Effectiveness of seven non-pharmacological interventions to improve cognitive function in aged adults with cognitive decline:a Bayesian network meta-analysis
Objective To evaluate the effect of different non-pharmacological interventions on the cognitive function of elderly people with cognitive decline,and provide useful reference for improving cognitive function of the elderly.Methods Computer searches of PubMed,Embase,the Cochrane Library,Web of Science,China National Knowledge Infrastructure,VIP Database,Wanfang Data,and China Biomedical Literature Database for randomized controlled trials on non-pharmacological interventions for aged adults with cognitive decline were conducted,all with a search time frame from database inception to October 9th,2023.Literature screening,information extraction and bias risk assessment using RevMan 5.4 software were performed by two evaluators independently,and Stata 16.0 and R 4.3.0 software was used for network meta-analysis.Results A total of 27 articles involving 2 149 elderly patients and 7 intervention protocols were included.Among the 27 articles,8 were graded A and 19 were graded B for quality.The network meta-analysis revealed that,using the Montreal Cognitive Assessment(MoCA)as the evaluating metric,virtual reality[mean difference(MD)=6.01,95％confidence interval(CI)(0.90,10.75)],cognitive training[MD=4.99,95％CI(0.56,9.12)],and exercise training[MD=3.88,95％CI(0.47,7.27)]were better than community services,respectively(P＜0.05),and exercise training was also better than conventional care[MD=3.05,95％CI(0.92,5.12),P＜0.05];using the Mini-Mental State Examination(MMSE)as the evaluation indicator,multimodal exercise[MD=3.00,95％CI(0.89,4.96)],cognitive training[MD=2.50,95％CI(0.27,4.82)],traditional Chinese exercise[MD=2.30,95％CI(0.34,4.28)],psychotherapy[MD=1.76,95％CI(0.56,2.96)],and exercise training[MD=1.36,95％CI(0.18,2.59)]were better than conventional care,respectively(P＜0.05),and multimodal exercise[MD=3.32,95％CI(0.62,5.81)],cognitive training[MD=2.82,95％CI(0.75,4.90)],and traditional Chinese exercise[MD=2.63,95％CI(0.08,5.13)]were also better than community service,respectively(P＜0.05).The results of the cumulative probability ranking showed that virtual reality had the highest probability of being the best intervention in terms of improving MoCA metrics(0.863),and multimodal exercise had the highest probability of being the best intervention in terms of improving MMSE metrics(0.868).Conclusion Using MoCA as an evaluation indicator,virtual reality may be the best non-pharmacological intervention;using MMSE as an evaluation indicator,multimodal exercise may be the best non-pharmacological intervention.
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