Review Article

The Effects of Cognitive-Based Interventions in Older Adults: A Systematic Review and Meta-Analysis


Background: Cognitive-based intervention is divided into three types: Cognitive Stimulation (CS), Cognitive Training (CT), and Cognitive Rehabilitation (CR). This study was conducted to identify systematically the effects of cognitive-based interventions in randomized controlled trials (RCTs) applied to older adults in the following three groups: cognitively healthy, mild cognitive impairment (MCI), and dementia.

Methods: This search was carried out using the Ovid-MEDLINE, EMBASE, Cochrane library, CINAHL, ProQuest, and Korea databases. The effectiveness of the intervention was verified using the CMA 2.0 program.

Results: A total of 54 RCTs were included in systematic reviews and 38 studies were analyzed by meta-analysis. Meta-analysis showed that cognitive-based interventions were effective in improving the cognitive function (SMD=0.39, 95% CI=0.32-0.44) of older adults. The subgroup analysis of cognitive function revealed that CT was the most effective in the cognitively healthy (SMD=0.40, 95% CI=0.33-0.46) and the MCI (SMD=0.45, 95% CI=0.27-0.63) groups, and CS was the most effective in the dementia group (SMD=0.57, 95% CI=0.43-0.70).

Conclusion: In order to improve the cognitive function of older adults in each group, the most effective intervention type needs to be considered first. Evidence on the appropriate type of Cognitive-based intervention will be helpful in nursing practice.

