Table 1.

Interventions to Improve Cognitive Performance for Individuals With Dementia and Mild Cognitive Impairment

Author, Year Level of Evidence (types of study designs) Risk of Bias (RoB) Setting	Systematic Review Details	Findings From Reviews
Subtheme: Cognitive Therapy Three Level 1a reviews provide strong strength of evidence to support the use of cognitive-oriented approaches, especially when combined with another intervention like medication or standard occupational therapy, were effective at improving cognitive performance in individuals with MCI and forms of dementia.
Ham et al. (2021) Level 1a—SR with meta-analysis of all seven studies RoB Low Setting Home, community-based, hospital, dementia center, not described	Participants N = 453 participants, diagnosed with AD, majority in their 70s Number of Articles Seven RCT Databases Searched MEDLINE, CINAHL, PubMed, and Academic Search Complete Outcome(s) of Interest Cognition Intervention(s) of Interest OT-based with a combination intervention, included other treatment modalities (5/7) and intervention using only OT which includes a cognitive-oriented approach (2/7) Delivery Methods Group (3), individual (3), mixed (1) Dose Ranges 1–5 hr, 1–3×/wk, 8–24 wk (most effective programs >1×/wk for >16 wk)	In the meta-analysis, the impact of OT programs with a cognition-oriented approach as well as OT programs with a cognition-oriented approach and a multimodal approach, had a statistically significant moderate effect size for improving cognition. Group interventions were more likely to use multiple treatment modalities and occur with a greater frequency and duration which improved intervention effectiveness.
Chow et al. (2021) Level 1a—SR with five studies included in meta-analysis RoB Low Setting Not stated	Participants N = 966 total participants, N = 294 included in meta-analysis, age 70–77 with MCI Number of Articles 10 RCT, five included in meta-analysis Databases Searched PubMed, Cochrane Central Register of Controlled Trials (Cochrane), Excerpta Medica Database (EMBASE), Scopus, CINAHL, Psychological Abstracts (PsycINFO), and Web of Science, EMBASE and ProQuest Dissertations and Theses Outcome(s) of Interest Cognitive performance (memory and executive function) Intervention(s) of Interest Psychosocial interventions including behavioral therapy, cognitive therapy, and CBT. Interventions to enhance memory include behavior modification and activation, memory training, visual imagery, storytelling, memory aids, journaling, and exercise. Delivery Methods Group (7), individual (3) Dose Ranges 2–20 mo. Interventions addressing memory that are longer in duration (more than 2 mo) have more therapeutic encounters (more than 10) and are delivered individually had larger effect sizes.	Significant improvement in memory with a small effect size; however, large heterogeneity was observed in the five studies pooled for meta-analysis.
Duan et al. (2018) Level 1a—SRs with meta-analysis RoB Moderate Setting Not reported	Participants N = 682, mean age 74–84, people with AD (no MCI, no non-AD) (no way to determine number of participants in meta-analysis) Number of Articles 11 RCTs, six included in meta-analysis Databases Searched MEDLINE, EMBASE, PsycINFO through OVID database, CENTRAL through the Cochrane Library Outcome(s) of Interest Cognitive symptoms Intervention(s) of Interest Combination of psychosocial intervention and ChEls 4 studies N = 285 ▪ Cognitive stimulation and acetylcholinesterase inhibitor ▪ Mindfulness-based Alzheimer’s stimulation and acetylcholinesterase inhibitor ▪ Cognitive training and acetylcholinesterase inhibitor Delivery Methods Group and individual Dose Ranges 10 wk to 2 yr	Cognitive therapy + acetylcholinesterase inhibitor was the best psychosocial/drug combined intervention for improving cognitive symptoms. It was statistically better than medication alone or therapy alone.
Subtheme: Music Interventions Two Level 1a reviews provide strong strength of evidence to support the use of music interventions paired with movement to improve cognitive performance for individuals with MCI and dementia.
Lee et al. (2022) Level 1a—systematic review with meta-analysis RoB Low Setting Not stated	Participants N = 3,443 participants total with n = 2,551 included in meta-analysis, mean age ranged from 69.1 to 94.9 yr; female participants ranged from 40% to 100% with any form of dementia; 11 music intervention articles, N = 386; six articles that addressed cognition n = 104 Number of Articles 36 RCTs, 30 included in the meta-analysis Databases Searched PubMed, CINAHL, PsychINFO, Embase, Cochrane Database of Systematic Reviews Outcome(s) of Interest Cognition (21 articles) Intervention(s) of Interest Music intervention completing movements while accompanied by music Delivery Methods Individual and group+ Dose Ranges 10–90 min for 1–21 sessions	Music interventions had a small effect size but was statistically significant for improving cognitive performance.
