Effect of Cognitive Improvement Programs for Mild Cognitive Impairment in Korean Elderly: A Meta-Analysis

Kyoungyun Kim; Eunjoo Lee

doi:10.7475/kjan.2017.29.2.177

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Kim and Lee: Effect of Cognitive Improvement Programs for Mild Cognitive Impairment in Korean Elderly: A Meta-Analysis

Original Article

Korean J Adult Nurs 2017;29(2):177-189.

Published online: 9 April 2017

DOI: https://doi.org/10.7475/kjan.2017.29.2.177

Effect of Cognitive Improvement Programs for Mild Cognitive Impairment in Korean Elderly: A Meta-Analysis

Kyoungyun Kim, MSN, RN¹, Eunjoo Lee, Ph.D., RN^2,

¹Doctoral Student, College of Nursing, Kyungpook National University, Daegu, Korea

²Professor, College of Nursing, Reserch Institute of Nursing Science, Kyungpook National University, Daegu, Korea

Corresponding author: Lee, Eunjoo College of Nursing, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea. Tel: +82-53-420-4934, Fax: +82-53-421-2758, E-mail: jewelee@knu.ac.kr

Received 21 February 201720 April 2017 Accepted 25 April 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

A meta-analysis was conducted to identify the effect of cognitive improvement programs for the elderly with mild cognitive impairment (MCI) in Korea.

Methods

Five databases, as well as relevant reference lists, of studies published from 2000 to 2016, were searched. Fourteen studies were identified. Quality assessments of included studies were conducted using the Scottish Intercollegiate Guidelines Network checklist. An R program was used to analyze effect sizes and to identify possible sources of heterogeneity among studies. The potential for publication bias was investigated using a funnel plot, Egger's regression test and sensitivity analysis.

Results

The total effect size was large (Standardized Mean Difference [SMD]=1.44, 95% CI: 1.11~1.77), with cognition based intervention (SMD= 1.77, 95% CI: 1.26~2.29) and exercise intervention (SMD=1.13, 95% CI: 0.82~1.44). Statistically significant moderators were identified intervention type by meta-ANOVA analyses. Finally, no significant evidence of publication bias was found.

Conclusion

There is clear evidence that cognitive improvement programs can greatly enhance cognition in elderly with MCI. Future research should examine the effects of non-pharmacological interventions targeting elderly populations with mild-to-severe cognitive impairment in order to develop and enhance the effectiveness of cognitive improvement programs in Korea.

Keywords: Dementia, Cognition disorders, Aged, Exercise, Meta-analysis

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Figure 1.

PRISMA flowchart.

Figure 2.

Forest plot of the effects of cognition improvement program on MCI elderly.

Figure 3.

Result of publication bias analysis.

Table 1.

General Characteristics of Included Studies

No	Author (year)	Pub.	Study design	Subjects				Setting	Intervention				Outcome measurement
No	Author (year)	Pub.	Study design	Gender	Age (year)	Exp.(n)	Cont.(n)	Setting	Type	Length (min)	Sessions	Duration (wks)	Outcome measurement
1	Choi & Kim (2013)	J	NRCT	M	Over 65	30	32	Community	Exercise program	60	36	12	MMSE-K
2	Choi & Lee (2012)	J	NRCT	F	Over 75	27	26	Community	Recreational combination gymnastics program	50	12	6	MMSE-KC
3	Chu et al (2007)	J	NRCT	M	Over 65	21	19	Community	Cognitive behavior program	50	12	6	MMSE-K
4	Hong (2013)	T	RCT	M	Over 65	10	12	Community	Resistance exercise	60	24	12	K-MoCA
5	Jeon et al (2014)	J	RCT	F	Exp. 76.47 Cont. 79.35	17	17	Nursing facilities	Elastic band exercise	60	36	12	K-HDS
6	Ji & Kim (2012)	J	NRCT	M	Over 65	18	18	DSC	Cognitive reinforcement program	90	8	8	MoCA-K
7	Kim et al (2010)	J	NRCT	M	Over 60	17	15	Geriatric hospitals	Cognitive training program	30	12	4	MMSE-K
8	Kim (2014)	T	NRCT	M	Over 65	28	24	Community	Cognitive intervention program	60	10	5	MoCA-K
9	Kong & Kim (2014)	J	NRCT	M	Over 65	28	26	Community	Integrative cognitive training program	90	24	12	MMSE-K1
10	Lee & Choi (2014)	J	NRCT	F	Over 65	8	8	Community	Aquatic exercise	60	36	12	K-MMSE
11	Lee (2012)	T	RCT	M	65~80	18	18	N/R	Gym ball program	50	24	12	MMSE-K
12	Lee (2014)	T	RCT	M	65~80	15	15	N/R	Swiss ball program	50	24	12	MMSE-K
13	Lim et al (2015)	J	NRCT	M	Over 65	14	15	DSC	Occupational therapy and music therapy	60	48	48	K-MMSE
14	Youn (2014)	J	NRCT	M	Over 65	10	11	Day care center	Integrative arts therapy	50	12	6	MMSE-DS

