The design, evaluation, and reporting on non-pharmacological, cognition-oriented treatments for older adults: Results of a survey of experts

Sharon Sanz Simon; Mary Castellani; Sylvie Belleville; Tzvi Dwolatzky; Benjamin M Hampstead; Alex Bahar-Fuchs

doi:10.1002/trc2.12024

The design, evaluation, and reporting on non-pharmacological, cognition-oriented treatments for older adults: Results of a survey of experts

Alzheimers Dement (N Y). 2020 Jun 7;6(1):e12024. doi: 10.1002/trc2.12024. eCollection 2020.

Authors

Sharon Sanz Simon^{1

2}, Mary Castellani³, Sylvie Belleville^{4

5}, Tzvi Dwolatzky⁶, Benjamin M Hampstead^{7

8}, Alex Bahar-Fuchs³

Affiliations

¹ Cognitive Neuroscience Division Department of Neurology Columbia University New York New York.
² Old Age Research Group (PROTER) Department of Psychiatry São Paulo Medical School University of São Paulo São Paulo Brazil.
³ Academic Unit for Psychiatry of Old Age Department of Psychiatry University of Melbourne Melbourne Australia.
⁴ Psychology Department Université de Montréal Montreal Canada.
⁵ Research Center Institut Universitaire de Gériatrie de Montréal Montreal Canada.
⁶ Rambam Health Care Campus and Rappaport Faculty of Medicine Technion-Israel Institute of Technology Haifa Israel.
⁷ Mental Health Service VA Ann Arbor Healthcare System Ann Arbor Michigan.
⁸ Neuropsychology Section Department of Psychiatry University of Michigan Ann Arbor Michigan.

Abstract

Introduction: Cognitive decline and dementia significantly affect independence and quality of life in older adults; therefore, it is critical to identify effective cognition-oriented treatments (COTs; eg, cognitive training, rehabilitation) that can help maintain or enhance cognitive functioning in older adults, as well as reduce dementia risk or alleviate symptoms associated with pathological processes.

Methods: The Cognitive Intervention Design Evaluation and Reporting (CIDER), a working group from the Non-Pharmacological Interventions Professional Interest Area (NPI-PIA) of the Alzheimer's Association conducted as survey in 2017 with experts in COTs worldwide. The survey's aims were three-fold: (1) determine the common attitudes, beliefs, and practices of experts involved in the COTs research targeting older people; (2) identify areas of relative agreement and disagreement among experts in the field; and (3) offer a critical review of the literature, including recommendations for future research.

Results: The survey identified several areas of agreements among experts on critical features of COTs, and on study design and outcome measures. Nevertheless, there were some areas with relative disagreement. Critically, expert opinions were not always supported by scientific evidence, suggesting that methodologic improvements are needed regarding design, implementation, and reporting of COTs. There was a clear consensus that COTs provide benefits and should be offered to cognitively unimpaired older adults, mild cognitive impairment (MCI), and mild dementia, but opinions differed for moderate and severe dementia. In addition, there is no consensus on the potential role of COTs in dementia prevention, indicating that future research should prioritize this aspect.

Discussion: Evidence of COTs in older adults is encouraging, but additional evidence is needed to enhance dementia prevention. Consensus building and guidelines in the field are critical to improve and accelerate the development of high-quality evidence for COTs in cognitively unimpaired older adults, and those with MCI and dementia.

Keywords: Alzheimer's disease; aging; cognitive intervention; cognitive rehabilitation; cognitive stimulation; cognitive training; dementia; mild cognitive impairment.

Publication types

Review