Cognitive stimulation and cognitive results in older adults: A systematic review and meta-analysis 老年人的認知刺激與認知結果：系統性回顧與統合分析
Patricia Peralta-Marrupe ^("a "){ }^{\text {a }}, Eva Latorre ^("c,d "){ }^{\text {c,d }}, Juan Nicolás Cuenca Zaldívar ^("e,f "){ }^{\text {e,f }}, Estela Calatayud 帕特里夏·佩拉爾塔-馬魯佩，艾娃·拉托雷，胡安·尼古拉斯·昆卡·薩爾迪瓦爾，埃斯特拉·卡拉塔尤德^("a,b "){ }^{\text {a,b }}^(a){ }^{a} Department of Physiatry and Nursing, Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain 薩拉戈薩大學健康科學院物理醫學與護理系，西班牙薩拉戈薩^(b){ }^{\mathrm{b}} Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain 阿拉貢健康研究所 (IIS Aragón)，西班牙薩拉戈薩^("c "){ }^{\text {c }} Department of Biochemistry and Molecular and Cell Biology, Faculty of Sciences, Universidad de Zaragoza, Zaragoza, Spain 薩拉戈薩大學科學學院生物化學與分子及細胞生物學系，西班牙薩拉戈薩^(d){ }^{\mathrm{d}} Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza, Spain ^(d){ }^{\mathrm{d}} 成長、運動、營養與發展 (GENUD) 研究小組，薩拉戈薩大學，西班牙薩拉戈薩^(e){ }^{\mathrm{e}} Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute - Segovia de Arana (IDIPHISA), Madrid, Spain ^(e){ }^{\mathrm{e}} 護理與健康照護研究小組，鐵門健康研究所 - 塞戈維亞·德·阿拉納 (IDIPHISA)，西班牙馬德里^(f){ }^{\mathrm{f}} Primary Health Center "El Abajon", 28231 Las Rozas de Madrid, Spain ^(f){ }^{\mathrm{f}} 基本健康中心 "El Abajon"，28231 馬德里拉斯羅薩斯，西班牙
Background and Purpose: The lack of cognitive activity accelerates age cognitive decline. Cognitive stimulation (CS) tries to enhance cognitive functioning. The purpose of this systematic review and meta-analysis was to evaluate the effects of CS on cognitive outcomes (general cognitive functioning and specific cognitive domains) in older adults (aged 65 years or older, cognitively healthy participants, or with mild cognitive impairment, or dementia). Methods: PubMed, Scopus and Web of Science databases were examined from inception to October 2021. A total of 1,997 studies were identified in these databases, and. 33 studies were finally included in the systematic review and the meta-analysis. Raw means and standard deviations were used for continuous outcomes. Publication bias was examined by Egger’s Regression Test for Funnel Plot Asymmetry and the quality assessment tools from the National Institutes of Health. Results: CS significantly improves general cognitive functioning (mean difference =MD=1.536,95%CI,0.832=\mathrm{MD}=1.536,95 \% \mathrm{CI}, 0.832 to 2.240 ), memory ( MD=0.365,95%CI,0.300\mathrm{MD}=0.365,95 \% \mathrm{CI}, 0.300 to 0.430 ), orientation ( MD=0.428,95%CI,0.306\mathrm{MD}=0.428,95 \% \mathrm{CI}, 0.306 to 0.550 ), praxis ( MD=0.278,95%CI,0.094\mathrm{MD}=0.278,95 \% \mathrm{CI}, 0.094 to 0.462 ) and calculation ( MD=0.228,95%CI,0.112\mathrm{MD}=0.228,95 \% \mathrm{CI}, 0.112 to 0.343 ). Conclusion: CS seems to increase general cognitive functioning, memory, orientation, praxis, and calculation in older adults. 背景與目的：缺乏認知活動會加速年齡相關的認知衰退。認知刺激（CS）旨在增強認知功能。本系統性回顧和元分析的目的是評估 CS 對老年人（65 歲或以上，認知健康參與者，或輕度認知障礙，或癡呆症）的認知結果（一般認知功能和特定認知領域）的影響。方法：檢查了 PubMed、Scopus 和 Web of Science 數據庫，範圍從創建至 2021 年 10 月。在這些數據庫中共識別出 1,997 項研究，最終有 33 項研究被納入系統性回顧和元分析。對於連續結果，使用原始均值和標準差。通過 Egger 回歸檢驗漏斗圖不對稱性和國立衛生研究院的質量評估工具來檢查出版偏倚。結果：CS 顯著改善一般認知功能（均值差異 =MD=1.536,95%CI,0.832=\mathrm{MD}=1.536,95 \% \mathrm{CI}, 0.832 至 2.240）、記憶（ MD=0.365,95%CI,0.300\mathrm{MD}=0.365,95 \% \mathrm{CI}, 0.300 至 0.430）、定向（ MD=0.428,95%CI,0.306\mathrm{MD}=0.428,95 \% \mathrm{CI}, 0.306 至 0.550）、實踐（ MD=0.278,95%CI,0.094\mathrm{MD}=0.278,95 \% \mathrm{CI}, 0.094 至 0.462）和計算（ MD=0.228,95%CI,0.112\mathrm{MD}=0.228,95 \% \mathrm{CI}, 0.112 至 0.343）。 結論：CS 似乎能提高老年人的一般認知功能、記憶、定向、實踐能力和計算能力。
1. Introduction 1. 介紹
Cognitive function decline is a common phenomenon on that occurs with age (Mahncke et al., 2006). The cognitive alterations have received a lot of attention in aging by the scientific community, especially on memory alterations (Novoa et al., 2008). Late-life cognitive decline ranges from normal, mildest, through mild cognitive impairment (MCI), to dementia as most severe form (Millán-Calenti et al., 2012). 認知功能衰退是隨著年齡增長而常見的現象（Mahncke et al., 2006）。認知變化在老年中受到科學界的廣泛關注，特別是記憶變化（Novoa et al., 2008）。晚年認知衰退範圍從正常、輕微的，通過輕度認知障礙（MCI），到最嚴重的形式——癡呆（Millán-Calenti et al., 2012）。
In fact, perception, processing speed, attention, memory (Burke & Barnes, 2006) and executive function (Kaido et al., 2020) deteriorate during aging, thus cognitively healthy elderly subjects also have complaints in the ability to acquire, consolidate and remember new information. 事實上，感知、處理速度、注意力、記憶（Burke & Barnes, 2006）以及執行功能（Kaido et al., 2020）在老化過程中會惡化，因此認知健康的老年受試者在獲取、鞏固和記住新資訊的能力上也會有抱怨。
MCI describes a stage of intermediate cognitive dysfunction, where the risk of conversion to dementia is increased, however, it is also possible that people diagnosed with MCI could revert to a normal cognitive state without deterioration over time (Gauthier et al., 2006). Cognitive problems in MCI include difficulties in memory, language, attention, orientation, calculation, abilities visuospatial and executive functions while the language is preserved (Langa & Levine, 2014). The prevalence of MCI in adults above 65 years is estimated around 18,5% (). Memory failures are predictors of future dementia in MCI subjects and vary depending on the level of cognitive impairment (Wolfsgruber et al., 2014). The probability that an MCI patient will develop dementia within 10 years of initial MCI diagnosis is 4.35 times than a healthy subject (Zhu et al., 2001). 輕度認知障礙（MCI）描述了一種中度認知功能障礙的階段，在這個階段，轉變為癡呆的風險增加，然而，診斷為 MCI 的人也有可能在沒有惡化的情況下恢復到正常的認知狀態（Gauthier et al., 2006）。MCI 中的認知問題包括記憶、語言、注意力、定向、計算、視空間能力和執行功能的困難，而語言能力則保持完整（Langa & Levine, 2014）。65 歲以上成人中 MCI 的流行率估計約為 18.5%（）。記憶失誤是 MCI 患者未來癡呆的預測指標，並根據認知障礙的程度而有所不同（Wolfsgruber et al., 2014）。MCI 患者在初次診斷後 10 年內發展為癡呆的概率是健康個體的 4.35 倍（Zhu et al., 2001）。
Dementia is the supreme worldwide burden for welfare and the health care system in the 21st century. The estimated number of people with dementia will increase from 47 million in 2015 to more than 140 million in 2050. As deterioration increases in patients with dementia, the costs of daily activity assistance and medical care also increase (Alzheimer’s Disease International. 2013). Expenditure on long-term care services for older people with cognitive impairment in 2031, it may range between 0.83%0.83 \% and 1.11%1.11 \% of the Gross Domestic Product; these figures do not include the costs of informal care (Comas-Herrera & Knapp, 2016). 癡呆症是 21 世紀全球福利和醫療系統的主要負擔。預計癡呆症患者的數量將從 2015 年的 4700 萬增加到 2050 年的超過 1.4 億。隨著癡呆症患者的病情惡化，日常活動協助和醫療護理的成本也隨之增加（阿茲海默症國際組織，2013）。到 2031 年，對於認知障礙老年人的長期護理服務支出可能會在國內生產總值的 0.83%0.83 \% 到 1.11%1.11 \% 之間；這些數字不包括非正式護理的成本（Comas-Herrera & Knapp，2016）。
ACE-III: The Addenbrooke’s Cognitive Examination; AChEIs: acetylcholinesterase inhibitors; AD: Alzheimer’s disease; ADAS-Cog: Alzheimer disease assessment scale-cognitive; ADL: activities of daily living; CS: Cognitive stimulation; GDS: Global deterioration scale; MCI: Mild cognitive impairment; MEC-35: Spanish version of Mini-Mental State Examination; MMSE: Mini-Mental State Examination; MoCA: Montreal Cognitive Assessment score; PDD: Parkinson’s disease dementia; TAU: Treatment as usual. ACE-III：阿登布魯克認知評估；AChEIs：乙醯膽鹼酯酶抑制劑；AD：阿茲海默症；ADAS-Cog：阿茲海默症評估量表-認知；ADL：日常生活活動；CS：認知刺激；GDS：全球惡化量表；MCI：輕度認知障礙；MEC-35：西班牙版迷你心理狀態檢查；MMSE：迷你心理狀態檢查；MoCA：蒙特利爾認知評估分數；PDD：帕金森病癡呆；TAU：常規治療。
Cognitive stimulation (CS) plays an important role in learning and memory (Mather, 2020) and could offer beneficial effects on cognitive reserve and dementia risk (Collins et al., 2021). Moreover, the lack of cognitive activity accelerates cognitive decline (Woods et al., 2012); being able to accelerate the deterioration of both cognitively healthy elderly subjects and patients with dementia (Salthouse, 2006), therefore it should be started the as soon as possible (Woods et al., 2012). CS was defined by Clare & Woods, (2004) as “engagement in a range of group activities and discussions (usually in a group), aimed at general enhancement of cognitive and social functioning”. On the one hand, it differs from cognitive training, that is, guided practice on a set of standard tasks to improve a specific cognitive function, and, on the other hand, from cognitive rehabilitation, an individualized approach aimed at improving performance in the daily life to achieve preselected personal goals. 認知刺激（CS）在學習和記憶中扮演著重要角色（Mather, 2020），並可能對認知儲備和癡呆風險產生有益影響（Collins et al., 2021）。此外，缺乏認知活動會加速認知衰退（Woods et al., 2012）；能夠加速認知健康老年人和癡呆患者的惡化（Salthouse, 2006），因此應儘早開始（Woods et al., 2012）。CS 由 Clare & Woods（2004）定義為“參與一系列小組活動和討論（通常在小組中），旨在一般增強認知和社交功能”。一方面，它與認知訓練不同，即在一組標準任務上進行指導性練習以改善特定的認知功能；另一方面，它也不同於認知康復，這是一種個性化的方法，旨在改善日常生活中的表現，以實現預先選定的個人目標。
CS includes different types of approaches such as: (1) reality orientation, which involves constant repetition of everyday life facts, (basic but important information, referring to person, place and time (Cafferata et al., 2021; Massoud & Léger, 2011); (2) validation, focuses on the attitude of respect, empathic listening and the person’s subjective experience as opposed to objective facts (Cafferata et al., 2021; Spector et al., 2001); (3) reminiscence, consists of talking about past events and reflecting on the person’s life, often with the help of props such as photographs, music, videos and objects (Cafferata et al., 2021; Lobbia et al., 2019; Spector et al., 2001); (4) multisensory therapy, is based on stimulation of the sense organs (smell, touch, vision, taste, and hearing), and includes activities such as fruit tasting, singing, and dancing (Kor et al., 2022); (5) cognitive activities, are activities designed for the prevention of cognitive function impairments (Calatayud et al., 2020; De Oliveira et al., 2014; Gomez-Soria et al., 2020) and (6) implicit learning, focused on acquiring knowledge about the structure of the environment without conscious awareness (Spector et al., 2010). CS 包括不同類型的方法，例如：(1) 現實導向，涉及對日常生活事實的持續重複（基本但重要的信息，指人、地點和時間（Cafferata et al., 2021; Massoud & Léger, 2011）；(2) 驗證，專注於尊重的態度、同理心的傾聽和個人的主觀經驗，而非客觀事實（Cafferata et al., 2021; Spector et al., 2001）；(3) 回憶，包含談論過去事件並反思個人的生活，通常借助於道具如照片、音樂、視頻和物品（Cafferata et al., 2021; Lobbia et al., 2019; Spector et al., 2001）；(4) 多感官療法，基於對感官器官（嗅覺、觸覺、視覺、味覺和聽覺）的刺激，包括水果品嚐、唱歌和跳舞等活動（Kor et al., 2022）；(5) 認知活動，旨在預防認知功能障礙的活動（Calatayud et al., 2020; De Oliveira et al., 2014; Gomez-Soria et al.）。，2020）和（6）隱性學習，專注於在沒有意識的情況下獲取有關環境結構的知識（Spector et al.，2010）。
CS programs, which combine cognitive, emotional, and physical activities using various elements, can stimulate various aspects of cognitive function, making them more effective than single component programs. Furthermore, they have the advantage of arousing more the interest of the participants and encouraging a more active participation (Reijnders et al., 2013). In the UK, CS was firstly recommended by the National Institute for Health and Clinical Excellence NICE SCIE Guidelines have been upgraded in the recent revision (Duff, 2018) to improve cognition in people with mild to moderate dementia. In addition, CS is explicitly recommended in three criteria of a standard for psychosocial interventions by the National Memory Services Accreditation Program (MSNAP) (Hodge et al. 2016). CS is a cost-effective psychosocial intervention, recommended by national guidance (Dickinson et al., 2017). Therefore, different reviews and meta-analyses have evaluated the impact of CS on general cognitive functioning (Aguirre et al., 2013; Cafferata et al. 2021; Kim et al., 2017; Lobbia et al., 2019; Saragih et al., CS 計劃結合了認知、情感和身體活動，使用各種元素，可以刺激認知功能的各個方面，使其比單一組件計劃更有效。此外，它們還具有激發參與者更多興趣和鼓勵更積極參與的優勢（Reijnders et al., 2013）。在英國，CS 首次由國家健康與臨床卓越研究所（NICE）推薦，SCIE 指導方針在最近的修訂中得到了升級（Duff, 2018），以改善輕度至中度癡呆患者的認知。此外，CS 在國家記憶服務認證計劃（MSNAP）的一項心理社會干預標準的三個標準中明確推薦（Hodge et al. 2016）。CS 是一種具有成本效益的心理社會干預，受到國家指導的推薦（Dickinson et al., 2017）。因此，不同的評估和綜合分析已評估 CS 對一般認知功能的影響（Aguirre et al., 2013; Cafferata et al. 2021; Kim et al., 2017; Lobbia et al., 2019; Saragih et al.）。
2022; Sun et al., 2022; Wong et al., 2021; Woods et al., 2012), and only two of them have evaluated the impact of CS on specific cognitive domains (Cafferata et al., 2021; Lobbia et al., 2019). Furthermore, all these studies included only dementia patients. 2022；Sun et al.，2022；Wong et al.，2021；Woods et al.，2012），而且只有兩項研究評估了 CS 對特定認知領域的影響（Cafferata et al.，2021；Lobbia et al.，2019）。此外，所有這些研究僅包括癡呆患者。
Therefore, this systematic review and meta-analysis aimed to evaluate the impact of CS (independently or together with pharmacological treatment, particularly acetylcholinesterase inhibitors (AChEIs)) on cognitive outcomes, general cognitive functioning and specific cognitive domains (such as memory, attention, orientation, executive functions, language, verbal fluency, praxis, visuospatial abilities and calculation) in cognitively healthy elderly individuals, or with MCI, or dementia. 因此，本系統性回顧和統合分析旨在評估 CS（獨立或與藥物治療一起，特別是乙醯膽鹼酯酶抑制劑（AChEIs））對認知結果、一般認知功能和特定認知領域（如記憶、注意力、定向、執行功能、語言、語言流暢性、實踐能力、視空間能力和計算）在認知健康的老年人、輕度認知障礙（MCI）或癡呆患者中的影響。
2. Methods 2. 方法
This systematic review adheres to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) (Rethlefsen et al., 2021) (see supplementary file 1, Table S1) and was registered in the PROSPERO database (ID number: CRD42021238120). 本系統性回顧遵循 PRISMA（系統性回顧和 Meta 分析的首選報告項目）（Rethlefsen 等，2021）（見補充文件 1，表 S1），並已在 PROSPERO 數據庫中註冊（ID 號碼：CRD42021238120）。
2.1. Search strategy 2.1. 搜尋策略
The databases PubMed, Web of Science and Scopus were used in this study. The specific search parameters used in all online databases (see supplementary file 2, Table S2). The search terms were adjusted to each respective database. The search was conducted from inception to October 2021. 本研究使用了 PubMed、Web of Science 和 Scopus 數據庫。所有在線數據庫中使用的具體搜索參數（見補充文件 2，表 S2）。搜索詞根據各自的數據庫進行了調整。搜索從創建之初進行到 2021 年 10 月。
When possible, the search included a vocabulary thesaurus (list of MeSH terms in PubMed). First, the CS related terms were combined. Secondly, the mental and cognitive outcome related terms were combined as follows: “healthy aging” OR “cognitive impairment” OR “Alzheimer” OR “dementia” OR “Parkinson” OR “Lewy Body Disease” OR “Pick Disease” OR “Huntington’s Disease”. Finally, both the CS and the mental and cognitive outcome terms were combined with “AND.”. 當可能時，搜索包括了一個詞彙同義詞庫（PubMed 中的 MeSH 術語列表）。首先，將與 CS 相關的術語進行合併。其次，將與心理和認知結果相關的術語合併如下：“健康老化”或“認知障礙”或“阿茲海默症”或“癡呆”或“帕金森病”或“路易體病”或“皮克病”或“亨廷頓病”。最後，將 CS 和心理及認知結果術語用“AND”進行合併。
2.2. Eligibility criteria 2.2. 資格標準
A specific question was constructed according to the PICOS (Participants, Interventions, Control, Outcomes, Study Design) principle (Table 1). 根據 PICOS（參與者、干預、對照、結果、研究設計）原則構建了一個具體問題（表 1）。
The following inclusion criteria were applied: (1) original studies (randomized controlled trials, clinical trials, observational studies, and pre-post studies); (2) studies performed in humans; (3) studies written in English, Spanish (4) participants aged 65 years or older of mean age and (5) studies with (5.1) cognitively healthy elderly participants with normal levels of cognitive functioning, (that is, i.e., Mini-Mental State Examination (MMSE) score > 24>24, Spanish version of Mini-Mental State Examination (MEC-35) score > 27>27 or Montreal Cognitive Assessment score (MoCA) >= 26\geq 26 ) or (5.2) participants diagnosed of MCI, that is i.e., MMSE >= 24\geq 24, MEC-35 24-27; Clinical Dementia Rating score 0.5 , and National Institute of Neurological and Communicative Criteria for Disorders and Stroke-AD and Related Disorders Association (NINCDS- 以下納入標準適用於： (1) 原創研究（隨機對照試驗、臨床試驗、觀察性研究和前後研究）； (2) 在人類中進行的研究； (3) 以英語、西班牙語撰寫的研究； (4) 參與者年齡在 65 歲或以上的平均年齡； (5) 研究中包含 (5.1) 認知健康的老年參與者，具有正常的認知功能水平（即，迷你心理狀態檢查（MMSE）得分 > 24>24 ，西班牙語版迷你心理狀態檢查（MEC-35）得分 > 27>27 或蒙特利爾認知評估得分（MoCA） >= 26\geq 26 ）或 (5.2) 被診斷為輕度認知障礙（MCI）的參與者，即 MMSE >= 24\geq 24 ，MEC-35 24-27；臨床癡呆評定量表得分 0.5，以及國家神經病學和溝通障礙研究所-阿茲海默病及相關障礙協會（NINCDS-
Table 1 表 1
PICOS criteria for inclusion and exclusion of studies. PICOS 標準用於研究的納入和排除。
Parameter 參數
Participants 參與者
65 歲或以上的老年人，認知健康，或有輕度認知障礙，或癡呆。干預措施 控制/比較組
Older adults aged 65 years or older cognitively healthy, or
with mild cognitive impairment, or dementia.
Interventions
Control/comparator
group
Older adults aged 65 years or older cognitively healthy, or
with mild cognitive impairment, or dementia.
Interventions
Control/comparator
group| Older adults aged 65 years or older cognitively healthy, or |
| :--- |
| with mild cognitive impairment, or dementia. |
| Interventions |
| Control/comparator |
| group |
CS according to the classification of Clare & Woods (2003). 根據 Clare & Woods（2003）的分類，CS。
Passive (no intervention, treatment as usual) or active 被動（無介入，常規治療）或主動
controls (same or different intervention than intervention 對照組（與干預相同或不同的干預）
group). 群體)。
Evaluate psychosocial variables, at least one of them 評估心理社會變數，至少其中一項
(activities of daily living, mood-depression, mood-anxiety, 日常生活活動、情緒-抑鬱、情緒-焦慮、
quality of life, well-being, loneliness). 生活質量、幸福感、孤獨感)。
Parameter
Participants "Older adults aged 65 years or older cognitively healthy, or
with mild cognitive impairment, or dementia.
Interventions
Control/comparator
group"
CS according to the classification of Clare & Woods (2003).
Passive (no intervention, treatment as usual) or active
controls (same or different intervention than intervention
group).
Evaluate psychosocial variables, at least one of them
(activities of daily living, mood-depression, mood-anxiety,
quality of life, well-being, loneliness).
