A Cochrane review included 15 RCTs with 718 patients with dementia. The studies included participants from a variety of settings, interventions that were of varying duration and intensity, and were from several different countries. Of 718 participants, 407 received cognitive stimulation and 311 were in control groups. The length of the intervention varied from 4 weeks to 24 months. The primary analysis was on changes that were evident immediately at the end of the treatment period. A few studies provided data allowing evaluation of whether any effects were subsequently maintained. A consistent benefit on cognitive function was associated with cognitive stimulation (SMD 0.41, 95% CI 0.25-0.57; 14 trials, n=658). This remained evident at follow-up 1-3 months after the end of treatment. In secondary analyses with smaller total sample sizes, benefits were also noted on self-reported quality of life and well-being (SMD 0.38, 95% CI 0.11- 0.65; 4 trials, n=219); and on staff ratings of communication and social interaction (SMD 0.44, 95% CI 0.17-0.71; 4 trials, n=223). No differences in relation to mood (self-report or staff-rated), activities of daily living, general behavioural function or problem behaviour were noted. In the few studies reporting family caregiver outcomes, no differences were noted. Importantly, there was no indication of increased strain on family caregivers in the one study where they were trained to deliver the intervention.
Comment: The quality of the evidence is downgraded by study quality (unclear allocation concealment, short follow-up time) and inconsistency (heterogeneity in patients, interventions and outcomes).
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