
N1 - Funding Information:
Acknowledgments This material is the result of work supported with resources and the use of facilities at the Portland Veterans Affairs Medical Center, Portland, Oregon and Oregon Health & Science University, Portland Oregon. This work is in part supported by VA Merit Review awards to DS and JK, a grant from the National Institute on Drug Abuse to MH (2P50DA018165-06A1), and grants from the National Institute on Aging to JK (P30AG08017; P30AG024978). All authors read and approved the final contents of the manuscript.
PY - 2013/3
Y1 - 2013/3
N2 - To evaluate the efficacy of cognitive rehabilitation therapies (CRTs) for mild cognitive impairment (MCI). Our review revealed a need for evidence-based treatments for MCI and a lack of a theoretical rehabilitation model to guide the development and evaluation of these interventions. We have thus proposed a theoretical rehabilitation model of MCI that yields key intervention targets-cognitive compromise, functional compromise, neuropsychiatric symptoms, and modifiable risk and protective factors known to be associated with MCI and dementia. Our model additionally defines specific cognitive rehabilitation approaches that may directly or indirectly target key outcomes-restorative cognitive training, compensatory cognitive training, lifestyle interventions, and psychotherapeutic techniques. Fourteen randomized controlled trials met inclusion criteria and were reviewed. Studies markedly varied in terms of intervention approaches and selected outcome measures and were frequently hampered by design limitations. The bulk of the evidence suggested that CRTs can change targeted behaviors in individuals with MCI and that CRTs are associated with improvements in objective cognitive performance, but the pattern of effects on specific cognitive domains was inconsistent across studies. Other important outcomes (i.e., daily functioning, quality of life, neuropsychiatric symptom severity) were infrequently assessed across studies. Few studies evaluated long-term outcomes or the impact of CRTs on conversion rates from MCI to dementia or normal cognition. Overall, results from trials are promising but inconclusive. Additional well-designed and adequately powered trials are warranted and required before CRTs for MCI can be considered evidence-based.
AB - To evaluate the efficacy of cognitive rehabilitation therapies (CRTs) for mild cognitive impairment (MCI). Our review revealed a need for evidence-based treatments for MCI and a lack of a theoretical rehabilitation model to guide the development and evaluation of these interventions. We have thus proposed a theoretical rehabilitation model of MCI that yields key intervention targets-cognitive compromise, functional compromise, neuropsychiatric symptoms, and modifiable risk and protective factors known to be associated with MCI and dementia. Our model additionally defines specific cognitive rehabilitation approaches that may directly or indirectly target key outcomes-restorative cognitive training, compensatory cognitive training, lifestyle interventions, and psychotherapeutic techniques. Fourteen randomized controlled trials met inclusion criteria and were reviewed. Studies markedly varied in terms of intervention approaches and selected outcome measures and were frequently hampered by design limitations. The bulk of the evidence suggested that CRTs can change targeted behaviors in individuals with MCI and that CRTs are associated with improvements in objective cognitive performance, but the pattern of effects on specific cognitive domains was inconsistent across studies. Other important outcomes (i.e., daily functioning, quality of life, neuropsychiatric symptom severity) were infrequently assessed across studies. Few studies evaluated long-term outcomes or the impact of CRTs on conversion rates from MCI to dementia or normal cognition. Overall, results from trials are promising but inconclusive. Additional well-designed and adequately powered trials are warranted and required before CRTs for MCI can be considered evidence-based.
KW - Cognitive rehabilitation therapy
KW - Cognitive training
KW - Dementia
KW - Mild cognitive impairment
KW - Neuropsychological
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=84874946358&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84874946358&partnerID=8YFLogxK
U2 - 10.1007/s11065-013-9230-9
DO - 10.1007/s11065-013-9230-9
M3 - Review article
C2 - 23471631
AN - SCOPUS:84874946358
SN - 1040-7308
VL - 23
SP - 63
EP - 80
JO - Neuropsychology Review
JF - Neuropsychology Review
IS - 1
ER -