Randomized controlled trials, clinical trials, observational
and pre-post studies | Parameter | |
| :--- | :--- |
| Participants | Older adults aged 65 years or older cognitively healthy, or <br> with mild cognitive impairment, or dementia. <br> Interventions <br> Control/comparator <br> group |
| CS according to the classification of Clare & Woods (2003). | |
| Passive (no intervention, treatment as usual) or active | |
| controls (same or different intervention than intervention | |
| group). | |
| Evaluate psychosocial variables, at least one of them | |
| (activities of daily living, mood-depression, mood-anxiety, | |
| quality of life, well-being, loneliness). | |
| Randomized controlled trials, clinical trials, observational | |
| and pre-post studies | |
quad\quad
ADRDA) (McKhann et al., 1984), Petersen (Petersen, 2004; Petersen et al., 1999) Winblad et al., 2004, Gauthier et al., 2006, Spector ( Spector et al., 2006; Spector et al., 2003) Diagnostic and Statistical Manual of Mental Disorders 5 (DSM5) (American Psychiatric Association, 2013), or (5.3) criteria for dementia, that is probable AD, patients diagnosed of AD, vascular dementia, Parkinsons Disease dementia and other types of dementia (e.g., assessed with by a neurologist or psychiatrist or neuropsychological tests, Statistical Manual of Mental Disorders DSM, the National Institute of Neurological Disorders and Stroke, Association International Neurosciences and the Association Internationale pour la Recherche et l’Enseignement en Neurosciences (NINDS-AIREN) (Román et al., 1993), or a MoCA score 12-25 and MMSE score 10-25). Parkinson’s disease dementia (PDD) or mild cognitive impairment or dementia (PD-MCI) according to (Emre et al., 2007; Litvan et al., 2012) and dementia with Lewy bodies (DLB) according to (McKeith et al., 2017). Furthermore, cognitive decline ranging from MCI to dementia according to scores of the Global Deterioration Scale (GDS) between 3 and 5 . ADRDA) (McKhann et al., 1984)，Petersen (Petersen, 2004; Petersen et al., 1999) Winblad et al., 2004，Gauthier et al., 2006，Spector (Spector et al., 2006; Spector et al., 2003) 精神疾病診斷與統計手冊第 5 版 (DSM5) (美國精神醫學會，2013)，或 (5.3) 癡呆症標準，即可能的阿茲海默症，診斷為阿茲海默症、血管性癡呆、帕金森病癡呆及其他類型的癡呆（例如，由神經科醫生或精神科醫生或神經心理測試評估，精神疾病診斷手冊 DSM，國家神經疾病與中風研究所，國際神經科學協會及國際神經科學研究與教育協會 (NINDS-AIREN) (Román et al., 1993)，或 MoCA 分數 12-25 和 MMSE 分數 10-25）。根據 (Emre et al., 2007; Litvan et al., 2012) 的帕金森病癡呆 (PDD) 或輕度認知障礙或癡呆 (PD-MCI)，以及根據 (McKeith et al., 2017) 的路易體癡呆 (DLB)。此外，根據全球惡化量表 (GDS) 的分數在 3 到 5 之間的認知衰退範圍從輕度認知障礙到癡呆。
The following exclusion criteria were applied: (1) articles that did not provide original data (e.g., systematic reviews, meta-analyses, literature reviews); (2) participants diagnosed with other cognitive impairments different to MCI and dementia; (3) studies that included other types of cognitive intervention different than CS; (4) articles that did not provide a control group. 以下排除標準適用於： (1) 未提供原始數據的文章（例如，系統評價、統合分析、文獻回顧）； (2) 被診斷為其他不同於輕度認知障礙（MCI）和癡呆的認知障礙參與者； (3) 包含其他類型的認知介入而非認知訓練（CS）的研究； (4) 未提供對照組的文章。
2.3. Study selection and data extraction 2.3. 研究選擇與數據提取
Two authors (IG-S, EC) independently searched each database to obtain publications. Agreement between the authors was found for 90%90 \% of the publications while the remaining discrepancies were resolved by discussion. Relevant articles were obtained in full and assessed against the inclusion and exclusion criteria. Disagreements between the reviewers were resolved by consensus, when consensus could not be reached, arbitration by a third reviewer was applied (AA). 兩位作者（IG-S, EC）獨立搜尋每個資料庫以獲取出版物。作者之間對於 90%90 \% 篇出版物達成一致，而其餘的差異則通過討論解決。相關文章已完整獲取並根據納入和排除標準進行評估。審稿人之間的分歧通過共識解決，當無法達成共識時，則由第三位審稿人（AA）進行仲裁。
2.4. Quality assessment and publication bias 2.4. 質量評估與出版偏倚
Publication bias was examined by performing Egger’s Regression Test for Funnel Plot Asymmetry (Egger et al., 1997). Further confirmation was obtained through visual inspection of funnel plot symmetry, plotting the effect size in relation to the standard error. 發表偏倚是通過執行埃格爾回歸檢驗來檢查漏斗圖不對稱性（Egger et al., 1997）。進一步的確認是通過對漏斗圖對稱性的視覺檢查，將效應大小與標準誤差繪製在一起。
Funnel plots were created using JAMOVI (Jamovi, 2021) to investigate publication bias. Publication bias was assessed by the Egger linear regression test, following the guidelines provided by Peters et al., 2006. Thus, funnel plots were created and tests were carried out when the meta-analysis had more than 10 studies, as a small number of studies lowers the test power to a point where it is too low to distinguish chance from actual asymmetry (Sterne et al., 2011). Besides, trim and fill funnel plots according to Duval & Tweedie (Duval & Tweedie, 2000a, 2000b) were created using the R Ver. 3.5.1 program (R Foundation for Statistical Computing, Institute for Statistics and Mathematics, Welthandelsplatz 1, 1020 Vienna, Austria) and the meta and metaphor packages (Supplementary file 81, Fig. 10). 漏斗圖是使用 JAMOVI（Jamovi, 2021）創建的，以調查出版偏倚。出版偏倚是通過埃格線性回歸測試進行評估的，遵循 Peters 等人於 2006 年提供的指導方針。因此，當元分析有超過 10 項研究時，創建了漏斗圖並進行了測試，因為研究數量少會降低測試的效能，至低到無法區分機會與實際不對稱（Sterne 等人，2011）。此外，根據 Duval & Tweedie（Duval & Tweedie, 2000a, 2000b）創建的修剪和填充漏斗圖是使用 R Ver. 3.5.1 程序（R 統計計算基金會，統計與數學研究所，Welthandelsplatz 1, 1020 維也納，奧地利）和 meta 及 metaphor 套件（補充文件 81，圖 10）。
Additionally, National Heart, Lung, and Blood Institute website (“Quality Assessment Tool for Controlled Intervention Studies, Observational Cohort and Cross-Sectional Studies and Pre-Post Studies With No Control Group. NIH National Heart, Lung, and Blood Institute Website. [Online].,” 2013) was used for the assessment of the quality of the studies included in the present systematic review and meta-analyses. 此外，國家心臟、肺部和血液研究所網站（“受控干預研究、觀察性隊列和橫斷面研究及無對照組的前後研究質量評估工具。NIH 國家心臟、肺部和血液研究所網站。[在線]。”，2013 年）被用於評估本系統性回顧和元分析中納入研究的質量。
2.5. Statistical analyses to conduct the meta-analyses 2.5. 進行統合分析的統計分析
All the studies included in the present meta-analysis and systematic review met the established inclusion criteria. However, when extracting the data, some information was missing. Although corresponding authors were contacted to collect the missing information to conduct the 本次元分析和系統評估中包含的所有研究均符合既定的納入標準。然而，在提取數據時，部分信息缺失。儘管已聯繫對應作者以收集缺失的信息以進行分析，
meta-analyses (Leroi et al., 2019; Lok et al., 2020; Marinho et al., 2021; Middelstadt et al., 2016, Oliveira et al., 2018; Vega Rozo et al., 2016) only two authors responded and gave us the required missing data (Leroi et al., 2019; Lok et al., 2020). meta 分析（Leroi et al., 2019; Lok et al., 2020; Marinho et al., 2021; Middelstadt et al., 2016, Oliveira et al., 2018; Vega Rozo et al., 2016）只有兩位作者回應並提供了我們所需的缺失數據（Leroi et al., 2019; Lok et al., 2020）。
The following subgroups were analyzed: (1) cognitive status (“cognitively healthy elderly or “MCI”; or “dementia”); (2) age (” <= 75\leq 75 years/ “>75 years”); (3) “computerized CS”; or “traditional CS”; (4) “personalized-adapted CS” or “non-personalized/non-adapted CS”; (5) “individual CS” or “group CS”; (6) “short-term” (duration of the CS is less than 3 months); “maintenance or medium-term” (duration of the CS is between 3 and 6 months); or “long-term” (duration of the CS is more than 12 months) (Aguirre et al., 2010); (7) 30min//30 \mathrm{~min} / session; < 45<45min//\mathrm{min} / session; or > 45min//session>45 \mathrm{~min} / \mathrm{session}; (8) subtype of control (active, passive or TAU); (9) “fair”; or “good” quality of studies; (10) “alone CS” or “CS + AChEIs”; (11) origin of the studies (“America”, “Asia”, or “Europe”); (12) “type of memory” (fixation memory, short-term, episodic memory, visuospatial memory, visual memory, or auditive memory); (13) type of orientation (temporal or spatial); (14) “type of verbal fluency” (semantic or phonemic); and (15) type of praxis (ideational or constructional) as long as the information was available. The gender of the participants could not be analyzed. 以下子群體進行了分析：（1）認知狀態（“認知健康的老年人”或“MCI”；或“癡呆”）；（2）年齡（“ <= 75\leq 75 歲/ “>75 歲”）；（3）“電腦化的 CS”；或“傳統的 CS”；（4）“個性化適應的 CS”或“非個性化/非適應的 CS”；（5）“個體 CS”或“團體 CS”；（6）“短期”（CS 的持續時間少於 3 個月）；“維持或中期”（CS 的持續時間在 3 到 6 個月之間）；或“長期”（CS 的持續時間超過 12 個月）（Aguirre et al., 2010）；（7） 30min//30 \mathrm{~min} / 次會議； < 45<45min//\mathrm{min} / 次會議；或 > 45min//session>45 \mathrm{~min} / \mathrm{session} ；（8）控制類型（主動、被動或 TAU）；（9）研究的“公平”；或“良好”質量；（10）“單獨 CS”或“CS + AChEIs”；（11）研究的來源（“美洲”、“亞洲”或“歐洲”）；（12）“記憶類型”（固定記憶、短期、情節記憶、視空間記憶、視覺記憶或聽覺記憶）；（13）方向類型（時間或空間）；（14）“語言流利性類型”（語義或音韻）；以及（15）實踐類型（意念性或建構性），只要信息可用。參與者的性別無法進行分析。
With the continuous variables “time of session”, “number of sessions (min)”, “total duration (weeks)” and “scores quality of studies (%”), heterogeneity was assessed through meta-regressions using the restricted maximum likelihood (REML), recommended as an estimator of heterogeneity to avoid bias (Tanriver-Ayder et al., 2021). 隨著連續變數「會議時間」、「會議次數（分鐘）」、「總持續時間（週）」和「研究質量得分（%）」，通過使用限制最大似然法（REML）進行元回歸來評估異質性，這被推薦作為評估異質性的估計量以避免偏差（Tanriver-Ayder et al., 2021）。
The standardized mean difference was chosen as the effect size metric to combine the results. When it was not directly provided by the authors, it was calculated from the mean, standard deviation, and sample size. When the Standard Deviation (SD) was not reported in the study, the authors were contacted. If no response was received, the following formula was applied: standard error =SD//sqrt()n=\mathrm{SD} / \sqrt{ } \mathrm{n}; SD=\mathrm{SD}= interquartile range //1.35/ 1.35. When the mean was not reported in the studies, the median was used. When possible, subgroup analyses were conducted. Several specific subgroup analyses were not performed because of a lack of studies (i.e., subgroups for which data could be obtained from only one study). 標準化平均差被選為效果大小指標以結合結果。當作者未直接提供時，則根據平均值、標準差和樣本大小進行計算。當研究中未報告標準差（SD）時，會聯繫作者。如果未收到回覆，則應用以下公式：標準誤差 =SD//sqrt()n=\mathrm{SD} / \sqrt{ } \mathrm{n} ; SD=\mathrm{SD}= 四分位距 //1.35/ 1.35 。當研究中未報告平均值時，則使用中位數。若有可能，進行了亞組分析。由於缺乏研究，幾個特定的亞組分析未能進行（即僅能從一項研究中獲得數據的亞組）。
Then, all results were pooled using the DerSimonian-Laird method in a random-effects meta-analysis (DerSimonian & Kacker, 2007) with the OpenMetaAnalyst software (Wallace et al., 2012). 然後，所有結果使用 DerSimonian-Laird 方法在隨機效應的統合分析中進行匯總（DerSimonian & Kacker, 2007），並使用 OpenMetaAnalyst 軟體（Wallace et al., 2012）。
In addition, heterogeneity across studies using the I^(2)\mathrm{I}^{2} statistic was estimated. Heterogeneity was considered as not important ( 0%-40%0 \%-40 \% ), moderate ( 30%-60%30 \%-60 \% ), substantial ( 50%-90%50 \%-90 \% ), or considerable ( 75%-75 \%-100%100 \% ) (Higgins & Thompson, 2002). Moreover, the corresponding p-values were also taken into account. 此外，使用 I^(2)\mathrm{I}^{2} 統計量的研究之間的異質性被估計。異質性被認為不重要 ( 0%-40%0 \%-40 \% )、中等 ( 30%-60%30 \%-60 \% )、顯著 ( 50%-90%50 \%-90 \% ) 或相當 ( 75%-75 \%-100%100 \% ) (Higgins & Thompson, 2002)。此外，相關的 p 值也被考慮在內。
3. Results 3. 結果
3.1. Study selection 3.1. 研究選擇
The initial search provided a total of 2,108 records. The process used to detect duplicates was carried out through Microsoft Excel and the process was repeated twice, with a final manual revision. After removing duplicates and including studies identified through reference scanning, 1,997 potentially relevant studies were found, which were further filtered based on their title and abstract, remaining 64. After reading the full texts, 33 articles were finally included in the systematic review and the meta-analysis. The PRISMA diagram for the study selection is detailed in Fig. 1 and studies excluded by text complete (see Supplementary file 3 , Table S 3 ). 初步搜尋共提供了 2,108 條記錄。檢測重複的過程是通過 Microsoft Excel 進行的，並重複了兩次，最後進行了手動修訂。在刪除重複項並包括通過參考掃描識別的研究後，發現了 1,997 項潛在相關研究，這些研究根據其標題和摘要進一步篩選，剩下 64 項。在閱讀完整文本後，最終有 33 篇文章被納入系統評價和元分析。研究選擇的 PRISMA 圖詳見圖 1，文本完整性排除的研究見補充文件 3，表 S3。
32 studies evaluated general cognitive functioning (Fig. 2a.) (Alvares-Pereira et al., 2020; Alves et al., 2014; Calatayud et al., 2020; Capotosto et al., 2017; Carbone et al., 2021; Coen et al., 2011; Cove et al., 2014; Ciarmiello et al., 2015; Fernández Calvo et al., 2010; Folkerts et al., 2018; Gibbor, et al., 2020; Gómez-Soria et al., 2020; Gómez-Soria, Brandín-de la Cruz, et al., 2021; Gómez-Soria, Esteban, 32 項研究評估了一般認知功能（圖 2a.）（Alvares-Pereira 等，2020；Alves 等，2014；Calatayud 等，2020；Capotosto 等，2017；Carbone 等，2021；Coen 等，2011；Cove 等，2014；Ciarmiello 等，2015；Fernández Calvo 等，2010；Folkerts 等，2018；Gibbor 等，2020；Gómez-Soria 等，2020；Gómez-Soria，Brandín-de la Cruz 等，2021；Gómez-Soria，Esteban，
Fig. 1. PRISMA Diagram- the process of study selection. From: Rethlefsen, M. L., Kirtley, S., Waffenschmidt, S., Ayala, A. P., Moher, D., Page, M. J., & Koffel, J. B. (2021). PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews. Systematic Reviews, 10(1), 1-19. https://doi. org/10.1186/S13643-020-01542-Z. 圖 1. PRISMA 圖示 - 研究選擇過程。來源：Rethlefsen, M. L., Kirtley, S., Waffenschmidt, S., Ayala, A. P., Moher, D., Page, M. J., & Koffel, J. B. (2021)。PRISMA-S：系統評價文獻檢索報告的 PRISMA 聲明擴展。系統評價，10(1)，1-19。https://doi.org/10.1186/S13643-020-01542-Z。
et al., 2021; Juárez-Cedillo et al., 2020; Justo-Henriques et al., 2019, 2021; Leroi et al., 2019; Liu et al., 2021; Lok et al., 2020; López et al., 2020; Miranda-Castillo et al., 2013; Niu et al., 2010; Oliveira et al., 2021; Orgeta et al., 2015; Orrell et al., 2014; Piras et al., 2017; Polito et al., 2015; Spector et al., 2003; Tarnanas et al., 2014; Tsai et al., 2019), 18 studies evaluated specific cognitive domains (memory, attention, orientation, executive functions, language, verbal fluency, praxis, et al., 2021; Juárez-Cedillo et al., 2020; Justo-Henriques et al., 2019, 2021; Leroi et al., 2019; Liu et al., 2021; Lok et al., 2020; López et al., 2020; Miranda-Castillo et al., 2013; Niu et al., 2010; Oliveira et al., 2021; Orgeta et al., 2015; Orrell et al., 2014; Piras et al., 2017; Polito et al., 2015; Spector et al., 2003; Tarnanas et al., 2014; Tsai et al., 2019)，18 項研究評估了特定的認知領域（記憶、注意力、定向、執行功能、語言、語言流暢性、實踐能力，
calculation and visuospatial abilities) (Alvares-Pereira et al., 2020; Alves et al., 2014; Calatayud et al., 2020; Capotosto et al., 2017; Carbone et al., 2021; Ciarmiello et al., 2015; Djabelkhir et al., 2017; Gómez-Soria, Brandín-de la Cruz, et al., 2021; Gómez-Soria, Esteban, et al., 2021; Juárez-Cedillo et al., 2020; Justo-Henriques et al., 2019; Leroi et al., 2019; Liu et al., 2021; López et al., 2020; Piras et al., 2017; Polito et al., 2015; Spector et al., 2010; Tarnanas et al., 2014) (Fig. 2b). 計算和視空間能力) (Alvares-Pereira et al., 2020; Alves et al., 2014; Calatayud et al., 2020; Capotosto et al., 2017; Carbone et al., 2021; Ciarmiello et al., 2015; Djabelkhir et al., 2017; Gómez-Soria, Brandín-de la Cruz, et al., 2021; Gómez-Soria, Esteban, et al., 2021; Juárez-Cedillo et al., 2020; Justo-Henriques et al., 2019; Leroi et al., 2019; Liu et al., 2021; López et al., 2020; Piras et al., 2017; Polito et al., 2015; Spector et al., 2010; Tarnanas et al., 2014) (圖 2b)。
Fig. 2a. General cognitive functioning. 圖 2a. 一般認知功能。
In the Fernández Calvo et al., 2010 study, one group performs CS in format individual and other group CS in format group. 在 Fernández Calvo 等人於 2010 年的研究中，一組以個別形式進行 CS，另一組則以團體形式進行 CS。
3.2. Study characteristics 3.2. 研究特徵
The main characteristics of the participants and CS were extracted from the selected studies and can be consulted in Table 2. Additionally, the specific cognitive domains and activities of CS are shown (see 參與者和 CS 的主要特徵已從所選研究中提取，詳情可參見表 2。此外，CS 的具體認知領域和活動顯示於（見
Fig. 2b. Specific cognitive domains. 圖 2b. 特定認知領域。
supplementary file 4, Table 4). Measurements and the observed effect included in psychosocial variables in each individual study is available (see supplementary file 5, Table 5.) 補充檔案 4，表 4）。每個個別研究中包含的心理社會變數的測量和觀察效果可用（見補充檔案 5，表 5）。
A total of 2.724 participants ( 63.8%63.8 \% females) were analyzed. The mean age of the participants was 78.8 years. Regarding the origin of the studies 81,8%81,8 \% were conducted in Europe, 12.1%12.1 \% in Asia, and 6.1%6.1 \% in America. 3% of studies included cognitively healthy elderly individuals, 3%3 \% of studies included both cognitively healthy elderly individuals and MCI, 24.2% of studies included participants with MCI, and 60.6%60.6 \% of the studies included participants with dementia and 9.1%9.1 \% of the studies included both, MCI and dementia. 總共有 2,724 名參與者（ 63.8%63.8 \% 名女性）被分析。參與者的平均年齡為 78.8 歲。關於研究的來源， 81,8%81,8 \% 在歐洲進行， 12.1%12.1 \% 在亞洲進行， 6.1%6.1 \% 在美國進行。3%的研究包括認知健康的老年人， 3%3 \% 的研究包括認知健康的老年人和輕度認知障礙（MCI），24.2%的研究包括有 MCI 的參與者， 60.6%60.6 \% 的研究包括有癡呆症的參與者， 9.1%9.1 \% 的研究同時包括 MCI 和癡呆症的參與者。
The intervention provider was nurse ( n=1n=1 ), neuropsychologist ( n=n= 5 ), occupational therapist (n=5)(n=5), psychologist ( n=3n=3 ), psychologist and therapeutic assistants (n=1)(n=1) therapist (n=3)(n=3), carer (n=2)(n=2), and team specially ( n=2n=2 ). In 11 studies they did not specify which professional carried out the intervention. The study setting was residential care ( n=n= 7), community ( n=18n=18 ) and residential care together community ( n=n= 8). 介入提供者為護理師 ( n=1n=1 )、神經心理學家 ( n=n= 5)、職業治療師 (n=5)(n=5) 、心理學家 ( n=3n=3 )、心理學家及治療助理 (n=1)(n=1) 、治療師 (n=3)(n=3) 、照顧者 (n=2)(n=2) ，以及專門團隊 ( n=2n=2 )。在 11 項研究中，他們未具體說明是由哪位專業人員執行介入。研究環境為住院護理 ( n=n= 7)、社區 ( n=18n=18 ) 及住院護理與社區結合 ( n=n= 8)。
Interventions carried out were diverse: 30 studies included traditional interventions and 3 studies computerized interventions, 27 studies include group intervention, 5 studies included individual intervention and one study both (group and individual). Particularly, the studies included the following types of CS: 30 studies applied cognitive activities, 21 studies applied reality orientation, 12 studies administered multisensory stimulation, 7 studies applied reminiscence, 6 studies introduced implicit learning, 1 study applied validation therapy; in addition, 8 studies introduced external aids. Furthermore, in 16 studies adjusted the level of difficulty of the CS or personalized the intervention. Regarding the pharmacological treatment; in 4 studies participants did not take AChEIs, in 2 studies participants took AChEIs and 26 studies did not specify whether participants take or not AChEIs. In the study of Orrell et al. (2014), subgroup analyses were also carried out, differentiating between the participants who only took CS and those who, in 所進行的干預措施多樣化：30 項研究包括傳統干預，3 項研究包括計算機化干預，27 項研究包括團體干預，5 項研究包括個別干預，1 項研究同時包括團體和個別干預。特別是，這些研究包括以下類型的認知刺激（CS）：30 項研究應用了認知活動，21 項研究應用了現實導向，12 項研究進行了多感官刺激，7 項研究應用了回憶，6 項研究引入了隱性學習，1 項研究應用了驗證療法；此外，8 項研究引入了外部輔助工具。此外，在 16 項研究中調整了認知刺激的難度水平或個性化了干預。關於藥物治療；在 4 項研究中參與者未服用乙醯膽鹼酯酶抑制劑（AChEIs），在 2 項研究中參與者服用了 AChEIs，26 項研究未具體說明參與者是否服用 AChEIs。在 Orrell 等人（2014）的研究中，還進行了亞組分析，區分了僅接受認知刺激的參與者和那些同時接受其他干預的參與者。
addition to CS, took AChEIs. 除了 CS，還服用了 AChEIs。
There were some differences regarding the type of control used. Six studies included an active control group. Tarnanas et al. (2014), included an active and passive control group. Orrell et al. (2014) included treatment as usual (TAU) and in the subgroup also included AChEIs. In 24 studies participants received their TAU and in 2 studies the participants were in a waitlist for intervention. 在使用的控制類型方面存在一些差異。六項研究包括了一個主動控制組。Tarnanas 等人（2014）包括了一個主動和一個被動控制組。Orrell 等人（2014）包括了常規治療（TAU），並在子組中也包括了 AChEIs。在 24 項研究中，參與者接受了他們的 TAU，而在 2 項研究中，參與者則在干預的候補名單中。
3.3. Methodological quality assessment in Individual Studies 3.3. 個別研究的方法學質量評估
The risk of bias assessment for all included studies is summarized (see supplementary file 6-8, Tables S6.a-6.c). Overall, our analysis indicates that 14 studies had good methodological quality and 19 studies presented fair methodological quality. 所有納入研究的偏倚風險評估已總結（見補充文件 6-8，表 S6.a-6.c）。總體而言，我們的分析顯示 14 項研究具有良好的方法學質量，19 項研究呈現公平的方法學質量。
On the one hand, the method of randomization was not reported in 9 studies and in the others 10 studies the treatment allocation concealed not reported. On the other hand, participants and providers were not blinded to treatment group assignment in 18 studies and in 6 studies people assessing the outcomes were not blinded to the participants’ group assignments. Besides, there was no high adherence to the intervention protocols for each treatment group in 21 studies; the authors did not report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80%80 \% power in 7 studies. In addition, the outcomes not reported subgroups analyzed pre-specified in 7 studies, and in 22 studies, an intention-totreat analysis was not performed. 一方面，9 項研究未報告隨機化方法，而在其他 10 項研究中，治療分配的隱蔽性未報告。另一方面，18 項研究中參與者和提供者未對治療組分配進行盲法，而在 6 項研究中，評估結果的人員未對參與者的組別分配進行盲法。此外，在 21 項研究中，各治療組的介入協議遵循率不高；作者未報告樣本量足夠大，以便在 7 項研究中以至少 80%80 \% 的效能檢測組間主要結果的差異。此外，在 7 項研究中未報告預先指定的亞組分析結果，而在 22 項研究中未進行意向治療分析。
3.4. Effects of CS in relation to cognitive variables in older adults 3.4. CS 對老年人認知變數的影響
3.4.1. General cognitive functioning 3.4.1. 一般認知功能
As shown in Fig. 3a a significant improvement in general cognitive functioning was found in the group receiving CS (independently or together with AChEIs) compared to those who did not receive CS 如圖 3a 所示，接受 CS（獨立或與 AChEIs 一起）的小組在一般認知功能方面顯著改善，與未接受 CS 的小組相比。
Table 2 表 2
Main characteristics of the participants and cognitive stimulation. 參與者的主要特徵和認知刺激。
Study (Author, year and design) 研究（作者，年份和設計）
Type of CS (AChEIs) (Individual or group) CS 的類型（AChEIs）（個別或群體）
Control group 對照組
Frequency (duration, session/ week, duration) 頻率（持續時間，每週次數，持續時間）
Cognitive status (Diagnosis criteria) 認知狀態（診斷標準）
N (male/ female) N（男性/女性）
Professionals that administered the intervention 執行干預的專業人員
Country (Setting) 國家（環境）
Mean age (Standard deviation) 平均年齡（標準差）
Education (Standard deviation) 教育（標準差）
Baseline score general cognitive functioning 基線分數一般認知功能
CS: reality orientation, reminiscence, implicit learning and multisensory. (No specific if take AChEIs) (Group) CS：現實導向、回憶、隱性學習和多感官。（如果不特定使用 AChEIs）（組別）
Three times a week, except the last week twice a week
1.5 months, 17
sessions
(Short-Term)
60min// session
Three times a week, except the last week twice a week
1.5 months, 17
sessions
(Short-Term)| $60 \mathrm{~min} /$ session |
| :--- |
| Three times a week, except the last week twice a week |
| 1.5 months, 17 |
| sessions |
| (Short-Term) |
From MCI to mild to moderate dementia GDS 3-5 從輕度認知障礙到輕度至中度癡呆 GDS 3-5
Family carers Carer training and support was provided by the research (team mental health nurses, clinical psychologists, occupational therapists or research assistants) 家庭照顧者 研究提供了照顧者的培訓和支持（團隊精神健康護理師、臨床心理學家、職業治療師或研究助理）
英國（社區）
UK
(Community)
UK
(Community)| UK |
| :--- |
| (Community) |
78.2
Highest level of education School leaver (14-16 years) 60% 最高教育程度 學校畢業生（14-16 歲） 60%
Trail Making Test and self-esteem: sd ntinued on next page)
MMSE: no sd.
Trail Making Test and self-esteem: sd ntinued on next page)| MMSE: no sd. |
| :--- |
| Trail Making Test and self-esteem: sd ntinued on next page) |
Study (Author, year and design) Type of CS (AChEIs) (Individual or group) Control group Frequency (duration, session/ week, duration) Cognitive status (Diagnosis criteria) N" (male/ " female) Professionals that administered the intervention Country (Setting) Mean age (Standard deviation) Education (Standard deviation) "Baseline score
general
cognitive
functioning" Main Results
9- Orrell et al. 2014 RCT Alone CS (reality orientation, cognitive activities and multisensory) and CS + AChEIs (Group) TAU AChEIs 45min// session Once a week 24 weeks, 24 sessions (Maintenance) Dementia DSM-IV "236
(86/150)
Alone CS: 81
CS+AChEIs:42
TAU:79
AChEIs: 34" ns "London
(Residential care, and community)" 83.1 (7.55) ns " MMSE
17.8(5.5)" CS + AChEIs MMSE: sd (three and six months) ADAS-Cog: no sd
Study (Author, year and design) Type of CS (AChEIs) (Individual or group) Control group Frequency (duration, session/ week, duration) Cognitive status (Diagnosis criteria) N (male/ female) Professionals that administered the intervention "Country
Setting" Mean age (Standard deviation) Education (Standard deviation) "Baseline score
general
cognitive
functioning" Main Results
" 10- Polito et al.
2014
RCT " CS: reality orientation, implicit learning and cognitive activities. (No specific if take AChEIs) (Group) "Active
Two interactive 60min meetings" "90min//session
Twice a week
10 weeks
20 sessions" HA and MCI Petersen's criteria 2004 and Guaitäs criteria et al.,2013 "77 CHA
(29/48)
IG: 38
CG: 39
44 MCI
(31/13)
IG:22
CG:22" Trained Neuropsychologist Italy (Community and residential care home) " HA
73.8 (1.25)
MCI
74.15
(1.55)" " HA
7.65 (3.0)
MCI
7.45 (3.2) " "HA MMSE
28.05 (1.55)
MCI MMSE
25.75 (1.95)" Cognitive healthy elderly and MCI: MMSE and MoCA sd Cognitive healthy elderly and MCI: MMSE: no sd.
"11- Tarnanas et al. 2014
RCT" CCS cognitive activities, implicit learning, virtual reality and external aids. (AChEIs not specified) (Group) "Active
Learningbased memory training.
Passive
No-contact" "90-min session
Twice a week
5 months, 40
sessions
(Maintenance)" "MCI
Petersen's criteria
1999, 2004
Winblad 2004
Gauthier et al.
2006" "95
(41/54)
IG: 32
CAG: 39
CG: 34" Psychologists Greece (Day Clinic) 70.37 (4.4) ns " MMSE
26.4 (3.43) " ".MMSE: sd.
