Clare L, Woods R T, Moniz Cook E D, Orrell M, Spector A
Sub-department of Clinical Health Psychology, University College London, Gower Street, London, UK, WC1E 6BT.
Cochrane Database Syst Rev. 2003(4):CD003260. doi: 10.1002/14651858.CD003260.
Memory problems are a defining feature of the early stages of Alzheimer's disease (AD) and vascular dementia. Cognitive training and cognitive rehabilitation are specific approaches designed to address everyday memory difficulties.
The main aim was to evaluate the effectiveness and impact of cognitive training and cognitive rehabilitation interventions aimed at improving memory functioning for people in the early stages of Alzheimer's disease or vascular dementia. The two types of intervention were considered separately.
The CDCIG Specialized Register, which contains records from MEDLINE, EMBASE, CINAHL, PsycINFO and many other databases, was searched on 9 April 2003.
RCTs comparing cognitive rehabilitation or cognitive training interventions with comparison conditions, and reporting outcomes for the person with dementia and/or the family caregiver, were considered for inclusion.
Six studies reporting cognitive training interventions were included. Statistical analyses were conducted to provide an indication of intervention effect sizes. Data from ordinal scales was treated as continuous, and a fixed effects model was applied in calculating weighted mean differences and 95% confidence intervals. No studies were found that reported a fully individualised cognitive rehabilitation approach.
None of the six studies reporting cognitive training interventions demonstrated any statistically significant effects in any domain, although there were indications of some modest, non-significant effects in various domains of cognitive functioning.
REVIEWER'S CONCLUSIONS: The present findings do not provide strong support for the use of cognitive training interventions for people with early-stage AD or vascular dementia, although these findings must be viewed with caution due to the limited number of RCTs available and to the methodological limitations identified, and further well-designed trials would help to provide more definitive evidence. Due to a complete absence of RCTs evaluating an individualised cognitive rehabilitation approach, It is not possible at present to draw conclusions about the efficacy of individualised cognitive rehabilitation interventions for people with early-stage dementia, and further research is required in this area.
记忆问题是阿尔茨海默病（AD）和血管性痴呆早期阶段的一个典型特征。认知训练和认知康复是旨在解决日常记忆困难的特定方法。
主要目的是评估针对阿尔茨海默病或血管性痴呆早期患者改善记忆功能的认知训练和认知康复干预措施的有效性和影响。对这两种干预类型分别进行了考量。
2003年4月9日检索了CDCIG专业注册库，该注册库包含来自MEDLINE、EMBASE、CINAHL、PsycINFO以及许多其他数据库的记录。
纳入比较认知康复或认知训练干预措施与对照条件，并报告痴呆患者和/或家庭照顾者结局的随机对照试验（RCT）。
纳入了六项报告认知训练干预措施的研究。进行了统计分析以显示干预效应大小。将有序量表数据视为连续数据，并应用固定效应模型计算加权平均差和95%置信区间。未发现报告完全个体化认知康复方法的研究。
六项报告认知训练干预措施的研究中，没有一项在任何领域显示出任何统计学上的显著效果，尽管在认知功能的各个领域有迹象表明存在一些适度的、不显著的效果。
目前的研究结果并不强烈支持对早期AD或血管性痴呆患者使用认知训练干预措施，不过由于可用的随机对照试验数量有限以及所发现的方法学局限性，这些结果必须谨慎看待，进一步设计良好的试验将有助于提供更确凿的证据。由于完全没有评估个体化认知康复方法的随机对照试验，目前无法就个体化认知康复干预措施对早期痴呆患者的疗效得出结论，该领域需要进一步研究。
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