Pub.=Publication; Exp.=Experimental group; Cont.=Control group; J=Journal; T=Thesis; M=Mixed; F=Female; N/R=Not reported; RCT=Randomized controlled trials; NRCt=Non-randomized controlled trials; DSC=Dementia supporting center; MMSE-K=Mini mental state examination-Korea; MMSE-K1=Mini-mental state examination-Korean version 1; MMSE-KC=Mini metal status examination in the Korean version of the CERAD assessment packet; MMSE-DS=Korean version of MMSE for dementia screening; K-MMSE=Korean mini mental state examination; MoCA-K=The Korean version of montreal cognitive assessment; K-MoCA=Korean-montreal cognitive assessment; K-HDS=Korean version of hasegawa dementia scale.

Table 2.

Result of Moderator Analysis by Meta-ANOVA

Variables	Categories	K	SMD	95% CI		I² (%)	Q _b (p)
Variables	Categories	K	SMD	Lower limit	Upper Limit	I² (%)	Q _b (p)
Study design	RCT	4	1.02	0.46	1.59	53.2	2.63 (.105)
Study design	NRCT	10	1.61	1.23	1.99	60.8
Publication type	Journal	10	1.64	1.25	2.02	59.4	3.46 (.063)
Publication type	Thesis	4	0.99	0.49	1.50	47.6
Gender	Female	3	1.26	0.83	1.69	0	0.14 (.707)
Gender	Mixed	11	1.48	1.07	1.89	69.8
Intervention type	Cognition	7	1.77	1.26	2.29	66.9	4.43 (.035)
Intervention type	Exercise	7	1.13	0.82	1.44	20.7
Tool type	MMSE	10	1.56	1.14	1.98	66.4	1.00 (.316)
Tool type	Others	4	1.18	0.66	1.71	51.5

K=number of studies; SMD=standardized mean difference; CI=confidence interval; Q _b=Q-value between subgroups; RCT=randomized controlled trials; NRCT=non-randomized controlled trials; MMSE=mini mental state examination.

Appendix 3.

Quality Assessment of Studies Included in Meta-Analysis

Item study ID	1	2	3	4	5	6	7	8	9	10	11	12	13	14
An appropriate and clearly focused question	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
An adequate concealment	N	N	N	Y	C/S	N	N	N	N	N	C/S	C/S	N	N
Double blind about treatment allocation	N	N	N	C/S	C/S	N	N	N	N	N	C/S	C/S	N	N
Baseline homogeneity	Y	Y	Y	Y	C/S	Y	Y	Y	Y	C/S	Y	Y	Y	Y
The only difference between groups is the treatment	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
Use valid and reliable measurement methods	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
Dropout rate	11	9	7	0	0	23	0	16	4	0	14	17	0	0
Perform analysis as assigned	N	N	N	Y	Y	N	Y	N	N	Y	N	N	Y	Y
Homogeneity of each experimental site	Y	Y	Y	NA	NA	NA	NA	Y	NA	NA	C/S	C/S	NA	NA
Total quality assessment	+	+	+	++	++	+	+	+	+	+	++	++	+	+

Y=Yes; N=No; C/S=can't say; NA=Not applied; ++=High quality (All or most of the criteria met. Little of no risk of bias. Conclusions unlikely to be changed by further studies); +=Acceptable (Some of the criteria met; Some fault in the study with an associated risk of bias. Result may change in the light of further research).

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