Fan Brian J Y, Wong Roger Y M
Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
Division of Geriatric Medicine, University of British Columbia; Vancouver, BC V5Z 1M9, Canada.
Geriatrics (Basel). 2019 Jul 18;4(3):44. doi: 10.3390/geriatrics4030044.
There is increasing interest in the effect of non-pharmacological treatments on preserving cognition and function in older adults without major neurocognitive disorder (dementia). However, its effect on everyday function in terms of instrumental activities of daily living (IADL) is unclear. We conducted a systematic review to examine whether cognitive training, independent of other interventions, can improve IADL function in older adults without major neurocognitive disorder. We searched multiple databases including MEDLINE, EMBASE, and PSYCINFO and found thirteen studies that met our inclusion criteria with 7130 participants in total. Six out of thirteen studies reported a significant change on validated IADL assessment. On subgroup analysis, five studies included older adults with normal cognition and one included mild cognitive impairment (MCI). Eleven out of twelve studies showed improvement in measures of cognition. None of the studies described changes in the ability to live independently. While variation in study protocol, outcome measurement, and effect size reporting precluded further inferential statistical analysis, our review found a sizable number of studies showing improvement in IADL. Cognitive training may have some benefit in improving IADL function in older adults without major neurocognitive disorder. Future long-term studies focusing on maintained IADL function and preserved independence are needed.
非药物治疗对无重大神经认知障碍（痴呆症）的老年人认知和功能的保护作用日益受到关注。然而，其对日常生活工具性活动（IADL）方面日常功能的影响尚不清楚。我们进行了一项系统综述，以研究独立于其他干预措施的认知训练是否能改善无重大神经认知障碍老年人的IADL功能。我们检索了多个数据库，包括MEDLINE、EMBASE和PSYCINFO，共找到13项符合纳入标准的研究，总计7130名参与者。13项研究中有6项报告了经验证的IADL评估有显著变化。亚组分析中，5项研究纳入了认知正常的老年人，1项纳入了轻度认知障碍（MCI）患者。12项研究中有11项显示认知指标有所改善。没有研究描述独立生活能力的变化。虽然研究方案、结果测量和效应大小报告的差异妨碍了进一步的推断性统计分析，但我们的综述发现大量研究显示IADL有所改善。认知训练可能对改善无重大神经认知障碍老年人的IADL功能有一定益处。未来需要开展关注维持IADL功能和保持独立性的长期研究。
