Home-Based Cognitive Stimulation for Dementia Delivers Few Gains

Research published in the recent Health Technology Assessment reported that people with dementia who underwent home-based individual cognitive stimulation therapy led by their spouse or another caregiver failed to experience gains in cognition or quality of life. The physical and mental health of caregivers, too, was unaffected.

Because group cognitive stimulation therapy programs have been shown to have positive effects on cognition and quality of life for people with dementia, Martin Orell and his team at the Institute of Mental Health, University of Nottingham, UK, aimed to assess whether home-based programs could be just as beneficial. The home program developed for the study was based on an established group cognitive stimulation therapy program and included 75 different activities including creativity sessions, word games, and current affairs exercises.

A total of 356 patient-caregiver dyads were randomized to either the home-based program, which included up to three 30-minute sessions per week over 25 weeks, or treatment as usual. 

At the 26-week point, researchers found no differences in any of the primary outcomes (cognition and quality of life for patients, mental and physical health for caregivers) between the two groups. However, people with dementia in the intervention group did report better relationship quality with their caregiver compared with patients in the control group. Caregivers in the intervention group, meanwhile, reported a higher health-related quality of life than caregivers in the control group.

“Despite evidence of improvements in the caregiving relationship for people with dementia and health-related quality of life for carers,” researchers concluded, “this study provides no evidence that carer-led cognitive stimulation interventions help cognition or quality of life for people with dementia.”

Low compliance likely played a role in the disappointing outcomes. Of the 356 pairs recruited to participate, just 273 completed the study.

“Although carers and people with dementia initially expressed interest in taking part, only 65% of the sample allocated to treatment completed more than 10 sessions, with 22% completing no sessions, indicating that, for some people with dementia and their carers, this type of intervention will not be feasible and that methods for compliance need to be improved,” researchers wrote.

Although the study’s findings may limit the wider implementation of home-based, caregiver-led approaches for now, researchers suggested further studies be done to addresswhether the group setting is key to the effectiveness of cognitive stimulation as well as factors such as compliance in caregiver-led interventions.—Jolynn Tumolo