Is mindfulness effective in maintaining cognitive capacities of patients with Alzheimer’s disease?
Date of publication of the randomized controlled trial: January 2016
Design
Randomized controlled trial (RCT).
Participants
168 patients (mean age: not reported, male %: 45%) with Alzheimer’s disease (AD) with Mini-Mental State Examination (MMSE) score ≥18 and treated with donepezil.
Intervention
Weekly 90 min group sessions of mindfulness-based Alzheimer’s stimulation (MBAS) plus donepezil for 2 years.
Comparator
Comparison 1: MBAS plus donepezil versus usual caretaking-at-home plus donepezil in mild-moderate AD patients;
Comparison 2: MBAS plus donepezil versus usual caretaking-at-home plus donepezil in moderate-severe AD patients.
Major Outcomes
Outcome 1: MMSE score. Higher scores indicated lower level of cognitive impairment;
Outcome 2: Cambridge Cognitive Examination (CAMCOG) score. Higher scores indicated lower level of cognitive impairment.
Settings
This trial was performed in an outpatient setting.
Comparison    MBAS plus donepezil versus usual caretaking at home plus donepezil among mild-moderate AD patients.
Main Results
MBAS group had significantly better result in maintaining cognitive capacities among patients with mild-moderate AD as measured by MMSE (mean difference(MD): 3.91, p< 0.001) and CAMCOG (MD: 17.11, p< 0.001).
Comparison: MBAS plus donepezil versus usual caretaking at home plus donepezil among mild-moderate AD patients.
Outcomes No. of studies (Total number of participants) Mean score (SD)/ No. of participants Heterogeneity test (I2) MD p value Overall quality of evidence*
Intervention Comparator
1 1 (130) 20.86 (3.81)/ not reported 14.12 (5.11)/ not reported Not applicable as there is only 1 study. 3.91 < 0.001 Very High
2 1 (130) 68.49 (14.5)/ not reported 59.48 (22.13)/ not reported Not applicable as there is only 1 study. 17.11 < 0.001 Very High
Keys: SD = standard deviation; MD = mean difference.
Comparison    MBAS plus donepezil versus usual caretaking at home plus donepezil among moderate-severe AD patients.
Main Results
Compared to usual caretaking at home, patients in MBAS group had higher score in both MMSE (MD: 4.82) and CAMCOG (MD: 17.28). However, the result is not statistically significant (p>0.05).
Comparison: MBAS plus donepezil versus usual caretaking at home plus donepezil among moderate-severe AD patients.
Outcomes No. of studies (Total number of participants) Mean score (SD)/ No. of participants Heterogeneity test (I2) MD p value Overall quality of evidence*
Intervention Comparator
1 1 (21) 18.00 (1.73)/ not reported 11.29 (5.25)/ not reported Not applicable as there is only 1 study. 4.82 0.09 High
2 1 (21) 57.33 (8.74)/ not reported 30.29(17.25)/ not reported Not applicable as there is only 1 study. 17.28 0.06 High
Keys: SD = standard deviation; MD = mean difference.
Comparison    MBAS plus donepezil versus usual caretaking at home plus donepezil among mild-moderate AD patients.
Main Results
MBAS group had significantly better result in maintaining cognitive capacities among patients with mild-moderate AD as measured by MMSE (mean difference(MD): 3.91, p< 0.001) and CAMCOG (MD: 17.11, p< 0.001).
Comparison: MBAS plus donepezil versus usual caretaking at home plus donepezil among mild-moderate AD patients.
Outcomes 1 2
No. of studies (Total number of participants) 1 (130) 1 (130)
Mean score (SD)/ No. of participants Intervention 20.86 (3.81)/ not reported 68.49 (14.5)/ not reported
Comparator 14.12 (5.11)/ not reported 59.48 (22.13)/ not reported
MD 3.91 17.11
p value < 0.001 < 0.001
Overall quality of evidence* Very High Very High
Keys: SD = standard deviation; MD = mean difference.
Comparison    MBAS plus donepezil versus usual caretaking at home plus donepezil among moderate-severe AD patients.
Main Results
Compared to usual caretaking at home, patients in MBAS group had higher score in both MMSE (MD: 4.82) and CAMCOG (MD: 17.28). However, the result is not statistically significant (p>0.05).
Comparison: MBAS plus donepezil versus usual caretaking at home plus donepezil among moderate-severe AD patients.
Outcomes 1 2
No. of studies (Total number of participants) 1 (21) 1 (21)
Mean score (SD)/ No. of participants Intervention 18.00 (1.73)/ not reported 57.33 (8.74)/ not reported
Comparator 11.29 (5.25)/ not reported 30.29(17.25)/ not reported
MD 4.82 17.28
p value 0.09 0.06
Overall quality of evidence* High High
Keys: SD = standard deviation; MD = mean difference.
Conclusion
Benefits
MBAS intervention had significant benefits on maintaining cognitive capacities among mild-moderate AD patients compared to usual caretaking at home. Benefits on moderate-severe AD patients were also observed, but the results were not significant. For Comparison 1, the overall quality of evidence for both of its outcome is very high. Further research is most unlikely to have an important impact on our confidence in this estimate of effect. For Comparison 2, the overall quality of evidence for both of its outcome is high. Further research is unlikely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events were reported.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/26639952
The synopsis is based on the following article:
Quintana-Hernández DJ, Miró-Barrachina MT, Ibáñez-Fernández IJ, Pino AS, Quintana-Montesdeoca MP, Rodríguez-de Vera B, et al. Mindfulness in the maintenance of cognitive capacities in Alzheimer’s disease: a randomized clinical trial. Journal of Alzheimer's Disease. 2016 Jan 1;50(1):217-32.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.