Effects of cognitive training on cognition and quality of life in older adults with dementia

Eeva-Liisa Kallio

Research output: ThesisDoctoral ThesisCollection of Articles


Dementia is an age-related, progressive and chronic syndrome, which is characterized by cognitive decline from a person’s prior performance level, neuropsychiatric symptoms, and severe inability to manage everyday activities. The most common late-life cause of dementia is Alzheimer’s disease, followed by vascular dementia, Lewy body dementia, and mixed dementia. The limited efficacy of current pharmacological treatments has directed research increasingly to various non-pharmacological therapies, such as cognitive training (CT). The findings so far are inconsistent and conflicting. The two aims of this thesis were (1) to systematically evaluate the current evidence on the effects of CT in dementia; and (2) to explore the feasibility and effectiveness of a systematic CT program for patients with established dementia in a randomized controlled trial (RCT). The effects of CT on participants’ cognition, psychological well-being, and health-related quality of life (HRQoL) were investigated in a Finnish Cognitive Intervention (FINCOG) trial among older home-dwelling patients with mild to moderate dementia who participated in regular adult day care. The systematic review focused on 35 eligible RCTs including participants with dementia, using restorative or compensatory CT programs, and concerning the effects of CT on cognition, functional abilities, psychological well-being, and quality of life of patients. Beneficial effects of CT were primarily reported on global cognition, training-specific functioning, and occasionally on mood, however, several limitations in research methodology decrease the current grade of evidence. Low methodological quality of a trial resulted predominantly from low statistical power, poorly described randomization methods, and non-robust statistical methodology. Furthermore, CT interventions were highly heterogeneous, trial drop-outs inadequately described, and intention-to-treat analysis as well as long-term follow-up infrequently used. The FINCOG participants (n = 147) were randomized in two arms: CT intervention (n = 76), and control groups (n = 71). Measures of cognition, psychological well-being, and HRQoL were assessed before the intervention, and three and nine months after baseline assessment. A systematic 12-week CT program was conducted in adult day-care centers twice a week for 45 minutes. Regular CT was found to be feasible, and subjective gain was achieved by 76 % of the feedback responders. However, CT did not improve or stabilize cognition in older adults with dementia. Moreover, the participants did not benefit from CT either in terms of their HRQoL, or psychological well-being. In conclusion, the findings of this thesis do not support the effectiveness of CT among older patients with established dementia
Original languageEnglish
  • Pitkälä, Kaisu, Supervisor
  • Hietanen, Marja Helena, Supervisor
  • Hokkanen, Laura , Supervisor
Place of PublicationHelsinki
Print ISBNs978-951-51-4895-7
Electronic ISBNs978-951-51-4896-4
Publication statusPublished - 2019
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • Aged
  • Cognitive Dysfunction
  • +prevention & control
  • +rehabilitation
  • +therapy
  • Dementia
  • Alzheimer Disease
  • Cognition Disorders
  • Quality of Life
  • Memory Disorders
  • Rehabilitation
  • +methods
  • Neuroprotection
  • Treatment Outcome
  • Feasibility Studies
  • 3112 Neurosciences
  • 3124 Neurology and psychiatry

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