Dorris et al. (2021) Level 1a—with meta-analysis RoB Moderate Setting Long-term care facilities, day centers, specialty outpatient units, and community.	Participants N = 1,472 total (n = 495 in meta-analysis) participants; mean age in studies ranged from 68.925 to 87.926 yr; probable MCI or mild to moderate dementia Number of Articles 21 articles, nine included in meta-analysis Databases Searched Medline (Ovid), APA PsycInfo (Ovid), CINAHL (Ebsco), and Embase (Elsevier) Outcomes Cognitive function Intervention Active music-making, as defined by “physically participating in music”; 17 studies used recreating music by singing/playing instruments, 10 used improvisation, six used movement, one used imagery, one used breathing entrainment, and two had other characteristics: one created attention exercises where participants reacted to a stimulus, such as clapping when hearing a drum but refraining when hearing a drum preceded by a cymbal, one created dual task training Delivery Interventions performed by psychologists, music therapist, occupational therapists, and professional musicians. No details on if individual or group intervention used. Dose Ranges 4–40 wk, sessions were from 30 min 2 hr in length and happened from one to five times a week.	Music making for MCI or dementia showed a small, but statistically significant positive effect on cognitive performance.
Subtheme: Exercise Two Level 1a reviews provide strong strength of evidence to support the use of exercise, specifically the use of WP and exercise paired with memory games and music therapy, to improve cognitive performance in individuals with a form of dementia.
Duan et al. (2018) Level 1a—SRs with meta-analysis RoB Moderate Setting Not reported	Participants N = 682, mean age 74–84, people with AD (no MCI, no non-AD) (no way to determine number of participants in meta-analysis) Number of Articles 10 RCTs, six included in meta-analysis Databases Searched MEDLINE, EMBASE, PsycINFO through OVID database, CENTRAL through the Cochrane Library Outcome(s) of Interest Cognitive symptoms Intervention(s) of Interest ▪ Home-based exercise (HE) 1 study, N = 161 ▪ GE 1 study, N = 161 ▪ WP 1 study N = 21 Delivery Methods Group and individual Dose Ranges 6 mo to 1 yr	WP intervention and home-based exercise were significantly better than the control at improving cognition. WP was more effective compared with other treatments in the study including the home exercise program.
Hui et al. (2021) Level 1a—14 RCT RoB Low Setting Residential homes	Participants N = 1,161 participants, studies ranged from n = 21 to 189 older adults, age 62+, individuals with moderate to severe dementia Number of Articles 14 RCT Databases Searched CINAHL, MEDLINE, PsycINFO, EMBASE, CENTRAL, and Web of Science Outcome(s) of Interest Cognition Intervention(s) of Interest Multisensory stimulation intervention (6), multicomponent interventions (5), exercise programs (2), and reminiscence program (1) Delivery Methods Caregiver and physical therapist administered Dose Ranges 15 min/day for 15 mo (cycling) and 30 min/day for 6 mo (walking)	Significant improvement in cognitive function in interventions which included aerobic exercise, memory games, and music therapy Exercise program group had statistically significant improvement in cognitive performance (control group had decline).
Subtheme: Dance for MCI One Level 1a review provides moderate strength of evidence to support the use of group dance training to improve global cognitive performance in individuals diagnosed with a MCI.
Wu et al. (2021) Level 1a—RCT and meta-analysis RoB Low Setting Not stated	Participants N = 455, 31 to 201 across the eight studies with the mean age of the participants ranging from 65 to 81 yr old. All had MCI. Number of Articles Eight RCT, seven in meta-analysis on cognition Databases Searched Cochrane Library, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Science Direct and ProQuest Dissertations and Theses Outcomes Cognition (eight studies), memory (six studies), visuospatial, language Intervention Dance training Delivery Group, in person led by professional dance instructor Dose Ranges 12–40 wk, 1–3 sessions/wk for 35–60 min	Dance interventions significantly improved global cognition, memory, visuospatial, and language, in older adults with MCI.
Subtheme: Reminiscence Two Level 1a reviews provide strong strength of evidence to support the use of RT to improve cognitive performance in individuals diagnosed with a form of dementia.
Duan et al. (2018) Level 1a—(SRs with meta-analysis) RoB Moderate Setting Not reported	Participants N = 682, mean age 74–84, people with AD (no MCI, no non-AD) (no way to determine number of participants in meta-analysis) Number of Articles 11 RCTs, six articles included in meta-analysis Databases Searched MEDLINE, EMBASE, PsycINFO through OVID database, CENTRAL through the Cochrane Library Outcome(s) of Interest Cognitive symptoms Intervention(s) of Interest RT, two studies n = 144 Delivery Methods Group and individual Dose Ranges 4–12 wk	RT had a significantly positive effective on cognitive performance compared with control groups.
Lee et al. (2022) Level 1a—systematic review with meta-analysis RoB Low Setting Not stated	Participants N = 3,443 participants total with n = 2,551 included in meta-analysis, mean age ranged from 69.1 to 94.9 yr; female participants ranged from 40% to 100% with any form of dementia Number of Articles 36 RCTs, 30 were included in the meta-analysis Databases Searched PubMed, CINAHL, PsychINFO, Embase, Cochrane Database of Systematic Reviews Outcome(s) of Interest Cognition (21 studies) Intervention(s) of Interest RT (14, n = 580) Delivery Methods Individual and group Dose Ranges 10–60 min/wk for 1–21 sessions	RT had moderate positive effect on cognition that was statistically significant.

Note: AD = Alzheimer’s disease; CBT = cognitive behavioral therapy; GE = group exercise; MCI = mild cognitive impairment; OT = occupational therapy; RT = reminiscence therapy; WP = walking programs.