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Abstract
Objective
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of cognitive stimulation therapy (CST) of different durations for Alzheimer’s disease (AD).
Methods
A comprehensive search was carried out in three databases. The primary outcome was Mini-Mental State Examination (MMSE) score. We conducted a meta-analysis with Review Manager, version 5.3 and assessed the methodological quality of the included studies using the Cochrane Collaboration Recommendations assessment tool.
Results
Treatment effects from the meta-analysis showed that CST plus acetylcholinesterase inhibitors (ChEIs) was better than the control assessed by MMSE. In addition, the meta-analysis indicated that long-term CST was better than short-term or maintenance CST.
Conclusion
Our study confirmed that the combination of CST and drug treatment for AD is effective in AD, regardless of whether short-term CST, maintenance CST, or long-term CST is used. The long-term CST appears to be more effective.
Acknowledgments
This work was supported by National Natural Science Foundation of China (Project No. 81873375). Juexuan Chen and Yuting Duan should be considered joint senior authors for this study.
Data sharing statement
All data are freely available within the supplementary materials.
Abbreviations list
AD, Alzheimer’s disease; CST, cognitive stimulation therapy; ChEIs, acetylcholinesterase inhibitor; MMSE, Mini–Mental State Examination; ADAS-Cog, Alzheimer’s Disease Assessment Scale-cognitive; QoL-AD, Quality of Life – Alzheimer’s Disease; NPI, neuropsychiatric inventory; RevMan, Review Manager; PRISMA, Preferred Reporting Items for Systematic Review and Meta-Analyses; RCTs, randomized controlled trials.
Supplementary materials
Search strategy
MEDLINE (OVID) search strategy, May 25, 2019
exp Dementia.mp.
(Dementias OR Amentia OR Amentias OR Senile Paranoid Dementia OR Dementias, Senile Paranoid OR Paranoid Dementia, Senile OR Paranoid Dementias, Senile OR Senile Paranoid Dementias OR Familial Dementia OR Dementia, Familial
OR Dementias, Familial OR Familial Dementias) .tw.
3. 1 OR 2
4. exp Alzheimer Disease.mp.
5. (Disease, Alzheimer OR Alzheimer Sclerosis OR Sclerosis, Alzheimer OR Alzheimer Syndrome OR Syndrome, Alzheimer OR Alzheimer Dementia OR Dementia, Alzheimer OR Alzheimer-Type Dementia OR Alzheimer Type Dementia OR Dementia, Alzheimer-Type OR Primary Senile Degenerative Dementia OR Dementia, Senile OR Senile Dementia OR Dementia, Alzheimer Type OR Alzheimer Type Dementia OR Senile Dementia, Alzheimer Type OR Alzheimer Type Senile Dementia OR Dementia, Primary Senile Degenerative OR Alzheimer’s Disease OR Disease, Alzheimer’s OR Acute Confusional Senile Dementia OR Senile Dementia, Acute Confusional OR Dementia, Presenile OR Presenile Dementia OR Alzheimer Disease, Late Onset OR Late Onset Alzheimer Disease OR Alzheimer’s Disease, Focal Onset OR Focal Onset Alzheimer’s Disease
OR Familial Alzheimer Disease OR Alzheimer Disease, Early Onset Early Onset Alzheimer Disease OR Presenile Alzheimer Dementia).tw.
6. 4 OR 5
7. exp Cognitive stimulation Therapy.mp.
8. (Therapy, Cognitive stimulation OR cognitive stimulation Therapies OR Therapies, Cognitive stimulation OR CST).tw.
9. 7 OR 8
10. Randomized controlled trial.pt.
11. controlled clinical trial.pt.
12. randomized.ti,ab.
13. placebo.ti,ab.
14. randomly.ti,ab.
15. trial.ti,ab.
16. groups.ti,ab.
17. OR/10-16
18. 3 AND 6 AND 9 AND 17
EMBASE (OVID) search strategy, May 25, 2019
1. exp Dementia.mp.
2. (Dementias OR Amentia OR Amentias OR Senile Paranoid Dementia OR Dementias, Senile Paranoid OR Paranoid Dementia, Senile OR Paranoid Dementias, Senile OR Senile Paranoid Dementias OR Familial Dementia OR Dementia, Familial
OR Dementias, Familial OR Familial Dementias) .tw.
3. 1 OR 2
4. exp Alzheimer Disease.mp.
5. (Disease, Alzheimer OR Alzheimer Sclerosis OR Sclerosis, Alzheimer OR Alzheimer Syndrome OR Syndrome, Alzheimer OR Alzheimer Dementia OR Dementia, Alzheimer OR Alzheimer-Type Dementia OR Alzheimer Type Dementia OR Dementia, Alzheimer-Type OR Primary Senile Degenerative Dementia OR Dementia, Senile OR Senile Dementia OR Dementia, Alzheimer Type OR Alzheimer Type Dementia OR Senile Dementia, Alzheimer Type OR Alzheimer Type Senile Dementia OR Dementia, Primary Senile Degenerative OR Alzheimer’s Disease OR Disease, Alzheimer’s OR Acute Confusional Senile Dementia OR Senile Dementia, Acute Confusional OR Dementia, Presenile OR Presenile Dementia OR Alzheimer Disease, Late Onset OR Late Onset Alzheimer Disease OR Alzheimer’s Disease, Focal Onset OR Focal Onset Alzheimer’s Disease
OR Familial Alzheimer Disease OR Alzheimer Disease, Early Onset Early Onset Alzheimer Disease OR Presenile Alzheimer Dementia).tw.
