Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. Dementia is a rising concern for patients, families and health services around the world; highlighting the need to find ways to alleviate its impact. The Cochrane Review of cognitive stimulation to improve cognitive functioning in people with dementia was updated in January 2023 and we asked lead author, Bob Woods from Bangor University in Wales, to let us know about the importance of the review and the latest findings.

Bob: For over 60 years, practitioners and researchers have been seeking answers to the question: what are the effects of engaging people with dementia in activities designed to provide mental and social stimulation? Over this time, the number of people affected by dementia has grown dramatically, as has awareness of its effects on both people with dementia and their supporters; effective approaches to dementia care are needed more than ever.
In 2012, we published a Cochrane review of what we described as ‘Cognitive Stimulation' for people with dementia. This approach involves a wide range of activities aiming to stimulate thinking and memory generally, including discussion of past and present events and topics of interest, word games, puzzles, music and creative practical activities in a social context with an emphasis on fun and enjoyment. Typically delivered by trained staff working with a small group of people with dementia for around 45 minutes twice a week, it can also be provided on a one-to-one basis and, with training and support, by family carers.
A decade on, with the considerable international growth in dementia care research, we wanted to examine whether our previous conclusion that cognitive stimulation leads to improvements in cognition, quality of life and social interaction in people with dementia still holds. We also wanted to identify any aspects of cognitive stimulation programmes associated with more positive outcomes.
We found 37 studies, from 17 countries and five continents, with two-thirds published since 2012. The studies included nearly 2800 participants with mild or moderate dementia with an average age of 79 years. As before, we found a small benefit to cognition at the end of the course of sessions, when compared with usual care or unstructured activities. For example, using results from the widely used Mini Mental State Exam (MMSE) cognitive test, we estimated that this benefit equates roughly to a six-month delay in the cognitive decline usually expected in mild-to-moderate dementia. We also found preliminary evidence suggesting greater cognitive benefits when group sessions occurred at least twice a week (rather than once weekly) and that benefits were greater in studies where participants' dementia at the outset was of mild severity.
Improvements on other outcomes were more wide-ranging than in the original review. Again, participants improved on measures of communication and social interaction and, slightly, on quality of life but we've now also found slight benefits in day-to-day activities, in the person's own ratings of their mood and in ratings of what has been described as ‘behaviour that challenges'.
However, our confidence in these findings is in most cases only moderate because of concerns about differences in results between studies. We cannot be certain of the exact reasons for these inconsistencies, but we noted that studies varied in several ways including whether the cognitive stimulation was group or individual; whether participants were in care homes or hospitals or lived at home; whether the sessions were led by a trained professional, a care-worker or a family carer; and the length of the programme. We were unable to examine as many of these potential sources of variation as we would have liked; in particular, there are relatively few studies of individual cognitive stimulation.
Our findings are consistent with recommendations to those commissioning health and social care in the 2018 NICE guideline for dementia care to ‘offer group cognitive stimulation therapy to people living with mild to moderate dementia'. Further research is needed to help us understand the effects of different delivery methods (including digital and remote implementation) and of multi-component programmes, for example combining cognitive stimulation and physical exercise. The impact of frequency of group sessions and the person's level of dementia severity should also be studied further, as should the potential benefits and clinical significance of longer-term cognitive stimulation programmes. These remaining questions are important because they concern not whether cognitive stimulation in general is effective, but how best to maximise its benefits and how to target it most effectively.

Mike: If you'd like to read this latest version of Bob's review and to watch for the next update, it's available at Cochrane library dot com. If you go to the website and search ‘cognitive stimulation and dementia', you'll see a link to it.