Estimulación cognitiva para mejorar el funcionamiento cognitivo en personas con demencia
Referencias
Referencias de los estudios incluidos en esta revisión
Referencias de los estudios excluidos de esta revisión
Referencias de los estudios en curso
Referencias adicionales
Referencias de otras versiones publicadas de esta revisión
Characteristics of studies
Characteristics of included studies [ordered by study ID]
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 40 (23F/17M) Confirmed clinical diagnosis of mild or moderate dementia in adults (aged 40 and over) with premorbid mild or moderate intellectual disability Age 60.4 (SD 8.2) Most (72.5%) living in supported housing/residential care 45% receiving anti‐dementia medication | |
| Interventions | Individual cognitive stimulation delivered by carers (N = 20) (most carers (82.5%) were paid carers; remainder are relatives or friends) Waiting‐list controls receiving usual treatment (N = 20) | |
| Outcomes | Cognition: Cambridge Cognitive Examination for Older Adults with Down Syndrome (CAM‐COG‐DS); Modified Memory for Quality of life: QoL‐AD (proxy‐completed) ADL: Alzheimer’s Dementia Cooperative Study‐Activities of Daily Living Inventory (ADCS‐ADL) Caregiver outcomes: Care Giving Burden Scale; Sense of Competence in Dementia Care Staff Scale (SCIDS); Hospital Anxiety and Depression Scale (HADS) | |
| Notes | Recommended 30 minutes, twice a week, for 20 weeks | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | "The randomisation process was performed centrally using a web‐based system". |
| Allocation concealment (selection bias) | Low risk | Randomisation carried out by external administrator and unblinded researcher informed participants of allocation. |
| Blinding of outcome assessment (detection bias) | Low risk | Blinded evaluator |
| Incomplete outcome data (attrition bias) | Low risk | Low attrition at end‐point and intention‐to‐treat analyses reported |
| Selective reporting (reporting bias) | Low risk | All outcomes cited in protocol paper appeared to be reported. |
| Other bias ‐ training and supervision | Low risk | One‐to‐one training and ongoing support provided to carers implementing the intervention |
| Other bias ‐ treatment manual | Low risk | Used adapted version of iCST Manual (Yates 2014) |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 105 (91F/14M) Met the DSM‐5 criteria for neurocognitive disorder (dementia) (no information regarding medication) Age 83.6 (SD 7.6; range 59‐98) Eight centres participated (2 day‐centres, 2 nursing homes, 2 psychogeriatric centres, 1 hospital, 1 rehabilitation centre) | |
| Interventions | Cognitive stimulation group sessions (N = 55) Treatment‐as‐usual (N = 50) | |
| Outcomes | Cognition: ADAS‐Cog; Clinical Dementia Rating (CDR) Cognitive Reserve Questionnaire Quality of life: QoL‐AD (self‐report & proxy scores combined in paper ‐ separate scores provided by authors) Communication: Holden Communication Scale Mood: Cornell Scale for Depression in Dementia (CSDD); RAID (Rating of Anxiety in Dementia) Behaviour: Behaviour Rating Scale (CAPE) | |
| Notes | 45 minutes, twice a week, for 7 weeks | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomisation process performed centrally using a web‐based system |
| Allocation concealment (selection bias) | Low risk | Randomisation carried out by external administrator; participants informed of group allocation by an unblinded researcher |
| Blinding of outcome assessment (detection bias) | Low risk | Outcome assessors blinded |
| Incomplete outcome data (attrition bias) | Low risk | No attrition in intervention group ‐ reasons given for larger dropout in control group |
| Selective reporting (reporting bias) | Low risk | All outcomes cited in Methods section were reported. |
| Other bias ‐ training and supervision | Low risk | Facilitators trained by researchers who had trained at International CST centre |
| Other bias ‐ treatment manual | Low risk | Used Portugese adaptation of CST Manual (Spector 2006) |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 23 (23F/0M) Alzheimer’s (SDAT) Mean MMSE 20.6 (SD 4.9) Mean age 84.5 (SD 6.4; range 75‐94) All resident in institution | |
| Interventions | RO group sessions (N = 13) Treatment‐as‐usual (N = 10) | |
| Outcomes | Cognition: MMSE; Berg Orientation Scale Mood: GDS‐30 ADL: Stewart ADL scale | |
