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. 2019 Mar 25;2019(3):CD013069. doi: 10.1002/14651858.CD013069.pub2

Jelcic 2014.

Methods An RCT comparing LSS delivered through telecommunication technology vs the same training delivered face to face and with unstructured cognitive treatment in persons with early AD
Participants 27 participants residing in daycare centres for the elderly in Venice, Italy, with a diagnosis of probable AD, according to NINCDS‐ADRDA, who were not on anti‐dementia drug therapy. Mean age of participants was 83.7, and they had received a minimum of 6 years of formal education. Twenty‐one were female and 6 were male. Participants are presumed to be community‐dwelling persons
Interventions Participants in the LSS‐direct intervention condition (n = 10) received face‐to‐face training on lexical tasks that aimed to enhance semantic verbal processing
 
 Participants in the LSS‐telecondition (n = 7) received the LSS intervention through telecommunication
 
 Participants in the control condition (n = 10) completed face‐to‐face exercises, such as practising manual skills or reading the newspaper and engaging in discussion
 
 The same therapist delivered all interventions, which lasted for 3 months and included two 1‐hour small‐group sessions per week. Between sessions, caregivers were encouraged to deliver non‐specific cognitive reinforcement
Outcomes Primary outcomes were global cognitive performance, lexical‐semantic abilities, and episodic verbal memory
 Secondary outcomes were changes in attention, working memory, executive functions, and visual‐spatial abilities
 These domains were assessed by a neuropsychologist at baseline and after 3 months of treatment
Country Italy
Registration status  No information provided; presumed to be unregistered
Conflict of Interests  No
Notes We tried to contact study authors to ask for mean, SD, and sample size for Trail Making Test (A and B), NPI, and ROCF Copy Test at baseline and at post‐intervention assessment, but we received no reply
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) High risk No information is provided regarding the method of randomisation. However, study authors state, "The unequal distribution among the three treatment groups was due to the preference of two patients, initially enrolled in the LSS‐tele group, to not be involved with computer technology and who were shifted into the other two treatment arms"
Allocation concealment (selection bias) High risk Two participants who were initially enrolled in the LSS‐tele group were then allocated to the other 2 conditions, with their preferences considered. For this reason, allocation concealment was not possible in these cases
Blinding of participants and personnel (performance bias) 
 All outcomes Unclear risk Study authors did not mention blinding of participants. They compared CT vs an active condition, so blinding may have been possible
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk All assessments were carried out by an experienced neuropsychologist who was blinded to the treatment group to which each participant was allocated
Incomplete outcome data (attrition bias) 
 All outcomes Low risk No outcome data were missing. No participants dropped out of the study; all were included in the analysis
Selective reporting (reporting bias) High risk Results of Trail Making Tests A and B (secondary outcome measures) were not reported
Other bias Low risk Study appears to be free of other sources of bias