Effects of Combined Physical and Cognitive Interventions on Older Adults With Dementia: A Systematic Review and Meta-Analysis

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association Pub Date : 2025-07-24 DOI:10.1016/j.jamda.2025.105757

Dandan Xue PhD, RN , Yanqiu Hu MSN, RN , Rui Zhang MSN, RN , Jiaying Li PhD, RN

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引用次数: 0

Abstract

Objectives

Physical and cognitive interventions provide benefits to persons with dementia (PwD); however, the evidence on the effects of combined physical and cognitive interventions on PwD remains inconsistent. This review aimed to synthesize existing evidence and compare the effects of combined interventions with those of each intervention alone on cognitive, physical, psychological, functional, and health-related quality of life (HRQoL) outcomes for PwD.

Design

Systematic review and meta-analysis.

Setting and Participants

Older adults with dementia.

Methods

Searches were conducted across 8 English and Chinese databases from their inception dates to September 10, 2024. Quality appraisal was performed using Cochrane's risk of bias tool. Random-effects models were used for meta-analysis, and subgroup analyses and meta-regression were applied to explore potential moderators.

Results

A total of 23 studies involving 1716 participants were included. Combined interventions significantly improved global cognition [standardized mean difference (SMD), 0.65; 95% CI, 0.35–0.95; P < .001], processing speed (SMD, 0.33; 95% CI, 0.03–0.63; P = .03), functional mobility (SMD, 0.85; 95% CI, 0.18–1.53; P = .01), strength (SMD, 0.95; 95% CI, 0.28–1.61; P = .005), depression (SMD, −1.04; 95% CI, −1.73 to −0.36; P = .003), and HRQoL (SMD, 0.71; 95% CI, 0.24–1.18; P = .003) compared with active or passive controls. Combined interventions did not provide better overall benefits than using either intervention alone. Further analysis showed that the effectiveness of combined interventions on global cognition depended on the age of PwD.

Conclusions and Implications

Combined interventions are effective in improving cognitive, physical, psychological, and HRQoL outcomes in PwD. They should be integrated into dementia management protocols. Future research should focus on multiarm randomized controlled trials with long-term follow-up to directly compare the effects of combined interventions with those of single interventions and explore their long-term sustainability.

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身体和认知联合干预对老年痴呆患者的影响：系统回顾和荟萃分析。

目标：身体和认知干预为痴呆症患者（PwD）提供益处；然而，关于身体和认知联合干预对PwD的影响的证据仍然不一致。本综述旨在综合现有证据，并比较联合干预与单独干预对PwD认知、生理、心理、功能和健康相关生活质量（HRQoL）结局的影响。设计：系统回顾和荟萃分析。环境和参与者：老年痴呆患者。方法：对8个中英文数据库进行检索，检索时间为数据库建立之日至2024年9月10日。采用Cochrane偏倚风险工具进行质量评价。随机效应模型用于meta分析，亚组分析和meta回归用于探索潜在的调节因子。结果：共纳入23项研究，涉及1716名受试者。联合干预显著改善了全局认知(标准化平均差[SMD]， 0.65；95% ci, 0.35-0.95；P < 0.001)，处理速度(SMD, 0.33；95% ci, 0.03-0.63；P = .03)，功能活动能力(SMD, 0.85；95% ci, 0.18-1.53；P = 0.01)，强度(SMD, 0.95；95% ci, 0.28-1.61；P = 0.005)，抑郁(SMD, -1.04；95% CI, -1.73 ~ -0.36；P = 0.003), HRQoL (SMD, 0.71；95% ci, 0.24-1.18；P = .003)。联合干预并不比单独使用任何一种干预提供更好的总体效益。进一步分析表明，综合干预对整体认知的影响取决于PwD患者的年龄。结论和意义：综合干预措施可有效改善PwD患者的认知、生理、心理和HRQoL结果。它们应纳入痴呆症管理方案。未来的研究应侧重于长期随访的多组随机对照试验，直接比较联合干预与单一干预的效果，并探讨其长期可持续性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Medical Directors Association 医学-老年医学

CiteScore

11.10

自引率

6.60%

发文量

472

审稿时长

44 days

期刊介绍： JAMDA, the official journal of AMDA - The Society for Post-Acute and Long-Term Care Medicine, is a leading peer-reviewed publication that offers practical information and research geared towards healthcare professionals in the post-acute and long-term care fields. It is also a valuable resource for policy-makers, organizational leaders, educators, and advocates. The journal provides essential information for various healthcare professionals such as medical directors, attending physicians, nurses, consultant pharmacists, geriatric psychiatrists, nurse practitioners, physician assistants, physical and occupational therapists, social workers, and others involved in providing, overseeing, and promoting quality