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Computerized Cognitive Training In People With Depression: A Systematic Review And Meta-analysis Of Randomized Clinical Trials

Nathalie H. Launder, Ruth Minkov, Christopher G. Davey, Carsten Finke, Hanna Malmberg Gavelin, Amit Lampit

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AbstractImportanceCognitive impairment is a common feature of both symptomatic and remitted states of depression that is associated with poorer psychosocial outcomes and treatment non-response. As such, finding treatments to maintain or enhance cognition in people with depression is imperative.ObjectiveTo investigate the efficacy of computerized cognitive training (CCT) on cognitive and functional outcomes in people with depression.Data SourcesMEDLINE, EMBASE and PsycINFO databases were screened through the Ovid interface for eligible studies from inception to 29 June 2020, with no language or publication type restrictions.Study SelectionTwo independent reviewers conducted duplicate study screening and assessed against the following inclusion criteria: (1) adults with depression, (2) CCT with minimum three hours practice, (3) active or passive control group, (4) cognitive and/or functional outcomes measured at baseline and post-intervention, (5) randomized controlled trials. Of 3666 identified studies, 24 met selection criteria.Data Extraction and SynthesisThe methods used followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data extraction and risk of bias assessment using the revised Cochrane Risk of Bias Tool (RoB2) was conducted independently by two reviewers. Analysis of the pooled results was conducted using robust variance estimation (RVE) based on a correlational dependence model.Main Outcomes and MeasuresThe primary outcome was change from baseline to post-intervention in overall cognition. Secondary outcomes were depressive symptoms, psychiatric symptoms, psychosocial functioning, daily functioning, subjective cognition, global cognition and domain-specific cognitive function.ResultsTwenty-four studies encompassing 28 comparisons and 1,141 unique participants met inclusion criteria. The pooled effect size of CCT for overall cognition was small and significant (g=0.26; 95% CI 0.15 to 0.36; P<.001; τ2=0.057; I2=37%; prediction interval −0.25 to 0.76) and for depressive symptoms was small and significant (g=0.24; 95% CI 0.04 to 0.45; P=.02; τ2=0.075; I2=46%; prediction interval −0.37 to 0.86). Evidence of small-study effect was found for both overall cognition and depressive symptoms, with trim-and-fill analysis imputing two studies for each. Sensitivity analyses of overall cognition and depressive symptoms revealed the main analyses to be robust. Benefits of CCT were also found for psychosocial functioning and domain-specific cognitive function in abstract reasoning, learning/encoding efficiency, retrieval fluency, high working memory, low working memory, inhibition and processing speed. No significant effect was found for psychiatric symptoms, subjective cognition, global cognition or domain-specific cognitive function in short-term memory and shifting. No separate pooled analyses were conducted for daily functioning or verbal reasoning, updating and visual processing domains due to two or less studies reporting outcomes for each. A moderating effect of dose was found for overall cognition, with larger doses of CCT associated with greater effect size estimates.Conclusions and RelevanceThis systematic review and meta-analysis indicates that CCT is an efficacious intervention for overall cognition, depressive symptoms, psychosocial functioning and domain-specific cognitive function for people with depression.