Cognitive training, Dementia and RehaCom

RehaCom is the best known system for Computerised Cognitive Training (CCT), is used around the world and by more than 90% of facilities involved in brain injury rehabilitation in Germany. The system is designed to offer opportunities for restitution of cognitive function as part of an overall approach that typical would blend both compensation and restitution strategies as appropriate.

Little is formally known about the efficacy of CCT in people with mild cognitive impairment or dementia.  Previous meta-analyses indicate that CCT is a safe and efficacious intervention for cognition in older adults. However, efficacy varies across populations and cognitive domains.

A recent study found that CCT was efficacious on global cognition, select cognitive domains, and psychosocial functioning in people with mild cognitive impairment.

Dementia is a progressive neurocognitive disorder characterised by cognitive and functional decline until death. At present, the global prevalence of dementia is estimated at 5%−7% of people over 60 years.  Mild cognitive impairment often precedes dementia and is characterized by largely intact everyday function despite objective evidence of cognitive decline. Mild cognitive impairment is a risk factor for dementia, falls, and higher health expenditure. The risk increases proportionally with the number of impaired cognitive domains and with symptom severity.

Mild cognitive impairment is an unstable cognitive state with potential to avert progression to dementia and therefore avoid the serious health and societal consequences.

CCT has generated considerable attention as a safe, relatively inexpensive and scalable intervention that aims to maintain cognition in older adults. 

The authors advise that applying CCT involves guided drill-and-practice on standardized tasks designed to focus on specific cognitive processes, typically without explicit teaching of memory or problem-solving strategies, which distinguish CCT from other approaches for cognitive remediation. CCT can target single or multiple cognitive domains and usually adapts task difficulty to individual performance. Recent meta-analyses of randomized controlled trials of CCT have found moderate effect sizes on cognition in healthy older adults and in Parkinson’s disease, as well as on symptom severity, daily functioning, and cognition in major depression.

In this study, the authors searched Medline, Embase, PsychINFO, CINAHL, and CENTRAL from inception to July 1, 2016 for randomized controlled trials examining the effects of CCT on one or more cognitive or behavioral outcomes in older adults with mild cognitive impairment or dementia.

Based on results from 17 randomized controlled trials of moderate quality, the authors conclude that CCT is a viable intervention for enhancing cognition in people with mild cognitive impairment. The overall effect size on cognition was larger than effect sizes previously reported for healthy older adults and for Parkinson’s disease. The authors conclude that
in mild cognitive impairment, CCT is efficacious on global cognition, memory, working memory, and attention and helps improve psychosocial functioning, including depressive symptoms.

Reference

N.T.M. Hill, L. Mowszowski, S. L. Naismith, M. Valenzuela, A. Lampit (2016).
Computerized Cognitive Training in Older Adults With Mild Cognitive Impairment or Dementia: A Systematic Review and Meta-Analysis
American Journal of Psychiatry,, Volume 174, Issue 4 , November 2016, Pages 329-340
Published Online:14 Nov 2016 https://doi.org/10.1176/appi.ajp.2016.16030360