RAVLT delayed recall, ROCF inmediate recall BNT, digit span forward, letter fluency and Trail B: sd"
"12- Ciarmiello et al. 2015
Observa-tional study" CS: multisensory and cognitive activities. (Group) "Active
Informal
meeting" "45min//session
Twice a week
4 months, 32
sessions
(Maintenance)" "MCI
MMSE >= 24" "30
(12//17)
IG: 15
CG: 15" Experienced Neuropsychologists "Italy
(Hospital's
Neurology Unit)" "71.59
(7.13)" 8.56 (2.82) " MMSE
27.85(1.84)" Prose memory: sd
" 13- Orgeta et al.
2015
RCT " Home-based CS (reality orientation, reminiscence, validation, implicit learning, multisensory and cognitive activities) + AChEIs (Individual) TAU "30min//session
Three times
weekly
25 weeks, 75
sessions
(Maintenance)" "Dementia
DSM-IV
MMSE > 10" "356
(191/165)
IG: 180
CG: 176" Family carers Carer training and support was provided by the research (team mental health nurses, clinical psychologists, occupational therapists or research assistants) "UK
(Community)" 78.2 Highest level of education School leaver (14-16 years) 60% "MMSE
21.22 (4.30)" MMSE, ADAS-Cog: no sd
Study (Author, year and design) Type of CS (AChEIs) (Individual or group) Control group Frequency (duration, session/week, duration) Cognitive status (Diagnosis criteria) N (male/ female) Professionals that administered the intervention Country Setting Mean age (Standard deviation) "Education
(Standard
deviation)" Baseline score general cognitive functioning Main Results
"14- Capotosto et al. 2017
RCT" CS adapted: reality orientation, implicit learning, and cognitive activities.(Group) Active Educational activities. "45min// session
Twice a week
7 weeks, 14
sessions
(Short-Term)" Mild to moderate dementia Spector et al. 2006 "39
(12//27)
IG: 20
CG: 19" ns "Italy
(Residential care)" "88.25
(5.15)" 6.15 (2.60) " MMSE
18.25 (3.39) " ADAS-Cog: sd.
15- Djabelkhir et al. 2017 CCS: cognitive activities and external aids. Active CCE and stimulate 90min// session Once a week 3 months, 12 "MCI
Petersen 2004 and Winbland 2004." "20
(6//14)" Neuropsychologist France (Community) 76.7 (6.7) 52.2% Degree or higher MMSE 27.55 "MMSE: no sd.
Trail Making Test and self-esteem: sd ntinued on next page)"| Study (Author, year and design) | Type of CS (AChEIs) (Individual or group) | Control group | Frequency (duration, session/ week, duration) | Cognitive status (Diagnosis criteria) | $\mathrm{N} \text { (male/ }$ female) | Professionals that administered the intervention | Country (Setting) | Mean age (Standard deviation) | Education (Standard deviation) | Baseline score <br> general <br> cognitive <br> functioning | Main Results |
| :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: |
| 9- Orrell et al. 2014 RCT | Alone CS (reality orientation, cognitive activities and multisensory) and CS + AChEIs (Group) | TAU AChEIs | $45 \mathrm{~min} /$ session Once a week 24 weeks, 24 sessions (Maintenance) | Dementia DSM-IV | 236 <br> (86/150) <br> Alone CS: 81 <br> CS+AChEIs:42 <br> TAU:79 <br> AChEIs: 34 | ns | London <br> (Residential care, and community) | 83.1 (7.55) | ns | $\begin{aligned} & \text { MMSE } \\ & 17.8(5.5) \end{aligned}$ | CS + AChEIs MMSE: sd (three and six months) ADAS-Cog: no sd |
| Study (Author, year and design) | Type of CS (AChEIs) (Individual or group) | Control group | Frequency (duration, session/ week, duration) | Cognitive status (Diagnosis criteria) | N (male/ female) | Professionals that administered the intervention | Country <br> Setting | Mean age (Standard deviation) | Education (Standard deviation) | Baseline score <br> general <br> cognitive <br> functioning | Main Results |
| $\begin{aligned} & \text { 10- Polito et al. } \\ & 2014 \\ & \text { RCT } \end{aligned}$ | CS: reality orientation, implicit learning and cognitive activities. (No specific if take AChEIs) (Group) | Active <br> Two interactive 60min meetings | $90 \mathrm{~min} / \mathrm{session}$ <br> Twice a week <br> 10 weeks <br> 20 sessions | HA and MCI Petersen's criteria 2004 and Guaitäs criteria et al.,2013 | 77 CHA <br> (29/48) <br> IG: 38 <br> CG: 39 <br> 44 MCI <br> (31/13) <br> IG:22 <br> CG:22 | Trained Neuropsychologist | Italy (Community and residential care home) | $\begin{aligned} & \text { HA } \\ & 73.8 \text { (1.25) } \\ & \text { MCI } \\ & 74.15 \\ & (1.55) \end{aligned}$ | $\begin{aligned} & \text { HA } \\ & 7.65 \text { (3.0) } \\ & \text { MCI } \\ & 7.45 \text { (3.2) } \end{aligned}$ | HA MMSE <br> 28.05 (1.55) <br> MCI MMSE <br> 25.75 (1.95) | Cognitive healthy elderly and MCI: MMSE and MoCA sd Cognitive healthy elderly and MCI: MMSE: no sd. |
| 11- Tarnanas et al. 2014 <br> RCT | CCS cognitive activities, implicit learning, virtual reality and external aids. (AChEIs not specified) (Group) | Active <br> Learningbased memory training. <br> Passive <br> No-contact | 90-min session <br> Twice a week <br> 5 months, 40 <br> sessions <br> (Maintenance) | MCI <br> Petersen's criteria <br> 1999, 2004 <br> Winblad 2004 <br> Gauthier et al. <br> 2006 | 95 <br> (41/54) <br> IG: 32 <br> CAG: 39 <br> CG: 34 | Psychologists | Greece (Day Clinic) | 70.37 (4.4) | ns | $\begin{aligned} & \text { MMSE } \\ & 26.4 \text { (3.43) } \end{aligned}$ | .MMSE: sd. <br> RAVLT delayed recall, ROCF inmediate recall BNT, digit span forward, letter fluency and Trail B: sd |
| 12- Ciarmiello et al. 2015 <br> Observa-tional study | CS: multisensory and cognitive activities. (Group) | Active <br> Informal <br> meeting | $45 \mathrm{~min} / \mathrm{session}$ <br> Twice a week <br> 4 months, 32 <br> sessions <br> (Maintenance) | MCI <br> MMSE $\geq 24$ | $\begin{aligned} & 30 \\ & (12 / 17) \\ & \text { IG: } 15 \\ & \text { CG: } 15 \end{aligned}$ | Experienced Neuropsychologists | Italy <br> (Hospital's <br> Neurology Unit) | $\begin{aligned} & 71.59 \\ & (7.13) \end{aligned}$ | 8.56 (2.82) | $\begin{aligned} & \text { MMSE } \\ & 27.85(1.84) \end{aligned}$ | Prose memory: sd |
| $\begin{aligned} & \text { 13- Orgeta et al. } \\ & 2015 \\ & \text { RCT } \end{aligned}$ | Home-based CS (reality orientation, reminiscence, validation, implicit learning, multisensory and cognitive activities) + AChEIs (Individual) | TAU | $30 \mathrm{~min} / \mathrm{session}$ <br> Three times <br> weekly <br> 25 weeks, 75 <br> sessions <br> (Maintenance) | Dementia <br> DSM-IV <br> MMSE > 10 | 356 <br> (191/165) <br> IG: 180 <br> CG: 176 | Family carers Carer training and support was provided by the research (team mental health nurses, clinical psychologists, occupational therapists or research assistants) | UK <br> (Community) | 78.2 | Highest level of education School leaver (14-16 years) 60% | MMSE <br> 21.22 (4.30) | MMSE, ADAS-Cog: no sd |
| Study (Author, year and design) | Type of CS (AChEIs) (Individual or group) | Control group | Frequency (duration, session/week, duration) | Cognitive status (Diagnosis criteria) | N (male/ female) | Professionals that administered the intervention | Country Setting | Mean age (Standard deviation) | Education <br> (Standard <br> deviation) | Baseline score general cognitive functioning | Main Results |
| 14- Capotosto et al. 2017 <br> RCT | CS adapted: reality orientation, implicit learning, and cognitive activities.(Group) | Active Educational activities. | $45 \mathrm{~min} /$ session <br> Twice a week <br> 7 weeks, 14 <br> sessions <br> (Short-Term) | Mild to moderate dementia Spector et al. 2006 | $\begin{aligned} & 39 \\ & (12 / 27) \\ & \text { IG: } 20 \\ & \text { CG: } 19 \end{aligned}$ | ns | Italy <br> (Residential care) | $\begin{aligned} & 88.25 \\ & (5.15) \end{aligned}$ | 6.15 (2.60) | $\begin{aligned} & \text { MMSE } \\ & 18.25 \text { (3.39) } \end{aligned}$ | ADAS-Cog: sd. |
| 15- Djabelkhir et al. 2017 | CCS: cognitive activities and external aids. | Active CCE and stimulate | $90 \mathrm{~min} /$ session Once a week 3 months, 12 | MCI <br> Petersen 2004 and Winbland 2004. | $\begin{aligned} & 20 \\ & (6 / 14) \end{aligned}$ | Neuropsychologist | France (Community) | 76.7 (6.7) | 52.2% Degree or higher | MMSE $27.55$ | MMSE: no sd. <br> Trail Making Test and self-esteem: sd ntinued on next page) |
Study (Author, year and design) 研究（作者，年份和設計）
Type of CS (AChEIs) (Individual or group) CS 的類型（AChEIs）（個別或群體）
Control group 對照組
Frequency (duration, session/ week, duration) 頻率（持續時間，每週次數，持續時間）
PD-MCI (Level 1), PDD (probable or possible)
Litvan et al. 2012, Emre et al. 2007, or DLB
Mckeith et al. 2017| PD-MCI (Level 1), PDD (probable or possible) |
| :--- |
| Litvan et al. 2012, Emre et al. 2007, or DLB |
| Mckeith et al. 2017 |
A specially trained implementer (eg, nurse, therapist or researcher) visit the dyad at home and provide intervention 一位經過專門訓練的執行者（例如，護士、治療師或研究人員）在家中拜訪雙方並提供介入
UK (Community) 英國（社區）
74.75
Up to 18-year-old schooling Further education and higher 至 18 歲的學校教育 進一步教育和高等教育
Short and long term
MMSE: sd
Shor-term
ADAS-Cog y
Narrative Language
Test
ntinued on next page)| Short and long term |
| :--- |
| MMSE: sd |
| Shor-term |
| ADAS-Cog y |
| Narrative Language |
| Test |
| ntinued on next page) |
Study (Author, year and design) Type of CS (AChEIs) (Individual or group) Control group Frequency (duration, session/ week, duration) Cognitive status (Diagnosis criteria) "N (male/
female) " Professionals that administered the intervention Country (Setting) Mean age (Standard deviation) "Education
(Standard
deviation)" Baseline score general cognitive functioning Main Results
"High school
11.85%
College
4.15%
Unknown
4.15%"
Study (Author, year and design) Type of CS (AChEIs) (Individual or group) Control group Frequency (duration, session/week, duration) Cognitive status (Diagnosis criteria) N (male/ female) Professionals that administered the intervention "Country
Setting" Mean age (Standard deviation) Education (Standard deviation) Baseline score general cognitive functioning "Main
Results"
23- Alvares-Pereira et al. 2020 RCT CS: cognitive activities. (AChEIs not specified) (Group). TAU "45-60 min/ session
Twice a week
7 weeks, 14
sessions
(Short-Term)" Neurocognitive disorder (dementia) DSM5 "100
(9/91)
IG: 50
CG: 50" ns Portugal (Residential care, psychogeriatric and rehabilitation center) "83.60
(7.64)" "55.65%
<= 4 years " ns ADAD-Cog: sd.
" 24- Gibbor et al.
2020
RCT " CS adapted: reality orientation, multisensory and cognitive activities. (AChEIs not specified) (Individual) TAU "45min//session
Twice a week
7 weeks, 14
sessions
(Short-Term)" Mild to moderate dementia DSM-IV "33
(17//16)
IG 17
CG: 16" ns UK (Residential care) "81.85
(10.31)" ns " MMSE
21.70(3.51)" MMSE: no sd. ADAS-Cog: sd.
"25-Gómez-Soria
et al. 2020
RCT " "CS personalized and adapted: reality orientation, cognitive activities and external aids.
(AChEIs not specified) (Group)" TAU 45min// session Once a week 10 weeks, 10 sessions (Short-Term) "MCI
MEC-35: 24-27" "122
(28//94)
IG: 54
CG: 68" Trained Occupational Therapist "Spain
(Health Center)" "74.99
(6.02)" "Primary
88.78%
Secondary
11.05%" " MEC-35
25.91 (1.03) " Short and médium term MEC-35: sd.
"26- Juárez-Cedillo
et al. 2020
RCT" "Multicom-
ponent CS adapted (reality orientation, multisensory, cognitive activities and external aids) + AChEIs (Group)" TAU "90min//session
Twice a week
8 weeks, 16
sessions
(Short-Term)" "Mild
neurocognitive
disorder
DSM5 and
NINCDS-ADRDA" "67
(21//46)
IG: 39
CG: 28" Neuropsychologist "Mexico
(Institute of Social Security)" 77.7 (8.15) 14.5 % None 24% 4 years 61.5 < 3 years MMSE 22.4" (0.8) " "MMSE, ADAS-Cog,
Semantic and
Phonemic Verbal
Fluency: sd"
Study (Author, year and design) Type of CS (AChEIs) (Individual or group) Control group Frequency (duration, session/week, duration) Cognitive status (Diagnosis criteria) N (male/ female) Professionals that administered the intervention "Country
Setting" Mean age (Standard deviation) Education (Standard deviation) Baseline score general cognitive functioning Main Results
" 27- López et al.
2020
Pre-post study " CS 'review notebooks' adapted (reality orientation and cognitive activities) (AChEIs not specified) (Group) TAU "60min//session
Three times a week 6 months" Mild-moderate dementia type Alzheimer's Stage 4-5 on the GDS scale. "30
(5//15)
GI: 15
15" ns Spain (/Center for Attention to people with AD and other dementias) 81.9 (5.47) ns " MMSE
17.84 (3.73) " MMSE, ADAS-Cog: no sd WCST-Errors: sd
28- Carbone et al. 2021 Controlled clinical trial CS adapted:reality orientation and cognitive activities. (AChEIs not specified) (Group) Active Educational activities. "45min// session.
Twice a week
7 weeks, 14
sessions
(Short-Term)" "Major neurocognitive disorder.
DSM 5
Mild-to-moderate Dementia.
Spector et al., 2003" "225
(76/149)
IG: 123
CG: 102" Trained Psychologists "Italy
(Residential care or day centers)" "83.66
(8.10)" 6.47 (3.67) " MMSE
20.04 (4.19) " "Short and long term
MMSE: sd
Shor-term
ADAS-Cog y
Narrative Language
Test
ntinued on next page)"| Study (Author, year and design) | Type of CS (AChEIs) (Individual or group) | Control group | Frequency (duration, session/ week, duration) | Cognitive status (Diagnosis criteria) | $\begin{aligned} & \mathrm{N} \text { (male/ } \\ & \text { female) } \end{aligned}$ | Professionals that administered the intervention | Country (Setting) | Mean age (Standard deviation) | Education <br> (Standard <br> deviation) | Baseline score general cognitive functioning | Main Results |
| :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: |
| | | | | | | | | | High school <br> 11.85% <br> College <br> 4.15% <br> Unknown <br> 4.15% | | |
| Study (Author, year and design) | Type of CS (AChEIs) (Individual or group) | Control group | Frequency (duration, session/week, duration) | Cognitive status (Diagnosis criteria) | N (male/ female) | Professionals that administered the intervention | Country <br> Setting | Mean age (Standard deviation) | Education (Standard deviation) | Baseline score general cognitive functioning | Main <br> Results |
| 23- Alvares-Pereira et al. 2020 RCT | CS: cognitive activities. (AChEIs not specified) (Group). | TAU | 45-60 min/ session <br> Twice a week <br> 7 weeks, 14 <br> sessions <br> (Short-Term) | Neurocognitive disorder (dementia) DSM5 | $\begin{aligned} & 100 \\ & \text { (9/91) } \\ & \text { IG: } 50 \\ & \text { CG: } 50 \end{aligned}$ | ns | Portugal (Residential care, psychogeriatric and rehabilitation center) | $\begin{aligned} & 83.60 \\ & (7.64) \end{aligned}$ | $\begin{aligned} & 55.65 \% \\ & \leq 4 \text { years } \end{aligned}$ | ns | ADAD-Cog: sd. |
| $\begin{aligned} & \text { 24- Gibbor et al. } \\ & 2020 \\ & \text { RCT } \end{aligned}$ | CS adapted: reality orientation, multisensory and cognitive activities. (AChEIs not specified) (Individual) | TAU | $45 \mathrm{~min} / \mathrm{session}$ <br> Twice a week <br> 7 weeks, 14 <br> sessions <br> (Short-Term) | Mild to moderate dementia DSM-IV | $\begin{aligned} & 33 \\ & (17 / 16) \\ & \text { IG } 17 \\ & \text { CG: } 16 \end{aligned}$ | ns | UK (Residential care) | $\begin{aligned} & 81.85 \\ & (10.31) \end{aligned}$ | ns | $\begin{aligned} & \text { MMSE } \\ & 21.70(3.51) \end{aligned}$ | MMSE: no sd. ADAS-Cog: sd. |
| $\begin{aligned} & 25 \text {-Gómez-Soria } \\ & \text { et al. } 2020 \\ & \text { RCT } \end{aligned}$ | CS personalized and adapted: reality orientation, cognitive activities and external aids. <br> (AChEIs not specified) (Group) | TAU | $45 \mathrm{~min} /$ session Once a week 10 weeks, 10 sessions (Short-Term) | MCI <br> MEC-35: 24-27 | $\begin{aligned} & 122 \\ & (28 / 94) \\ & \text { IG: } 54 \\ & \text { CG: } 68 \end{aligned}$ | Trained Occupational Therapist | Spain <br> (Health Center) | $\begin{aligned} & 74.99 \\ & (6.02) \end{aligned}$ | Primary <br> 88.78% <br> Secondary <br> 11.05% | $\begin{aligned} & \text { MEC-35 } \\ & 25.91 \text { (1.03) } \end{aligned}$ | Short and médium term MEC-35: sd. |
| 26- Juárez-Cedillo <br> et al. 2020 <br> RCT | Multicom- <br> ponent CS adapted (reality orientation, multisensory, cognitive activities and external aids) + AChEIs (Group) | TAU | $90 \mathrm{~min} / \mathrm{session}$ <br> Twice a week <br> 8 weeks, 16 <br> sessions <br> (Short-Term) | Mild <br> neurocognitive <br> disorder <br> DSM5 and <br> NINCDS-ADRDA | $\begin{aligned} & 67 \\ & (21 / 46) \\ & \text { IG: } 39 \\ & \text { CG: } 28 \end{aligned}$ | Neuropsychologist | Mexico <br> (Institute of Social Security) | 77.7 (8.15) | 14.5 % None 24% 4 years $61.5<3$ years | MMSE $22.4 \text { (0.8) }$ | MMSE, ADAS-Cog, <br> Semantic and <br> Phonemic Verbal <br> Fluency: sd |
| Study (Author, year and design) | Type of CS (AChEIs) (Individual or group) | Control group | Frequency (duration, session/week, duration) | Cognitive status (Diagnosis criteria) | N (male/ female) | Professionals that administered the intervention | Country <br> Setting | Mean age (Standard deviation) | Education (Standard deviation) | Baseline score general cognitive functioning | Main Results |
| $\begin{aligned} & \text { 27- López et al. } \\ & 2020 \\ & \text { Pre-post study } \end{aligned}$ | CS 'review notebooks' adapted (reality orientation and cognitive activities) (AChEIs not specified) (Group) | TAU | $60 \mathrm{~min} / \mathrm{session}$ <br> Three times a week 6 months | Mild-moderate dementia type Alzheimer's Stage 4-5 on the GDS scale. | $\begin{aligned} & 30 \\ & (5 / 15) \\ & \text { GI: } 15 \\ & 15 \end{aligned}$ | ns | Spain (/Center for Attention to people with AD and other dementias) | 81.9 (5.47) | ns | $\begin{aligned} & \text { MMSE } \\ & 17.84 \text { (3.73) } \end{aligned}$ | MMSE, ADAS-Cog: no sd WCST-Errors: sd |
| ```28- Carbone et al. 2021 Controlled clinical trial``` | CS adapted:reality orientation and cognitive activities. (AChEIs not specified) (Group) | Active Educational activities. | $45 \mathrm{~min} /$ session. <br> Twice a week <br> 7 weeks, 14 <br> sessions <br> (Short-Term) | Major neurocognitive disorder. <br> DSM 5 <br> Mild-to-moderate Dementia. <br> Spector et al., 2003 | 225 <br> (76/149) <br> IG: 123 <br> CG: 102 | Trained Psychologists | Italy <br> (Residential care or day centers) | $\begin{aligned} & 83.66 \\ & (8.10) \end{aligned}$ | 6.47 (3.67) | $\begin{aligned} & \text { MMSE } \\ & 20.04 \text { (4.19) } \end{aligned}$ | Short and long term <br> MMSE: sd <br> Shor-term <br> ADAS-Cog y <br> Narrative Language <br> Test <br> ntinued on next page) |
Study (Author, year and design) 研究（作者，年份和設計）
Type of CS (AChEIs) (Individual or group) CS 的類型（AChEIs）（個別或群體）
Control group 對照組
Frequency (duration, session/ week, duration) 頻率（持續時間，每週次數，持續時間）
30- Gómez-Soria, Brandín-de la Cruz et al. 2021 RCT 30- Gómez-Soria, Brandín-de la Cruz 等人 2021 隨機對照試驗
CS 個性化和適應：現實導向、認知活動和外部輔助工具（未指定 AChEIs）（組）
CS personalized and adapted: reality orientation, cognitive activities and external aids
(AChEIs not specified) (Group)
CS personalized and adapted: reality orientation, cognitive activities and external aids
(AChEIs not specified) (Group)| CS personalized and adapted: reality orientation, cognitive activities and external aids |
| :--- |
| (AChEIs not specified) (Group) |
TAU
45min//45 \mathrm{~min} / session Once a week 10 weeks, 10 sessions (Short-Term) 45min//45 \mathrm{~min} / 會議 每週一次 10 週，10 次會議（短期）
33- Oliveira et al. 2021
Pilot RCT| 33- Oliveira et al. 2021 |
| :--- |
| Pilot RCT |
CCS 認知活動、外部輔助工具和虛擬現實。（未指定 AChEIs）（組別）
CCS cognitive activities, exteranal aids and virtual reality.
(AChEIs not specified) (Group)
CCS cognitive activities, exteranal aids and virtual reality.
(AChEIs not specified) (Group)| CCS cognitive activities, exteranal aids and virtual reality. |
| :--- |
| (AChEIs not specified) (Group) |
Study (Author, year and design) Type of CS (AChEIs) (Individual or group) Control group Frequency (duration, session/ week, duration) Cognitive status (Diagnosis criteria) "N (male/
female) " Professionals that administered the intervention Country (Setting) Mean age (Standard deviation) "Education
(Standard deviation)" "Baseline score
general
cognitive
functioning" Main Results
29- Gómez-Soria, Andrés-Esteban et al. 2021 RCT "CS personalized and adapted:reality orientation, cognitive activities and external aids.
(AChEIs not specified) (Group)" TAU 45min// session Once a week 10 weeks, 10 sessions (Short-Term) "MCI
MEC-35: 24-27" "29
(6/23)
IG: 15
CG: 14" Trained Occupational Therapist "Spain
(Health Center)" 72.7 (5.05) "Primary
48.3%
Secondary
51.7%" " MEC-35
26.14(0,92)" "Short, médium and long-term MEC-35: s.d.
Spatial orientation: s.d."
30- Gómez-Soria, Brandín-de la Cruz et al. 2021 RCT "CS personalized and adapted: reality orientation, cognitive activities and external aids
(AChEIs not specified) (Group)" TAU 45min// session Once a week 10 weeks, 10 sessions (Short-Term) "MCI
MEC-35: 24-27" "50
(11//39)
IG: 23
CG: 27" Trained Occupational Therapist "Spain
(Health Center)" "74.32
(5.47)" Primary complete 44% " MEC. 35
25.87 (1.058) " Long-term MEC-35, global orientation and spatial orientation: s.d.
Study (Author, year and design) Type of CS (AChEIs) (Individual or group) Control group Frequency (duration, session/week, duration) Cognitive status (Diagnosis criteria) "N
(male/ female)" Professionals that administered the intervention Country Setting Mean age (Standard deviation) Education (Standard deviation) Baseline score general cognitive functioning "Main
Results"
"31-
Justo-Henriques et al. 2021
Pre-post study" "CS: reality orientation and cognitive actitivities.
(AChEIs not specified) (Individual)" TAU. 45min// session Twice a week 44 weeks, 88 sessions (Long-Term) Mild neurocognitive disorder DSM 5 "82
(24//58)
IG: 41
CG: 41" Trained Therapists "Portugal
(Psychosocial
support
organization)" 79.3 (10) "76.8%
1-4 years " MMSE 19.9" (3.3) " "MMSE and MoCA:
sd"
32- Liu et al. 2021 Observa-tional study CS adapted:cognitive activities. (AChEIs not specified) (Group) TAU "45min// session
Twice a week
7 weeks, 14
sessions
(Short-Term)" "Mild to moderate dementia.
Clinical diagnosis MMSE > 18" "29
(10//19)
IG: 16
CG: 13" ns "China
(Community)" "80.29
(6.16)" 4.78 (4.67) " ADAS-Cog
21.54 (8.29) " ADAS-Cog: no sd.
"33- Oliveira et al. 2021
Pilot RCT" "CCS cognitive activities, exteranal aids and virtual reality.
