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Non-Pharmacologic Interventions for Older Adults with Subjective Cognitive Decline: Systematic Review, Meta-Analysis, and Preliminary Recommendations

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Abstract

In subjective cognitive decline (SCD), older adults present with concerns about self-perceived cognitive decline but are found to have clinically normal function. However, a significant proportion of those adults are subsequently found to develop mild cognitive impairment, Alzheimer’s dementia or other neurocognitive disorder. In other cases, SCD may be associated with mood, personality, and physical health concerns. Regardless of etiology, adults with SCD may benefit from interventions that could enhance current function or slow incipient cognitive decline. The objective of this systematic review and meta-analysis, conducted in accordance with the PRISMA guidelines, is to examine the benefits of non-pharmacologic intervention (NPI) in persons with SCD. Inclusion criteria were studies of adults aged 55 + with SCD defined using published criteria, receiving NPI or any control condition, with cognitive, behavioural, or psychological outcomes in controlled trails. Published empirical studies were obtained through a standardized search of CINAHL Complete, Cochrane Central Register of Controlled Trials, MEDLINE with Full Text, PsycINFO, and PsycARTICLES, supplemented by a manual retrieval of relevant articles. Study quality and bias was determined using PEDro. Nine studies were included in the review and meta-analysis. A wide range of study quality was observed. Overall, a small effect size was found on cognitive outcomes, greater for cognitive versus other intervention types. The available evidence suggests that NPI may benefit current cognitive function in persons with SCD. Recommendations are provided to improve future trials of NPI in SCD.

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Acknowledgements

CMS was supported by the Alzheimer Society of Canada (Young Investigator Award #1216). CH was supported by a Salary Award (Chercheur-boursier, Senior) from the Fonds de Recherche du Québec–Santé. AT was supported by BRACE-Alzheimer’s Research (Registered Charity 297965). HH is supported by the AXA Research Fund, the Fondation Université Pierre et Marie Curie and the “Fondation pour la Recherche sur Alzheimer”, Paris, France. The research leading to these results has received funding from the program“Investissements d’avenir” ANR-10-IAIHU-06. The authors are grateful to Dr. Simone Lista for research assistance with completion of this study.

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Authors and Affiliations

  1. Department of Psychology, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, V8W 2Y2, Canada

    Colette M. Smart, Justin E. Karr, Corson N. Areshenkoff & Jordan I. Ali

  2. Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada

    Colette M. Smart

  3. Brooklyn College and The Graduate Center of The City University of New York, New York, NY, USA

    Laura A. Rabin

  4. Universite Laval, Quebec City, QC, Canada

    Carol Hudon

  5. Centre de Recherche de l’Institut Universitaire en Santé Mentale de Québec, Quebec City, QC, Canada

    Carol Hudon

  6. University of New South Wales, Sydney, Australia

    Nicola Gates

  7. INSERM, U1077, 14074, Caen, France

    Eider M. Arenaza-Urquijo & Gael Chetelat

  8. Université de Caen Basse-Normandie UMR-S1077, 14074, Caen, France

    Eider M. Arenaza-Urquijo & Gael Chetelat

  9. Ecole Pratique des Hautes Etudes, UMR-S1077, 14074, Caen, France

    Eider M. Arenaza-Urquijo & Gael Chetelat

  10. CHU de Caen, U1077, 14000, Caen, France

    Eider M. Arenaza-Urquijo & Gael Chetelat

  11. Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia

    Rachel F. Buckley

  12. Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia

    Rachel F. Buckley

  13. Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Rachel F. Buckley

  14. AXA Research Fund and UPMC Chair, Sorbonne Universities, Pierre et Marie Curie University, Paris, France

    Harald Hampel

  15. Institute of Memory and Alzheimer’s Disease (IM2A) and Brain and Spine Institute (ICM) UMR S 1127, Department of Neurology, Pitié-Salpêtrière University Hospital, Paris, France

    Harald Hampel

  16. Department of Psychiatry, University of Cologne, Medical Faculty, Cologne, Germany

    Frank Jessen

  17. German Center for Neurodegenerative Diseases (DZNE), Bonn/Cologne, Germany

    Frank Jessen

  18. Division of Psychiatry, University College London, London, England, UK

    Natalie L. Marchant

  19. Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands

    Sietske A. M. Sikkes, Wiesje M. van der Flier & Linda Wesselman

  20. Swansea University, Swansea, Wales, UK

    Andrea Tales

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and the Subjective Cognitive Decline Initiative (SCD-I) Working Group

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Correspondence to Colette M. Smart.

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The authors declare that they have no conflict of interest.

Ethical Approval

The referenced article Smart et al. (2016) was performed by the first author, and all procedures performed were in accordance with the ethical standards of the institution and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Beyond this referenced article, the current article does not contain any studies with human participants performed by any of the authors.

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In the referenced article Smart et al. (2016), conducted by the first author, informed consent was obtained from all individual participants included in the study.

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Smart, C.M., Karr, J.E., Areshenkoff, C.N. et al. Non-Pharmacologic Interventions for Older Adults with Subjective Cognitive Decline: Systematic Review, Meta-Analysis, and Preliminary Recommendations. Neuropsychol Rev 27, 245–257 (2017). https://doi.org/10.1007/s11065-017-9342-8

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