Cognitive interventions

People with dementia experience a gradual decline in cognitive function which can have an impact on their ability to perform daily activities. [1] Researchers have tested a range of cognitive approaches for delaying the loss of cognitive ability associated with dementia. This includes cognitive training and cognitive stimulation. [2] It is thought that these approaches can help people adapt to cognitive losses or compensate for them. This might then lead to improvements in self-care abilities, autonomy, and sense of personhood. [3]

The two types of cognitive interventions serve different purposes: [2]

Cognitive training uses repeated practice on standardised tasks targeting problem areas such as impaired memory, attention, problem-solving and executive function. [3] Training can be one-to-one or in a group and led by a health professional or trained family carer. [4] It might also be computer-based or involve paper and pencil exercises.

Cognitive stimulation therapy is a psychological approach. It aims to stimulate the individual’s intellectual and social abilities through activities and discussions, usually in a group setting. [3] Cognitive stimulation overlaps with reality orientation therapy. This form of therapy involves care workers or family members repeating the date, time of day, and location to the person living with dementia to help them connect with their surroundings. [5] This may be best suited to people with mild to moderate dementia.

This evidence theme on cognitive interventions is a summary of one of the key topics identified by a scoping review of dementia research. If you need more information on this topic, try using the PubMed search below.

We found six reviews that assessed the effectiveness of cognitive interventions on cognitive function. The most promising interventions appear to be those based on cognitive stimulation. Cognitive stimulation studies showed:

• Improvement in overall cognitive skills and general memory in people with dementia living in residential care. [6]
• Decreased apathy levels and a small effect on responsive behaviours in people with dementia living in residential care. [6, 7]
• Increased verbal memory, verbal fluency, attention, and problem-solving in carer-led interventions in the home setting. [3]
•  Longer-term cognitive stimulation therapy appears to be more effective in improving cognitive function than short-term therapy. [8]
• Reality orientation therapy improves cognitive function but not responsive behaviours and depression. [5]

Findings were inconclusive for cognitive training. One review found cognitive training improved overall cognitive function and memory. [9] A more recent review, however, did not find any conclusive evidence that cognitive training had an impact on cognitive function. [10] This difference may have occurred because the second review included a smaller number of studies with few participants. [10]

The reviews on cognitive interventions raised several concerns between them as to the methods used in some of the studies. This reduces the degree of certainty we might have about the benefits of cognitive interventions. These include:

• Involving participants of different ages and at different levels of cognitive functioning.
• Comparing interventions of different types delivered by people with differing levels of training and supervision.
• The variable frequency and length of each intervention.
• High participant dropout rates with people leaving studies before their conclusion. [3]

• Consider reading more about cognitive stimulation therapy and cognitive training programs.
• If delivering reality orientation therapy to orient a person to their present situation, it is important to do so sensitively in a non-confrontational way.

• Consider trialling some group activities in the workplace. They do not appear to have any adverse effects and some people may enjoy them.
• Find out more about cognitive stimulation therapy, training requirements, and costs involved at the International Cognitive Stimulation Therapy Centre, UK.

1. Guideline Adaptation Committee. Clinical practice guidelines and principles of care for people with dementia [Internet]. Sydney, NSW: NHMRC Partnership Centre for Dealing with Cognitive and Related Functional Decline in Older People; 2016 [cited 2023 Jun 29]. Available from: https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/CDPC-Dementia-Guidelines_WEB.pdf.
2. Clare L, Woods RT, Moniz Cook ED, Orrell M, Spector A. Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia. Cochrane Database Syst Rev. 2003(4):Cd003260.
3. Silva R, Bobrowicz-Campos E, Cardoso D, Costa P, Couto F, Camarneiro AP, et al. Effects of caregiver-provided individual cognitive interventions on cognition, social functioning and quality of life in older adults with major neurocognitive disorders: A systematic review. JBI Evid Synth. 2020;18(4):743-806.
4. Clare L, Woods RT. Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer's disease: A review. Neuropsychol Rehabil. 2004;14(4):385-401.
5. Chiu H-Y, Chen P-Y, Chen Y-T, Huang H-C. Reality orientation therapy benefits cognition in older people with dementia: A meta-analysis. Int J Nurs Stud. 2018;86:20-8.
6. Folkerts AK, Roheger M, Franklin J, Middelstadt J, Kalbe E. Cognitive interventions in patients with dementia living in long-term care facilities: Systematic review and meta-analysis. Arch Gerontol Geriatr. 2017;73:204-21.
7. Goris ED, Ansel KN, Schutte DL. Quantitative systematic review of the effects of non-pharmacological interventions on reducing apathy in persons with dementia. J Adv Nurs. 2016;72(11):2612-28.
8. Chen J, Duan Y, Li H, Lu L, Liu J, Tang C. Different durations of cognitive stimulation therapy for Alzheimer's disease: A systematic review and meta-analysis. Clin Interv Aging. 2019;14:1243-54.
9. Song YW, Lee JS, Song AY. Meta-analysis about cognitive intervention effect applied to dementia patients. NeuroRehabil. 2016;39(2):319-27.
10. Orgeta V, McDonald KR, Poliakoff E, Hindle JV, Clare L, Leroi I. Cognitive training interventions for dementia and mild cognitive impairment in Parkinson's disease. Cochrane Database Syst Rev. 2020;2:CD011961.