(AChEIs not specified) (Group)" TAU "45min// session
Twice a week
6 weeks, 12
sessions
(Short-Term)" Major neurocognitive disorders due to AD by a psychologist "17
(5/12)
IG: 10
CG: 7" "Clinical
Neuropsychologist" Portugal (Residential care) "83.24
(5.66)" "23.5%
Higher " MMSE 15.8" (7.01) " MMSE: sd.| Study (Author, year and design) | Type of CS (AChEIs) (Individual or group) | Control group | Frequency (duration, session/ week, duration) | Cognitive status (Diagnosis criteria) | $\begin{aligned} & \mathrm{N} \text { (male/ } \\ & \text { female) } \end{aligned}$ | Professionals that administered the intervention | Country (Setting) | Mean age (Standard deviation) | Education <br> (Standard deviation) | Baseline score <br> general <br> cognitive <br> functioning | Main Results |
| :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: |
| 29- Gómez-Soria, Andrés-Esteban et al. 2021 RCT | CS personalized and adapted:reality orientation, cognitive activities and external aids. <br> (AChEIs not specified) (Group) | TAU | $45 \mathrm{~min} /$ session Once a week 10 weeks, 10 sessions (Short-Term) | MCI <br> MEC-35: 24-27 | $\begin{aligned} & 29 \\ & \text { (6/23) } \\ & \text { IG: } 15 \\ & \text { CG: } 14 \end{aligned}$ | Trained Occupational Therapist | Spain <br> (Health Center) | 72.7 (5.05) | Primary <br> 48.3% <br> Secondary <br> 51.7% | $\begin{aligned} & \text { MEC-35 } \\ & 26.14(0,92) \end{aligned}$ | Short, médium and long-term MEC-35: s.d. <br> Spatial orientation: s.d. |
| 30- Gómez-Soria, Brandín-de la Cruz et al. 2021 RCT | CS personalized and adapted: reality orientation, cognitive activities and external aids <br> (AChEIs not specified) (Group) | TAU | $45 \mathrm{~min} /$ session Once a week 10 weeks, 10 sessions (Short-Term) | MCI <br> MEC-35: 24-27 | $\begin{aligned} & 50 \\ & (11 / 39) \\ & \text { IG: } 23 \\ & \text { CG: } 27 \end{aligned}$ | Trained Occupational Therapist | Spain <br> (Health Center) | $\begin{aligned} & 74.32 \\ & (5.47) \end{aligned}$ | Primary complete $44 \%$ | $\begin{aligned} & \text { MEC. } 35 \\ & 25.87 \text { (1.058) } \end{aligned}$ | Long-term MEC-35, global orientation and spatial orientation: s.d. |
| Study (Author, year and design) | Type of CS (AChEIs) (Individual or group) | Control group | Frequency (duration, session/week, duration) | Cognitive status (Diagnosis criteria) | N <br> (male/ female) | Professionals that administered the intervention | Country Setting | Mean age (Standard deviation) | Education (Standard deviation) | Baseline score general cognitive functioning | Main <br> Results |
| 31- <br> Justo-Henriques et al. 2021 <br> Pre-post study | CS: reality orientation and cognitive actitivities. <br> (AChEIs not specified) (Individual) | TAU. | $45 \mathrm{~min} /$ session Twice a week 44 weeks, 88 sessions (Long-Term) | Mild neurocognitive disorder DSM 5 | $\begin{aligned} & 82 \\ & (24 / 58) \\ & \text { IG: } 41 \\ & \text { CG: } 41 \end{aligned}$ | Trained Therapists | Portugal <br> (Psychosocial <br> support <br> organization) | 79.3 (10) | $\begin{aligned} & 76.8 \% \\ & 1-4 \text { years } \end{aligned}$ | MMSE $19.9 \text { (3.3) }$ | MMSE and MoCA: <br> sd |
| 32- Liu et al. 2021 Observa-tional study | CS adapted:cognitive activities. (AChEIs not specified) (Group) | TAU | $45 \mathrm{~min} /$ session <br> Twice a week <br> 7 weeks, 14 <br> sessions <br> (Short-Term) | Mild to moderate dementia. <br> Clinical diagnosis MMSE > 18 | $\begin{aligned} & 29 \\ & (10 / 19) \\ & \text { IG: } 16 \\ & \text { CG: } 13 \end{aligned}$ | ns | China <br> (Community) | $\begin{aligned} & 80.29 \\ & (6.16) \end{aligned}$ | 4.78 (4.67) | $\begin{aligned} & \text { ADAS-Cog } \\ & 21.54 \text { (8.29) } \end{aligned}$ | ADAS-Cog: no sd. |
| 33- Oliveira et al. 2021 <br> Pilot RCT | CCS cognitive activities, exteranal aids and virtual reality. <br> (AChEIs not specified) (Group) | TAU | $45 \mathrm{~min} /$ session <br> Twice a week <br> 6 weeks, 12 <br> sessions <br> (Short-Term) | Major neurocognitive disorders due to AD by a psychologist | $\begin{aligned} & 17 \\ & \text { (5/12) } \\ & \text { IG: } 10 \\ & \text { CG: } 7 \end{aligned}$ | Clinical <br> Neuropsychologist | Portugal (Residential care) | $\begin{aligned} & 83.24 \\ & (5.66) \end{aligned}$ | $\begin{aligned} & 23.5 \% \\ & \text { Higher } \end{aligned}$ | MMSE $15.8 \text { (7.01) }$ | MMSE: sd. |
Fig. 3a. Forest plot of effect sizes (ESs) from the studies that assessed general cognitive functioning. 圖 3a. 評估一般認知功能的研究效果大小（ESs）森林圖。
(control groups) (MD=1.53695%CI,0.832(\mathrm{MD}=1.53695 \% \mathrm{CI}, 0.832 to 2.240)). Heterogeneity among studies for general cognitive functioning was very high ( I^(2)=\mathrm{I}^{2}= 99.72; p < 0.001p<0.001 ). （對照組） (MD=1.53695%CI,0.832(\mathrm{MD}=1.53695 \% \mathrm{CI}, 0.832 到 2.240 )) 。研究間一般認知功能的異質性非常高（ I^(2)=\mathrm{I}^{2}= 99.72; p < 0.001p<0.001 ）。
However, the CS+AChEIs subgroup (file S19, Fig. S1.k.) showed significantly worse scores in general cognitive functioning ( MD=\mathrm{MD}= -1.854 ; 95%CI, -3.521 to -0.187; file S19, Fig. S1.k.). 然而，CS+AChEIs 子組（檔案 S19，圖 S1.k.）在一般認知功能的評分上顯示出顯著較差的結果（ MD=\mathrm{MD}= -1.854；95%CI，-3.521 至 -0.187；檔案 S19，圖 S1.k.）。
Publication bias was detected for the estimation of the mean change of general cognitive functioning (Egger test, p < .001p<.001 ) (file S21, Fig. S1. ll.). 發現出版偏差影響一般認知功能平均變化的估計（Egger 測試， p < .001p<.001 ）（檔案 S21，圖 S1. ll.）。
3.4.2. Specific cognitive domains 3.4.2. 特定認知領域
3.4.2.1. Memory. As shown in Fig. 3b a significant improvement in memory was found in the group receiving CS (independently or together with AChEIs) compared to those who did not receive CS (control groups) ( MD=0.365,95%CI,0.300\mathrm{MD}=0.365,95 \% \mathrm{CI}, 0.300 to 0.430 ). Heterogeneity among studies for memory was very high ( I^(2)=99.86;p < 0.001\mathrm{I}^{2}=99.86 ; p<0.001 ). 3.4.2.1. 記憶。如圖 3b 所示，接受 CS（獨立或與 AChEIs 一起）的小組在記憶方面顯著改善，與未接受 CS（對照組）的人相比（ MD=0.365,95%CI,0.300\mathrm{MD}=0.365,95 \% \mathrm{CI}, 0.300 至 0.430）。各研究之間的記憶異質性非常高（ I^(2)=99.86;p < 0.001\mathrm{I}^{2}=99.86 ; p<0.001 ）。
Publication bias was detected for the estimation of the mean change of general cognitive functioning (Egger test, p < .001p<.001 ) (file S31, Fig. S1. j.). 發現出版偏差影響一般認知功能平均變化的估計（Egger 測試， p < .001p<.001 ）（檔案 S31，圖 S1.j.）。
3.4.2.2. Attention. As shown in Fig. 3c no significant improvement in attention was found in the group that received CS (independently or together with AChEIs) compared to those who did not receive CS (control groups) ( MD=0.044,95%CI,-0.142\mathrm{MD}=0.044,95 \% \mathrm{CI},-0.142 to 0.229 ). Heterogeneity among studies for attention was very high ( I^(2)=98.17;p < 0.001\mathrm{I}^{2}=98.17 ; p<0.001 ). 3.4.2.2. 注意力。如圖 3c 所示，接受 CS（獨立或與 AChEIs 一起）的小組在注意力方面與未接受 CS（對照組）相比，未發現顯著改善（ MD=0.044,95%CI,-0.142\mathrm{MD}=0.044,95 \% \mathrm{CI},-0.142 至 0.229）。各研究之間在注意力方面的異質性非常高（ I^(2)=98.17;p < 0.001\mathrm{I}^{2}=98.17 ; p<0.001 ）。
Subgroup analysis (file S32-S34, Fig.s S3.a.-S3.c.) showed no significant difference in attention. 亞組分析（檔案 S32-S34，圖 S3.a.-S3.c.）顯示注意力沒有顯著差異。
Publication bias was detected for the estimation of the mean change 發現了出版偏差以估計平均變化
Fig. 3b. Forest plot of effect sizes (ESs) from the studies that assessed memory. 圖 3b. 評估記憶的研究效果大小（ESs）森林圖。
Fig. 3c. Forest plot of effect sizes (ESs) from the studies that assessed attention. 圖 3c. 評估注意力的研究效果大小（ESs）森林圖。
of attention (Egger test, p < .001p<.001 ) (file S35, Fig. S3.d.). 注意力（埃格檢驗， p < .001p<.001 ）（文件 S35，圖 S3.d.）。
3.4.2.3. Orientation. As shown in Fig. 3d significant improvement in orientation was found in the group receiving CS (independently or together with AChEIs) compared to those who did not receive CS (control groups) ( MD=0.428,95%CI,0.306\mathrm{MD}=0.428,95 \% \mathrm{CI}, 0.306 to 0.550 ). Heterogeneity among studies for orientation was very high ( I^(2)=95.1;p < 0.001\mathrm{I}^{2}=95.1 ; p<0.001 ). 3.4.2.3. 定向。 如圖 3d 所示，接受 CS（獨立或與 AChEIs 一起）的小組在定向方面顯著改善，與未接受 CS（對照組）的人相比（ MD=0.428,95%CI,0.306\mathrm{MD}=0.428,95 \% \mathrm{CI}, 0.306 至 0.550）。 研究之間的定向異質性非常高（ I^(2)=95.1;p < 0.001\mathrm{I}^{2}=95.1 ; p<0.001 ）。
Subgroup analysis found statistically significant increases in temporal orientation (MD =0.363=0.363; 95%CI,0.25795 \% \mathrm{CI}, 0.257 to 0.468 ; file S36, Fig. S4. a.), spatial orientation (MD =0.491=0.491; 95%CI,0.29495 \% \mathrm{CI}, 0.294 to 0.688 ; file S36, Fig. S4.a.), those cognitively healthy elderly individuals ( MD=0.197\mathrm{MD}=0.197; 95%95 \% CI, 0.076 to 0.319 ; file S37, Fig. S4.b.), and Mild Cognitive Impairment (MD = 0.488; 95%CI, 0.307 to 0.669; file S37, Fig. S4.b.), <=\leq 75 years ( MD=0.419\mathrm{MD}=0.419; 95%CI, 0.294 to 0.544 ; file S38, Fig. S4.c.), studies with personalized/adapted CS (MD =0.404;95%CI,0.281=0.404 ; 95 \% \mathrm{CI}, 0.281 to 0.527 ; file S39, Fig. S4.d.), Short-term CS (MD = 0.419;95%0.419 ; 95 \% CI, 0.294 to 0.544 ; file S40, Fig. S4.e.), and studies with Fair quality assessment scores ( MD=0.419M D=0.419; 95%95 \% CI, 0.294 to 0.544 ; file S41, Fig. S4.f.).Publication bias was detected for the estimation of the mean change of orientation (Egger test, p < .001p<.001 ) (file S42, Fig. S4.g.). 亞組分析發現時間定向（MD =0.363=0.363 ; 95%CI,0.25795 \% \mathrm{CI}, 0.257 至 0.468 ; 文件 S36, 圖 S4.a.）、空間定向（MD =0.491=0.491 ; 95%CI,0.29495 \% \mathrm{CI}, 0.294 至 0.688 ; 文件 S36, 圖 S4.a.）、那些認知健康的老年人（ MD=0.197\mathrm{MD}=0.197 ; 95%95 \% CI, 0.076 至 0.319 ; 文件 S37, 圖 S4.b.）、輕度認知障礙（MD = 0.488; 95%CI, 0.307 至 0.669; 文件 S37, 圖 S4.b.）、 <=\leq 75 歲（ MD=0.419\mathrm{MD}=0.419 ; 95%CI, 0.294 至 0.544 ; 文件 S38, 圖 S4.c.）、具有個性化/適應性 CS 的研究（MD =0.404;95%CI,0.281=0.404 ; 95 \% \mathrm{CI}, 0.281 至 0.527 ; 文件 S39, 圖 S4.d.）、短期 CS（MD = 0.419;95%0.419 ; 95 \% CI, 0.294 至 0.544 ; 文件 S40, 圖 S4.e.）、以及具有公平質量評估分數的研究（ MD=0.419M D=0.419 ; 95%95 \% CI, 0.294 至 0.544 ; 文件 S41, 圖 S4.f.）。在定向平均變化的估計中檢測到出版偏倚（Egger 測試, p < .001p<.001 ）(文件 S42, 圖 S4.g.)。
3.4.2.4. Executive functions. As shown in Fig. 3e no significant improvement in executive functions was found in the group that received CS (independently or together with AChEIs) compared to those who did not receive CS (control groups) (MD =-0.01995%=-0.01995 \% CI, -0.263 to 0.225)0.225). Heterogeneity among studies for executive functions was very high ( I^(2)=95.45;p < 0.001\mathrm{I}^{2}=95.45 ; p<0.001 ). 3.4.2.4. 執行功能。如圖 3e 所示，接受 CS（獨立或與 AChEIs 一起）的小組在執行功能方面與未接受 CS（對照組）相比，未發現顯著改善（MD =-0.01995%=-0.01995 \% CI，-0.263 至 0.225)0.225) 。執行功能的研究間異質性非常高（ I^(2)=95.45;p < 0.001\mathrm{I}^{2}=95.45 ; p<0.001 ）。
Subgroup analysis showed statistically significant increases in executive function scores in 45min//45 \mathrm{~min} / session (MD =0.186;95%CI,0.151=0.186 ; 95 \% \mathrm{CI}, 0.151 to 0.220 ; see supplementary file 46 , Fig. 5.d.). Other subgroup analyses did not show statistical differences in executive functions (files S43-S45 and 亞組分析顯示在 45min//45 \mathrm{~min} / 次會議中執行功能得分有統計學上顯著的增加 (MD =0.186;95%CI,0.151=0.186 ; 95 \% \mathrm{CI}, 0.151 至 0.220 ; 參見補充文件 46 , 圖 5.d.)。其他亞組分析未顯示執行功能的統計差異 (文件 S43-S45 和
S47-S50, files S5.a.-S5.c., S5.e.-S5.h.) S47-S50，檔案 S5.a.-S5.c.，S5.e.-S5.h.)
Publication bias was detected for the estimation of the mean change of executive functions (Egger test, p < .001p<.001 ) (file S51, Fig. S5.i.). 發現了出版偏差，對執行功能的平均變化進行估計（Egger 測試， p < .001p<.001 ）（檔案 S51，圖 S5.i.）。
3.4.3.5. Language. As shown in Fig. 3f a significant improvement in language was found in the group receiving CS (independently or together with AChEIs) compared to those who did not receive CS (control groups) ( MD=0.097,95%CI,-0.128\mathrm{MD}=0.097,95 \% \mathrm{CI},-0.128 to 0.322 ). Heterogeneity among studies for language was very high ( I^(2)=98.37;p < 0.001\mathrm{I}^{2}=98.37 ; p<0.001 ). 3.4.3.5. 語言。如圖 3f 所示，接受 CS（獨立或與 AChEIs 一起）的小組在語言方面顯著改善，與未接受 CS（對照組）的人相比（ MD=0.097,95%CI,-0.128\mathrm{MD}=0.097,95 \% \mathrm{CI},-0.128 至 0.322）。語言方面的研究異質性非常高（ I^(2)=98.37;p < 0.001\mathrm{I}^{2}=98.37 ; p<0.001 ）。
Subgroup analysis revealed statistically significant increases in language in those participants with MCI (MD =0.330=0.330; 95%CI,0.03095 \% \mathrm{CI}, 0.030 to 0.629 ; file S52, Fig. S6.a.), <= 75\leq 75 years ( MD=0.154\mathrm{MD}=0.154; 95%CI,-0.0995 \% \mathrm{CI},-0.09 to 0.298 ; file S53, Fig. S6.b.), and studies with non-personalized/nonadapted CS (MD =0.494=0.494; 95%95 \% CI, 0.086 to 0.901 ; file S54, Fig. S6.c.) and Long-term CS (MD =0.753=0.753; 95%95 \% CI, 0.459 to 1.047; file S55, Fig. S6. d.). The other subgroups (files S56-S57, Figs. S6.e.-S6.f.) did not show significant differences in language domain. 亞組分析顯示，輕度認知障礙（MCI）參與者的語言能力有統計學上顯著的增加（MD =0.330=0.330 ; 95%CI,0.03095 \% \mathrm{CI}, 0.030 至 0.629 ; 檔案 S52, 圖 S6.a.）， <= 75\leq 75 年（ MD=0.154\mathrm{MD}=0.154 ; 95%CI,-0.0995 \% \mathrm{CI},-0.09 至 0.298 ; 檔案 S53, 圖 S6.b.），以及使用非個性化/非適應性認知訓練（CS）的研究（MD =0.494=0.494 ; 95%95 \% CI, 0.086 至 0.901 ; 檔案 S54, 圖 S6.c.）和長期認知訓練（MD =0.753=0.753 ; 95%95 \% CI, 0.459 至 1.047; 檔案 S55, 圖 S6.d.）。其他亞組（檔案 S56-S57, 圖 S6.e.-S6.f.）在語言領域未顯示出顯著差異。
Publication bias was detected for the estimation of the mean change of language (Egger test, p=0.012\mathrm{p}=0.012 ) (file 58, Fig. S6.g.). 發現出版偏差影響語言變化的平均估計（Egger 測試， p=0.012\mathrm{p}=0.012 ）（檔案 58，圖 S6.g.）。
3.4.3.6. Verbal fluency. The group receiving CS (independently or together with AChEIs) compared to those who did not receive CS (control groups) ( MD=0.519,95%CI,-0.386\mathrm{MD}=0.519,95 \% \mathrm{CI},-0.386 to 1.425 ) did not showed differences in verbal fluency (Fig. 3 g ). Heterogeneity among studies for verbal fluency was very high ( I^(2)=98.1;p < 0.001\mathrm{I}^{2}=98.1 ; p<0.001 ). 3.4.3.6. 語言流暢性。接受 CS（獨立或與 AChEIs 一起）的小組與未接受 CS（對照組）相比（ MD=0.519,95%CI,-0.386\mathrm{MD}=0.519,95 \% \mathrm{CI},-0.386 至 1.425），在語言流暢性上未顯示出差異（圖 3 g）。語言流暢性研究之間的異質性非常高（ I^(2)=98.1;p < 0.001\mathrm{I}^{2}=98.1 ; p<0.001 ）。
Fig. 3e. Forest plot of effect sizes (ESs) from the studies that assessed executive functions. 圖 3e. 評估執行功能的研究效果大小（ESs）森林圖。
Fig. 3f. Forest plot of effect sizes (ESs) from the studies that assessed language. 圖 3f. 評估語言的研究效果大小（ESs）森林圖。
non-adapted CS (MD =2.367=2.367; 95%CI, 1.029 to 3.706; file S64, Fig. S7. f.), computerized CS (MD =2.367=2.367; 95%CI,1.02995 \% \mathrm{CI}, 1.029 to 3.706 ; file S65, Fig. S7.g.). The other subgroups did not show a statistically significant difference in verbal fluency (file S62, Fig. S7.c., and file S66, Fig. S7.h.). 非適應性 CS (MD =2.367=2.367 ; 95%CI, 1.029 至 3.706; 檔案 S64, 圖 S7.f.), 電腦化 CS (MD =2.367=2.367 ; 95%CI,1.02995 \% \mathrm{CI}, 1.029 至 3.706 ; 檔案 S65, 圖 S7.g.). 其他子組在語言流暢性上未顯示出統計學上顯著的差異 (檔案 S62, 圖 S7.c., 和檔案 S66, 圖 S7.h.).
Publication bias was detected for the estimation of the mean change of verbal fluency (Egger test, p < .001p<.001 ) (file S67, Fig. S7.i.). 發現了出版偏差，對於口語流暢性平均變化的估計（Egger 測試， p < .001p<.001 ）（文件 S67，圖 S7.i.）。
3.4.3.7. Praxis. As shown in Fig. 3h a statistically significant improvement in praxis was found in the group that received CS (independently or together with AChEIs) compared to those who did not receive CS (control groups) ( MD=0.278,95%CI,0.094\mathrm{MD}=0.278,95 \% \mathrm{CI}, 0.094 to 0.462 ). Heterogeneity among studies for praxis was very high ( I^(2)=97.86;p < 0.001\mathrm{I}^{2}=97.86 ; p<0.001 ). 3.4.3.7. 實踐。如圖 3h 所示，接受 CS（獨立或與 AChEIs 一起）的小組在實踐方面的統計顯著改善，相較於未接受 CS（對照組）的參與者（ MD=0.278,95%CI,0.094\mathrm{MD}=0.278,95 \% \mathrm{CI}, 0.094 至 0.462）。實踐的研究異質性非常高（ I^(2)=97.86;p < 0.001\mathrm{I}^{2}=97.86 ; p<0.001 ）。
Subgroup analysis indicated statistically significant increases in praxis in those cognitively healthy elderly individuals ( MD=0.371\mathrm{MD}=0.371; 95%95 \% CI, 0.195 to 0.548 ; file S69, Fig. S8.b.), TAU control (MD =0.212=0.212; 95%95 \% CI, 0.052 to 0.371 ; file S70, Fig. S8.c.), <= 75\leq 75 years (MD =0.356=0.356; 亞組分析顯示，在那些認知健康的老年人中，實踐能力有統計學上顯著的增加 ( MD=0.371\mathrm{MD}=0.371 ; 95%95 \% CI, 0.195 至 0.548 ; 檔案 S69, 圖 S8.b.), TAU 控制 (MD =0.212=0.212 ; 95%95 \% CI, 0.052 至 0.371 ; 檔案 S70, 圖 S8.c.), <= 75\leq 75 年 (MD =0.356=0.356 ; 95%95 \% CI, 0.157 to 0.555 ; file S71, Fig. S8.d.), personalized/adapted CS (MD =0.472;95%=0.472 ; 95 \% CI, 0.285 to 0.659 ; file S74, Fig. S8.g.), Fair quality (MD =0.356;95%CI,0.157=0.356 ; 95 \% C I, 0.157 to 0.555 ; file S75, Fig. S8.h.). The other subgroups did not show a statistically significant (files S68, S72 and S73, Figs. S8.a., S8.e. and S8.f.). 95%95 \% CI, 0.157 至 0.555 ; 檔案 S71, 圖 S8.d.), 個性化/調整的 CS (MD =0.472;95%=0.472 ; 95 \% CI, 0.285 至 0.659 ; 檔案 S74, 圖 S8.g.), 公平質量 (MD =0.356;95%CI,0.157=0.356 ; 95 \% C I, 0.157 至 0.555 ; 檔案 S75, 圖 S8.h.). 其他子組未顯示統計學上顯著性 (檔案 S68, S72 和 S73, 圖 S8.a., S8.e. 和 S8.f.).
