Cognitive Decline Slowed With Cognitive Remediation in At-Risk Adults
FRIDAY, Nov. 1, 2024 -- For older adults at risk for cognitive decline, especially those with remitted major depressive disorder (rMDD), with or without mild cognitive impairment (MCI), cognitive remediation (CR) plus transcranial direct current stimulation (tDCS) is effective for slowing cognitive decline, according to a study published online Oct. 30 in JAMA Psychiatry.
Tarek K. Rajji, M.D., from the Campbell Family Mental Health Research Institute in Toronto, and colleagues examined the efficacy of CR plus tDCS targeting the prefrontal cortex in older adults with rMDD, MCI, or both. A total of 486 older adults provided consent; 375 received at least one intervention session.
The researchers found that CR and tDCS slowed cognitive decline in older adults with rMDD or MCI during a median follow-up of 48.3 months (adjusted z score difference at month 60, 0.21; 95 percent confidence interval, 0.07 to 0.35). CR and tDCS did not improve cognition acutely in the preplanned primary analysis (adjusted z score difference at month 2, 0.06; 95 percent confidence interval, −0.006 to 0.12). There was a weak and not significant effect seen for CR and tDCS on delaying progression from normal cognition to MCI or from MCI to dementia (hazard ratio, 0.66; 95 percent confidence interval, 0.40 to 1.08). Treatment effects were seen for executive function and verbal memory in preplanned analyses; interactions were seen with diagnosis and APOE ε4, indicating a larger effect for those with rMMD and for APOE ε4 noncarriers.
"Our trial demonstrated the efficacy of a combined therapy of CR and tDCS in slowing cognitive decline in a high-risk sample," the authors write.
Several authors disclosed ties to the biopharmaceutical industry.
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