Cognitive stimulation as an underrated treatment for dementia patients
Why non-drug treatments such as cognitive training and social participation should become more important in the treatment of Alzheimer’s and dementia
Despite decades of research, there are still no specific drug therapies for neurodegenerative diseases such as Alzheimer’s and other forms of dementia. Other modern therapeutic approaches, such as non-invasive brain stimulation methods (NIBS), are still in the process of being established and are not widely available. In neurological and psychiatric practice, therefore, the possibilities of prevention and patient-supporting measures, including cognitive training, the all-important social participation and the promotion of everyday skills, should be used more actively. However, they are often given far too little consideration.
Now a new meta-study from Italy impressively demonstrates how effective these non-pharmacological interventions can be in improving cognitive function, quality of life and the well-being of those affected. These findings once again draw attention to the importance of holistic approaches that demonstrably promote brain plasticity and enable better use of existing cognitive resources.
Meta-analysis provides comprehensive analysis of the effectiveness of cognition-oriented treatments
The meta-analysis, conducted by a research team from the Italian National Institute of Health led by Elisa Fabrizi, Alice Paggetti and Ylenia Druda, provides a comprehensive analysis of the effectiveness of cognition-oriented treatments (COTs) in people with dementia. These non-pharmacological interventions include cognitive stimulation (CS), cognitive training (CT) and cognitive rehabilitation (CR). The aim of all these approaches is to support cognitive performance and mobilize existing neuronal resources to compensate for deficits.
Cognitive stimulation often takes place in a group setting and involves a variety of activities that promote memory, language and problem solving. These interventions are particularly effective because they not only stimulate cognitive function but also promote social interaction. Cognitive training, on the other hand, is more specific and uses exercises to improve certain cognitive abilities such as attention, memory and executive function. Cognitive rehabilitation aims to strengthen individual skills for daily living and to help those affected to maintain or regain a degree of independence.
Proven effects that benefit patients and their families
The results of the new meta-analysis confirm that cognitive stimulation and training can significantly improve the cognitive abilities of people with dementia, especially in patients with mild dementia. Cognitive rehabilitation has also proven to be particularly useful in maintaining the functional abilities of patients that are crucial for everyday life. Furthermore, it has been shown that such interventions not only benefit the patients themselves, but also reduce the burden on caregiving relatives by promoting the independence and well-being of those affected.
The importance of social participation: an integral part of therapy
Another important point highlighted by the study is the social component of cognitive interventions: Social participation is not just a supplement, but a crucial factor that is closely linked to cognitive stimulation. Regular social interactions naturally stimulate the brain and promote its plasticity. The study shows that isolation and loneliness can accelerate the progression of cognitive deficits, while social contacts help to slow the progression of dementia and improve quality of life.
Neuroplasticity and cognitive reserve: the basis for successful interventions
A central theme highlighted by Fabrizi and her colleagues is neuroplasticity – the brain’s ability to reorganize and adapt. Cognitive interventions activate these mechanisms by strengthening neural connections and promoting new networks.
This process enables the brain to continue to make functional adjustments even in the presence of neurodegenerative processes. This is where the concept of cognitive reserve comes into play, which describes how the brain can compensate for damage in order to maintain a certain level of functionality. The researchers emphasize that measures to promote neuroplasticity and cognitive reserve form a highly important basis for successful, non-drug dementia therapy.
Cognitive stimulation and social participation should be more strongly incorporated into the practice focus.
Berlin psychiatrist Dr. Arnim Quante, managing senior physician at the Clinic for Psychiatry and Psychotherapy at the Friedrich von Bodelschwingh Clinic and head of the memory outpatient clinic and the gerontopsychiatric institute outpatient clinic, has long advocated a stronger focus on the importance of cognitive stimulation and social participation in the treatment of dementia.
“Cognitive training and stimulation are effective in the treatment of dementia!”, emphasizes Dr. Quante. “In my daily work in the memory outpatient clinic, I am repeatedly asked what patients can do to slow the progression of the disease. In addition to the well-known basic measures such as exercise, a healthy diet and social contacts, cognitive stimulation is an important factor.”
Dr. Quante emphasizes that the practical implementation of these interventions is unfortunately not always easy: “Many patients and their relatives don’t even know where they can find such therapies, especially those that are covered by health insurance. I often prescribe occupational therapy and recommend that patients talk to their therapists beforehand to find out whether they offer this form of cognitive stimulation at all.” He also points to digital health applications that could help to promote cognitive abilities, even though older patients often reject them because they don’t know how to use cell phones.
He therefore also advocates simple options that patients and their relatives can incorporate into their daily lives at home, such as reading, solving puzzles or playing an instrument. According to the psychiatrist, the list is long, because many of the things that patients enjoyed before their illness can still bring them pleasure even with dementia.
“Living with dementia means promoting participation,” adds Dr. Quante. “Conveying joy and optimism is essential, and cognitive stimulation can be a lot of fun. But first of all, it is important that we specialists guide patients and their relatives towards these options and support them in doing so.” In saying this, he is also explicitly addressing the general practitioners who are usually the first point of contact and support for dementia patients.
The findings of the Italian meta-study also show that cognitive stimulation, training and rehabilitation, supplemented by social participation, offer far-reaching benefits for people with dementia and their families. Further research is, of course, necessary, according to the authors, in order to evaluate the long-term effectiveness and the optimal conditions for these interventions even more precisely. This includes standardized protocols, uniform methodologies and a more detailed investigation of the mechanisms of neuroplasticity and cognitive reserve.
More attention for proven measures: what specialists and general practitioners should do
However, it is already clear today that these non-pharmacological approaches should be used more and integrated into practice. The positive effects on cognitive function, everyday skills and well-being have been proven and can significantly improve the lives of those affected and their families. By increasing the use of these interventions in memory clinics and, above all, in general practitioners’ offices, an important step would be taken to give people with dementia a better quality of life and more hope.
The meta-study “The efficacy of cognitive stimulation, cognitive training, and cognitive rehabilitation for people living with dementia: a systematic review and meta-analysis” was published in GeroScience on November 1, 2024:
https://link.springer.com/article/10.1007/s11357-024-01400-z