6. 4 OR 5
7. exp Cognitive stimulation Therapy.mp.
8. (Therapy, Cognitive stimulation OR cognitive stimulation Therapies OR Therapies, Cognitive stimulation OR CST).tw.
9. 7 OR 8
10. Randomized controlled trial.pt.
11. controlled clinical trial.pt.
12. randomized.ti,ab.
13. placebo.ti,ab.
14. randomly.ti,ab.
15. trial.ti,ab.
16. groups.ti,ab.
17. OR/10-16
18. 3 AND 6 AND 9 AND 17
PsycINFO (OVID) search strategy, May 25, 2019
1. exp Dementia.mp.
2. (Dementias OR Amentia OR Amentias OR Senile Paranoid Dementia OR Dementias, Senile Paranoid OR Paranoid Dementia, Senile OR Paranoid Dementias, Senile OR Senile Paranoid Dementias OR Familial Dementia OR Dementia, Familial
OR Dementias, Familial OR Familial Dementias) .tw.
3. 1 OR 2
4. exp Alzheimer Disease.mp.
5. (Disease, Alzheimer OR Alzheimer Sclerosis OR Sclerosis, Alzheimer OR Alzheimer Syndrome OR Syndrome, Alzheimer OR Alzheimer Dementia OR Dementia, Alzheimer OR Alzheimer-Type Dementia OR Alzheimer Type Dementia OR Dementia, Alzheimer-Type OR Primary Senile Degenerative Dementia OR Dementia, Senile OR Senile Dementia OR Dementia, Alzheimer Type OR Alzheimer Type Dementia OR Senile Dementia, Alzheimer Type OR Alzheimer Type Senile Dementia OR Dementia, Primary Senile Degenerative OR Alzheimer’s Disease OR Disease, Alzheimer’s OR Acute Confusional Senile Dementia OR Senile Dementia, Acute Confusional OR Dementia, Presenile OR Presenile Dementia OR Alzheimer Disease, Late Onset OR Late Onset Alzheimer Disease OR Alzheimer’s Disease, Focal Onset OR Focal Onset Alzheimer’s Disease
OR Familial Alzheimer Disease OR Alzheimer Disease, Early Onset Early Onset Alzheimer Disease OR Presenile Alzheimer Dementia).tw.
6. 4 OR 5
7. exp Cognitive stimulation Therapy.mp.
8. (Therapy, Cognitive stimulation OR cognitive stimulation Therapies OR Therapies, Cognitive stimulation OR CST).tw.
9. 7 OR 8
10. Randomized controlled trial.pt.
11. controlled clinical trial.pt.
12. randomized.ti,ab.
13. placebo.ti,ab.
14. randomly.ti,ab.
15. trial.ti,ab.
16. groups.ti,ab.
17. OR/10-16
18. 3 AND 6 AND 9 AND 17
CENTRAL (Cochrane Library) search strategy, May 25, 2019s
1. MeSH descriptor: [Dementia] explode all trees
2. (Dementias or Amentia or Amentias or Senile Paranoid Dementia or Dementias, Senile Paranoid or Paranoid Dementia, Senile or Paranoid Dementias, Senile or Senile Paranoid Dementias or Familial Dementia or Dementia, Familial or Dementias, Familial or Familial Dementias):ti,ab,kw (Word variations have been searched)
3. #1 or #2
4. MeSH descriptor: [Alzheimer Disease] explode all trees
5. (Disease, Alzheimer or Alzheimer Sclerosis or Sclerosis, Alzheimer or Alzheimer Syndrome or Syndrome, Alzheimer or Alzheimer Dementia or Dementia, Alzheimer or Alzheimer-Type Dementia or Alzheimer Type Dementia or Dementia, Alzheimer-Type or Primary Senile Degenerative Dementia or Dementia, Senile or Senile Dementia or Dementia, Alzheimer Type or Alzheimer Type Dementia or Senile Dementia, Alzheimer Type or Alzheimer Type Senile Dementia or Dementia, Primary Senile Degenerative or Alzheimer’s Disease or Disease, Alzheimer’s or Acute Confusional Senile Dementia or Senile Dementia, Acute Confusional or Dementia, Presenile or Presenile Dementia or Alzheimer Disease, Late Onset or Late Onset Alzheimer Disease or Alzheimer’s Disease, Focal Onset or Focal Onset Alzheimer’s Disease
or Familial Alzheimer Disease or Alzheimer Disease, Early Onset Early Onset Alzheimer Disease or Presenile Alzheimer Dementia):ti,ab,kw (Word variations have been searched)
6. #4 or #5
7. MeSH descriptor: [Cognitive stimulation Therapy] explode all trees
8. (Therapy, Cognitive stimulation OR cognitive stimulation Therapies OR Therapies, Cognitive stimulation OR CST):ti,ab,kw (Word variations have been searched)
9. #7 or #8
10. #3 and #6 and #9
Author Contributions
JC, YD, HL, LL, JL and CT conceived and designed the study. JC, YD, and LL selected the articles and JC and YD extracted the data. HL, CT and JL analyzed the data. JC, YD, and LL wrote the first draft of the manuscript. HL, CT and JL interpreted the data and wrote the final version of the manuscript. All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.