Cognitive training in MCI may stimulate pre-existing neural reserves or recruit neural circuitry as "compensatory scaffolding" prompting neuroplastic reorganization to meet task demands (Reuter-Lorenz & Park, 2014). However, existing systematic reviews and meta-analytic studies exploring the benefits of cognitive interventions in MCI have been mixed. An updated examination regarding the efficacy of cognitive intervention in MCI is needed given improvements in adherence to MCI diagnostic criteria in subject selection, better defined interventions and strategies applied, increased use of neuropsychological measures pre- and post-intervention, as well as identification of moderator variables which may influence treatment. As such, this meta-analytic review was conducted to examine the efficacy of cognitive intervention in individuals diagnosed with mild cognitive impairment (MCI) versus MCI controls based on performance of neuropsychological outcome measures in randomized controlled trials (RCT). RCT studies published from January 1995 to June 2017 were obtained through source databases of MEDLINE-R, PubMed, Healthstar, Global Health, PSYCH-INFO, and Health and Psychological Instruments using search parameters for MCI diagnostic category (mild cognitive impairment, MCI, pre-Alzheimer's disease, early cognitive decline, early onset Alzheimer's disease, and preclinical Alzheimer's disease) and the intervention or training conducted (intervention, training, stimulation, rehabilitation, or treatment). Other inclusion and exclusion criteria included subject selection based on established MCI criteria, RCT design in an outpatient setting, MCI controls (active or passive), and outcomes based on objective neuropsychological measures. From the 1199 abstracts identified, 26 articles met inclusion criteria for the meta-analyses completed across eleven (11) countries; 92.31% of which have been published within the past 7 years. A series of meta-analyses were performed to examine the effects of cognitive intervention by cognitive domain, type of training, and intervention content (cognitive domain targeted). We found significant, moderate effects for multicomponent training (Hedges' g observed = 0.398; CI [0.164, 0.631]; Z = 3.337; p = 0.001; Q = 55.511; df = 15; p = 0.000; I 2  = 72.978%; τ 2  = 0.146) as well as multidomain-focused strategies (Hedges' g = 0.230; 95% CI [0.108, 0.352]; Z = 3.692; p  < 0.001; Q = 12.713; df = 12; p = 0.390; I 2  = 5.612; τ 2  = 0.003). The effects for other interventions explored by cognitive domain, training type, or intervention content were indeterminate due to concerns for heterogeneity, bias, and small cell sizes. In addition, subgroup and meta-regression analyses were conducted with the moderators of MCI category, mode of intervention, training type, intervention content, program duration (total hours), type of control group (active or passive), post-intervention follow-up assessment period, and control for repeat administration. We found significant overall effects for intervention content with memory focused interventions appearing to be more effective than multidomain approaches. There was no evidence of an influence on outcomes for the other covariates examined. Overall, these findings suggest individuals with MCI who received multicomponent training or interventions targeting multiple domains (including lifestyle changes) were apt to display an improvement on outcome measures of cognition post-intervention. As such, multicomponent and multidomain forms of intervention may prompt recruitment of alternate neural processes as well as support primary networks to meet task demands simultaneously. In addition, interventions with memory and multidomain forms of content appear to be particularly helpful, with memory-based approaches possibly being more effective than multidomain methods. Other factors, such as program duration, appear to have less of an influence on intervention outcomes. Given this, although the creation of new primary network paths appears strained in MCI, interventions with memory-based or multidomain forms of content may facilitate partial activation of compensatory scaffolding and neuroplastic reorganization. The positive benefit of memory-based strategies may also reflect transfer effects indicative of compensatory network activation and the multiple-pathways involved in memory processes. Limitations of this review are similar to other meta-analysis in MCI, including a modest number studies, small sample sizes, multiple forms of interventions and types of training applied (some overlapping), and, while greatly improved in our view, a large diversity of instruments used to measure outcome. This is apt to have contributed to the presence of heterogeneity and publication bias precluding a more definitive determination of the outcomes observed.

