A meta-analytic investigation of cognitive remediation for mood disorders: Efficacy and the role of study quality, sample and treatment factors.
Bipolar illness
Clinical trial
Cognitive training
Major depressive disorder
Thinking skills
Journal
Journal of affective disorders
ISSN: 1573-2517
Titre abrégé: J Affect Disord
Pays: Netherlands
ID NLM: 7906073
Informations de publication
Date de publication:
01 06 2023
01 06 2023
Historique:
received:
11
01
2023
revised:
23
02
2023
accepted:
25
02
2023
medline:
31
3
2023
pubmed:
4
3
2023
entrez:
3
3
2023
Statut:
ppublish
Résumé
The number of randomized, controlled studies of cognitive remediation (CR) for mood disorders (major depressive disorder [MDD] and bipolar illness [BD]), has grown substantially over the past 10 years. The role of study quality, participant characteristics, and intervention features in CR treatment effects remains largely unknown. Electronic databases were searched up to February 2022 using variants of the key words: "cognitive remediation", "clinical trials", "major depressive disorder" and "bipolar disorder". This search produced 22 unique randomized, controlled trials that met all inclusion criteria for the study. Data were extracted by 3 authors with strong reliability (>90 %). Primary cognitive, and secondary symptom and functional outcomes were assessed with random effects models. The meta-analysis (993 participants) revealed that CR produced significant small-to-moderate size effects in attention, verbal learning and memory, working memory and executive function (Hedge's g = 0.29-0.45). CR produced a small-moderate effect on one secondary outcome: depressive symptoms (g = 0.33). CR programs that used an individualized approach produced larger effects on executive function. Samples with lower baseline IQ were more likely to benefit from CR on measures of working memory. Sample age, education, gender, or baseline depressive symptomatology did not serve as barriers to treatment gains, and observed effects were not epiphenomena of poorer design quality. The number of RCTs remains low. CR produces small to moderate improvements in cognition and depressive symptoms in mood disorders. Future research should study how CR might be optimized to help generalize CR-related cognitive and symptom improvements to function.
Sections du résumé
BACKGROUND
The number of randomized, controlled studies of cognitive remediation (CR) for mood disorders (major depressive disorder [MDD] and bipolar illness [BD]), has grown substantially over the past 10 years. The role of study quality, participant characteristics, and intervention features in CR treatment effects remains largely unknown.
METHODS
Electronic databases were searched up to February 2022 using variants of the key words: "cognitive remediation", "clinical trials", "major depressive disorder" and "bipolar disorder". This search produced 22 unique randomized, controlled trials that met all inclusion criteria for the study. Data were extracted by 3 authors with strong reliability (>90 %). Primary cognitive, and secondary symptom and functional outcomes were assessed with random effects models.
RESULTS
The meta-analysis (993 participants) revealed that CR produced significant small-to-moderate size effects in attention, verbal learning and memory, working memory and executive function (Hedge's g = 0.29-0.45). CR produced a small-moderate effect on one secondary outcome: depressive symptoms (g = 0.33). CR programs that used an individualized approach produced larger effects on executive function. Samples with lower baseline IQ were more likely to benefit from CR on measures of working memory. Sample age, education, gender, or baseline depressive symptomatology did not serve as barriers to treatment gains, and observed effects were not epiphenomena of poorer design quality.
LIMITATIONS
The number of RCTs remains low.
CONCLUSIONS
CR produces small to moderate improvements in cognition and depressive symptoms in mood disorders. Future research should study how CR might be optimized to help generalize CR-related cognitive and symptom improvements to function.
Identifiants
pubmed: 36868388
pii: S0165-0327(23)00309-9
doi: 10.1016/j.jad.2023.02.137
pii:
doi:
Types de publication
Meta-Analysis
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
74-82Informations de copyright
Copyright © 2023 Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of interest The authors report no actual or potential conflicts-of-interest.