Summary of findings 4. Cognitive training compared to alternative treatment in the medium term (3 to 12 months post intervention) for people with mild to moderate dementia.
| Cognitive training compared to alternative treatment in the medium term (3 to 12 months 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 in the medium term (3 to 12 months 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 in the medium term (3 to 12 months post intervention) | Risk with cognitive training | |||||
| Change in a global measure of cognition (composite) | Mean change in a global measure of cognition (composite) was set at 0 SDs | SMD 1.31 SD higher (1.03 lower to 3.65 higher) | ‐ | 73 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW | We are unable to determine whether there is any effect on global cognition (composite) due to very low quality of the evidence |
| Change in a global measure of cognition | Mean change in a global measure of cognition was set at 0 SDs | SMD 3.2 higher (2.89 lower to 9.29 higher) | ‐ | 73 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW | We are unable to determine whether there is any effect on performance in a screening measure of global cognition due to very low quality of the evidence |
| Change in disease progression | ‐ | See comment | ‐ | (0 studies) | ‐ | None of the included studies have evaluated this outcome |
| Change in delayed memory | Mean change in delayed memory was set at 0 SDs | SMD 3.13 higher (3.57 lower to 9.83 higher) | ‐ | 73 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW | 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 set at 0 SDs | SMD 0.66 lower (1.35 lower to 0.02 higher) | ‐ | 39 (1 RCT) | ⊕⊕⊝⊝ LOWa | Cognitive training may not have an effect on a participants' mood |
| Change in capacity for activities of daily living | ‐ | See comment | ‐ | (0 studies) | ‐ | None of the included studies have evaluated this outcome |
| Change in mood and well‐being (caregiver) | ‐ | See comment | ‐ | (0 studies) | ‐ | None of the included studies have evaluated this outcome |
| *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.