Publication bias was not detected for the estimation of the mean change of praxis (Egger test, p=0.459p=0.459 ) (file S76, Fig. S8.i.). 未檢測到發表偏倚以估算實踐的平均變化（Egger 測試， p=0.459p=0.459 ）（檔案 S76，圖 S8.i.）。
3.4.3.8. Calculation. As shown in Fig. 3i a statistically significant improvement in calculation was found in the group receiving CS (independently or together with AChEIs) compared to those who did not receive CS (control groups) ( MD=0.228,95%CI,0.112\mathrm{MD}=0.228,95 \% \mathrm{CI}, 0.112 to 0.343 ). Heterogeneity among studies for calculation was very high ( I^(2)=94.68\mathrm{I}^{2}=94.68; p < 0.001p<0.001 ). 3.4.3.8. 計算。 如圖 3i 所示，接受 CS（獨立或與 AChEIs 一起）組別的計算有顯著統計學改善，與未接受 CS（對照組）相比（ MD=0.228,95%CI,0.112\mathrm{MD}=0.228,95 \% \mathrm{CI}, 0.112 至 0.343）。 研究之間的計算異質性非常高（ I^(2)=94.68\mathrm{I}^{2}=94.68 ； p < 0.001p<0.001 ）。
Subgroup analysis revealed statistically significant increases in calculation in participants with Mild Cognitive Impairment (MD = 亞組分析顯示，輕度認知障礙參與者的計算能力有統計學上顯著的增加 (MD =
Fig. 3g. Forest plot of effect sizes (ESs) from the studies that assessed verbal fluency. 圖 3g. 評估語言流暢性的研究效果大小（ESs）森林圖。
Studies 研究
Spector et al, 2010 (dementia, n=201\mathrm{n}=201, ADAS-Cog-Constructional Praxis) Spector 等人, 2010 (癡呆, n=201\mathrm{n}=201 , ADAS-Cog-建構性實踐)
Spector et al, 2010 (dementia, n=201n=201, ADAS-Cog-Ideational Praxis) Spector 等人, 2010 (癡呆, n=201n=201 , ADAS-Cog-概念性實踐)
Spector et al, 2010 (dementia, n=201, ADAS-Cog-Commands) Spector 等人, 2010 (癡呆, n=201, ADAS-Cog-指令)
Tarnanas et al, 2014 (MCI, n=71, ROCF-Copy, active control) Tarnanas 等人, 2014 (輕度認知障礙, n=71, ROCF-抄寫, 主動對照)
Tarnanas et al, 2014 (MCI, n=66, ROCF-Copy, passive control) Tarnanas 等人, 2014 (輕度認知障礙, n=66, ROCF-抄寫, 被動控制)
Ciarmiello et al, 2015 (MCI, n=30n=30, ROCF-Copy) Ciarmiello 等人, 2015 (輕度認知障礙, n=30n=30 , ROCF-抄寫)
Calatayud et al, 2018 (Cognitive Healthy Elderly, n=149, MEC-35-Praxis, post-intervention) Calatayud et al, 2018 (Cognitive Healthy Elderly, n=113\mathrm{n}=113, MEC-35-Praxis, 6 months) Calatayud et al, 2018 (Cognitive Healthy Elderly, n=87\mathrm{n}=87, MEC-35-Praxis, 12 months) Justo-Henriques et al, 2019 (MCI, n=30, MMSE-Visuoconstructive ability) Alvares-Pereira et al, 2020 (dementia, n=100\mathrm{n}=100, ADAS-Cog-Constructional) Alvares-Pereira et al. 2020 (dementia, n=100\mathrm{n}=100, ADAS-Cog-Ideational Praxis) Alvares-Pereira et al, 2020 (dementia, n=100\mathrm{n}=100, ADAS-Cog-Commands) ópez et al, 2020 (dementia, n=30\mathrm{n}=30, Block design-WAIS-III) Calatayud et al, 2018 (認知健康老年人, n=149, MEC-35-實踐, 介入後) Calatayud et al, 2018 (認知健康老年人, n=113\mathrm{n}=113 , MEC-35-實踐, 6 個月) Calatayud et al, 2018 (認知健康老年人, n=87\mathrm{n}=87 , MEC-35-實踐, 12 個月) Justo-Henriques et al, 2019 (輕度認知障礙, n=30, MMSE-視覺建構能力) Alvares-Pereira et al, 2020 (癡呆, n=100\mathrm{n}=100 , ADAS-Cog-建構) Alvares-Pereira et al. 2020 (癡呆, n=100\mathrm{n}=100 , ADAS-Cog-概念實踐) Alvares-Pereira et al, 2020 (癡呆, n=100\mathrm{n}=100 , ADAS-Cog-指令) ópez et al, 2020 (癡呆, n=30\mathrm{n}=30 , 塊設計-WAIS-III)
Gómez-Soria, Andres-Esteban et al. 2021 (MCI, n=29, MEC-35-Praxis, post-intervention) Gomez-Soria, Andres-Esteban et al. 2021 (MCl, n=29, MEC-35-Praxis, 6 months) Gomez-Soria, Andres-Esteban et al. 2021 (MCl, n=29\mathrm{n}=29, MEC-35-Praxis, 12 months Gómez-Soria, Andrés-Esteban et al. 2021 (MCI, n=29, MEC-35-Praxis, 48 months) Gómez-Soria, Brandín de la Cruz et al. 2021 (MCl, n=50,MEC-35-\mathrm{n}=50, \mathrm{MEC}-35- Praxis, post-intervention) omez-Soria, Brandin de la Cruz et al. 2021 (MCl, n=50,MEC-35\mathrm{n}=50, \mathrm{MEC}-35-Praxis, 6 months) Gomez-Soria, Brandin de la Cruz et al. 2021 (MCl, n=50n=50, MEC-35-Praxis, 12 months) Liu et al, 2021 (dementia, n=39n=39, ADAS-Cog-Praxis) 戈麥斯-索里亞，安德烈斯-埃斯特班等，2021（輕度認知障礙，n=29，MEC-35-Praxis，介入後）戈麥斯-索里亞，安德烈斯-埃斯特班等，2021（輕度認知障礙，n=29，MEC-35-Praxis，6 個月）戈麥斯-索里亞，安德烈斯-埃斯特班等，2021（輕度認知障礙， n=29\mathrm{n}=29 ，MEC-35-Praxis，12 個月）戈麥斯-索里亞，安德烈斯-埃斯特班等，2021（輕度認知障礙，n=29，MEC-35-Praxis，48 個月）戈麥斯-索里亞，布蘭丁·德拉克魯斯等，2021（輕度認知障礙， n=50,MEC-35-\mathrm{n}=50, \mathrm{MEC}-35- Praxis，介入後）戈麥斯-索里亞，布蘭丁·德拉克魯斯等，2021（輕度認知障礙， n=50,MEC-35\mathrm{n}=50, \mathrm{MEC}-35 -Praxis，6 個月）戈麥斯-索里亞，布蘭丁·德拉克魯斯等，2021（輕度認知障礙， n=50n=50 ，MEC-35-Praxis，12 個月）劉等，2021（癡呆， n=39n=39 ，ADAS-Cog-Praxis）
Fig. 3i. Forest plot of effect sizes (ESs) from the studies that assessed calculation. 圖 3i. 評估計算的研究效果大小（ESs）森林圖。
Fig. 3j. Forest plot of effect sizes (ESs) from the studies that assessed visuospatial abilities. 圖 3j. 評估視空間能力的研究效果大小（ESs）森林圖。 0.228,95%CI,0.1120.228,95 \% \mathrm{CI}, 0.112 to 0.34 ). (file S78, Fig. S9.a.). Publication bias was not detected for the estimation of the mean change of calculation (Egger test, p=.078\mathrm{p}=.078 ) (file S79, Fig. S9.b.). 0.228,95%CI,0.1120.228,95 \% \mathrm{CI}, 0.112 到 0.34）。(文件 S78, 圖 S9.a.)。未檢測到發表偏倚以估算計算的平均變化 (Egger 測試, p=.078\mathrm{p}=.078 ) (文件 S79, 圖 S9.b.)。
3.4.3.9. Visuospatial abilities. As shown in Fig. 3j a statistically significant improvement in visuospatial abilities was found in the group receiving CS (independently or together with AChEIs) compared to those who did not receive CS (control groups) (MD =1.725;95%CI=1.725 ; 95 \% \mathrm{CI}, -2.910 to 6.360 ). Heterogeneity among studies for visuospatial abilities was very high ( I^(2)=99.56;p < 0.001\mathrm{I}^{2}=99.56 ; p<0.001 ). 3.4.3.9. 視空間能力。如圖 3j 所示，接受 CS（獨立或與 AChEIs 一起）的小組在視空間能力方面的統計顯著改善，與未接受 CS（對照組）的人相比（MD =1.725;95%CI=1.725 ; 95 \% \mathrm{CI} ，-2.910 至 6.360）。視空間能力的研究間異質性非常高（ I^(2)=99.56;p < 0.001\mathrm{I}^{2}=99.56 ; p<0.001 ）。
3.4.2.10. Summary the effects of CS in relation to cognitive variables in older adults. The effects observed through the analysis in the different subgroups of the different variables analyzed are shown (file S80, table S7). 3.4.2.10. 總結 CS 對老年人認知變數的影響。通過對不同變數分析的不同子組進行分析所觀察到的影響顯示在（文件 S80，表 S7）。
Regarding the risk of bias, using Trim and fill’ method, funnel plots showed that in all the variables used in the meta-analysis, a high publication bias was observed, with most of the studies located outside the significance bands (file S81, Fig. S10). 關於偏倚風險，使用修剪與填補方法，漏斗圖顯示在所有用於元分析的變數中，觀察到高出版偏倚，大多數研究位於顯著性帶之外（檔案 S81，圖 S10）。
3.6. Meta-regression 3.6. 元回歸分析
The meta-regression shows how in the variable Executive Functions the Total duration (weeks), in the variable Language the Number of sessions (min) and the Total duration (weeks) and in the variable Verbal Fluency, Total duration (weeks) and Scores quality of studies (%) significantly influence heterogeneity (file S82, table S8). 元回歸顯示，在執行功能變數中，總持續時間（週）、在語言變數中，會議次數（分鐘）和總持續時間（週），以及在口語流暢性變數中，總持續時間（週）和研究質量得分（%）顯著影響異質性（檔案 S82，表 S8）。
In the variable Executive Functions, the Total duration (weeks) significantly influences the heterogeneity ( 0.117 ( SE=0.036\mathrm{SE}=0.036 ), 95%CI95 \% \mathrm{CI} (0.042, 0.192 ), p=0.004p=0.004 ), increasing it ( I^(2)=96.907%\mathrm{I}^{2}=96.907 \% vs I^(2)\mathrm{I}^{2} original =95.45%=95.45 \% ) with a coefficient R^(2)\mathrm{R}^{2} that explains the 6.034%6.034 \% of the variance caused by heterogeneity. Cochrane’s Q test indicates that the unexplained heterogeneity is significant ( p < 0.001p<0.001 ) while the significant moderation test ( p=0.004p=0.004 ) indicates that this covariate does not influence the effect sizes of the studies. 在變數執行功能中，總持續時間（週）顯著影響異質性（0.117（ SE=0.036\mathrm{SE}=0.036 ）， 95%CI95 \% \mathrm{CI} （0.042，0.192）， p=0.004p=0.004 ），使其增加（ I^(2)=96.907%\mathrm{I}^{2}=96.907 \% 對 I^(2)\mathrm{I}^{2} 原始 =95.45%=95.45 \% ），其係數 R^(2)\mathrm{R}^{2} 解釋了由異質性引起的變異數的 6.034%6.034 \% 。Cochrane 的 Q 檢驗顯示，無法解釋的異質性是顯著的（ p < 0.001p<0.001 ），而顯著的調節檢驗（ p=0.004p=0.004 ）則表明此協變量不影響研究的效應大小。
In the variable Language, the Number of sessions (min) significantly influences the heterogeneity ( 0.088(SE=0.028)0.088(\mathrm{SE}=0.028), 95%CI(0.03,0.146)95 \% \mathrm{CI}(0.03,0.146), p=0.005p=0.005 ), although almost without modifying it ( I^(2)=98.596%\mathrm{I}^{2}=98.596 \% vs I^(2)\mathrm{I}^{2} original =98.37%=98.37 \% ) with a coefficient R^(2)\mathrm{R}^{2} that explains the 30.541%30.541 \% of the variance caused by heterogeneity. Cochrane’s QQ test indicates that unexplained heterogeneity is significant ( p < 0.001p<0.001 ) while the significant moderation test ( p=0.005p=0.005 ) indicates that this covariate has no influence on effect sizes. of the studies. Total duration (weeks) also significantly influences heterogeneity ( 0.075(SE=0.02)0.075(\mathrm{SE}=0.02), 95%CI ( 0.033 , 0.117 ), p=0.001p=0.001 ), although again almost without modifying it ( I^(2)=\mathrm{I}^{2}=98.445%98.445 \% vs I^(2)\mathrm{I}^{2} original =98.37%=98.37 \% ) with a coefficient R^(2)\mathrm{R}^{2} that explains the 37.474%37.474 \% of the variance caused by the heterogeneity. Cochrane’s Q test indicates that the unexplained heterogeneity is significant ( p < 0.001p<0.001 ) while the significant moderation test ( p=0.001p=0.001 ) indicates that this covariate does not influence effect sizes. of the studies. 在變數語言中，會議次數（分鐘）顯著影響異質性（ 0.088(SE=0.028)0.088(\mathrm{SE}=0.028) ， 95%CI(0.03,0.146)95 \% \mathrm{CI}(0.03,0.146) ， p=0.005p=0.005 ），儘管幾乎沒有改變它（ I^(2)=98.596%\mathrm{I}^{2}=98.596 \% 對 I^(2)\mathrm{I}^{2} 原始 =98.37%=98.37 \% ），其係數 R^(2)\mathrm{R}^{2} 解釋了由異質性引起的變異的 30.541%30.541 \% 。Cochrane 的 QQ 測試表明，無法解釋的異質性是顯著的（ p < 0.001p<0.001 ），而顯著的調節測試（ p=0.005p=0.005 ）表明這個協變量對研究的效應大小沒有影響。總持續時間（週）也顯著影響異質性（ 0.075(SE=0.02)0.075(\mathrm{SE}=0.02) ，95%CI（0.033，0.117）， p=0.001p=0.001 ），儘管再次幾乎沒有改變它（ I^(2)=\mathrm{I}^{2}=98.445%98.445 \% 對 I^(2)\mathrm{I}^{2} 原始 =98.37%=98.37 \% ），其係數 R^(2)\mathrm{R}^{2} 解釋了由異質性引起的變異的 37.474%37.474 \% 。Cochrane 的 Q 測試表明，無法解釋的異質性是顯著的（ p < 0.001p<0.001 ），而顯著的調節測試（ p=0.001p=0.001 ）表明這個協變量對研究的效應大小沒有影響。
In the variable Verbal Fluency, the Total duration (weeks) significantly influences the heterogeneity ( 0.141 ( SE=0.041\mathrm{SE}=0.041 ), 95%CI ( 0.055 , 0.227),p=0.0030.227), p=0.003 ), reducing it (I^(2)=97.639%:}\left(\mathrm{I}^{2}=97.639 \%\right. vs I^(2)\mathrm{I}^{2} original {:=98.1%)\left.=98.1 \%\right) with a coefficient R^(2)\mathrm{R}^{2} that explains the 38.811%38.811 \% of the variance caused by heterogeneity. Cochrane’s Q test indicates that the unexplained heterogeneity is significant ( p < 0.001p<0.001 ) while the significant moderation test ( p=0.003p=0.003 ) indicates that this covariate does not influence the effect sizes of the studies. Also, the Scores quality of studies (%) significantly influences the heterogeneity ( -0.11 ( SE=0.045\mathrm{SE}=0.045 ), 95%CI (-0.204(-0.204, -0.016),p=0.024-0.016), p=0.024 ), although almost without modifying it ( I^(2)=98.158%\mathrm{I}^{2}=98.158 \% vs I^(2)\mathrm{I}^{2} original =98.1%=98.1 \% ) with a coefficient R^(2)\mathrm{R}^{2} that explains the 21.18%21.18 \% of the variance caused by heterogeneity. Cochrane’s Q test indicates that unexplained heterogeneity is significant ( p < 0.001p<0.001 ) while the significant moderation test ( p=0.024p=0.024 ) indicates that this covariate has no influence on effect sizes of the studies. 在變數口語流暢性中，總持續時間（週）顯著影響異質性（0.141（ SE=0.041\mathrm{SE}=0.041 ），95%CI（0.055， 0.227),p=0.0030.227), p=0.003 ），減少 (I^(2)=97.639%:}\left(\mathrm{I}^{2}=97.639 \%\right. 對 I^(2)\mathrm{I}^{2} 原始 {:=98.1%)\left.=98.1 \%\right) 的影響，具有解釋異質性所造成變異的 R^(2)\mathrm{R}^{2} 的係數 38.811%38.811 \% 。Cochrane 的 Q 檢驗顯示，無法解釋的異質性是顯著的（ p < 0.001p<0.001 ），而顯著的調節檢驗（ p=0.003p=0.003 ）表明這個協變量不影響研究的效應大小。此外，研究的質量得分（%）顯著影響異質性（-0.11（ SE=0.045\mathrm{SE}=0.045 ），95%CI (-0.204(-0.204 ， -0.016),p=0.024-0.016), p=0.024 ），儘管幾乎沒有改變它（ I^(2)=98.158%\mathrm{I}^{2}=98.158 \% 對 I^(2)\mathrm{I}^{2} 原始 =98.1%=98.1 \% ），具有解釋異質性所造成變異的 R^(2)\mathrm{R}^{2} 的係數 21.18%21.18 \% 。Cochrane 的 Q 檢驗顯示無法解釋的異質性是顯著的（ p < 0.001p<0.001 ），而顯著的調節檢驗（ p=0.024p=0.024 ）表明這個協變量對研究的效應大小沒有影響。
The bubble plots show how the covariates have a positive relationship with the effects, the greater the Total duration (weeks) or Number of sessions (min), the greater the effect size reported in the intervention group versus the control group for the variables Executive Functions, Language and Verbal Fluency except in the covariate Scores quality of studies (%) where, the higher the percentage of quality, the lower it is the effect reported in the intervention group versus the control group for the domain Verbal Fluency. 氣泡圖顯示協變量與效果之間的正相關，總持續時間（週）或會議次數（分鐘）越大，干預組與對照組在執行功能、語言和口語流暢性變量中報告的效果大小越大，除了在協變量研究質量分數（%）中，質量百分比越高，干預組與對照組在口語流暢性領域報告的效果越低。
In any case, the percentage of heterogeneity and variance not explained by the models is very high and only the covariate Total duration (weeks) in the Verbal Fluency shows a higher value R^(2)\mathrm{R}^{2}38.811%38.811 \% and best fit of studies to the regression line (file S83, Fig. 11). 無論如何，模型未解釋的異質性和變異數百分比非常高，只有在語言流暢性中的協變量總持續時間（週）顯示出較高的值 R^(2)\mathrm{R}^{2}38.811%38.811 \% ，並且研究與回歸線的最佳擬合（文件 S83，圖 11）。
4. Discussion 4. 討論
This systematic review and meta-analysis aimed to assess the impact of CS (independently or together with pharmacological treatment, particularly AChEIs) on general cognitive functioning and some specific cognitive domains such as memory, orientation, praxis, and calculation in older adults cognitively healthy, with MCI, or dementia. 本系統性回顧和統合分析旨在評估 CS（獨立或與藥物治療（特別是 AChEIs）一起）對於認知健康的老年人、輕度認知障礙（MCI）或癡呆患者的一般認知功能及一些特定認知領域（如記憶、定向、實踐和計算）的影響。
In contrast to previously published studies, our research has assessed the impact of CS on general cognitive functioning and different cognitive functions not only in older adults with dementia, but also in cognitively healthy elderly participants and patients with MCI. 與先前發表的研究相比，我們的研究評估了 CS 對一般認知功能和不同認知功能的影響，不僅在患有癡呆的老年人中，還在認知健康的老年參與者和輕度認知障礙患者中。
In addition, we have analysed different subgroups that previous studies have not evaluated, such as cognitive status, age of participants, duration of the CS session, tailored or personalised intervention/nonpersonalised or non-tailored intervention, traditional intervention/ computerised intervention, origin of the studies (according to the origin of the participants by continent), and types of memory, orientation and praxis. 此外，我們分析了以往研究未評估的不同子群體，例如認知狀態、參與者年齡、CS 會議的持續時間、量身定制或個性化干預/非個性化或非量身定制干預、傳統干預/計算機化干預、研究的來源（根據參與者的洲別來源）以及記憶、定向和實踐的類型。
Our results show improvements in general cognitive functioning in cognitive healthy elderly participants, those with MCI, and those with dementia. In agreement, other authors also found similar results in general cognitive functioning (Aguirre et al., 2013; Cafferata et al., 2021; Kim et al., 2017; Saragih et al., 2022; Sun et al., 2022; Wong et al., 2021; Woods et al., 2012) in participants with dementia. Cafferata et al. (2021) describes important improvements in memory for participants with dementia; however they did not find differences in language. In contrast, Kim et al. (2017), did not find variations in cognition for dementia patients. 我們的結果顯示，在認知健康的老年參與者、輕度認知障礙（MCI）患者以及癡呆症患者中，整體認知功能有所改善。與此一致，其他作者也在癡呆症參與者中發現了類似的整體認知功能結果（Aguirre et al., 2013; Cafferata et al., 2021; Kim et al., 2017; Saragih et al., 2022; Sun et al., 2022; Wong et al., 2021; Woods et al., 2012）。Cafferata et al.（2021）描述了癡呆症參與者在記憶方面的重要改善；然而，他們未發現語言方面的差異。相反，Kim et al.（2017）未發現癡呆症患者的認知變化。
We have shown significant better scores in MMSE, MoCA y MEC-35 assessments. Similarly, Kim et al. (2017) and Woods, et al., 2013 found significant benefits in MMSE and ADAS-Cog. In addition, (Cafferata et al., 2021,; Aguirre et al., 2013) also showed benefits in ADAS-Cog. The results of Aguirre et al. (2013) support the hypothesis that CS is effective regardless of whether AChEIs are not prescribed, and any effects are in addition to those associated with medications. 我們在 MMSE、MoCA 和 MEC-35 評估中顯示出顯著的改善分數。同樣，Kim 等人（2017）和 Woods 等人（2013）發現 MMSE 和 ADAS-Cog 有顯著的益處。此外，（Cafferata 等人，2021；Aguirre 等人，2013）也顯示 ADAS-Cog 有益處。Aguirre 等人（2013）的結果支持了這一假設，即 CS 是有效的，無論是否處方 AChEIs，任何效果都是在藥物相關效果之上的。
Based on the type of control, significant differences were found in both active control and TAU control in general cognitive functioning and memory, and in TAU control as well as in praxis. Wong et al. (2021) describes apositive treatment effect through CS on general cognitive functioning in dementia participants, compared with inactive controls (including no active treatment, waitlisted for intervention, and treatment as usual). 根據控制類型，發現主動控制和 TAU 控制在一般認知功能和記憶方面存在顯著差異，而在 TAU 控制以及在實踐方面也有差異。Wong 等人（2021）描述了通過 CS 對癡呆參與者的一般認知功能產生的積極治療效果，與非主動控制（包括沒有主動治療、等待介入和常規治療）相比。
Regarding cognitive status, we can observe improvements with significant differences in general cognitive functioning. Cognitive healthy elderly participants showed better scores in memory, orientation, praxis and calculation. In addition, in MCI participants we also describe improvements in in language and verbal fluency. In our study, we have differentiated between sub-groups “individual CS” versus “group CS” in general cognitive functioning, finding statistically significant improvements in group CS. Orfanos et al. (2021) found therapeutic advantages inherent in the group of CS and Devita et al. (2021) suggested that by including the social component, the group CS had more beneficial effects on neuroplasticity compared to pharmacological interventions. 關於認知狀態，我們可以觀察到一般認知功能的顯著改善。認知健康的老年參與者在記憶、定向、實踐和計算方面的得分較好。此外，在輕度認知障礙（MCI）參與者中，我們也描述了語言和口語流利度的改善。在我們的研究中，我們區分了“個體 CS”和“群體 CS”在一般認知功能上的差異，發現群體 CS 有統計學上顯著的改善。Orfanos 等人（2021）發現 CS 群體固有的治療優勢，而 Devita 等人（2021）則建議通過納入社會成分，群體 CS 對神經可塑性有比藥物干預更有益的效果。
However, the study of Wong et al. (2021), did not find differences between individual CS and group CS. 然而，Wong 等人（2021）的研究未發現個別 CS 與團體 CS 之間的差異。
Regarding the duration of CS programs, our meta-analysis showed that “short-term CS” or “long-term CS”, could improve the level of general cognitive functioning. “Short-term CS”, or “maintenance CS”, seem to improve memory, “short-term CS” seem to increase orientation, “long-term CS” seen to improve language and “maintenance CS” seem to increase verbal fluency. On the one hand, Chen et al. (2019) concluded that “CS and AChEIs” were effective in AD, regardless of whether short, maintenance, or long-term CS were applied; although the latter appears to be more effective on cognitive function. On the other hand, Brown et al. (2019), showed that maintenance CS might be cost-effective compared to standard treatment for participants who lived alone and those with higher levels of cognitive functioning. However, Wong et al. (2021) performed a subgroup analysis based on the CS duration and did not find significant differences between <= 3\leq 3 months and > 3>3 months. Besides, Jean et al. (2010) found that applying fewer sessions (between 6 and 20) was more cost-effective for clinical purposes. In terms of duration, CS programs with more than 12 weeks showed no extra benefits compared to shorter programs. Therefore, the 12 -week programs seem to be a good option, especially to reduce the risks of attrition. In addition, personalized CS may be more effective in the short and long-term than a standard CS (Calatayud et al., 2022). 關於 CS 計劃的持續時間，我們的元分析顯示“短期 CS”或“長期 CS”可以改善一般認知功能水平。“短期 CS”或“維持 CS”似乎改善記憶，“短期 CS”似乎增加定向能力，“長期 CS”似乎改善語言能力，而“維持 CS”似乎增加語言流暢性。一方面，陳等人（2019）得出結論認為“CS 和 AChEIs”在阿茲海默症中是有效的，無論是短期、維持還是長期 CS 的應用；儘管後者似乎對認知功能更有效。另一方面，布朗等人（2019）顯示，對於獨居參與者和認知功能較高的參與者，維持 CS 可能比標準治療更具成本效益。然而，黃等人（2021）根據 CS 持續時間進行了亞組分析，並未發現 <= 3\leq 3 個月和 > 3>3 個月之間有顯著差異。此外，讓等人（2010）發現，應用較少的會議（介於 6 到 20 次之間）對臨床目的更具成本效益。 在持續時間方面，超過 12 週的 CS 計劃與較短的計劃相比，並未顯示出額外的好處。因此，12 週的計劃似乎是一個不錯的選擇，特別是可以減少流失的風險。此外，個性化的 CS 在短期和長期內可能比標準的 CS 更有效（Calatayud et al., 2022）。
Concerning the duration of the CS sessions, our meta-analysis showed that " 45min//45 \mathrm{~min} / session" improves general cognitive functioning, memory, executive functions, and verbal fluency. However, " > 45min//>45 \mathrm{~min} / session" also show higher scores in general cognitive functioning. Different authors recommend 45 min by session (Abraha et al., 2017; Aguirre et al., 2013; Aguirre et al., 2014; Clare & Woods, 2004; Coma-s-Herrera & Knapp, 2016; Knapp et al., 2006; Orrell et al., 2014; Spector et al., 2006; Woods et al., 2012; Yamanaka et al., 2013). 關於 CS 會議的持續時間，我們的元分析顯示「 45min//45 \mathrm{~min} / 次會議」能改善一般認知功能、記憶、執行功能和語言流暢性。然而，「 > 45min//>45 \mathrm{~min} / 次會議」在一般認知功能上也顯示出更高的分數。不同的作者建議每次會議 45 分鐘（Abraha et al., 2017; Aguirre et al., 2013; Aguirre et al., 2014; Clare & Woods, 2004; Coma-s-Herrera & Knapp, 2016; Knapp et al., 2006; Orrell et al., 2014; Spector et al., 2006; Woods et al., 2012; Yamanaka et al., 2013）。
Our results indicate that a “personalized/adapted CS” significantly improves general cognitive functioning, orientation, and praxis. However, “non-personalized/adapted CS” also significantly improves general cognitive functioning, memory, language, and verbal fluency. Despite these contradictory results, we suggest adapting the activities to participants’ specific cognitive levels (Gómez-Soria et al., 2021; Calatayud et al., 2022), personal preferences and limitations of the participants (Félix et al., 2020). Satisfactory sessions are essential to achieve an adequate selection of CS tasks, which it can be by adapting the cognitive level, being interesting avoiding boredom, and being meaningful for the person who performs them and to be close to the issues of everyday life (Muñoz Marrón, 2009). 我們的結果顯示，“個性化/適應性認知訓練”（CS）顯著改善了一般認知功能、定向能力和實踐能力。然而，“非個性化/適應性認知訓練”（CS）也顯著改善了一般認知功能、記憶、語言和口語流利度。儘管這些結果存在矛盾，我們建議根據參與者的具體認知水平（Gómez-Soria et al., 2021; Calatayud et al., 2022）、個人偏好和參與者的限制（Félix et al., 2020）來調整活動。滿意的訓練課程對於達成適當的認知訓練任務選擇至關重要，這可以通過調整認知水平、保持趣味性以避免無聊，以及對執行者有意義並接近日常生活的議題來實現（Muñoz Marrón, 2009）。
Our study found that “traditional CS” obtained better results than “computerized CS” in general cognitive functioning. However, we found contradictory results in verbal fluency, as significant differences were found in “computerized CS”. In memory, we have described important improvements in both “traditional CS” and “computerized CS”. Acosta et al. (2022), found that computerized CS can offer a more personalized and flexible approach compared to traditional CS. 我們的研究發現，“傳統 CS”在一般認知功能上獲得了比“電腦化 CS”更好的結果。然而，我們在語言流暢性方面發現了矛盾的結果，因為在“電腦化 CS”中發現了顯著差異。在記憶方面，我們描述了“傳統 CS”和“電腦化 CS”都取得了重要的改善。Acosta 等人（2022）發現，與傳統 CS 相比，電腦化 CS 可以提供更個性化和靈活的方法。
