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Meta-Analysis
. 2025 Feb;47(1):409-444.
doi: 10.1007/s11357-024-01400-z. Epub 2024 Nov 1.

The efficacy of cognitive stimulation, cognitive training, and cognitive rehabilitation for people living with dementia: a systematic review and meta-analysis

Alice Paggetti #  1 , Ylenia Druda #  2 , Francesco Sciancalepore  1   3 , Francesco Della Gatta  4 , Antonio Ancidoni  1 , Nicoletta Locuratolo  1 , Paola Piscopo  5 , Luca Vignatelli  6 , Luciano Sagliocca  7 , Antonio Guaita  8 , Piero Secreto  9 , Andrea Stracciari  10 , Paola Caffarra  11 , Nicola Vanacore  1 , Elisa Fabrizi  12 , Eleonora Lacorte  1 ; Italian Dementia Guideline Working Group
Collaborators, Affiliations
Meta-Analysis

The efficacy of cognitive stimulation, cognitive training, and cognitive rehabilitation for people living with dementia: a systematic review and meta-analysis

Alice Paggetti et al. Geroscience. 2025 Feb.

Erratum in

Abstract

Cognition-oriented treatments (COTs) are a group of non-pharmacological treatments aimed at maintaining or improving cognitive functioning. Specific recommendations on the use of these interventions in people living with dementia (PLwD) are included in the Italian Guideline on the Diagnosis and Treatment of Dementia and Mild Cognitive Impairment, developed by the Italian National Institute of Health. This systematic review and meta-analysis, based on the GRADE methodology, is part of the guideline. Considered outcomes included the cognitive functions, quality of life, and functional abilities of PLwD, taking into account disease severity, modality and system of delivery, and form of the intervention. The effectiveness of these interventions on caregivers' outcomes was also assessed. Both group and individual cognitive stimulation were reported as effective in supporting cognitive functions in PLwD at any degree of severity. Individual cognitive training and group cognitive training were reported as effective in improving global cognitive functions in people with mild dementia. Cognitive rehabilitation appeared to be effective only in improving the functional abilities of people with mild dementia. Cognitive rehabilitation appeared to be the most effective in improving caregivers' outcomes, with results suggesting a reduction in care burden. The observed differences in the effectiveness of these interventions in people with different disease severity can be explained by the intrinsic characteristics of each intervention. Despite the large number of available studies, a high clinical, statistical, and methodological heterogeneity was observed. More methodologically rigorous studies are needed to clarify the effectiveness of each protocol and modality of intervention.

Keywords: Cognitive interventions; Cognitive rehabilitation; Cognitive stimulation; Cognitive training; Dementia; Guideline; Systematic review.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the literature
Fig. 2
Fig. 2
Forest plot for group cognitive stimulation effect on cognitive functions (MMSE). Note. Chi2: heterogeneity test; CI: confidence interval; CS: cognitive stimulation; df: degrees of freedom; I.2: heterogeneity index; IV: inverse variance method; MMSE: Mini-Mental State Examination; Random: random effects model; SD: standard deviation; UC: usual care; Z: test for overall mean difference. *Data calculated by the NICE Guideline working group (NG97)
Fig. 3
Fig. 3
Forest plot for individual cognitive stimulation effect on cognitive functions (MMSE). Note. Chi2: heterogeneity test; CI: confidence interval; CS: cognitive stimulation; df: degrees of freedom; I.2: heterogeneity index; IV: inverse variance method; MMSE: Mini-Mental State Examination; Random: random effects model; SD: standard deviation; Z: test for overall mean difference. *Data calculated by the NICE Guideline working group (NG97)
Fig. 4
Fig. 4
Forest plot for group cognitive training effect on cognitive functions (MMSE). Note. Chi2: heterogeneity test; CI: confidence interval; CT: cognitive training; df: degrees of freedom; I2: heterogeneity index; IV: inverse variance method; MMSE: Mini-Mental State Examination; Random: random effects model; SD: standard deviation; Z: test for overall mean difference
Fig. 5
Fig. 5
Forest plot for individual cognitive training effect on cognitive functions (MMSE). Note. Chi2: heterogeneity test; CI: confidence interval; CT: cognitive training; df: degrees of freedom; I2: heterogeneity index; IV: inverse variance method; MMSE: Mini-Mental State Examination; Random: random effects model; SD: standard deviation; Z: test for overall mean difference
See this image and copyright information in PMC

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