Motter Jeffrey N, Pimontel Monique A, Rindskopf David, Devanand Davangere P, Doraiswamy P Murali, Sneed Joel R
The Graduate Center, City University of New York, USA; Queens College, City University of New York, USA.
The Graduate Center, City University of New York, USA.
J Affect Disord. 2016 Jan 1;189:184-91. doi: 10.1016/j.jad.2015.09.022. Epub 2015 Sep 26.
Depression is common, frequently resistant to antidepressant treatment, and associated with impairments in cognition and everyday functioning. Computerized cognitive training (CCT) paradigms offer potential to improve cognition, mood and everyday functioning, but their effectiveness is not well established. The goal of this article was to conduct a systematic review and meta-analysis to determine the efficacy of CCT in depressive disorders.
A search was conducted to identify high quality randomized controlled CCT trials per PRISMA guidelines using PsycINFO and MEDLINE with the keywords "Cognitive training" or "Cognitive remediation" or "Cognitive rehabilitation" and "Depression". 9 randomized trials for depressed adults met inclusion criteria. Effect sizes (Hedge's g) were calculated for key outcome measures of mood symptom severity, daily functioning, and cognition. A 3-level Bayesian hierarchical linear model was used to estimate effect sizes for each domain and study. Publication bias was assessed using Classic Fail Safe N's and homogeneity was evaluated using Q and I(2) indexes.
Significant small-moderate effects for Symptom Severity (0.43) and Daily Functioning (0.72), and moderate-large effects for Attention (0.67), Working Memory (0.72), and Global Functioning (1.05) were found. No significant effects were found for Executive Functioning or Verbal Memory. Moderator variable analysis revealed decreased effect of CCT with age. Gender and concurrent medication treatment did not affect the results.
Small sample size, short duration, pseudo-specificity, and high heterogeneity for Verbal Memory measures.
CCT is associated with improvement in depressive symptoms and everyday functioning, though produces inconsistent effects on cognition.
抑郁症很常见，常常对抗抑郁治疗有抵抗性，且与认知和日常功能受损相关。计算机化认知训练（CCT）模式有改善认知、情绪和日常功能的潜力，但其有效性尚未得到充分证实。本文的目的是进行一项系统综述和荟萃分析，以确定CCT在抑郁症中的疗效。
按照PRISMA指南进行检索，使用PsycINFO和MEDLINE数据库，关键词为“认知训练”或“认知矫正”或“认知康复”以及“抑郁症”，以识别高质量的随机对照CCT试验。9项针对成年抑郁症患者的随机试验符合纳入标准。计算了情绪症状严重程度、日常功能和认知等关键结局指标的效应量（Hedge's g）。使用三级贝叶斯分层线性模型估计每个领域和研究的效应量。使用经典失安全数评估发表偏倚，使用Q和I²指数评估同质性。
发现症状严重程度（0.43）和日常功能（0.72）有显著的小到中度效应，注意力（0.67）、工作记忆（0.72）和整体功能（1.05）有中度到较大效应。执行功能或言语记忆未发现显著效应。调节变量分析显示，CCT的效应随年龄增长而降低。性别和同时进行的药物治疗不影响结果。
样本量小、持续时间短、伪特异性以及言语记忆测量的高异质性。
CCT与抑郁症状和日常功能的改善相关，尽管对认知的影响不一致。
