Gates Nicola J, Rutjes Anne Ws, Di Nisio Marcello, Karim Salman, Chong Lee-Yee, March Evrim, Martínez Gabriel, Vernooij Robin Wm
Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Suite 407 185 Elizabeth Street, Sydney, NSW, Australia, 2000.
Cochrane Database Syst Rev. 2019 Mar 13;3(3):CD012278. doi: 10.1002/14651858.CD012278.pub2.
Normal aging is associated with changes in cognitive function that are non-pathological and are not necessarily indicative of future neurocognitive disease. Low cognitive and brain reserve and limited cognitive stimulation are associated with increased risk of dementia. Emerging evidence now suggests that subtle cognitive changes, detectable years before criteria for mild cognitive impairment are met, may be predictive of future dementia. Important for intervention and reduction in disease risk, research also suggests that engaging in stimulating mental activity throughout adulthood builds cognitive and brain reserve and reduces dementia risk. Therefore, midlife (defined here as 40 to 65 years) may be a suitable time to introduce cognitive interventions for maintaining cognitive function and, in the longer term, possibly preventing or delaying the onset of clinical dementia.
To evaluate the effects of computerised cognitive training interventions lasting at least 12 weeks for maintaining or improving cognitive function in cognitively healthy people in midlife.
We searched up to 31 March 2018 in ALOIS (www.medicine.ox.ac.uk/alois), the specialised register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG). We ran additional searches in MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov, and the WHO Portal/ICTRP at www.apps.who.int/trialsearch, to ensure that the search was as comprehensive and as up-to-date as possible, to identify published, unpublished, and ongoing trials.
We included randomised controlled trials (RCTs) or quasi-RCTs, published or unpublished, reported in any language. Participants were cognitively healthy people between 40 and 65 years of age (80% of study population within this age range). Experimental interventions adhered to the following criteria: intervention was any form of interactive computerised cognitive intervention - including computer exercises, computer games, mobile devices, gaming console, and virtual reality - that involved repeated practice on standardised exercises of specified cognitive domain(s) for the purpose of enhancing cognitive function; duration of the intervention was at least 12 weeks; cognitive outcomes were measured; and cognitive training interventions were compared with active or inactive control interventions.
For preliminary screening of search results, we used a 'crowd' method to identify RCTs. At least two review authors working independently screened remaining citations against inclusion criteria; independently extracted data; and assessed the quality of the included trial, using the Cochrane risk of bias assessment tool. We used GRADE to describe the overall quality of the evidence.
We identified one eligible study that examined the effect of computerised cognitive training (CCT) in 6742 participants over 50 years of age, with training and follow-up duration of six months. We considered the study to be at high risk of attrition bias and the overall quality of the evidence to be low.Researchers provided no data on our primary outcome. Results indicate that there may be a small advantage for the CCT group for executive function (mean difference (MD) -1.57, 95% confidence interval (CI) -1.85 to -1.29; participants = 3994; low-quality evidence) and a very small advantage for the control group for working memory (MD 0.09, 95% CI 0.03 to 0.15; participants = 5831; low-quality evidence). The intervention may have had little or no effect on episodic memory (MD -0.03, 95% CI -0.10 to 0.04; participants = 3090; low-quality evidence).
AUTHORS' CONCLUSIONS: We found low-quality evidence from only one study. We are unable to determine whether computerised cognitive training is effective in maintaining global cognitive function among healthy adults in midlife. We strongly recommend that high-quality studies be undertaken to investigate the effectiveness and acceptability of cognitive training in midlife, using interventions that last long enough that they may have enduring effects on cognitive and brain reserve, and with investigators following up long enough to assess effects on clinically important outcomes in later life.
正常衰老与认知功能的变化相关，这些变化是非病理性的，不一定预示着未来会患神经认知疾病。认知和大脑储备较低以及认知刺激有限与患痴呆症的风险增加有关。新出现的证据表明，在达到轻度认知障碍标准的数年之前就能检测到的细微认知变化，可能预示着未来会患痴呆症。对干预和降低疾病风险很重要的是，研究还表明，在成年期持续参与刺激性的脑力活动可建立认知和大脑储备，并降低患痴呆症的风险。因此，中年（此处定义为40至65岁）可能是引入认知干预以维持认知功能、并从长远来看可能预防或延缓临床痴呆症发作的合适时机。
评估持续至少12周的计算机化认知训练干预对中年认知健康人群维持或改善认知功能的效果。
我们检索了截至2018年3月31日的ALOIS（www.medicine.ox.ac.uk/alois），即Cochrane痴呆与认知改善小组（CDCIG）的专业注册库。我们还在MEDLINE、Embase、PsycINFO、CINAHL、ClinicalTrials.gov以及世界卫生组织网站/国际临床试验注册平台（www.apps.who.int/trialsearch）上进行了额外检索，以确保检索尽可能全面和最新，从而识别已发表、未发表及正在进行的试验。
我们纳入了以任何语言发表或未发表的随机对照试验（RCT）或半随机对照试验。参与者为40至65岁的认知健康人群（该年龄范围内的研究对象占80%）。实验性干预符合以下标准：干预为任何形式的交互式计算机化认知干预——包括计算机练习、电脑游戏、移动设备、游戏机和虚拟现实——其涉及针对特定认知领域的标准化练习进行反复练习，目的是增强认知功能；干预持续时间至少为12周；测量了认知结果；并且将认知训练干预与主动或非主动对照干预进行了比较。
为对检索结果进行初步筛选，我们采用了一种“众包”方法来识别RCT。至少两名综述作者独立对照纳入标准筛选剩余的文献引用；独立提取数据；并使用Cochrane偏倚风险评估工具评估纳入试验的质量。我们使用GRADE来描述证据的总体质量。
我们识别出一项符合条件的研究，该研究在6742名50岁以上参与者中检验了计算机化认知训练（CCT）的效果，训练和随访持续时间为6个月。我们认为该研究存在较高的失访偏倚风险，证据的总体质量较低。研究人员未提供我们主要结局的数据。结果表明，CCT组在执行功能方面可能有较小优势（平均差值（MD）-1.57，95%置信区间（CI）-1.85至-1.29；参与者 = 3994；低质量证据），而对照组在工作记忆方面有非常小的优势（MD 0.09，95%CI 0.03至0.15；参与者 = 5831；低质量证据）。该干预对情景记忆可能几乎没有影响（MD -0.03，95%CI -0.10至0.04；参与者 = 3090；低质量证据）。
我们仅从一项研究中发现了低质量证据。我们无法确定计算机化认知训练对中年健康成年人维持整体认知功能是否有效。我们强烈建议开展高质量研究，以调查中年认知训练的有效性和可接受性，采用持续时间足够长、可能对认知和大脑储备产生持久影响的干预措施，并让研究人员进行足够长时间的随访，以评估对晚年临床重要结局的影响。
