Efeitos do treinamento cognitivo informatizado no pós-AVC: uma revisão sistemática e meta-análise sobre a relação com a reserva cognitiva
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Data
2023-04-26
Autores
Fava-Felix, Paloma Emanoela
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O acidente vascular cerebral (AVC) é a segunda maior causa de morte no mundo e a principal causa de incapacidade funcional, fortemente associado à dependência e à demência, provocando impactos na saúde pública e assistência social mundial. As proxies de reserva cognitiva (RC), como escolaridade, nível ocupacional e práticas regulares de atividade física, se apresentam como importantes fatores para contribuir no processo de reabilitação de lesões cerebrais, interferindo positivamente nos comprometimentos originados pelo AVC. Por isso, o objetivo geral desta revisão sistemática e meta-análise foi identificar a eficácia do treinamento cognitivo informatizado, considerando proxies de RC em sobreviventes de AVC com idades a partir de 18 anos, verificando o impacto na relação entre variáveis clínicas e RC, considerando a interação entre grupo e tempo de intervenção. Seguindo as recomendações PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analysis, ocorreram buscas de ensaios clínicos controlados nos bancos de dados CINAHL, Lilacs, PubMed, Scopus e Web of Science, sendo os artigos avaliados por pares sem restrição de data. Foram identificados 780 artigos e encontrados 19 estudos de intervenção, sendo selecionados 10 estudos para compor a amostra final, mediante os critérios de inclusão. Os estudos incluíram ferramentas informatizadas para reabilitação motora e cognitiva nos grupos experimentais, combinadas com outras intervenções, como fisioterapia, terapia ocupacional e exercício aeróbico. A revisão sistemática está composta por um total de 421 sobreviventes de AVC, estando 204 participantes no grupo controle e 217 no grupo experimental, entre 18 e 94 anos, com predominância masculina em 9 estudos (58,62%). O treinamento cognitivo informatizado apresentou melhores medidas de mudanças na avaliação cognitiva (MoCA) em 6 estudos, o treinamento cognitivo convencional apresentou melhor pontuação de mudança em 1 estudo e em 1 estudo os resultados regrediram em ambos os grupos. A meta-análise apresentou favorecimento à utilização de treinamento cognitivo informatizado, embora exista alta heterogeneidade. A combinação entre escolaridade, rápido início do treinamento cognitivo informatizado, alta intensidade semanal e AVC isquêmico mediaram os resultados da melhora cognitiva.
Stroke is the second leading cause of death in the world and the main cause of disability, strongly associated to dependence and dementia, causing an impact on public health and social assistance worldwide. Cognitive reserve (CR) proxies, such as schooling, occupational level and regular practice of physical activity, are presented as important factors to contribute to the process of rehabilitation of brain injuries, positively interfering in the impairments caused by the stroke. Therefore, the general objective of this systematic review and meta-analysis was to identify the effectiveness of computerized cognitive training, considering CR proxies in stroke survivors from aged 18 years and older, verifying the impact on the relationship between clinical variables and CR, considering the interaction between group and time of intervention. Following the PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations, controlled clinical trials were searched in the CINAHL, Lilacs, PubMed, Scopus and Web of Science databases, with peer-reviewed articles without date restrictions. It was identified 780 articles and 19 intervention studies were found, and 10 studies were selected to compose the final sample, according to the inclusion criteria. The studies included computerized tools for motor and cognitive rehabilitation in the experimental groups, combined with other interventions such as physiotherapy, occupational therapy and aerobic exercise. The systematic review is composed of a total of 421 stroke survivors, being 204 participants in the control group and 217 in the experimental group, between 18 and 94 years old, with male predominance in 9 studies (58.62%). The computerized cognitive training presented better measures of change in cognitive assessment (MoCA) in 6 studies, conventional cognitive training presented better score change in 1 study and in 1 study the results regressed in both groups. The meta-analysis favors the use of computerised cognitive training, although there is high heterogeneity. The combination of schooling, fast beginning of computer-based cognitive training, weekly high intensity, and ischemic stroke mediated cognitive improvement outcomes
Stroke is the second leading cause of death in the world and the main cause of disability, strongly associated to dependence and dementia, causing an impact on public health and social assistance worldwide. Cognitive reserve (CR) proxies, such as schooling, occupational level and regular practice of physical activity, are presented as important factors to contribute to the process of rehabilitation of brain injuries, positively interfering in the impairments caused by the stroke. Therefore, the general objective of this systematic review and meta-analysis was to identify the effectiveness of computerized cognitive training, considering CR proxies in stroke survivors from aged 18 years and older, verifying the impact on the relationship between clinical variables and CR, considering the interaction between group and time of intervention. Following the PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations, controlled clinical trials were searched in the CINAHL, Lilacs, PubMed, Scopus and Web of Science databases, with peer-reviewed articles without date restrictions. It was identified 780 articles and 19 intervention studies were found, and 10 studies were selected to compose the final sample, according to the inclusion criteria. The studies included computerized tools for motor and cognitive rehabilitation in the experimental groups, combined with other interventions such as physiotherapy, occupational therapy and aerobic exercise. The systematic review is composed of a total of 421 stroke survivors, being 204 participants in the control group and 217 in the experimental group, between 18 and 94 years old, with male predominance in 9 studies (58.62%). The computerized cognitive training presented better measures of change in cognitive assessment (MoCA) in 6 studies, conventional cognitive training presented better score change in 1 study and in 1 study the results regressed in both groups. The meta-analysis favors the use of computerised cognitive training, although there is high heterogeneity. The combination of schooling, fast beginning of computer-based cognitive training, weekly high intensity, and ischemic stroke mediated cognitive improvement outcomes
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Palavras-chave
Acidente vascular cerebral, Reserva cognitiva, Reabilitação cognitiva, Treinamento cognitivo informatizado, Stroke, Cognitive reserve, Cognitive rehabilitation, Computerised cognitive training