Furthermore, our results indicated that “participants aged 75 years or younger” significantly increased their levels of general cognitive functioning, memory, orientation, language, and praxis when using CS. However, in "participants aged 75+75+ ", even if CS improved levels of general cognitive functioning there were no improvements in the other cognitive functions analysed. The study by Tesky et al. (2011), based on cognitive stimulating leisure activities, describes significant differences attention in older adults ( >= 75\geq 75 years) and in subjective memory decline in younger participants ( < 75<75 years). Besides, Park et al. (2019), found differences in visuospatial/executive functions, language skills, and memory between the 65-79 years age group and the aged over 80 group in participants older adults through multicomponent CS. Further, regarding the relationship between the multicomponent CS and age, it was found that their interaction was significant only regarding visuospatial/executive ability. 此外，我們的結果顯示「年齡在 75 歲或以下的參與者」在使用認知刺激（CS）時，顯著提高了他們的一般認知功能、記憶、定向、語言和實踐能力。然而，在「年齡為 75+75+ 的參與者」中，即使 CS 提高了一般認知功能的水平，其他分析的認知功能卻沒有改善。Tesky 等人（2011）的研究基於認知刺激的休閒活動，描述了年長者（ >= 75\geq 75 歲）在注意力方面的顯著差異，以及年輕參與者（ < 75<75 歲）在主觀記憶衰退方面的差異。此外，Park 等人（2019）發現 65-79 歲年齡組和 80 歲以上年齡組的參與者在視空間/執行功能、語言技能和記憶方面存在差異，這是通過多元組合的 CS 進行的。此外，關於多元組合 CS 與年齡之間的關係，發現它們的互動僅在視空間/執行能力方面具有顯著性。
Consistent with these results, Fernández-Ballesteros et al. (2012), 與這些結果一致，Fernández-Ballesteros 等人（2012）
showed that younger participants had greater changes in cognitive function due to greater neural plasticity. Therefore, the earlier psychosocial intervention is initiated, the more likely it is that cognitive functions will be preserved (Vernooij-Dassen et al., 2010). 顯示年輕參與者因神經可塑性較高而在認知功能上有更大的變化。因此，越早開始心理社會干預，認知功能被保留的可能性就越大（Vernooij-Dassen et al., 2010）。
Regarding participants that received “alone CS”, we found that it was associated with better general cognitive functioning. However, the participants that received “CS+AChEIs” display worse levels in general cognitive functioning. The CS + AChEIs subgroup included just the results of three randomized controlled trials to evaluate the benefits in general cognitive functioning. Also, important characteristics such as lower baseline cognitive level, lower educational level and higher mean age of the participants were observed in the subgroup in which drugs (AChEIs) plus CS were combined compared to the subgroup in which only CS was conducted. These differences can explain the lack of additional effect combining drug and CS and therefore, results should be taken with caution. In other studies, the combination of CS and AChEIs, had more benefits than “alone CS” or “alone AChEIs” in memory (Devita et al., 2021), and cognition (D’Amico et al., 2015). Besides, “alone CS” showed significant improvements compared with “alone AChEIs” (Devita et al., 2021). Other investigations have suggested that CS was effective irrespective of whether or not AChEIs were prescribed (Aguirre et al., 2013; Streater et al., 2016; Woods et al., 2012). 關於接受「單獨 CS」的參與者，我們發現這與更好的一般認知功能相關。然而，接受「CS+AChEIs」的參與者在一般認知功能方面顯示出較差的水平。CS + AChEIs 亞組僅包括三項隨機對照試驗的結果，以評估在一般認知功能方面的益處。此外，在藥物（AChEIs）與 CS 結合的亞組中，觀察到參與者的基線認知水平較低、教育水平較低以及平均年齡較高，與僅進行 CS 的亞組相比。這些差異可以解釋藥物與 CS 結合的額外效果缺乏，因此，結果應謹慎對待。在其他研究中，CS 與 AChEIs 的結合在記憶（Devita et al., 2021）和認知（D’Amico et al., 2015）方面的益處超過了「單獨 CS」或「單獨 AChEIs」。此外，「單獨 CS」與「單獨 AChEIs」相比顯示出顯著改善（Devita et al., 2021）。其他研究表明，無論是否處方 AChEIs，CS 都是有效的（Aguirre et al.）。，2013；Streater 等，2016；Woods 等，2012）。
About the quality of the selected studies, our results showed that CS was associated with improvements in general cognitive functioning, memory, orientation and praxis in the subgroup “Fair quality”. In Lobbia et al. (2019) study, moderate levels of evidence were found for general cognitive functioning, comprehension and production of language in participants with dementia. However, the levels of evidence were weakest for short-term memory, orientation, and praxis in participants with dementia. Furthermore, in Sun et al. (2022), compared with the control group, maintenance CS (low-quality evidence) and group CS (very low-quality evidence) could significantly improve general cognitive functioning in participants with dementia. 關於所選研究的質量，我們的結果顯示，在“公平質量”子組中，CS 與一般認知功能、記憶、定向和實踐的改善相關。在 Lobbia 等人（2019）的研究中，對於患有癡呆症的參與者，一般認知功能、語言理解和產出發現了中等水平的證據。然而，對於患有癡呆症的參與者，短期記憶、定向和實踐的證據水平最弱。此外，在 Sun 等人（2022）的研究中，與對照組相比，維持 CS（低質量證據）和團體 CS（非常低質量證據）能顯著改善患有癡呆症的參與者的一般認知功能。
In reference to the origin of the studies, we observed that participants from Europe showed improvements in general cognitive functioning in those who received CS. However, there are limited studies from Asia and America. 關於研究的起源，我們觀察到來自歐洲的參與者在接受 CS 的情況下，普遍認知功能有所改善。然而，來自亞洲和美國的研究有限。
To date, no previous systematic reviews or meta-analyses based on CS have been carried out including cognitively healthy participants or with MCI besides dementia. Moreover, a high number of subgroup analyses were conducted to analyse the effect that cognitive status, type of assessments in general cognitive functioning, type of memory, type of orientation, type of verbal fluency, type of praxis, age, number of sessions and duration, type of CS, individual or group CS, type of control, treatment and personalization or adaptation, the quality of studies, and origin of the studies, could have on the cognitive outcomes assessed. 截至目前，尚未進行任何基於認知篩查（CS）的系統性回顧或統合分析，包括認知健康參與者或輕度認知障礙（MCI）以外的癡呆症。此外，進行了大量的子組分析，以分析認知狀態、一般認知功能評估類型、記憶類型、定向類型、語言流暢性類型、實踐類型、年齡、會議次數和持續時間、CS 類型、個別或團體 CS、對照類型、治療和個性化或調整、研究質量以及研究來源等因素對評估的認知結果可能產生的影響。
Concerning the limitations of the present systematic review and meta-analysis. Firstly, the overall quality of the evidence was limited due to the poor methodological quality of the included studies (Sun et al., 2022; Wong et al., 2021). Some studies lacked details in their methods of blinding participants (Sun et al., 2022). The absence of randomization in some studies was particularly problematic (Chao et al., 2020). Secondly, heterogeneity could not be explained by the results of subgroup analyses (Wong et al., 2021). Thirdly, the sample size of most of the studies was relatively small in some studies, although this is also common in other meta-analyses (Sun et al., 2022). 關於目前系統性回顧和統合分析的限制。首先，由於納入研究的方法學質量較差，整體證據質量受到限制（Sun et al., 2022; Wong et al., 2021）。一些研究在盲法參與者的方式上缺乏細節（Sun et al., 2022）。某些研究缺乏隨機化特別成為問題（Chao et al., 2020）。其次，亞組分析的結果無法解釋異質性（Wong et al., 2021）。第三，儘管這在其他統合分析中也很常見，但大多數研究的樣本量相對較小（Sun et al., 2022）。
Futures studies are needed to study what are the most beneficial contents, frequencies, durations, formats, number of sessions, strategies and activities of CS (Spector et al., 2012). Future research regarding the long-term effects of CS should be investigated (Cafferata et al., 2021; Chao et al., 2020) especially in cognitively healthy elderly participants and MCI (La rue, 2010). In addition, it would be necessary to know if the participants with CS take any pharmacological treatment to better differentiate between (1) those who are taking pharmacological drugs and receive CS, (2) those who only receive CS and (3) those who only take drugs. Moreover, the differences in function of gender of the 未來的研究需要探討哪些內容、頻率、持續時間、格式、會議次數、策略和活動對於 CS（Spector et al., 2012）最為有益。關於 CS 的長期效果的未來研究應該進行調查（Cafferata et al., 2021；Chao et al., 2020），特別是在認知健康的老年參與者和輕度認知障礙（MCI）中（La rue, 2010）。此外，還需要了解參與 CS 的參與者是否接受任何藥物治療，以便更好地區分（1）那些正在服用藥物並接受 CS 的人，（2）那些僅接受 CS 的人，以及（3）那些僅服用藥物的人。此外，性別功能的差異也應該考慮。
participants and age should be considered. 參與者和年齡應該被考慮。
4.1. Implications for clinical practice 4.1. 臨床實踐的意涵
Our findings suggest that personalized and tailored CS programmes in older adults (both institutionalized and non-institutionalized) improve general cognitive functioning, orientation, and praxis. Although, by applying any CS, benefits in older adults are obtained, some types of CS appear to be more effective, specially, reminiscence therapy, reality orientation and multisensory stimulation. In addition, short-term (less than 3 months) CS programmes applied to older adults (cognitively healthy participants, with MCI or dementia) could improve the level of general cognitive functioning and memory. Due to neuroplasticity, participants aged 75 years or younger could benefit more than older participants in different cognitive functions such as memory, orientation, language, and praxis when performing CS. For this reason, it would be advisable to administer CS programmes at younger ages. 我們的研究結果表明，為老年人（包括機構化和非機構化的老年人）量身定制的個性化認知刺激（CS）計劃能改善一般認知功能、定向能力和實踐能力。儘管任何形式的 CS 都能為老年人帶來益處，但某些類型的 CS 似乎更為有效，特別是回憶療法、現實定向和多感官刺激。此外，針對老年人（認知健康參與者、輕度認知障礙或癡呆症患者）實施的短期（少於 3 個月）CS 計劃可以提高一般認知功能和記憶水平。由於神經可塑性，75 歲或以下的參與者在執行 CS 時，可能在記憶、定向、語言和實踐等不同認知功能上獲益更多。因此，建議在較年輕的年齡實施 CS 計劃。
5. Conclusions 5. 結論
Our findings suggest that CS improves general cognitive functioning, memory, orientation, and praxis in older adults. Moreover, conducting traditional CS and CS alone in short- and long-term with a duration of 45 min per session seem to be the best option to improve general cognitive functioning in the elderly. 我們的研究結果表明，CS 能改善老年人的一般認知功能、記憶、定向能力和實踐能力。此外，進行傳統的 CS 和單獨的 CS，無論是短期還是長期，每次持續 45 分鐘，似乎是改善老年人一般認知功能的最佳選擇。
Both, traditional and computerized CS, in short-term and maintenance with a duration of 45 min or more per session could improve “memory” in cognitively healthy participants or with MCI. Regarding other cognitive areas, we have described contradictory results on personalized-adapted/non-personalized-non-adapted. Nevertheless, it has been observed that in executive functions and verbal fluency the interventions with a duration of 45 min per session get better results. In addition, in verbal fluency the maintenance CS and the computerized CS are more effective. In relation to quality of studies, “fair quality” has obtained better results in general cognitive functioning, memory, orientation and praxis. Finally, younger participants ( <= 75\leq 75 years) seem to obtain more benefits in general cognitive functioning, memory, orientation, language, and praxis compared to older participants. 傳統和電腦化的認知訓練（CS），在短期和維持階段，每次持續 45 分鐘或更長時間，能改善認知健康參與者或輕度認知障礙（MCI）者的“記憶”。關於其他認知領域，我們描述了個性化適應與非個性化非適應的矛盾結果。然而，已觀察到在執行功能和語言流暢性方面，每次持續 45 分鐘的介入獲得了更好的結果。此外，在語言流暢性方面，維持性 CS 和電腦化 CS 更為有效。關於研究質量，“公平質量”在一般認知功能、記憶、定向和實踐方面獲得了更好的結果。最後，年輕參與者（ <= 75\leq 75 歲）似乎在一般認知功能、記憶、定向、語言和實踐方面比年長參與者獲得更多的益處。
Disclosure statement 披露聲明
The authors declare no conflicts of interest. 作者聲明沒有利益衝突。
Isabel Gómez-Soria: Conceptualization, Methodology, Investigation, Resources, Data curation, Writing - original draft, Project administration. Isabel Iguacel: Investigation, Data curation, Writing - review & editing, Supervision. Alejandra Aguilar-Latorre: Investigation, Formal analysis, Resources, Data curation. Patricia Peralta-Marrupe: Investigation, Writing - review & editing. Eva Latorre: Investigation, Writing - review & editing, Supervision. Juan Nicolás Cuenca Zaldívar: Formal analysis, Data curation, Supervision. Estela Calatayud: Conceptualization, Methodology, Resources, Data curation. 伊莎貝爾·戈麥斯-索里亞：概念化、方法論、研究、資源、數據整理、撰寫 - 原始草稿、項目管理。伊莎貝爾·伊瓜塞爾：研究、數據整理、撰寫 - 審查與編輯、監督。亞歷杭德拉·阿吉拉爾-拉托雷：研究、正式分析、資源、數據整理。帕特里夏·佩拉爾塔-馬魯佩：研究、撰寫 - 審查與編輯。艾娃·拉托雷：研究、撰寫 - 審查與編輯、監督。胡安·尼古拉斯·昆卡·薩爾迪瓦爾：正式分析、數據整理、監督。埃斯特拉·卡拉塔尤德：概念化、方法論、資源、數據整理。
Declaration of Competing Interest 競爭利益聲明
The Authors declare that there is no conflict of interest. 作者聲明不存在利益衝突。
Acknowledgements 致謝
Neslihan Lok, Iracema Leroi and your teams for provide us the data Neslihan Lok、Iracema Leroi 及您的團隊提供我們數據
of the psychosocial variables of their studies to be able to carry out our meta-analysis. 他們研究的心理社會變數，以便能夠進行我們的統合分析。
Funding 資金
This research received no specific grant from any funding agency in the public, commercial, or not for- profit sectors. 本研究未獲得任何來自公共、商業或非營利部門的資助機構的特定資助。
Supplementary materials 補充材料
Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.archger.2022.104807. 與本文相關的補充材料可在在線版本中找到，網址為 doi:10.1016/j.archger.2022.104807。
References 參考文獻
Abraha, I., Rimland, J. M., Trotta, F. M., Dell’Aquila, G., Cruz-Jentoft, A., Petrovic, M., Gudmundsson, A., Soiza, R., O’Mahony, D., Guaita, A., & Cherubini, A. (2017). Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. the SENATOROnTop series. BMJ Open, 7(3). https://doi.org/10.1136/bmjopen-2016-012759 Abraha, I., Rimland, J. M., Trotta, F. M., Dell’Aquila, G., Cruz-Jentoft, A., Petrovic, M., Gudmundsson, A., Soiza, R., O’Mahony, D., Guaita, A., & Cherubini, A. (2017)。系統性回顧針對老年癡呆症患者行為障礙的非藥物干預的系統性回顧。SENATOROnTop 系列。BMJ Open, 7(3)。https://doi.org/10.1136/bmjopen-2016-012759
Acosta, C. O., Palacio, R. R., Borrego, G., García, R., & Rodríguez, M. J. (2022). Design guidelines and usability for cognitive stimulation through technology in Mexican older adults. Informatics for Health and Social Care, 47(1), 103-119. https://doi.org/ 10.1080/17538157.2021.1941973 Acosta, C. O., Palacio, R. R., Borrego, G., García, R., & Rodríguez, M. J. (2022)。透過科技對墨西哥老年人進行認知刺激的設計指導方針和可用性。《健康與社會護理資訊學》，47(1)，103-119。https://doi.org/10.1080/17538157.2021.1941973
Aguirre, E., Hoare, Z., Streater, A., Spector, A., Woods, B., Hoe, J., & Orrell, M. (2013). Cognitive stimulation therapy (CST) for people with dementia-who benefits most? International Journal of Geriatric Psychiatry, 28(3), 284-290. https://doi.org/ 10.1002/gps. 3823 Aguirre, E., Hoare, Z., Streater, A., Spector, A., Woods, B., Hoe, J., & Orrell, M. (2013)。認知刺激療法（CST）對於失智症患者的益處—誰受益最多？國際老年精神醫學期刊，28(3)，284-290。https://doi.org/10.1002/gps.3823
Aguirre, Elisa, Spector, A., Hoe, J., Russell, I. T., Knapp, M., Woods, R. T., & Orrell, M. (2010). Maintenance Cognitive Stimulation Therapy (CST) for dementia: A singleblind, multi-centre, randomized controlled trial of Maintenance CST vs. CST for dementia. Background Psychological treatments for dementia such as Reality Orientation (RO) and Reminiscence have been in use for nearly half a century, and are widely used in the UK and Trials, 11, 46. https://doi.org/10.1186/1745-6215-11-46. Aguirre, Elisa, Spector, A., Hoe, J., Russell, I. T., Knapp, M., Woods, R. T., & Orrell, M. (2010)。維持性認知刺激療法（CST）對於癡呆症的研究：一項單盲、多中心、隨機對照試驗，對比維持性 CST 與 CST 對於癡呆症的效果。背景：針對癡呆症的心理治療，如現實導向（RO）和回憶療法，已使用近半個世紀，並在英國廣泛應用。Trials, 11, 46. https://doi.org/10.1186/1745-6215-11-46。
Alves, J., Alves-Costa, F., Magalhães, R., Gonçalves, Ó. F., & Sampaio, A. (2014). Cognitive stimulation for Portuguese older adults with cognitive impairment: A randomized controlled trial of efficacy, comparative duration, feasibility, and experiential relevance. American Journal of Alzheimer’s Disease and Other Dementias, 29(6), 503-512. https://doi.org/10.1177/1533317514522541 Alves, J., Alves-Costa, F., Magalhães, R., Gonçalves, Ó. F., & Sampaio, A. (2014)。針對葡萄牙認知障礙老年人的認知刺激：一項隨機對照試驗的有效性、比較持續時間、可行性和體驗相關性。美國阿茲海默症及其他癡呆症期刊，29(6)，503-512。https://doi.org/10.1177/1533317514522541
Alzheimer’s Disease International. 2013. (n.d.). The global impact of dementia 2013-2050; policy brief: The global impact of dementia 2013-2050. Retrieved July 4, 2022, from https://www.alzint.org/u/2020/08/GlobalImpactDementia2013.pdf. 阿茲海默症國際組織。2013 年。（無日期）。2013-2050 年癡呆症的全球影響；政策簡報：2013-2050 年癡呆症的全球影響。於 2022 年 7 月 4 日檢索自 https://www.alzint.org/u/2020/08/GlobalImpactDementia2013.pdf。
American Psychiatric Association, E. (2013). Diagnostic and statistical manual of mental disorders (Fifth Edition (DSM-5)). 美國精神醫學會，E.（2013）。精神疾病診斷與統計手冊（第五版（DSM-5））。
Brown, H., D’Amico, F., Knapp, M., Orrell, M., Rehill, A., Vale, L., & Robinson, L. (2019). A cost effectiveness analysis of maintenance cognitive stimulation therapy (MCST) for people with dementia: Examining the influence of cognitive ability and living arrangements. Aging and Mental Health, 23(5), 602-607. https://doi.org/10.1080/ 13607863.2018.1442410 布朗，H.，達米科，F.，克納普，M.，奧雷爾，M.，瑞希爾，A.，瓦爾，L.，& 羅賓遜，L.（2019）。針對失智症患者的維持性認知刺激療法（MCST）成本效益分析：檢視認知能力和居住安排的影響。《老齡化與心理健康》，23（5），602-607。https://doi.org/10.1080/ 13607863.2018.1442410
Burke, S. N., & Barnes, C. A. (2006). Neural plasticity in the ageing brain. Nature Reviews Neuroscience, 7(1), 30-40. https://doi.org/10.1038/NRN1809 Burke, S. N., & Barnes, C. A. (2006). 老化大腦中的神經可塑性。自然神經科學評論，7(1)，30-40。https://doi.org/10.1038/NRN1809
Cafferata, R. M. T., Hicks, B., & von Bastian, C. C. (2021). Effectiveness of cognitive stimulation for dementia: A systematic review and meta-analysis. Psychological Bulletin, 147(5), 455-476. https://doi.org/10.1037/bul000032 Cafferata, R. M. T., Hicks, B., & von Bastian, C. C. (2021)。認知刺激對癡呆症的有效性：系統性回顧與元分析。《心理學公報》，147(5)，455-476。https://doi.org/10.1037/bul000032
Calatayud, E, Plo, F., & Muro, C. (2020). Analysis of the effect of a program of cognitive stimulation in elderly people with normal aging in primary care: Randomized clinical trial. Atencion Primaria, 52(1), 38-46. https://doi.org/10.1016/j. aprim.2018.09.007 Calatayud, E, Plo, F., & Muro, C. (2020). 在初級保健中對正常老化老年人進行認知刺激計劃的效果分析：隨機臨床試驗。初級護理，52(1)，38-46。https://doi.org/10.1016/j.aprim.2018.09.007
Calatayud, Estela, Jiménez-Sánchez, C., Calvo, S., Brandín-De la Cruz, N., Herrero, P., & Gómez-Soria, I. (2022). Effectiveness of cognitive stimulation personalized by the preexisting cognitive level in older adults: A randomized clinical trial. Topics in Geriatric Rehabilitation, 38(1), 73-80. https://doi.org/10.1097/ TGR. 0000000000000345 Calatayud, Estela, Jiménez-Sánchez, C., Calvo, S., Brandín-De la Cruz, N., Herrero, P., & Gómez-Soria, I. (2022). 根據既有認知水平個性化的認知刺激對老年人的有效性：一項隨機臨床試驗。老年康復學報，38(1)，73-80。https://doi.org/10.1097/TGR.0000000000000345
Capotosto, E., Belacchi, C., Gardini, S., Faggian, S., Piras, F., Mantoan, V., … Borella, E. (2017). Cognitive stimulation therapy in the Italian context: Its efficacy in cognitive and non-cognitive measures in older adults with dementia. International Journal of Geriatric Psychiatry, 32(3), 331-340. https://doi.org/10.1002/gps. 4521 Capotosto, E., Belacchi, C., Gardini, S., Faggian, S., Piras, F., Mantoan, V., … Borella, E. (2017)。意大利背景下的認知刺激療法：其在老年癡呆症患者的認知和非認知指標中的有效性。《國際老年精神病學期刊》，32(3)，331-340。https://doi.org/10.1002/gps.4521
Carbone, E., Gardini, S., Pastore, M., Piras, F., Vincenzi, M., & Borella, E. (2021). Cognitive stimulation therapy for older adults with mild-to-moderate dementia in Italy: Effects on cognitive functioning, and on emotional and neuropsychiatric symptoms. Journals of Gerontology - Series B Psychological Sciences and Social Sciences, 76(9), 1700-1710. https://doi.org/10.1093/geronb/gbab007 Carbone, E., Gardini, S., Pastore, M., Piras, F., Vincenzi, M., & Borella, E. (2021). 意大利輕度至中度癡呆老年人的認知刺激療法：對認知功能、情緒及神經精神症狀的影響。《老年學期刊 - B 系列 心理科學與社會科學》，76(9)，1700-1710。https://doi.org/10.1093/geronb/gbab007
Chao, I. C. I., Nicpon, K., & Roduta Roberts, M. (2020). Effect of cognitive stimulation therapy on quality of life: A critical review. Physical and Occupational Therapy in Geriatrics, 38(3), 203-229. https://doi.org/10.1080/02703181.2020.1716915 Chao, I. C. I., Nicpon, K., & Roduta Roberts, M. (2020). 認知刺激療法對生活品質的影響：一項關鍵評估。老年醫學中的物理與職業治療，38(3)，203-229。https://doi.org/10.1080/02703181.2020.1716915
Chen, J., Duan, Y., Li, H., Lu, L., Liu, J., & Tang, C. (2019). Different durations of cognitive stimulation therapy for Alzheimer’s disease: A systematic review and meta-analysis. Clinical Interventions in Aging, 14, 1243-1254. https://doi.org/ 10.2147/CIA.S210062 陳, J., 段, Y., 李, H., 陸, L., 劉, J., & 唐, C. (2019). 不同持續時間的認知刺激療法對阿茲海默症的影響：系統性回顧與統合分析。老年臨床介入, 14, 1243-1254. https://doi.org/ 10.2147/CIA.S210062
Ciarmiello, A., Gaeta, M., Benso, F., & Sette, M. (2015). FDG-PET in the evaluation of brain metabolic changes induced by cognitive stimulation in aMCI subjects. Current Ciarmiello, A., Gaeta, M., Benso, F., & Sette, M. (2015). FDG-PET 在評估輕度認知障礙（aMCI）受試者因認知刺激所引起的腦部代謝變化中的應用。
Radiopharmaceuticals, 8(1), 69-75. https://doi.org/10.2174/ 1874471008666150428122924 放射性藥物, 8(1), 69-75. https://doi.org/10.2174/ 1874471008666150428122924
Clare, L, & Woods, B. (2003). Cognitive rehabilitation and cognitive training for earlystage Alzheimer’s disease and vascular dementia. Cochrane Database of Systematic Reviews, 4. https://doi.org/10.1002/14651858.cd003260 Clare, L, & Woods, B. (2003). 認知康復與早期阿茲海默症及血管性癡呆的認知訓練。Cochrane 系統評價數據庫, 4. https://doi.org/10.1002/14651858.cd003260
Clare, L., & Woods, R. T. (2004). Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer’s disease: A review. Neuropsychological Rehabilitation, 14(4), 385-401. https://doi.org/10.1080/09602010443000074 Clare, L., & Woods, R. T. (2004). 早期阿茲海默症患者的認知訓練與認知康復：一項回顧。神經心理康復，14(4)，385-401。https://doi.org/10.1080/09602010443000074
Coen, R. F., Flynn, B., Rigney, E., O’Connor, E., Fitzgerald, L., Murray, C., Dunleavy, C., McDonald, M., Delaney, D., Merriman, N., & Edgeworth, J. (2011). Efficacy of a cognitive stimulation therapy programme for people with dementia. Irish Journal of Psychological Medicine, 28(3), 145-147. https://doi.org/10.1017/ S0790966700012131 Coen, R. F., Flynn, B., Rigney, E., O’Connor, E., Fitzgerald, L., Murray, C., Dunleavy, C., McDonald, M., Delaney, D., Merriman, N., & Edgeworth, J. (2011)。針對失智症患者的認知刺激療法計劃的療效。愛爾蘭心理醫學期刊，28(3)，145-147。https://doi.org/10.1017/S0790966700012131
Collins, J. M., Hill, E., Bindoff, A., King, A. E., Alty, J., Summers, M. J., & Vickers, J. C. (2021). Association between components of cognitive reserve and serum BDNF in healthy older adults. Frontiers in Aging Neuroscience, 13. https://doi.org/10.3389/ fnagi. 2021.725914 Collins, J. M., Hill, E., Bindoff, A., King, A. E., Alty, J., Summers, M. J., & Vickers, J. C. (2021). 認知儲備組件與健康老年人血清 BDNF 之間的關聯。老年神經科學前沿, 13. https://doi.org/10.3389/fnagi.2021.725914
Comas-Herrera, A., & Knapp, M. (2016). Cognitive Stimulation Therapy (CST): Summary of evidence on cost-effectiveness. London School of Economics, 1-5. May https://www .england.nhs.uk/wp-content/uploads/2018/01/dg-cognitive-stimulation-therapy. pdf. Comas-Herrera, A., & Knapp, M. (2016). 認知刺激療法 (CST)：成本效益證據摘要。倫敦經濟學院，1-5。五月 https://www .england.nhs.uk/wp-content/uploads/2018/01/dg-cognitive-stimulation-therapy. pdf.
