Comparative effectiveness of non-pharmacological interventions for depressive symptoms in mild cognitive impairment: systematic review with network meta-analysis

Objectives Depressive symptoms are common among mild cognitive impairment (MCI) patients. It is unknown how different the effects on depressive symptoms are among various pharmacological MCI interventions. This systematic review aimed to evaluate the comparative effectiveness of non-pharmacological MCI interventions on depressive symptoms among MCI patients. Methods A systematic review and network meta-analysis was conducted on randomized controlled trials (RCT) comparing the effect of different non-pharmacological MCI interventions on changes in depressive symptoms among MCI patients. RCTs were identified from MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO, and PsycARTICLES. Results were summarized as standardized mean differences (SMD) and 95% confidence intervals (CI). The surface under the cumulative ranking (SUCRA) was used to rank the effect of different interventions. Results Twenty-two RCTs were included in the network meta-analysis. Compared with non-active control, cognition-based intervention (SMD=-0.25, 95% CI: -0.46, -0.04) and physical exercise (SMD=-0.33, 95% CI: -0.56, -0.10) had significant positive effects to reduce depressive symptoms. Health education, psychosocial intervention, and the combination of physical exercise and cognition-based intervention had non-significant overall effects. The SUCRA demonstrated that physical exercise had the highest SUCRA for the reduction in depression symptoms (0.815). In subgroup analysis, health education, cognition-based intervention, physical exercise, and the combination of physical exercise and cognition-based intervention showed significant longer-term effects (6-12 months). Conclusion Physical exercise and cognition-based intervention were effective interventions for depressive symptoms in MCI patients. This study can provide additional evidence for healthcare providers to make decisions for selecting available and appropriate interventions for MCI patients.