1. Kelly ME, Loughrey D, Lawlor BA, et al (2014). The impact of cognitive training and mental stimulation on cognitive and everyday function-ing of healthy older adults: a systematic review and meta-analysis. Ageing Res Rev, 15:28-43.
2. Ertel KA, Glymour MM, Berkman LF (2008). Effects of social integration on preserving memory function in a nationally representative US elderly population. Am J Public Health, 98(7):1215-1220.
3. Baik OM (2015). The Trajectory and its predictors of the change of cognitive functioning among the elderly -A latent growth curve analysis. Locality and Globality: Korean Journal of Social Sciences, 39(3):79-103.
4. Pettersson AF, Olsson E, Wahlund LO (2005). Motor function in subjects with mild cognitive impairment and early alzheimer's disease. Dement Geriatr Cogn Disord, 19(5-6):299-304.
5. Clare L, Woods RT, Moniz Cook ED, et al (2003). Cognitive rehabilitation and cognitive training for early-stage Alzheimer’s disease and vascular de-mentia (Review). Cochrane Database Syst Rev, (4):CD003260.
6. Valenzuela M, Sachdev P (2009). Can cognitive exercise prevent the onset of dementia? System-atic review of randomized clinical trials with lon-gitudinal follow-up. Am J Geriatr Psychiatry, 17(3):179-87.
7. Hsu WY, Ku Y, Zanto TP, et al (2015). Effects of noninvasive brain stimulation on cognitive func-tion in healthy aging and Alzheimer's disease: a systematic review and meta-analysis. Neurobiol Ag-ing, 36(8):2348-59.
8. Buckley JS, Salpeter SR (2015). A risk-benefit as-sessment of dementia medications: systematic review of the evidence. Drugs Aging, 32(6):453-467.
9. Teixeira CVL, Gobbi LTB, Corazza DI, et al (2012). Non- pharmacological interventions on cognitive functions in older people with mild cognitive impairment (MCI). Arch Gerontol and Geriatr, 54(1):175-80.
10. Woods B, Aguirre E, Spector A, Orrell M (2012). Cognitive stimulation to improve cognitive func-tioning in people with dementia. Cochrane Database Syst Rev, 15;(2):CD005562.
11. Durlak JA, DuPre EP (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol, 41(3-4):327-50.
12. Tranter LJ, Koutstaal W (2008). Age and flexible thinking: An experimental demonstration of the beneficial effects of increased cognitively stimu-lating activity on fluid intelligence in healthy older adults. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn, 15(2):184-207.
13. Kim HY. Effects of cognitive control training on brain function in older adults [PhD thesis]. Yonsei University, Seoul;2012.
14. Tsolaki M, Kounti F, Agogiatou C, et al (2011). Effectiveness of nonpharmacological approaches in patients with mild cognitive impairment. Neu-rodegener Dis, 8:138-45.
15. Liu XY, Li L, Xlao JQ, et al (2016). Cognitive training in older adults with mild cognitive im-pairment. Biomed Environ Sci, 29(5):356-64.
16. Schmitter-Edgecombe M, Dyck, DG (2014). Cognitive rehabilitation multi-family group inter-vention for individuals with mild cognitive im-pairment and their care-partners. J Int Neuropsychol Soc, 20(9):897-908.
17. Mantzoukas S (2008). A review of evidence-based practice, nursing research and reflection: levelling the hierarchy. J Clin Nurs, 17(2):214-23.
18. Kim SH, Kim BK (2018). Effects of cognitive-based interventions of older adults with mild cognitive impairment: A systematic preview and meta-analysis. Korean Journal of Adult Nursing, 30(4):347-361.
19. Mewborn CM, Lindbergh CA, Miller LS (2017). Cognitive interventions for cognitively healthy, mildly impaired, and mixed samples of older adults: a systematic review and meta-analysis of randomized-controlled trials. Neuropsychol Rev, 27(4):1-37.
20. Kim SH. A systematic review and meta-analysis on the effectiveness of cognition-based interven-tions for older adults with dementia [PhD thesis]. Chung-ang University, Seoul;2018.
21. Jo MJ (2009). The prevalence and risk Factors of dementia in the Korean elderly. Health and welfare policy forum, 156:43-48.
22. Petersen RC, Morris JC. (2005). Mild cognitive impairment as a clinical entity and treatment tar-get. Arch Neurol, 62(7):1160-3.
23. Stein DJ, Phillips KA, Bolton D, et al (2010). What is a mental/psychiatric disorder? From DSM-IV to DSM-V. Psychol Med, 40(11):1759-1765.
24. Higgins JPT, Savovic J, Page MJ, et al (2016). Revised Cochrane risk of bias tool for random-ized trials (RoB 2.0) [Internet]. Bristol: Authors; [cited 2018 November 29].
25. Higgins JPT, Green S (2011). Cochrane hand-book for systematic reviews of interventions ver-sion 5.1.0 [Internet]. London (UK): The Cochrane Collaboration; [cited 2018 November 29]. Available from:
26. Cooper, Harris M (1998). Research synthesis and meta-analysis: a step-by-step approach. Califor-nia (US): SAGE Publications. p. 167-217.
27. Park SK, Hwang YS, Oh BT, et al (2017). The relationship between socioeconomic vulnerability and cognitive impairment among aged people in korea. Korean Journal of Clinical Geriatrics, 18(2):74-81.
28. Wolinsky FD, Mahncke HW, Kosinski M, et al (2009). The active cognitive training trial and pre-dicted medical expenditures. BMC Health Serv Res, 9:109.
29. Ryu SH (2018). The clinical significance of cogni-tive interventions for the patients with mild cog-nitive impairment. Journal of Korean Neuropsychiatric Association, 57(1):23-29.
30. Blazer DG (2003). Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci, 58(3):249-65.
31. Lohman MC, Rebok GW, Spira AP, et al (2013). Depressive symptoms and memory performance among older adults: results from the ACTIVE memory training intervention. J Aging Health. 25(0): 10.
IssueVol 51 No 1 (2022) QRcode
SectionReview Article(s)
Older adults Cognitive Education Rehabilitation Systematic review

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How to Cite
Yun S, Ryu S. The Effects of Cognitive-Based Interventions in Older Adults: A Systematic Review and Meta-Analysis. Iran J Public Health. 2022;51(1):1-11.