Comparative Effectiveness of Interventions for Global Cognition in Patients With Mild Cognitive Impairment: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

• Published in: Frontiers in aging neuroscience 2021-06, Vol.13, p.653340-653340
• Main Authors: Xu, Zijun, Sun, Wen, Zhang, Dexing, Chung, Vincent Chi-Ho, Sit, Regina Wing-Shan, Wong, Samuel Yeung-Shan
• Format: Article
• Language: English
• Subjects: Aging; Alzheimer's disease; Antioxidants; Bias; Clinical trials; cognition; Cognition & reasoning; Cognitive ability; Dementia; Exercise; Handbooks; Intervention; Meta-analysis; mild cognitive impairment; network meta-analysis; Neuroscience; Older people; Performance evaluation; randomized controlled trial; Systematic review
• ISSN: 1663-4365; 1663-4365
• DOI: 10.3389/fnagi.2021.653340

Background: There is a lack of study comprehensively comparing the effects of all existing types of interventions on global cognition among patients with mild cognitive impairment (MCI). Aims: To conduct a network meta-analysis to evaluate the effectiveness of different types of interventions in improving global cognition among MCI patients. Methods: Randomized controlled trials (RCTs) assessing the effects of pharmacological or non-pharmacological interventions on the Mini-Mental State Examination (MMSE) in MCI patients were included. Two authors independently screened the studies and extracted the data. Random-effects network meta-analysis was used to synthesize the data. Results were summarized as mean difference (MD) and corresponding 95% CIs of MMSE in forest plots. Results: Fifty RCTs with 5,944 MCI patients met the inclusion criteria and 49 were included in the network meta-analysis. Compared with the control group, cognition-based intervention (MD = 0.80, 95% CI 0.04–1.57), physical exercise (MD = 1.92, 95% CI 1.19–2.64), combined physical exercise and cognition-based intervention (MD = 1.86, 95% CI 0.60–3.12), and antioxidants (MD = 0.94, 95% CI 0.04–1.83) had positive effects on MMSE in participants with MCI. There was no significant difference between all other interventions included and the control group. Conclusions: This study suggested that cognition-based intervention, physical exercise, combined physical exercise and cognition-based intervention, and antioxidants could be among the most effective interventions on global cognition in older adults with MCI. The availability, acceptability, and cost-effectiveness of interventions should also be taken into consideration when selecting interventions. Registration: PROSPERO CRD42020171985.