| Notes | 60 minutes, 3 times a week for 3 months; 3‐month follow‐up data on cognitive measures | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Stated by email that their trials were randomised (with no detail of the methods used) |
| Allocation concealment (selection bias) | Unclear risk | Stated by email that their trials were randomised (with no detail of the methods used) |
| Blinding of outcome assessment (detection bias) | Unclear risk | No details of who assessors were |
| Incomplete outcome data (attrition bias) | Low risk | Zero attrition at 3‐month post‐treatment assessment; no attrition reported at follow‐up 3 months later |
| Selective reporting (reporting bias) | Low risk | Scores for all measures reported |
| Other bias ‐ training and supervision | Unclear risk | No details of who carried out the groups |
| Other bias ‐ treatment manual | Unclear risk | Described as 'formal ROT' |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 87 (61F/26M) 'Degenerative senile dementia of the Alzheimer’s type (SDAT)' (N = 46) and “vascular multi‐infarct dementia” (N = 41) Mean MMSE 20.7 (SD 3.0) Mean age 80.0 (range 65‐97) Resident in subacute care nursing home All had at least elementary schooling. "All had comorbid conditions consisting of vascular accidents with acute motor deficits of recent onset". | |
| Interventions | RO + physical therapy programme (N = 71) Physical therapy programme only (N = 16) | |
| Outcomes | Cognition: MMSE Mood: Geriatric Depression Scale (GDS‐30) ADL: Barthel | |
| Notes | 60 minutes, 5 days per week for one month | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Stated by email that their trials were randomised (with no detail of the methods used) |
| Allocation concealment (selection bias) | Unclear risk | Stated by email that their trials were randomised (with no detail of the methods used) |
| Blinding of outcome assessment (detection bias) | Unclear risk | No details of assessors given |
| Incomplete outcome data (attrition bias) | Low risk | Zero attrition reported |
| Selective reporting (reporting bias) | Low risk | Scores for all measures reported |
| Other bias ‐ training and supervision | Unclear risk | No information given on therapists |
| Other bias ‐ treatment manual | Unclear risk | No information given ‐ 'ROT sessions' |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 13 (9F/4M) 'Mildly impaired probable Alzheimer’s diagnosis' All participants taking rivastigmine 6‐12 mg/day for 2 months Mean MMSE 22.3 (SD 3.6; range 16‐28) Age 73.7 (range 62‐83) Outpatients | |
| Interventions | 'cognitive rehabilitation' plus rivastigmine; carers attended a support group at same time (N = 6) Treatment‐as‐usual: rivastigmine plus 30 minute monthly consultation with doctor in relation to medication (N = 7) | |
| Outcomes | Participants: Cognition: MMSE; ADAS‐Cog, plus battery of neuropsychological tests ADL (rated by carer) Carers' mood: Hamilton Anxiety and Montgomery‐Asberg Depression Rating Scales | |
| Notes | 90 minutes, once a week, for 5 months | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomised blocks design |
| Allocation concealment (selection bias) | Low risk | Random allocation to either group by telephone made by an assessor blind to the patient group |
| Blinding of outcome assessment (detection bias) | Low risk | Assessment made by assessors blinded to group allocation |
| Incomplete outcome data (attrition bias) | Low risk | Zero attrition reported |
| Selective reporting (reporting bias) | Low risk | Scores for all measures reported |
| Other bias ‐ training and supervision | Unclear risk | No information provided on therapists |
| Other bias ‐ treatment manual | Unclear risk | Some detail given of 'cognitive rehabilitation training sessions', meeting criteria for cognitive stimulation, but no mention of manual or protocol |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 61 (37F/24M) Diagnosis of dementia (DSM‐III) (90% have Alzheimer's disease) Age 77.1 (range 61‐93) Mean MMSE 21.5 (range 9‐29) Outpatients | |
| Interventions | Cognitive stimulation (N = 29) Treatment‐as‐usual (N = 27) | |
| Outcomes | Cognition: MMSE, CERAD ADL: ECA scale rated by family members | |
| Notes | 60 minutes, 2 times a week, for 5 weeks | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Described as randomised, but no details of randomisation reported |
