Letters Cognitive function in dementia

Social engagement may be as important as cognitive stimulation therapy in dementia

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e1607 (Published 06 March 2012) Cite this as: BMJ 2012;344:e1607
  1. Simon P Thacker, consultant psychiatrist1
  1. 1Derbyshire Healthcare Foundation NHS Trust, Albany House, Kingsway Hospital, Derby DE22 3LZ, UK
  1. simon.thacker{at}derbyshcft.nhs.uk

Orrell and colleagues confirm that group and individual cognitive stimulation therapy (CST) improves cognitive function in dementia but that the effect size is modest, and they do not mention the possibly large placebo effect of social engagement.1 In their own trial of group CST, they state that controls received usual activities, which generally meant inactivity.2 The principles of CST entail a focused process in the context of supportive relationships (with fellow participants and the facilitator), an expectation of helpfulness, and the prospect of an enjoyable experience. These features are not unique to CST but are embedded in numerous social activities, such as sing-alongs, group exercise, religious services, and intergenerational gatherings. Unless trials of CST are rigorously controlled, beneficial outcomes that could derive instead from already available activities could be unduly attributed to CST.

Wellbeing in later life is associated with strong community affiliation, a sense of purpose, and the opportunity to contribute to the lives of others,3 all of which are fostered by group CST. Therefore, the efficacy of group CST over individual CST probably results from the convergence of these associations.

Advocates of specific technologies and procedures are clamouring to join a burgeoning “marketplace of memory,”3 while, as the authors acknowledge,1 evidence suggests little transfer of the improvements effected by brain fitness training to more general performance. Dementia is a socially ostracising condition, and the most important task is to bridge the gap between those who are affected and wider society.


Cite this as: BMJ 2012;344:e1607


  • Competing interests: None declared.


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