The Effectiveness of Cognitive Stimulation for Dementia: A Comprehensive Review

To identify relevant studies for the intervention of cognitive stimulation (CS), a comprehensive search was conducted in the Cochrane Dementia and Cognitive Improvement Group Specialized Register. This systematic review aimed to evaluate the effectiveness of CS in people with dementia and explore potential variations in its implementation, according to a study published in Cochrane Database of Systematic Review.

CS is an intervention designed to enhance cognitive function, concentration, and memory in individuals with dementia. Although CS is widely recommended in dementia care guidelines and implemented internationally, questions persist regarding its delivery modes and the clinical significance of its benefits. To fully understand its effects, researchers not only included data provided by the Cochrane Dementia and Cognitive Improvement Group Specialized Register, but data was also supplemented by searches in major healthcare databases and trial registers, with the latest search performed in March 2022.

The inclusion criteria encompassed randomized controlled trials (RCTs), reporting cognitive change as an outcome measure. It included 37 RCTs involving 2,766 participants, with 26 studies published since the previous update. While most studies evaluated group-based CS, 8 examined individual CS. The median age of participants was 79.7 years, and 16 studies included residents from care homes or hospitals.

The analysis revealed moderate-quality evidence supporting a small cognitive benefit associated with CS. The Mini Mental State Examination (MMSE) test results showed a clinically important difference of 1.99 points between CS and control groups (95% CI: 1.24, 2.74).

Secondary analyses indicated moderate-quality evidence for improvements in self-reported quality of life (QOL) and QoL ratings by proxies (staff or caregivers). Evidence supported clinically relevant enhancements in staff/interviewer ratings of communication and social interaction. There were also slight benefits in instrumental Activities of Daily Living, self-reported depressed mood, staff/interviewer-rated anxiety, and general behavior ratings.

Exploratory subgroup analyses did not identify significant effects of modality (group vs individual) or setting (community vs care home). When participants had mild dementia at the start of CS intervention, improvements in cognition were more pronounced. However, "imbalance in numbers of studies and participants between subgroups and residual inconsistency requires these exploratory findings to be interpreted cautiously," according to researchers.

Study results suggest CS in dementia care has expanded considerably, reaffirming small, short-term cognitive benefits for individuals with mild to moderate dementia participating in CS programs. Clinically relevant improvements were also observed in communication, social interaction, QoL, mood, and behavior.

"We have identified that the frequency of group sessions and level of dementia severity may influence the outcomes of CS, and these aspects should be studied further. There remains an evidence gap in relation to the potential benefits of longer‐term CS [programs] and their clinical significance."

Reference

Woods B, Rai HK, Elliott E, Aguirre E, Orrell M, Spector A. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database of Systematic Reviews. 2023;2023(1). doi:10.1002/14651858.cd005562.pub3