Summary of findings 3. Cognitive training compared to alternative treatment immediately post intervention for people with mild to moderate dementia.
| Cognitive training compared to alternative treatment immediately post intervention for people with mild to moderate dementia | ||||||
| Patient or population: people with mild to moderate dementia Setting: Community dwelling or in residential care Intervention: cognitive training Comparison: alternative treatment immediately post intervention | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with alternative treatment immediately post intervention | Risk with cognitive training | |||||
| Change in a global measure of cognition (composite) | Mean change in a global measure of cognition (composite) was 0 SD | SMD 0.21 SD higher (0.23 lower to 0.64 higher) | ‐ | 769 (7 RCTs) | ⊕⊕⊝⊝ LOWa | Cognitive training may not have an effect on global cognition |
| Change in a global measure of cognition | Mean change in a global measure of cognition was 0 | SMD 0.16 higher (0.28 lower to 0.6 higher) | ‐ | 724 (7 RCTs) | ⊕⊝⊝⊝ VERY LOWa,b | We are unable to determine whether there is any effect on global cognition (as measured by a screening tool) due to very low quality of evidence |
| Change in delayed memory | Mean change in delayed memory was 0 | SMD 0.71 higher (0.33 lower to 1.75 higher) | ‐ | 147 (3 RCTs) | ⊕⊝⊝⊝ VERY LOWc,d | We are unable to determine whether there is any effect on performance in delayed memory due to very low quality of the evidence |
| Change in participants' mood | Mean change in participants' mood was 0 | SMD 0.11 lower (0.29 lower to 0.07 higher) | ‐ | 543 (3 RCTs) | ⊕⊕⊕⊝ MODERATEe | Cognitive training probably has no effect on participants' mood |
| Change in capacity for activities of daily living | Mean change in capacity for activities of daily living was 0 | SMD 0.25 lower (0.43 lower to 0.07 lower) | ‐ | 525 (3 RCTs) | ⊕⊕⊕⊝ MODERATEe | Cognitive training probably has no effect on capacity for activities of daily living |
| Participant burden (retention rates) | Study population | OR 0.78 (0.24 to 2.57) | 639 (4 RCTs) | ⊕⊝⊝⊝ VERY LOWa,b | We are unable to determine whether cognitive training increases participant burden (as measured by retention rates) | |
| 773 per 1000 | 727 per 1000 (450 to 898) | |||||
| Change in mood and well‐being (caregiver) | Mean change in mood and well‐being (caregiver) was 0 | SMD 1.5 higher (0.96 higher to 2.04 higher) | ‐ | 88 (1 RCT) | ⊕⊕⊕⊝ MODERATEf | Cognitive training probably has a large effect on mood and well‐being in the caregiver |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: odds ratio; RCT: randomised controlled trial; SD: standard deviation; SMD: standardised mean difference. | ||||||
| GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aImprecision: downgraded 2 points for very serious concerns related to imprecision because the confidence interval includes positive effect, negligible effect, and effect in the direction of the control group.
bInconsistency: downgraded 1 point for serious concerns regarding heterogeneity in effect size, which is moderate and statistically significant. Heterogeneity does not seem to be well explained by investigated effect moderators.
cInconsistency: downgraded 2 points for very serious concerns regarding heterogeneity in effect size, which is relatively large and statistically significant. Heterogeneity does not seem to be well explained by investigated effect moderators.
dImprecision: downgraded 2 points for very serious concerns related to imprecision because the analysis is based on fewer than 400 participants, and the confidence interval crosses the no effect threshold.
eImprecision: downgraded 1 point for serious concerns related to imprecision because the sample size includes fewer than 400 participants.