Cove, J., Jacobi, N., Donovan, H., Orrell, M., Stott, J., & Spector, A. (2014). Effectiveness of weekly cognitive stimulation therapy for people with dementia and the additional impact of enhancing cognitive stimulation therapy with a carer training program. Clinical Interventions in Aging, 9, 2143-2150. https://doi.org/10.2147/CIA.S66232 Cove, J., Jacobi, N., Donovan, H., Orrell, M., Stott, J., & Spector, A. (2014). 每週認知刺激療法對失智症患者的有效性及通過增強照顧者訓練計劃來提升認知刺激療法的額外影響。老年臨床介入，9，2143-2150。https://doi.org/10.2147/CIA.S66232
D’Amico, F., Rehill, A., Knapp, M., Aguirre, E., Donovan, H., Hoare, Z., Hoe, J., Russell, I., Spector, A., Streater, A., Whitaker, C., Woods, R. T., & Orrell, M. (2015). Maintenance cognitive stimulation therapy: An economic evaluation within a randomized controlled trial. Journal of the American Medical Directors Association, 16 (1), 63-70. https://doi.org/10.1016/j.jamda.2014.10.020 D’Amico, F., Rehill, A., Knapp, M., Aguirre, E., Donovan, H., Hoare, Z., Hoe, J., Russell, I., Spector, A., Streater, A., Whitaker, C., Woods, R. T., & Orrell, M. (2015)。維持性認知刺激療法：隨機對照試驗中的經濟評估。《美國醫療主任協會期刊》，16 (1)，63-70。https://doi.org/10.1016/j.jamda.2014.10.020
De Oliveira, T. C. G., Soares, F. C., De Macedo, L. D. E. D., Diniz, D. L. P. W., BentoTorres, N. V. O., & Picanço-Diniz, C. W. (2014). Beneficial effects of multisensory and cognitive stimulation on age-related cognitive decline in long-term-care institutions. Clinical Interventions in Aging, 9, 309-321. https://doi.org/10.2147/CIA. S54383 De Oliveira, T. C. G., Soares, F. C., De Macedo, L. D. E. D., Diniz, D. L. P. W., BentoTorres, N. V. O., & Picanço-Diniz, C. W. (2014)。多感官和認知刺激對長期照護機構中與年齡相關的認知衰退的有益影響。《老年臨床介入》，9，309-321。https://doi.org/10.2147/CIA.S54383
DerSimonian, R., & Kacker, R. (2007). Random-effects model for meta-analysis of clinical trials: An update. Contemporary Clinical Trials, 28(2), 105-114. https://doi.org/ 10.1016/j.cct.2006.04.004 DerSimonian, R., & Kacker, R. (2007). 隨機效應模型在臨床試驗的統合分析中的應用：更新。當代臨床試驗, 28(2), 105-114. https://doi.org/ 10.1016/j.cct.2006.04.004
Devita, M., Masina, F., Mapelli, D., Anselmi, P., Sergi, G., & Coin, A. (2021). Acetylcholinesterase inhibitors and cognitive stimulation, combined and alone, in treating individuals with mild Alzheimer’s disease. Aging Clinical and Experimental Research, 33(11), 3039-3045. https://doi.org/10.1007/s40520-021-01837-8 Devita, M., Masina, F., Mapelli, D., Anselmi, P., Sergi, G., & Coin, A. (2021)。乙醯膽鹼酯酶抑制劑與認知刺激，單獨或聯合使用，治療輕度阿茲海默症患者。《老化臨床與實驗研究》，33(11)，3039-3045。https://doi.org/10.1007/s40520-021-01837-8
Dickinson, C., Gibson, G., Gotts, Z., Stobbart, L., & Robinson, L. (2017). Cognitive stimulation therapy in dementia care: Exploring the views and experiences of service providers on the barriers and facilitators to implementation in practice using normalization process theory. International Psychogeriatrics, 29(11), 1869-1878. https://doi.org/10.1017/S1041610217001272 迪金森，C.，吉布森，G.，戈茨，Z.，斯托巴特，L.，& 羅賓遜，L.（2017）。癡呆照護中的認知刺激療法：探討服務提供者對於在實踐中實施的障礙和促進因素的看法和經驗，使用正規化過程理論。《國際心理老年學》，29(11)，1869-1878。https://doi.org/10.1017/S1041610217001272
Djabelkhir, L., Wu, Y. H., Vidal, J. S., Cristancho-Lacroix, V., Marlats, F., Lenoir, H., Carno, A., & Rigaud, A. S. (2017). Computerized cognitive stimulation and engagement programs in older adults with mild cognitive impairment: Comparing feasibility, acceptability, and cognitive and psychosocial effects. Clinical Interventions in Aging, 12, 1967-1975. https://doi.org/10.2147/CIA.S145769 Djabelkhir, L., Wu, Y. H., Vidal, J. S., Cristancho-Lacroix, V., Marlats, F., Lenoir, H., Carno, A., & Rigaud, A. S. (2017)。針對輕度認知障礙老年人的電腦化認知刺激與參與計劃：比較可行性、可接受性及認知與心理社會影響。《臨床老年介入》，12，1967-1975。https://doi.org/10.2147/CIA.S145769
Duff, C. (2018). Dementia: Assessment, management and support for people living with dementia and their carers. http://eprints.lincoln.ac.uk/id/eprint/38978/. Duff, C. (2018). 癡呆症：對生活在癡呆症中的人及其照顧者的評估、管理和支持。http://eprints.lincoln.ac.uk/id/eprint/38978/.
Duval, S., & Tweedie, R. (2000a). A nonparametric “Trim and Fill” method of accounting for publication bias in meta-analysis. Journal of the American Statistical Association, 95(449), 89-98. https://doi.org/10.1080/01621459.2000.10473905 Duval, S., & Tweedie, R. (2000a). 一種非參數的“修剪與填充”方法用於在元分析中考慮出版偏倚。美國統計協會期刊, 95(449), 89-98. https://doi.org/10.1080/01621459.2000.10473905
Duval, S., & Tweedie, R. (2000b). Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56(2), 455-463. https://doi.org/10.1111/j.0006-341X.2000.00455.x Duval, S., & Tweedie, R. (2000b). 修剪與填充：一種基於漏斗圖的簡單方法，用於測試和調整元分析中的出版偏倚。生物統計學, 56(2), 455-463. https://doi.org/10.1111/j.0006-341X.2000.00455.x
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal, 315(7109), 629-634. https://doi.org/10.1136/bmj.315.7109.629 Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). 透過簡單的圖形測試檢測元分析中的偏差。英國醫學期刊，315(7109)，629-634。https://doi.org/10.1136/bmj.315.7109.629
Emre, M., Aarsland, D., Brown, R., Burn, D. J., Duyckaerts, C., Mizuno, Y., Broe, G. A., Cummings, J., Dickson, D. W., Gauthier, S., Goldman, J., Goetz, C., Korczyn, A., Lees, A., Levy, R., Litvan, I., McKeith, I., Olanow, W., Poewe, W., & Dubois, B. (2007). Clinical diagnostic criteria for dementia associated with Parkinson’s disease. Movement Disorders, 22(12), 1689-1707. https://doi.org/10.1002/mds. 21507 Emre, M., Aarsland, D., Brown, R., Burn, D. J., Duyckaerts, C., Mizuno, Y., Broe, G. A., Cummings, J., Dickson, D. W., Gauthier, S., Goldman, J., Goetz, C., Korczyn, A., Lees, A., Levy, R., Litvan, I., McKeith, I., Olanow, W., Poewe, W., & Dubois, B. (2007)。與帕金森病相關的癡呆臨床診斷標準。運動障礙，22(12)，1689-1707。https://doi.org/10.1002/mds.21507
Félix, S. B., Ribeiro, O., & Maia, H. (2020). Personalized cognitive stimulation through personhood: A case report on dementia diagnosis acceptance and therapeutic engagement. Clinical Gerontologist, 43(2), 233-239. https://doi.org/10.1080/ 07317115.2019.1648349 費利克斯, S. B., 里貝羅, O., & 邁亞, H. (2020). 透過個人化的認知刺激：一例關於癡呆診斷接受與治療參與的案例報告. 臨床老年學家, 43(2), 233-239. https://doi.org/10.1080/ 07317115.2019.1648349
Fernández Calvo, B., Contador Castillo, I., Serna, A., Menezes de Lucena, V., & Ramos Campos, F. (2010). El efecto del formato de intervención individual o grupal en la estimulación cognitivade pacientes con enfermedad de Alzheimer. Revista de Psicopatología y Psicología Clínica, 15(2), 115-123. https://doi.org/10.5944/rppc. vol.15.num.2.2010.4090 Fernández Calvo, B., Contador Castillo, I., Serna, A., Menezes de Lucena, V., & Ramos Campos, F. (2010). 個別或團體介入格式對阿茲海默病患者認知刺激的影響。心理病理學與臨床心理學期刊, 15(2), 115-123. https://doi.org/10.5944/rppc.vol.15.num.2.2010.4090
Folkerts, A. K., Dorn, M., Roheger, M., Maassen, M., Koerts, J., Tucha, O., Altgassen, M., Sack, A. T., Smit, D., Haarmann, L., & Kalbe, E. (2018). Cognitive stimulation for individuals with Parkinson’s disease dementia living in long-term care: Preliminary data from a randomized crossover pilot study. Parkinson’s Disease. https://doi.org/ 10.1155/2018/8104673, 2018. Folkerts, A. K., Dorn, M., Roheger, M., Maassen, M., Koerts, J., Tucha, O., Altgassen, M., Sack, A. T., Smit, D., Haarmann, L., & Kalbe, E. (2018)。針對長期照護中帕金森病癡呆患者的認知刺激：來自隨機交叉試點研究的初步數據。《帕金森病》。https://doi.org/ 10.1155/2018/8104673，2018。
Gauthier, S., Reisberg, B., Zaudig, M., Petersen, R. C., Ritchie, K., Broich, K., & Belleville, S. (2006). Mild cognitive impairment. Lancet, 367(9518), 1262-1270 (2006)No Title. Lancet, 367(9618), 1262-1270. 高提耶，S.，瑞斯伯格，B.，扎烏迪格，M.，彼得森，R. C.，里奇，K.，布羅伊希，K.，& 貝爾維爾，S. (2006)。輕度認知障礙。柳葉刀，367(9518)，1262-1270 (2006)無標題。柳葉刀，367(9618)，1262-1270。
Gómez-Soria, I., Brandín-de la Cruz, N., Cuenca Zaldívar, J. N., Calvo, S., Herrero, P., & Calatayud, E. (2021). Effectiveness of personalized cognitive stimulation in older adults with mild possible cognitive impairment: A 12-month follow-up cognitive stimulation in mild cognitive impairment. Clinical Gerontologist, 45(4), 1-13. https:// doi.org/10.1080/07317115.2021.1937764 Gómez-Soria, I., Brandín-de la Cruz, N., Cuenca Zaldívar, J. N., Calvo, S., Herrero, P., & Calatayud, E. (2021)。針對輕度可能認知障礙的老年人進行個性化認知刺激的有效性：對輕度認知障礙的 12 個月後續認知刺激。臨床老年學家，45(4)，1-13。https://doi.org/10.1080/07317115.2021.1937764
Gómez-Soria, I., Esteban, E. M. A., Bruton, A. G., & Peralta-Marrupe, P. (2021). Análisis del efecto a largo plazo de un programa de estimulación cognitiva en mayores con deterioro cognitivo leve en Atención Primaria: Ensayo controlado aleatorizado. Atención Primaria, 53(7), Article 102053. Gómez-Soria, I., Esteban, E. M. A., Bruton, A. G., & Peralta-Marrupe, P. (2021). 在初級保健中對輕度認知障礙老年人進行認知刺激計劃的長期效果分析：隨機對照試驗。初級保健，53(7)，文章 102053。
Gomez-Soria, I., Peralta-Marrupe, P., & Plo, F. (2020). Cognitive stimulation program in mild cognitive impairment a randomized controlled trial. Dementia e Neuropsychologia, 14(2), 110-117. https://doi.org/10.1590/1980-57642020dn14020003 Gomez-Soria, I., Peralta-Marrupe, P., & Plo, F. (2020). 輕度認知障礙的認知刺激計劃：一項隨機對照試驗。癡呆與神經心理學，14(2)，110-117。https://doi.org/10.1590/1980-57642020dn14020003
Higgins, J. P. T., & Thompson, S. G. (2002). Quantifying heterogeneity in a metaanalysis. Statistics in Medicine, 21(11), 1539-1558. https://doi.org/10.1002/ sim. 1186 Higgins, J. P. T., & Thompson, S. G. (2002). 在元分析中量化異質性。醫學統計，21(11)，1539-1558。https://doi.org/10.1002/sim.1186
Hodge, S., Hailey, E., Colwill, A., Walker, L. and Orrell, M. (2016). Memory services national accreditation programme (MSNAP) (Pub. No. CCQ1221).http://www. rcpsych.ac.uk/PDF/MSNAPstandards.5th.edition.pdf. 霍奇，S.，海利，E.，科爾威爾，A.，沃克，L. 和奧雷爾，M.（2016）。記憶服務國家認證計劃（MSNAP）（出版號 CCQ1221）。http://www.rcpsych.ac.uk/PDF/MSNAPstandards.5th.edition.pdf。
Jamovi. (2021). The Jamovi project (Version 1.6) [Computer Software].https://www. jamovi.org. Jamovi. (2021). Jamovi 專案 (版本 1.6) [電腦軟體]. https://www.jamovi.org.
Jean, L., Bergeron, M.E…, Thivierge, S., & Simard, M. (2010). Cognitive intervention programs for individuals with mild cognitive impairment: Systematic review of the literature. American Journal of Geriatric Psychiatry, 18(4), 281-296. https://doi.org/ 10.1097/JGP.0b013e3181c37ce9 Jean, L., Bergeron, M.E…, Thivierge, S., & Simard, M. (2010). 輕度認知障礙者的認知介入計劃：文獻系統回顧。美國老年精神病學期刊，18(4)，281-296。https://doi.org/ 10.1097/JGP.0b013e3181c37ce9
Juárez-Cedillo, T., Gutiérrez-Gutiérrez, L., Sánchez-Hurtado, L. Al, MartínezRodríguez, N., & Juarez-Cedillo, E (2020). Randomized controlled trial of multicomponent cognitive stimulation therapy (SADEM) in community-dwelling demented adults. Journal of Alzheimer’s Disease, 78(3), 1033-1045. https://doi.org/ 10.3233/JAD-200574 Juárez-Cedillo, T., Gutiérrez-Gutiérrez, L., Sánchez-Hurtado, L. Al, MartínezRodríguez, N., & Juarez-Cedillo, E (2020)。社區居住失智成人的多元成分認知刺激療法（SADEM）隨機對照試驗。《阿茲海默病期刊》，78(3)，1033-1045。https://doi.org/10.3233/JAD-200574
Justo-Henriques, S. I., Elisa, A., Castro, M., Vázquez, F. L., & Torres-Iglesias, A. (2019). Long-term individual cognitive stimulation program in patients with mild neurocognitive disorder: A pilot study. Revue Neurologique, 68(7), 281-289. https:// doi.org/10.33588/rn.6807.2018321 Justo-Henriques, S. I., Elisa, A., Castro, M., Vázquez, F. L., & Torres-Iglesias, A. (2019)。輕度神經認知障礙患者的長期個體認知刺激計劃：一項初步研究。《神經學評論》，68(7)，281-289。https://doi.org/10.33588/rn.6807.2018321
Justo-Henriques, S. I., Otero, P., Torres, Á. J., & Vázquez, F. L. (2021). Effect of long-term individual cognitive stimulation intervention for people with mild neurocognitive disorder. Revista de Neurologia, 73(4), 121-129. https://doi.org/10.33588/ rn.7304.2021114 Justo-Henriques, S. I., Otero, P., Torres, Á. J., & Vázquez, F. L. (2021). 對輕度神經認知障礙者進行長期個別認知刺激介入的效果。神經學雜誌, 73(4), 121-129. https://doi.org/10.33588/ rn.7304.2021114
Kaido Id, M., Fukui, M., Kawashima Id, M., Negishi, K., & Tsubotaid, K. (2020). Relationship between visual function and cognitive function in the elderly: A crosssectional observational study. doi:10.1371/journal.pone. 0233381. Kaido Id, M., Fukui, M., Kawashima Id, M., Negishi, K., & Tsubotaid, K. (2020). 老年人視覺功能與認知功能之間的關係：一項橫斷面觀察研究。doi:10.1371/journal.pone. 0233381.
Kim, K., Han, J. W., So, Y., Seo, J., Kim, Y. J., Park, J. H., Lee, S. B., Lee, J. J., Jeong, H.G., Kim, T. H., & Kim, K. W. (2017). Cognitive stimulation as a therapeutic modality for dementia: A meta-analysis. Psychiatry Investigation, 14(5), 626-639. https://doi. org/10.4306/pi.2017.14.5.626 金, K., 韓, J. W., 蘇, Y., 徐, J., 金, Y. J., 朴, J. H., 李, S. B., 李, J. J., 鄭, H.G., 金, T. H., & 金, K. W. (2017). 認知刺激作為治療癡呆的療法：一項元分析。精神醫學調查, 14(5), 626-639. https://doi.org/10.4306/pi.2017.14.5.626
Knapp, M., Thorgrimsen, L., Patel, A., Spector, A., Hallam, A., Woods, B., & Orrell, M. (2006). Cognitive stimulation therapy for people with dementia: Cost-effectiveness analysis. British Journal of Psychiatry, 188(JUNE), 574-580. https://doi.org/ 10.1192/bjp.bp.105.010561 Knapp, M., Thorgrimsen, L., Patel, A., Spector, A., Hallam, A., Woods, B., & Orrell, M. (2006)。針對失智症患者的認知刺激療法：成本效益分析。《英國精神病學雜誌》，188（6 月），574-580。https://doi.org/10.1192/bjp.bp.105.010561
Kor, P. P. K., Yu, C. T. K., Liu, J. Y. W., Cheung, D. S. K., Kwan, R. Y. C., Leung, A. Y. M., Liu, D. P. M., & Hon, J. M. K. (2022). Pilot evaluation of a home-based multi-sensory cognitive stimulation intervention for older people with dementia and caregiver dyads during the COVID-19 pandemic. International Journal of Older People Nursing. https://doi.org/10.1111/OPN. 12471 Kor, P. P. K., Yu, C. T. K., Liu, J. Y. W., Cheung, D. S. K., Kwan, R. Y. C., Leung, A. Y. M., Liu, D. P. M., & Hon, J. M. K. (2022)。針對老年癡呆症患者及其照顧者在 COVID-19 疫情期間的居家多感官認知刺激介入的初步評估。《國際老年護理期刊》。https://doi.org/10.1111/OPN. 12471
La Rue, A. (2010). Healthy brain aging: Role of cognitive reserve, cognitive stimulation, and cognitive exercises. Clinics in Geriatric Medicine, 26, 99-111. https://doi.org/ 10.1016/j.cger.2009.11.003 La Rue, A. (2010). 健康的腦部老化：認知儲備、認知刺激和認知訓練的角色。老年醫學診所，26，99-111。https://doi.org/ 10.1016/j.cger.2009.11.003
Langa, K. M., & Levine, D. A. (2014). The diagnosis and management of mild cognitive impairment: A clinical review. JAMA - Journal of the American Medical Association, 312(23), 2551-2561. https://doi.org/10.1001/JAMA.2014.13806 Langa, K. M., & Levine, D. A. (2014). 輕度認知障礙的診斷與管理：臨床回顧。JAMA - 美國醫學會雜誌，312(23)，2551-2561。https://doi.org/10.1001/JAMA.2014.13806
Leroi, Iracema, Vatter, S., Carter, L. A., Smith, S. J., Orgeta, V., Poliakoff, E., McCormick, S. A (2019). Parkinson’s-adapted cognitive stimulation therapy: A pilot randomized controlled clinical trial. Therapeutic Advances in Neurological Disorders, 12. https://doi.org/10.1177/1756286419852217 Leroi, Iracema, Vatter, S., Carter, L. A., Smith, S. J., Orgeta, V., Poliakoff, E., McCormick, S. A (2019)。帕金森病適應的認知刺激療法：一項初步隨機對照臨床試驗。神經疾病治療進展，12。https://doi.org/10.1177/1756286419852217
Litvan, I., Goldman, J. G., Tröster, A. I., Schmand, B. A., Weintraub, D., Petersen, R. C., Mollenhauer, B., Adler, C. H., Marder, K., Williams-Gray, C. H., Aarsland, D., Kulisevsky, J., Rodriguez-Oroz, M. C., Burn, D. J., Barker, R. A., & Emre, M. (2012). Diagnostic criteria for mild cognitive impairment in Parkinson’s disease: Movement disorder society task force guidelines. Movement Disorders, 27(3), 349-356. https:// doi.org/10.1002/mds. 24893 Litvan, I., Goldman, J. G., Tröster, A. I., Schmand, B. A., Weintraub, D., Petersen, R. C., Mollenhauer, B., Adler, C. H., Marder, K., Williams-Gray, C. H., Aarsland, D., Kulisevsky, J., Rodriguez-Oroz, M. C., Burn, D. J., Barker, R. A., & Emre, M. (2012)。帕金森病輕度認知障礙的診斷標準：運動障礙學會工作小組指導方針。《運動障礙》，27(3)，349-356。https://doi.org/10.1002/mds.24893
Liu, T., Spector, A., Mograbi, D. C., Cheung, G., & Wong, G. H. Y. (2021). Changes in default mode network connectivity in resting-state fmri in people with mild dementia receiving cognitive stimulation therapy. Brain Sciences, 11(9). https://doi. org/10.3390/brainsci11091137 劉, T., 斯佩克特, A., 莫格拉比, D. C., 張, G., & 黃, G. H. Y. (2021). 輕度癡呆患者接受認知刺激療法時靜息態 fMRI 中默認模式網絡連接的變化。腦科學, 11(9). https://doi.org/10.3390/brainsci11091137
Lobbia, A, Carbone, E., Faggian, S., Gardini, S., Piras, F., Spector, A., & Borella, E. (2019). The efficacy of cognitive stimulation therapy (CST) for people with mild-to-moderate dementia: A review. European Psychologist, 24(3), 257-277. https://doi.org/ 10.1027/1016-9040/a000342 Lobbia, A, Carbone, E., Faggian, S., Gardini, S., Piras, F., Spector, A., & Borella, E. (2019)。輕度至中度癡呆患者的認知刺激療法（CST）療效：一項綜述。歐洲心理學家，24(3)，257-277。https://doi.org/10.1027/1016-9040/a000342
Lok, N., Buldukoglu, K., & Barcin, E. (2020). Effects of the cognitive stimulation therapy based on Roy’s adaptation model on Alzheimer’s patients’ cognitive functions, coping-adaptation skills, and quality of life: A randomized controlled trial. Lok, N., Buldukoglu, K., & Barcin, E. (2020). 基於羅伊適應模型的認知刺激療法對阿茲海默病患者的認知功能、應對適應技能和生活質量的影響：一項隨機對照試驗。
Perspectives in Psychiatric Care, 56(3), 581-592. https://doi.org/10.1111/ppc. 12472 Mahncke, H. W., Connor, B. B., Appelman, J., Ahsanuddin, O. N., Hardy, J. L., Wood, R. A., Joyce, N. M., Boniske, T., Atkins, S. M., & Merzenich, M. M. (2006). Memory enhancement in healthy older adults using a brain plasticity-based training program: A randomized, controlled study. Proceedings of the National Academy of 精神科護理觀點, 56(3), 581-592. https://doi.org/10.1111/ppc.12472 Mahncke, H. W., Connor, B. B., Appelman, J., Ahsanuddin, O. N., Hardy, J. L., Wood, R. A., Joyce, N. M., Boniske, T., Atkins, S. M., & Merzenich, M. M. (2006). 使用基於大腦可塑性的訓練計劃增強健康老年人的記憶：一項隨機對照研究。全國科學院會議錄
Sciences of the United States of America, 103(33), 12523-12528. https://doi.org/ 10.1073/pnas. 0605194103 美國科學院院刊, 103(33), 12523-12528. https://doi.org/ 10.1073/pnas. 0605194103
Marinho, V, Bertrand, E., Naylor, R., Bomilcar, I., Laks, J., Spector, A., & Mograbi, D. C. (2021). Cognitive stimulation therapy for people with dementia in Brazil (CSTBrasil): Results from a single blind randomized controlled trial. International Journal of Geriatric Psychiatry, 36(2), 286-293. https://doi.org/10.1002/gps. 5421 Marinho, V, Bertrand, E., Naylor, R., Bomilcar, I., Laks, J., Spector, A., & Mograbi, D. C. (2021)。巴西失智症患者的認知刺激療法 (CSTBrasil)：單盲隨機對照試驗的結果。《國際老年精神病學期刊》，36(2)，286-293。https://doi.org/10.1002/gps.5421
Massoud, F., & Léger, G. C. (2011). Pharmacological treatment of Alzheimer disease. Canadian Journal of Psychiatry, 56(10), 579-588. https://doi.org/10.1177/ 070674371105601003 Massoud, F., & Léger, G. C. (2011). 阿茲海默症的藥物治療。加拿大精神醫學期刊，56(10)，579-588。https://doi.org/10.1177/ 070674371105601003
Mather, M. (2020). How do cognitively stimulating activities affect cognition and the brain throughout life? Psychological Science in the Public Interest, 21(1), 1-5. https:// doi.org/10.1177/1529100620941808 Mather, M. (2020). 認知刺激活動如何影響整個生命週期中的認知和大腦？公共利益心理科學, 21(1), 1-5. https:// doi.org/10.1177/1529100620941808
McKeith, I. G., Boeve, B. F., DIckson, D. W., Halliday, G., Taylor, J. P., Weintraub, D., Aarsland, D., Galvin, J., Attems, J., Ballard, C. G., Bayston, A., Beach, T. G., Blanc, F., Bohnen, N., Bonanni, L., Bras, J., Brundin, P., Burn, D., Chen-Plotkin, A., & Kosaka, K. (2017). Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology, 89(1), 88-100. https://doi.org/ 10.1212/WNL. 0000000000004058 McKeith, I. G., Boeve, B. F., DIckson, D. W., Halliday, G., Taylor, J. P., Weintraub, D., Aarsland, D., Galvin, J., Attems, J., Ballard, C. G., Bayston, A., Beach, T. G., Blanc, F., Bohnen, N., Bonanni, L., Bras, J., Brundin, P., Burn, D., Chen-Plotkin, A., & Kosaka, K. (2017)。路易體癡呆的診斷與管理：DLB 聯盟第四次共識報告。神經學，89(1)，88-100。https://doi.org/ 10.1212/WNL. 0000000000004058
