| ObjectiveOur study was aimed to identify the optimal cognitive intervention for improving the cognitive function for dementia patients,optimize the services for them,maintain their cognitive function,delay the progression of dementia,improve their quality of life and their well-being.Our study may be useful for policy makers and service commissioners that provide scientific,stable and objective evidence when they make choices among different alternatives.MethodsAn exhaustive literature search was conducted based on PubMed,Embase,the Cochrane Central Register of Controlled Trials,Web of Science,PsycINFO,CRINAHL,the China National Knowledge Infrastructure database,the Chinese Biomedical Literature database,the Wan Fang database,and other database,and randomized controlled trials(RCTs)about cognitive interventions for elderly adults with dementia were identified from their inception to October 1,2018.We also manually searched relevant potential studies from other database.We screened and included the relevant studies according to the predefined inclusion and exclusion criteria,and extracted or transformed the primary outcome from each included studies.As the outcomes revealed on a continuous scale,we calculated the weight mean difference(WMD)to pool the effect size,along with their respective 95%credibility intervals(CrI).The node-splitting approach was executed to statistically examine the inconsistency between direct and indirect evidence throughout the entire network frame.The analyses for finally ranking the efficacy of each cognitive intervention regarding the Bayesian framework were performed in R language(Version 3.3.2),WinBUGS(Version 1.4.3),STATA(Version 14.0),RevMan(Version 5.3).ResultsOverall,44529 citations were identified through our initial search and only 68 were finally included our in our Bayesian NMA which including 8 cognitive interventions and 1 control group.These 8 cognitive interventions were Physical exercise(PE),Computerized cognitive training(CCT),Music therapy(MT),Cognitive stimulation therapy(CST),Cognitive rehabilitation(CR),Nursing therapy(NT),Psychosocial therapy(PST),Pharmacological therapy(PT)and control group(CG)that involving 9937 dementia people whose baseline age were range from 63.8 to 88.25 years old.28 trials(41.18%)were conducted in America and Europe while 37(54.41%)were in Asian.100.0%,45.6%,23.5%,98.5%,22.1%,36.8%,11.8%randomized controlled trails were mentioned the"Random sequence","Blind method","Allocation concealment","The completeness of outcome data","Describe the funding or registered in Clinical Trial","assessed the adverse effect","Without other bias" respectively.The results of network meta-analysis revealed that each cognitive intervention had significantly improved the cognitive ability of dementia patients,NT[MD=3.10,95%CrI(1.80,4.40),P?0.001],MT[MD=2.70,95%CrI(1.10,4.30),P?0.001],PE[MD=2.50,95%CrI(0.87,4.10),P<0.001],CR[MD=2.20,95%CrI(0.83,3.50),P?0.013],CST[MD=1.50,95%CrI(0.05,3.00),P?0.03],CCT[MD=1.30,95%CrI(0.33,2.30),P?0.001],PST[MD=1.00,95%CrI(0.41,1.30),P?0.042],PT[MD=0.83,95%CrI(0.05,2.20),P=0.052].NT had the highest probability among the 8 cognitive interventions[the surface under the cumulative ranking curve(SUCRA)=80.2%],followed by MT(SUCRA=50.0%),PE(SUCRA=62.3%),CR(SUCRA=57.3%),CST(SUCRA=34.5%),CCT(SUCRA=33.4%),PST(SUCRA=31.4%)and PT(SUCRA=28.7%).In all the cognitive drugs,Memantine(SUCRA=97.2%)was significantly efficacious in the treatment group in terms of MMSE.Followed by Galantamine(SUCRA=64.5%),Huperzine-A(SUCRA=62.8%),Rivastigmine(SUCRA=57.3%),Donepezil(SUCRA=38.9%),and Tacrine(SUCRA=31.3%).ConclusionThe results of our NMA revealed that overwhelming majority of cognitive interventions,including Pharmacological therapy,have a positive effect in improvement of cognitive function among dementia patients.Non-Pharmacological therapy may be better than Pharmacological therapy,and nursing therapy might be the best cognitive intervention for improving the cognitive ability of dementia patients at presents. |
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