School of Nursing, Peking University, Beijing, China.
Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
J Am Med Dir Assoc. 2022 Mar;23(3):461-467.e11. doi: 10.1016/j.jamda.2021.11.015. Epub 2021 Dec 20.
To compare and rank the effectiveness of group cognitive stimulation therapy (group CST), maintenance cognitive stimulation therapy (MCST), and individual cognitive stimulation therapy (iCST) on cognition and quality of life (QoL) in people with dementia.
Systematic review and network meta-analysis (NMA).
All published randomized controlled trials (RCTs) that compared the differences among 3 different settings of CST or a control group in treating people with dementia.
Relevant electronic databases, including PubMed, Embase, Cochrane Library for clinical trials, Web of Science, CINAHL, PsycINFO, Chinese National Knowledge Infrastructure (CNKI), and Wanfang Data were systematically searched from inception to March 2021. RCTs that compared the differences among 3 different settings of CST or a control group in treating people with dementia were included. Then, a pairwise and network meta-analysis was conducted to evaluate the relative effects and rank probability of different CST settings. PRISMA guidelines were used for abstracting data, and the Cochrane Risk of Bias tool was used to assess data quality.
In total, 17 studies were included, which enrolled 1680 participants. Compared with the control group, MSCT [standardized mean difference (SMD) = 1.39, 95% CI 0.86, 1.91; low-quality evidence] and group CST (SMD 0.62, 95% CI 0.39, 0.84; very low-quality evidence) could significantly improve cognitive function. MCST (SMD 1.00, 95% CI 0.16, 1.85; low-quality evidence) and group CST (SMD 0.53, 95% CI 0.13, 0.92; low-quality evidence) demonstrated a statistically significant effect in improving the QoL, whereas iCST was not significantly inferior to the control condition. None of the treatments were significantly different from each other with respect to acceptability.
For people with dementia, group CST and MCST seems to promote more consistent benefits in terms of cognition and QoL than the iCST, and MCST was likely to be the most effective CST setting. Further RCTs with respect to the MCST and iCST efficacy are needed.
比较和排序团体认知刺激疗法（group CST）、维持性认知刺激疗法（MCST）和个体认知刺激疗法（iCST）对痴呆患者认知和生活质量（QoL）的疗效。
系统评价和网络荟萃分析（NMA）。
所有已发表的比较 CST 三种不同设置或对照组在治疗痴呆患者方面差异的随机对照试验（RCT）。
系统检索包括 PubMed、Embase、Cochrane 临床试验图书馆、Web of Science、CINAHL、PsycINFO、中国知网（CNKI）和万方数据在内的所有电子数据库，检索时间从建库至 2021 年 3 月。纳入比较 CST 三种不同设置或对照组在治疗痴呆患者方面差异的 RCT。然后进行成对和网络荟萃分析，以评估不同 CST 设置的相对效果和排名概率。使用 PRISMA 指南提取数据，并使用 Cochrane 偏倚风险工具评估数据质量。
共纳入 17 项研究，纳入 1680 名参与者。与对照组相比，MSCT[标准化均数差（SMD）=1.39，95%CI 0.86，1.91；低质量证据]和团体 CST（SMD 0.62，95%CI 0.39，0.84；极低质量证据）可显著改善认知功能。MCST（SMD 1.00，95%CI 0.16，1.85；低质量证据）和团体 CST（SMD 0.53，95%CI 0.13，0.92；低质量证据）在改善生活质量方面具有统计学意义的效果，而 iCST 与对照组相比则没有显著差异。在可接受性方面，任何一种治疗方法都没有明显的差异。
对于痴呆患者，团体 CST 和 MCST 在认知和生活质量方面似乎比 iCST 更能带来一致的益处，而 MCST 可能是最有效的 CST 设置。需要进一步开展关于 MCST 和 iCST 疗效的 RCT。