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA work group ***\star under the auspices of department of health and human services task force on Alzheimer’s disease. Neurology, 34(7), 939-944. https://doi.org/10.1212/ WNL.34.7.939 McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E. M. (1984)。阿茲海默症的臨床診斷：NINCDS-ADRDA 工作組在健康與人類服務部阿茲海默症工作小組的支持下的報告。神經學，34(7)，939-944。https://doi.org/10.1212/WNL.34.7.939
Middelstadt, J., Folkerts, A. K., Blawath, S., & Kalbe, E. (2016). Cognitive stimulation for people with dementia in long-term care facilities: Baseline cognitive level predicts cognitive gains, moderated by depression. Journal of Alzheimer’s Disease : JAD, 54(1), 253-268. https://doi.org/10.3233/JAD-160181 Middelstadt, J., Folkerts, A. K., Blawath, S., & Kalbe, E. (2016). 長期照護機構中針對失智症患者的認知刺激：基線認知水平預測認知增益，並受到抑鬱的調節。阿茲海默病期刊：JAD, 54(1), 253-268. https://doi.org/10.3233/JAD-160181
Millán-Calenti, J. C., Tubío, J., Pita-Fernández, S., Rochette, S., Lorenzo, T., & Maseda, A. (2012). Cognitive impairment as predictor of functional dependence in an elderly sample. Archives of Gerontology and Geriatrics, 54(1), 197-201. https://doi.org/ 10.1016/J.ARCHGER.2011.02.010 Millán-Calenti, J. C., Tubío, J., Pita-Fernández, S., Rochette, S., Lorenzo, T., & Maseda, A. (2012). 認知障礙作為老年樣本中功能依賴的預測因子。老年學與老年醫學期刊，54(1)，197-201。https://doi.org/ 10.1016/J.ARCHGER.2011.02.010
Miranda-Castillo, C., Tapia, F. M., Herrera, A. R., Ghigliotto, F. M., & Guerra, L. S. (2013). Implementación de un programa de estimulación cognitiva en personas con demencia tipo alzheimer: Un estudio piloto en chilenos de la tercera edad*. Universitas Psychologica, 12(2), 445-456. https://doi.org/10.11144/Javeriana. UPSY12-2.ipec Miranda-Castillo, C., Tapia, F. M., Herrera, A. R., Ghigliotto, F. M., & Guerra, L. S. (2013). 在阿茲海默型癡呆症患者中實施認知刺激計劃：對智利老年人的一項初步研究*. Universitas Psychologica, 12(2), 445-456. https://doi.org/10.11144/Javeriana. UPSY12-2.ipec
Muñoz Marrón, E. (2009). Estimulación cognitiva y rehabilitación neuropsicológica. UOC (Ed.). 穆尼奧斯·馬龍，E.（2009）。認知刺激與神經心理康復。UOC（編輯）。
Niu, Y. X., Tan, J. P., Guan, J. Q., Zhang, Z. Q., & Wang, L. N. (2010). Cognitive stimulation therapy in the treatment of neuropsychiatric symptoms in Alzheimer’s disease: A randomized controlled trial. Clinical Rehabilitation, 24(12), 1102-1111. https://doi.org/10.1177/0269215510376004 牛耀欣、譚建平、關建權、張志強、王麗娜（2010）。認知刺激療法在阿茲海默症神經精神症狀治療中的應用：一項隨機對照試驗。《臨床康復》，24(12)，1102-1111。https://doi.org/10.1177/0269215510376004
Novoa, A. M., Juárez, O., & Nebot, M. (2008). Review of the effectiveness of cognitive interventions in preventing cognitive deterioration in healthy elderly individuals. Gaceta Sanitaria, 22(5), 474-482. https://doi.org/10.1157/13126930 Novoa, A. M., Juárez, O., & Nebot, M. (2008). 健康老年人認知衰退預防中認知介入效果的回顧。公共衛生雜誌，22(5)，474-482。https://doi.org/10.1157/13126930
Oliveira, J., Gamito, P., Alghazzawi, D. M., Fardoun, H. M., Rosa, P. J., Sousa, T., Picareli, L. F., Morais, D., & Lopes, P. (2018). Performance on naturalistic virtual reality tasks depends on global cognitive functioning as assessed via traditional neurocognitive tests. Applied Neuropsychology:Adult, 25(6), 555-561. https://doi. org/10.1080/23279095.2017.1349661 Oliveira, J., Gamito, P., Alghazzawi, D. M., Fardoun, H. M., Rosa, P. J., Sousa, T., Picareli, L. F., Morais, D., & Lopes, P. (2018)。自然主義虛擬現實任務的表現取決於通過傳統神經認知測試評估的整體認知功能。《應用神經心理學：成人》，25(6)，555-561。https://doi.org/10.1080/23279095.2017.1349661
Oliveira, J., Gamito, P., Souto, T., Conde, R., Ferreira, M., Corotnean, T., Fernandes, A., Silva, H., & Neto, T. (2021). Virtual reality-based cognitive stimulation on people with mild to moderate dementia due to Alzheimer’s disease: A pilot randomized controlled trial. International Journal of Environmental Research and Public Health, (10), 18. https://doi.org/10.3390/ijerph18105290 Oliveira, J., Gamito, P., Souto, T., Conde, R., Ferreira, M., Corotnean, T., Fernandes, A., Silva, H., & Neto, T. (2021)。基於虛擬現實的認知刺激對輕度至中度阿茲海默症患者的影響：一項初步隨機對照試驗。《國際環境研究與公共衛生期刊》，(10)，18。https://doi.org/10.3390/ijerph18105290
Orfanos, S., Gibbor, L., Carr, C., & Spector, A. (2021). Group-based cognitive stimulation therapy for dementia: A qualitative study on experiences of group interactions. Aging and Mental Health, 25(6), 991-998. https://doi.org/10.1080/ 13607863.2020.1746740 Orfanos, S., Gibbor, L., Carr, C., & Spector, A. (2021)。針對癡呆症的團體認知刺激療法：關於團體互動經驗的質性研究。《老齡與心理健康》，25(6)，991-998。https://doi.org/10.1080/ 13607863.2020.1746740
Orrell, M., Aguirre, E., Spector, A., Hoare, Z., Woods, R. T., Streater, A., Donovan, H., Hoe, J., Knapp, M., Whitaker, C., & Russell, I. (2014). Maintenance cognitive stimulation therapy for dementia: Single-blind, multicentre, pragmatic randomised controlled trial. British Journal of Psychiatry, 204(6), 454-461. https://doi.org/ 10.1192/bjp.bp.113.137414 Orrell, M., Aguirre, E., Spector, A., Hoare, Z., Woods, R. T., Streater, A., Donovan, H., Hoe, J., Knapp, M., Whitaker, C., & Russell, I. (2014)。維持性認知刺激療法對於癡呆症的研究：單盲、多中心、實用隨機對照試驗。《英國精神病學雜誌》，204(6)，454-461。https://doi.org/10.1192/bjp.bp.113.137414
Park, J. M., Kim, M. W., & Shim, H. Y. (2019). Effects of a multicomponent cognitive stimulation program on cognitive function improvement among elderly women. Asian Nursing Research, 13(5), 306-312. https://doi.org/10.1016/j.anr.2019.11.001 Park, J. M., Kim, M. W., & Shim, H. Y. (2019). 多成分認知刺激計劃對老年女性認知功能改善的影響。亞洲護理研究, 13(5), 306-312. https://doi.org/10.1016/j.anr.2019.11.001
Peters, J. L., Sutton, A. J., Jones, D. R., Abrams, K. R., & Rushton, L. (2006). Comparison of two methods to detect publication bias in meta-analysis. Journal of the American Medical Association, 295(6), 676-680. https://doi.org/10.1001/jama.295.6.676 Peters, J. L., Sutton, A. J., Jones, D. R., Abrams, K. R., & Rushton, L. (2006)。比較兩種檢測元分析中出版偏倚的方法。《美國醫學會雜誌》，295(6)，676-680。https://doi.org/10.1001/jama.295.6.676
Petersen, R. C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256(3), 183-194. https://doi.org/10.1111/j.13652796.2004.01388.x 彼得森，R. C. (2004)。輕度認知障礙作為診斷實體。《內科醫學雜誌》，256(3)，183-194。https://doi.org/10.1111/j.13652796.2004.01388.x
Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Tangalos, E. G., & Kokmen, E. (1999). Mild cognitive impairment: Clinical characterization and outcome. Archives of Neurology, 56(3), 303-308. 彼得森，R. C.，史密斯，G. E.，瓦林，S. C.，伊夫尼克，R. J.，坦加洛斯，E. G.，& 科克門，E.（1999）。輕度認知障礙：臨床特徵及結果。《神經學檔案》，56(3)，303-308。
Polito, L., Abbondanza, S., Vaccaro, R., Valle, E., Davin, A., Degrate, A., Villani, S., & Guaita, A. (2015). Cognitive stimulation in cognitively impaired individuals and cognitively healthy individuals with a family history of dementia: Short-term results from the “allena-Mente” randomized controlled trial. International Journal of Geriatric Psychiatry, 30(6), 631-638. https://doi.org/10.1002/GPS. 4194 Polito, L., Abbondanza, S., Vaccaro, R., Valle, E., Davin, A., Degrate, A., Villani, S., & Guaita, A. (2015)。在有認知障礙的個體和有癡呆家族史的認知健康個體中進行的認知刺激：來自“allena-Mente”隨機對照試驗的短期結果。《國際老年精神病學期刊》，30(6)，631-638。https://doi.org/10.1002/GPS.4194
Quality Assessment Tool for Controlled Intervention Studies, Observational cohort and cross-sectional studies and pre-post studies with no control group. NIH National Heart, Lung, and Blood Institute website. [Online]. (n.d.). NIH National Heart, Lung, and Blood Institute Website.https://www.nhlbi.nih.gov/health-topics/study-qualit y-assessment-tools. 控制干預研究、觀察性隊列和橫斷面研究以及無對照組的前後研究的質量評估工具。美國國立衛生研究院國家心臟、肺部和血液研究所網站。[線上]。(無日期)。美國國立衛生研究院國家心臟、肺部和血液研究所網站。https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools。
Reijnders, J., van Heugten, C., & van Boxtel, M. (2013). Cognitive interventions in healthy older adults and people with mild cognitive impairment: A systematic review. Ageing Research Reviews, 12(1), 263-275. https://doi.org/10.1016/j. arr.2012.07.003 Reijnders, J., van Heugten, C., & van Boxtel, M. (2013)。健康老年人和輕度認知障礙者的認知干預：系統性回顧。《老化研究評論》，12(1)，263-275。https://doi.org/10.1016/j.arr.2012.07.003
Rethlefsen, M. L., Kirtley, S., Waffenschmidt, S., Ayala, A. P., Moher, D., Page, M. J., & Koffel, J. B. (2021). PRISMA-S: An extension to the PRISMA statement for reporting literature searches in systematic reviews. Systematic Reviews, 10(1), 39. https://doi. org/10.1186/S13643-020-01542-Z Rethlefsen, M. L., Kirtley, S., Waffenschmidt, S., Ayala, A. P., Moher, D., Page, M. J., & Koffel, J. B. (2021). PRISMA-S：系統評價文獻搜尋報告的 PRISMA 聲明擴展。系統評價，10(1)，39。https://doi.org/10.1186/S13643-020-01542-Z
Román, G. C., Tatemichi, T. K., Erkinjuntti, T., Cummings, J. L., Masdeu, J. C., Garcia, J. H., Amaducci, L., Orgogozo, J. M., Brun, A., Hofman, A., Moody, D. M., O’Brien, M. D., Yamaguchi, T., Grafman, J., Drayer, B. P., Bennett, D. A., Fisher, M., Ogata, J., Kokmen, E., … Scheinberg, P. (1993). Vascular dementia. Neurology, 43 (2). https://doi.org/10.1212/WNL.43.2.250, 250-250. Román, G. C., Tatemichi, T. K., Erkinjuntti, T., Cummings, J. L., Masdeu, J. C., Garcia, J. H., Amaducci, L., Orgogozo, J. M., Brun, A., Hofman, A., Moody, D. M., O’Brien, M. D., Yamaguchi, T., Grafman, J., Drayer, B. P., Bennett, D. A., Fisher, M., Ogata, J., Kokmen, E., … Scheinberg, P. (1993)。血管性癡呆。神經學，43 (2)。https://doi.org/10.1212/WNL.43.2.250，250-250。
Salthouse, T. A. (2006). Mental exercise and mental aging evaluating the validity of the “Use It or Lose It” hypothesis. Salthouse, T. A. (2006). 心智運動與心智老化：評估「用或失」假說的有效性。
Saragih, I. D., Tonapa, S. I., Saragih, I. S., & Lee, B. O. (2022). Effects of cognitive stimulation therapy for people with dementia: A systematic review and metaanalysis of randomized controlled studies. International Journal of Nursing Studies, 128, Article 104181. https://doi.org/10.1016/J.IJNURSTU.2022.104181 Saragih, I. D., Tonapa, S. I., Saragih, I. S., & Lee, B. O. (2022)。針對失智症患者的認知刺激療法效果：隨機對照研究的系統評價與統合分析。《國際護理研究期刊》，128，文章 104181。https://doi.org/10.1016/J.IJNURSTU.2022.104181
Spector, A., Orrell, M., Davies, S., & Woods, B. (2001). Can reality orientation be rehabilitated? Development and piloting of an evidence-based programme of cognition-based therapies for people with dementia. Neuropsychological Rehabilitation, 11(3-4), 377-397. https://doi.org/10.1080/09602010143000068 Spector, A., Orrell, M., Davies, S., & Woods, B. (2001). 現實導向能否被康復？針對癡呆症患者的基於認知的療法的循證計劃的開發與試點。神經心理康復，11(3-4)，377-397。https://doi.org/10.1080/09602010143000068
Spector, A., Thorgrimsen, L., Woods, R. T., & Orrell, M. (2006). Making a difference: An evidence-based group programme to offer Cognitive Stimulation therapy (CST) to people with dementia. H. Publications (Ed.). Spector, A., Thorgrimsen, L., Woods, R. T., & Orrell, M. (2006). 產生影響：一項基於證據的團體計劃，為失智症患者提供認知刺激療法 (CST)。H. Publications (編輯)。
Spector, A., Orrell, M., Lattimer, M., Hoe, J., King, M., Harwood, K., Qazi, A., & Charlesworth, G. (2012). Cognitive behavioural therapy (CBT) for anxiety in people with dementia: study protocol for a randomised controlled trial. Trials, 13. https:// doi.org/10.1186/1745-6215-13-197 Spector, A., Orrell, M., Lattimer, M., Hoe, J., King, M., Harwood, K., Qazi, A., & Charlesworth, G. (2012)。針對失智症患者焦慮的認知行為療法（CBT）：隨機對照試驗的研究計劃。Trials, 13。https://doi.org/10.1186/1745-6215-13-197
Spector, A., Orrell, M., & Woods, B. (2010). Cognitive Stimulation Therapy (CST): Effects on different areas of cognitive function for people with dementia. International Journal of Geriatric Psychiatry, 25(12), 1253-1258. https://doi.org/10.1002/ gps. 2464 Spector, A., Orrell, M., & Woods, B. (2010). 認知刺激療法 (CST)：對失智症患者不同認知功能領域的影響。國際老年精神醫學期刊，25(12)，1253-1258。https://doi.org/10.1002/gps.2464
Spector, A., Thorgrimsen, L., Woods, B., Royan, L., Davies, S., Butterworth, M., & Orrell, M. (2003). Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: Randomised controlled trial. British Journal of Psychiatry, 183(SEPT), 248-254. https://doi.org/10.1192/bjp.183.3.248 Spector, A., Thorgrimsen, L., Woods, B., Royan, L., Davies, S., Butterworth, M., & Orrell, M. (2003)。針對失智症患者的基於證據的認知刺激療法計劃的有效性：隨機對照試驗。《英國精神病學雜誌》，183（九月），248-254。https://doi.org/10.1192/bjp.183.3.248
Sterne, J. A. C., Sutton, A. J., Ioannidis, J. P. A., Terrin, N., Jones, D. R., Lau, J., Carpenter, J., Rücker, G., Harbord, R. M., Schmid, C. H., Tetzlaff, J., Deeks, J. J., Peters, J., Macaskill, P., Schwarzer, G., Duval, S., Altman, D. G., Moher, D., & Higgins, J. P. T. (2011). Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ, 343(7818), 1-8. https://doi.org/10.1136/bmj.d4002 Sterne, J. A. C., Sutton, A. J., Ioannidis, J. P. A., Terrin, N., Jones, D. R., Lau, J., Carpenter, J., Rücker, G., Harbord, R. M., Schmid, C. H., Tetzlaff, J., Deeks, J. J., Peters, J., Macaskill, P., Schwarzer, G., Duval, S., Altman, D. G., Moher, D., & Higgins, J. P. T. (2011)。隨機對照試驗的元分析中檢查和解釋漏斗圖不對稱的建議。BMJ, 343(7818), 1-8。https://doi.org/10.1136/bmj.d4002
Streater, A., Spector, A., Aguirre, E., Stansfeld, J., & Orrell, M. (2016). ImpRess: An implementation readiness checklist developed using a systematic review of randomised controlled trials assessing cognitive stimulation for dementia. BMC Medical Research Methodology, (1), 16. https://doi.org/10.1186/s12874-016-0268-2 Streater, A., Spector, A., Aguirre, E., Stansfeld, J., & Orrell, M. (2016)。ImpRess：一個基於系統性回顧隨機對照試驗評估癡呆症認知刺激的實施準備檢查表。BMC 醫學研究方法學，(1)，16。https://doi.org/10.1186/s12874-016-0268-2
Sun, Y., Zhang, X., & Wang, Z. (2022). Comparative Effectiveness of 3 Settings of cognitive stimulation therapy on cognition and quality of life for people with dementia: A systematic review and network meta-analysis. Journal of the American Medical Directors Association, 23(3), 461-467. https://doi.org/10.1016/J. JAMDA.2021.11.015. e11. 孫, Y., 張, X., & 王, Z. (2022). 三種認知刺激療法對癡呆症患者的認知和生活質量的比較效果：系統評價和網絡元分析。《美國醫療主任協會期刊》，23(3)，461-467。https://doi.org/10.1016/J. JAMDA.2021.11.015. e11.
Tanriver-Ayder, E., Faes, C., Van De Casteele, T., McCann, S. K., & Macleod, M. R. (2021). Comparison of commonly used methods in random effects meta-analysis: Application to preclinical data in drug discovery research. BMJ Open Science, 5(1). https://doi.org/10.1136/bmjos-2020-100074 Tanriver-Ayder, E., Faes, C., Van De Casteele, T., McCann, S. K., & Macleod, M. R. (2021)。隨機效應元分析中常用方法的比較：應用於藥物發現研究中的前臨床數據。BMJ Open Science, 5(1)。https://doi.org/10.1136/bmjos-2020-100074
Tarnanas, I., Tsolakis, A., & Tsolaki, M. (2014). Assessing virtual reality environments as cognitive stimulation method for patients with MCI. In Studies in Computational Intelligence, 536, 39-74. https://doi.org/10.1007/978-3-642-45432-5_4. Tarnanas, I., Tsolakis, A., & Tsolaki, M. (2014)。評估虛擬現實環境作為輕度認知障礙患者的認知刺激方法。在《計算智能研究》，536，39-74。https://doi.org/10.1007/978-3-642-45432-5_4。
Tesky, V. A., Thiel, C., Banzer, W., & Pantel, J. (2011). Effects of a group program to increase cognitive performance through cognitively stimulating leisure activities in healthy older subjects. GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry, 24(2), 83-92. https://doi.org/10.1024/1662-9647/a000035 Tesky, V. A., Thiel, C., Banzer, W., & Pantel, J. (2011)。透過認知刺激的休閒活動提高健康老年人認知表現的團體計畫效果。GeroPsych: 老年心理學與老年精神醫學期刊，24(2)，83-92。https://doi.org/10.1024/1662-9647/a000035
Tsai, A. Y., Lee, M. C., Lai, C. C., Chou, Y. C., & Su, C. Y. (2019). The outcomes of cognitive stimulation therapy (CST) for community-dwelling older adults with cognitive decline in Taiwan. Topics in Geriatric Rehabilitation, 35(4), 306-312. https://doi.org/10.1097/TGR.0000000000000248 蔡安怡、李明志、賴志成、周雅君、蘇志勇（2019）。台灣社區居住的認知衰退老年人認知刺激療法（CST）的療效。老年康復學報，35(4)，306-312。https://doi.org/10.1097/TGR.0000000000000248
Vega Rozo, F., Rodríguez, O., Montenegro, Z., & Dorado, C. (2016). Efecto de la implementación de un programa de estimulación cognitiva en una población de adultos mayores institucionalizados en la ciudad de Bogotá. Revista Chilena de Neuropsicología, 11(1), 12-18. https://doi.org/10.5839/rcnp.2016.11.01.03 Vega Rozo, F., Rodríguez, O., Montenegro, Z., & Dorado, C. (2016). 在波哥大市一群機構化老年人中實施認知刺激計劃的效果。智利神經心理學雜誌，11(1)，12-18。https://doi.org/10.5839/rcnp.2016.11.01.03
Wallace, B. C., Dahabreh, I. J., Trikalinos, T. A., Lau, J., Trow, P., & Schmid, C. H. (2012). Closing the gap between methodologists and end-users: R as a computational backend. Journal of Statistical Software, 49(5), 1-15. https://doi.org/10.18637/jss.v049. i05 Wallace, B. C., Dahabreh, I. J., Trikalinos, T. A., Lau, J., Trow, P., & Schmid, C. H. (2012)。縮小方法學家與最終使用者之間的差距：R 作為計算後端。《統計軟體期刊》，49(5)，1-15。https://doi.org/10.18637/jss.v049.i05
Winblad, B., Palmer, K., Kivipelto, M., Jelic, V., Fratiglioni, L., Wahlund, L. O., Nordberg, A., Bäckman, L., Albert, M., Almkvist, O., Arai, H., Basun, H., Blennow, K., De Leon, M., Decarli, C., Erkinjuntti, T., Giacobini, E., Graff, C., Hardy, J., & Petersen, R. C. (2004). Mild cognitive impairment - Beyond controversies, towards a consensus: Report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256(3), 240-246. https://doi.org/10.1111/ j.1365-2796.2004.01380.x Winblad, B., Palmer, K., Kivipelto, M., Jelic, V., Fratiglioni, L., Wahlund, L. O., Nordberg, A., Bäckman, L., Albert, M., Almkvist, O., Arai, H., Basun, H., Blennow, K., De Leon, M., Decarli, C., Erkinjuntti, T., Giacobini, E., Graff, C., Hardy, J., & Petersen, R. C. (2004). 輕度認知障礙 - 超越爭議，邁向共識：國際輕度認知障礙工作組報告。內科醫學雜誌, 256(3), 240-246. https://doi.org/10.1111/j.1365-2796.2004.01380.x
Wolfsgruber, S., Wagner, M., Schmidtke, K., Frölich, L., Kurz, A., Schulz, S., Hampel, H., Heuser, I., Peters, O., Reischies, F. M., Jahn, H., Luckhaus, C., Hüll, M., Gertz, H. J., Schröder, J., Pantel, J., Rienhoff, O., Rüther, E., Henn, F., & Jessen, F. (2014).
Memory concerns, memory performance and risk of dementia in patients with mild cognitive impairment. PLoS ONE, 9(7). https://doi.org/10.1371/journal. pone. 0100812 記憶問題、記憶表現與輕度認知障礙患者的癡呆風險。PLoS ONE, 9(7). https://doi.org/10.1371/journal.pone.0100812
Wong, Y. L., Cheng, C. P. W., Wong, C. S. M., Wong, S. N., Wong, H. L., Tse, S., . Chan, W. C. (2021). Cognitive stimulation for persons with dementia: A systematic review and meta-analysis. East Asian Archives of Psychiatry : Official Journal of the Hong Kong College of Psychiatrists, 31(3), 55-66. https://doi.org/10.12809/ EAAP2102. = Dong Ya Jing Shen Ke Xue Zhi : Xianggang Jing Shen Ke Yi Xue Yuan Qi Kan. 黃耀麟、鄭志平、黃志明、黃思妍、黃浩霖、謝思、陳偉昌（2021）。針對失智症患者的認知刺激：系統性回顧與統合分析。《東亞精神科學誌：香港精神科醫學院官方期刊》，31(3)，55-66。https://doi.org/10.12809/EAAP2102。= 東亞精神科學誌：香港精神科醫學院期刊。
Woods, B, Aguirre, E., Spector, A. E., & Orrell, M. (2012). Cognitive stimulation to improve cognitive functioning in people with dementia. The Cochrane Database of Systematic Reviews, 2. https://doi.org/10.1002/14651858.CD005562.PUB2 Woods, B, Aguirre, E., Spector, A. E., & Orrell, M. (2012). 認知刺激以改善癡呆症患者的認知功能。《科克倫系統評價數據庫》，2。https://doi.org/10.1002/14651858.CD005562.PUB2
Yamanaka, K., Kawano, Y., Noguchi, D., Nakaaki, S., Watanabe, N., Amano, T., & Spector, A. (2013). Effects of cognitive stimulation therapy Japanese version (CST-J) for people with dementia: A single-blind, controlled clinical trial. Aging and Mental Health, 17(5), 579-586. https://doi.org/10.1080/13607863.2013.777395 山中健太郎、川野裕子、野口大輔、中秋、渡邊直樹、天野太郎、與斯佩克特（2013）。針對失智症患者的認知刺激療法日本版（CST-J）效果：一項單盲、對照臨床試驗。《老化與心理健康》，17(5)，579-586。https://doi.org/10.1080/13607863.2013.777395
Zhu, Z. Q., Li, C. B., & Zhang, M. Y. (2001). Prognosis and sequelae of mild cognitive impairment in the community’s elderly people. Shanghai Arch Psychiatry, 13, 12-14. 朱志強、李春波、張美燕（2001）。社區老年人輕度認知障礙的預後及後遺症。《上海精神醫學雜誌》，13，12-14。
Corresponding author at: Department of Physiatry and Nursing, Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain. 通訊作者：西班牙薩拉戈薩大學健康科學院物理醫學與護理系。