译文

MCI中的认知训练可能会刺激预先存在的神经储备或招募神经回路作为 “补偿支架”,促使神经可塑性重组以满足任务需求 (Reuter-Lorenz & Park,2014)。然而,现有的系统评价和荟萃分析研究探讨了认知干预对MCI的益处。需要对认知干预对MCI的有效性进行更新检查,因为在受试者选择中遵守MCI诊断标准的情况有所改善,应用了更好的定义干预措施和策略,干预前后神经心理学措施的使用增加以及识别可能影响治疗的调节变量。因此,在随机对照试验 (RCT) 中,基于神经心理学结局指标的表现,进行了这项荟萃分析评价,以检查认知干预对被诊断为轻度认知障碍 (MCI) 的个体与MCI对照组的疗效。1995年1月至2017年6月发表的RCT研究是通过MEDLINE-R、PubMed、Healthstar、全球健康、心理信息以及健康和心理工具的源数据库获得的,使用MCI诊断类别 (轻度认知障碍、MCI、阿尔茨海默氏病前、早期认知衰退、早发性阿尔茨海默病和临床前阿尔茨海默病) 以及进行的干预或训练 (干预、训练、刺激、康复或治疗)。其他纳入和排除标准包括基于既定MCI标准的受试者选择,门诊患者的RCT设计,MCI对照 (主动或被动) 以及基于客观神经心理学指标的结果。从确定的1199篇摘要中,有26篇文章符合11个国家/地区完成的荟萃分析的纳入标准; 其中92.31% 篇已在过去7年内发表。进行了一系列荟萃分析,以通过认知领域,训练类型和干预内容 (目标认知领域) 来检查认知干预的效果。我们发现多组分训练有显著的中等效果 (hedges的g observed  =   0.398; CI [0.164,0.631]; Z =   3.337; P =   0.001; Q =   55.511; df  =   15; P =   0.000; I 2   =   72.978%; Τ 2   =   0.146) 以及多域聚焦策略 (hedges的g   =   0.230; 95% CI [0.108,0.352]; Z   =   3.692; P   < 0.001; Q   =   12.713; df  =   12; P   =   0.390; I 2   =   5.612; Τ 2   =   0.003)。由于对异质性,偏倚和小细胞大小的担忧,通过认知领域,训练类型或干预内容探索的其他干预措施的效果是不确定的。此外,还对MCI类别,干预方式,培训类型,干预内容,计划持续时间 (总小时数),对照组类型 (主动或被动),干预后随访评估期和重复给药控制进行了亚组和荟萃回归分析。我们发现,以记忆为重点的干预措施对干预内容的整体效果似乎比多领域方法更有效。没有证据表明其他协变量对结果有影响。总体而言,这些发现表明接受多组分训练或针对多个领域 (包括生活方式改变) 的干预措施的MCI患者易于在干预后的认知结果指标上显示出改善。因此,多组分和多域形式的干预可能会促使替代神经过程的招募以及支持主要网络以同时满足任务需求。此外,对记忆和多域形式的内容的干预似乎特别有帮助,基于记忆的方法可能比多域方法更有效。其他因素,如项目持续时间,似乎对干预结果的影响较小。鉴于此,尽管在MCI中创建新的主要网络路径似乎很紧张,但对基于记忆或多域形式的内容进行干预可能会促进补偿性支架的部分激活和神经整形重组。基于记忆的策略的积极好处还可以反映出指示补偿性网络激活和记忆过程中涉及的多个路径的转移效应。本综述的局限性与MCI中的其他荟萃分析相似,包括数量适中的研究,小样本量,多种形式的干预措施和应用的培训类型 (有些重叠),尽管我们认为有很大的改善,但用于测量结果的工具种类繁多。这容易导致异质性和发表偏见的存在,从而无法对观察到的结果进行更明确的确定。

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