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Should we use individual cognitive stimulation therapy to improve cognitive function in people with dementia?

BMJ 2012; 344 doi: (Published 15 February 2012) Cite this as: BMJ 2012;344:e633
  1. Martin Orrell, professor of ageing and mental health12,
  2. Bob Woods, professor of clinical psychology of older people3,
  3. Aimee Spector, senior lecturer in clinical psychology24
  1. 1UCL Mental Health Sciences Unit, University College London, London, UK
  2. 2North East London Foundation Trust, Goodmayes Hospital, Ilford, UK
  3. 3Dementia Services Development Centre, Bangor University, Bangor, UK
  4. 4Department of Clinical, Educational and Health Psychology, University College London
  1. Correspondence to: M Orrell m.orrell{at}
  • Accepted 29 November 2011

Interest is growing in the potential for mental exercises and activities to maintain and improve cognitive function, especially for patients attending memory clinics. However, a recent six week study of online brain training1—using cognitive tasks designed to improve reasoning, memory, planning, visuospatial skills, and attention—found that although specific improvements occurred in each domain, these effects did not transfer to untrained tasks.

Psychological therapies targeting cognitive function in dementia have been in widespread use for several decades. These approaches may involve personalised interventions, such as cognitive rehabilitation (which focuses on coping with deficits and enhancing remaining cognitive skills)2 or cognitive training (which aims to enhance cognitive skills such as memory and attention through practice). More generic approaches include reminiscence, reality orientation, and cognitive stimulation therapy (box).3 Reality orientation, which involved re-teaching information related to orientation to everyday life (such as date, location, and current events), has now been superseded by cognitive stimulation, which uses more implicit methods, with activities including categorisation and word association. Group based cognitive stimulation therapy is now a well established, evidence based, and cost effective approach that can improve cognition and quality of life in people with dementia.3 4

Description of cognitive stimulation therapy

  • Cognitive stimulation therapy ( is an intervention for people with mild to moderate dementia that is usually delivered by specifically trained staff, who may include occupational therapists and mental health nurses

  • It can be conducted individually or (more usually) in groups of five to eight people, in settings including care homes, memory clinics, and day centres

  • Sessions include structured discussions about topics …

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