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Research

Treatment for mild cognitive impairment: a systematic review and meta-analysis

Donna Fitzpatrick-Lewis, Rachel Warren, Muhammad Usman Ali, Diana Sherifali and Parminder Raina
November 30, 2015 3 (4) E419-E427; DOI: https://doi.org/10.9778/cmajo.20150057
Donna Fitzpatrick-Lewis
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Rachel Warren
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Muhammad Usman Ali
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Diana Sherifali
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Parminder Raina
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    Figure 1

    Identification of eligible studies. MCI = mild cognitive impairment, RCT = randomized controlled trial.

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    Figure 2

    Effects of cholinesterase inhibitors on patient cognition as assessed by the Alzheimer's Disease Assessment Scale, cognition subscale. CI = confidence interval, MD = mean difference.

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    Figure 3

    Effects of cholinesterase inhibitors on patient cognition as assessed by the Mini-Mental State Examination. CI = confidence interval, MD = mean difference.

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    Figure 4

    Serious adverse events associated with the use of cholinesterase inhibitors in patients with mild cognitive impairment. CI = confidence interval.

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    Table 1: Characteristics of the included studies
    StudyNo. of participantsInterventionFollow-up
    de Jager et al.26N = 271
    Intervention: n =138
    Control: n = 133
    Daily dose of TrioBe Plus W containing folic acid (0.8 mg), cyanocobalamin (0.5 mg) and pyridoxine HCl (20 mg) for 24 moImmediate postintervention
    Doody et al.24N = 821
    Intervention: n = 409
    Control: n = 41
    Donepezil (5 mg/day for 6 wk, 10 mg/day for 42 wk); total duration of interview was 48 wkImmediate postintervention
    Feldman et al.16N = 1018
    Intervention: n = 508
    Control: n = 510
    Rivastigmine (3-12 mg daily) for up to 48 moImmediate postintervention
    Lee et al.22N = 36
    Intervention: n = 18
    Control: n = 18
    Three 1-g soft gelatine capsules each day, each containing docosahexaenoic acid (DHA, 430 mg) and eicosapentaenoic acid (EPA, 150 mg); total dosage for the fish oil group was about 1.3 g DHA and 0.45 mg EPA daily for 12 moImmediate postintervention
    Naeini et al.23N = 256
    Intervention: n = 127
    Control: n = 129
    Vitamin E (300 mg daily) plus vitamin C (400 mg daily) for 12 moImmediate postintervention
    Petersen et al.27N=769
    Intervention 1: n = 253
    Intervention 2: n = 257
    Control: n = 259
    Intervention 1 (donepezil, placebo Vitamin E and multivitamin): initial dose of 5 mg daily; increased to 10 mg daily after 6 wk for 36 mo
    Intervention 2 (vitamin E, placebo donepezil, multivitamin): initial dose of vitamin E of 1000 IU daily; increased to 2000 IU daily after 6 wk for 36 mo
    Immediate postintervention
    Rojas et al.21N = 46
    Intervention: n = 24
    Control: n = 22
    Cognitive stimulation training sessions and cognitive training delivered by two experienced neurophysiologists in 2 weekly group (4-5 participants) sessions of 120 min at hospital-based outpatient memory clinics over 6 mo6 mo
    Suzuki et al.18N = 50
    Intervention: n = 25
    Control: n = 25
    Multicomponent exercise group under the supervision of physiotherapists for 90 min/d, 2 d/wk, for a total of 80 times over 12 moImmediate postintervention
    Suzuki et al.25N = 100
    Intervention: n = 50
    Control: n = 50
    Six-month, multicomponent exercise program including biweekly 90-min sessions involving aerobic exercise, muscle strength training, postural balance retraining, and dual-task training, and focus on promoting exercise and behaviour changeImmediate postintervention
    Tsolaki et al.19N = 196
    Intervention: n =1 22
    Control: n = 79
    Therapeutic Techniques of nPhTh: holistic approach including cognitive training, cognitive stimulation and psychotherapeutic techniques for 6 moImmediate postintervention
    Wei et al.20N = 60
    Intervention: n = 30
    Control: n = 30
    Two groups (15 participants per group) exercised under the supervision of trained nurses for 30 min/d, 5 d/wk, for a total of 120 times over 6 moImmediate postintervention
    Winblad et al.17Study 1: N = 990
    Intervention: n = 494
    Control: n = 496
    Study 2: N = 1058
    Intervention: n = 532
    Control: n = 526
    Galantamine was administered at 4 mg twice daily for 1 mo, then 8 mg twice daily for 1 mo; If well-tolerated, the dosage would be titrated to 12 mg twice daily but would be lowered back to 8 mg twice daily after 1 mo if necessary; the dosage selected at month 3 (8 or 12 mg twice daily) was fixed for the remainder of the 24-mo studyImmediate postintervention
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    Table 2: Appraisal of the risk of bias of the included studies using the Cochrane risk-of-bias tool
    StudySequence generationAllocation concealmentBlindingIncomplete outcome dataSelective reportingOtherOverall
    Doody et al.24LLLLLHL
    Feldman et al.16LLLHLHU
    Petersen et al.27UULLLLU
    Salloway et al.28UULHLHU
    Winblad et al.17UULLLHU
    Suzuki et al.18UULLLHU
    Tsai et al.29LULLLHU
    de Jager et al.26LLLLLUL
    Tsolaki et al.19UUULLLU
    van Uffelen et al.30LLLLLHL
    Wei et al.20UUHULUU
    Suzuki et al.25LLLLLLL
    Rojas et al.21UULHLHU
    Lee et al.22LULLLHU
    Naeini et al.23UULLLLU
    Rondanelli et al.31UULLLHU
    Yakoot et al.32LLLLLHL

    Note: H = high, L = low, U = unclear.

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    9 Dec 2015
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    Treatment for mild cognitive impairment: a systematic review and meta-analysis
    Donna Fitzpatrick-Lewis, Rachel Warren, Muhammad Usman Ali, Diana Sherifali, Parminder Raina
    Oct 2015, 3 (4) E419-E427; DOI: 10.9778/cmajo.20150057

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    Treatment for mild cognitive impairment: a systematic review and meta-analysis
    Donna Fitzpatrick-Lewis, Rachel Warren, Muhammad Usman Ali, Diana Sherifali, Parminder Raina
    Oct 2015, 3 (4) E419-E427; DOI: 10.9778/cmajo.20150057
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