A meta-analysis of the effects of combined interventions centered on cognitive training on cognition, executive function, and negative emotions in patients with Alzheimer's disease.

OBJECTIVE

To systematically compare the effects of five intervention strategies centered on Cognitive Training (CT), including Routine Care (RC), CT, Physical Exercise (PE), Cognitive Plus Exercise Training (CET), and Cognitive Plus Non-Invasive Brain Stimulation (CNIBS), on cognitive function, executive function, and negative emotions in patients with Alzheimer's disease, using a network meta-analysis. The relative efficacy of different interventions was ranked to provide evidence-based support for optimizing combined treatment strategies in clinical practice.

METHODS

PubMed, Embase, Web of Science, Cochrane Library, and EBSCO databases were systematically searched to identify randomized controlled trials on CT and its combined interventions for Alzheimer's disease published from database inception to April 2026. A network meta-analysis was conducted within a frequentist framework using Stata 17.0 software. The efficacy of interventions was ranked using the surface under the cumulative ranking curve.

RESULTS

A total of 19 randomized controlled trials involving more than 2,000 patients were included. The network meta-analysis showed that, for cognitive function, CNIBS (SUCRA = 75.4%) and CET (SUCRA = 72.4%) ranked first and second, respectively, and were significantly superior to RC and single interventions. For executive function, CET ranked highest (SUCRA = 99.9%) and was significantly superior to PE alone (SMD = 3.71, 95% CI: 3.16 to 4.26) and RC (SMD = 1.69, 95% CI: 0.48 to 2.91), other interventions do not offer a significant advantage over RC. For negative emotions, CET ranked highest (SUCRA = 83.7%), followed by PE alone (SUCRA = 57.9%), and CNIBS was also superior to CT alone (SMD = 1.07, 95% CI: 0.53 to 1.61).

CONCLUSION

Combined interventions centered on CT are superior to single interventions in improving multidimensional symptoms in patients with Alzheimer's disease. Among them, CET shows the most prominent advantages in improving executive function and negative emotions, whereas CNIBS shows the greatest effect on overall cognitive function. In clinical practice, individualized intervention strategies should be selected according to the primary rehabilitation goal.