Comparative efficacy of cognitive training modalities in cognitive impairment: A systematic review and network meta-analysis.

BACKGROUND

Cognitive training is a widely utilized non-pharmacological intervention to enhance cognitive performance in individuals with cognitive impairment. Despite its potential, significant ambiguity remains regarding its definition, optimal modalities, and design parameters. It remains unclear which types of cognitive training are relatively optimal for different levels of cognitive impairment or how intervention designs can maximize therapeutic benefits.

OBJECTIVES

This systematic review and network meta-analysis aimed to compare the effects of various cognitive training modalities on cognitive, psychological, and quality-of-life outcomes in individuals with cognitive impairment. Additionally, it sought to identify optimal intervention approaches, clarify key design parameters, and examine critical factors influencing treatment efficacy.

METHODS

A comprehensive search was conducted across 12 databases from the establishment of the database until October 24, 2024, to identify eligible randomized controlled trials (RCTs) evaluating cognitive training interventions. Data were analyzed using pairwise meta-analysis and network meta-analysis in Review Manager 5.4 and Stata 18.

RESULTS

Totally 43 RCTs were included. Pairwise meta-analysis revealed that cognitive strategy training demonstrated superior to active control (AC) or passive control (PC) in improving language function, immediate memory, depressive symptoms and quality of life. However, no significant effects were detected regarding cognitive impairment severity, delivery format, interventionist expertise level, training duration, or control type. Network meta-analysis further identified reminiscence therapy as the most pronounced effective intervention for improving global cognition across all stages of cognitive impairment.

CONCLUSIONS

Reminiscence therapy has been demonstrated as a relatively optimal cognitive training modality for enhancing cognitive function in individuals with varying levels of cognitive impairment. Future studies should prioritize longitudinal investigations to validate the durability of therapeutic benefits and incorporate neuroimaging and biomarker analyses to elucidate underlying mechanisms. High-quality RCTs remain imperative to strengthen the evidence base and evaluate the consistency of effects across diverse cognitive training interventions.