| Allocation concealment (selection bias) | Unclear risk | No details of randomisation reported |
| Blinding of outcome assessment (detection bias) | Low risk | Cognitive assessments made by an assessor blind to group allocation; ADL assessment open |
| Incomplete outcome data (attrition bias) | Unclear risk | Five patients excluded as did not attend all training and evaluation sessions (3 from treatment group, 2 from controls) ‐ reasons for non‐attendance not provided |
| Selective reporting (reporting bias) | Unclear risk | Data on all measures reported, except for several scales which were deemed unsuitable due to ceiling effects |
| Other bias ‐ training and supervision | Unclear risk | Two therapists ‐ psychologist and physician ‐ training in cognitive stimulation techniques not specified |
| Other bias ‐ treatment manual | Unclear risk | Described as a 'cognitive stimulation programme' and some examples given, but no information regarding a manual or protocol |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 39 24 amnestic MCI; 15 mild Alzheimer's disease (only data on Alzheimer's patients reported in this review) 8F/7M Mean MMSE 24.9 (SD 1.6; range 22‐27) All on stable doses of AChEIs or memantine Age 75.9 (SD 8.1) Outpatients | |
| Interventions | Multi‐component cognitive group intervention ‐ for AD group (N = 8) emphasis on cognitive stimulation (for MCI group more emphasis on cognitive training); Control group (N = 7) had pencil and paper exercises for self‐study and monthly meetings. | |
| Outcomes | Cognition: MMSE; ADAS‐Cog, Trail Making Test, RBANS story memory & recall Quality of life: QoL‐AD Mood: Montgomery Asberg Depression Rating Scale | |
| Notes | 2 hours, once a week for 6 months (20 sessions) | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Blocked randomisation procedure; participants pooled in pairs with respect to age, gender, education and ApoE genotype, then randomly assigned pairs to intervention or control using a computerised random number generator |
| Allocation concealment (selection bias) | Low risk | Blocked randomisation procedure ‐ "a study‐independent person then randomly assigned pairs to the intervention or control arm". |
| Blinding of outcome assessment (detection bias) | Low risk | Assessors blind to group allocation |
| Incomplete outcome data (attrition bias) | Low risk | Zero attrition in AD group |
| Selective reporting (reporting bias) | Low risk | Data on all measures reported |
| Other bias ‐ training and supervision | Unclear risk | No information provided regarding training or supervision of the group leader, who remained constant throughout (first author) |
| Other bias ‐ treatment manual | Low risk | "Manual with reproducible detailed protocols" developed before start of programme |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 39 (27F/12M) Mild/moderate dementia (Alzheimer's, vascular or mixed); MMSE > 13; Clinical Dementia Rating (CDR) 1 or 2 Not receiving AChEI medication Mean MMSE 18.2 (SD 3.4) Age 87.4 (SD 5.4) Two residential homes for older people | |
| Interventions | Cognitive stimulation groups (N = 20) 'Active control' (Reading, discussions, creative activities) (N = 19) | |
| Outcomes | Cognition: MMSE; ADAS‐Cog; Digit Span backwards Communication: Narrative Language test Quality of Life: QoL‐AD Mood: Cornell Scale for Depression in Dementia (CSDD); De Jong social and emotional loneliness scale Behaviour Problems: NPI ADL/IADL: Disability Assessment for Dementia (DAD) | |
| Notes | 45 minutes, twice a week, for 7 weeks | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Very little detail given regarding randomisation except that random allocation took place |
| Allocation concealment (selection bias) | Unclear risk | No information given regarding who carried out randomisation |
| Blinding of outcome assessment (detection bias) | Low risk | Stated as 'single‐blind'. Not clear whether care home staff rating NPI and DAD would have been blind to treatment allocation |
| Incomplete outcome data (attrition bias) | Unclear risk | No information given regarding attrition after beginning of treatment; 5/44 had dropped out by that point (?pre‐randomisation). |
| Selective reporting (reporting bias) | Low risk | All outcome measures mentioned in methods were reported. |
| Other bias ‐ training and supervision | Low risk | "Two trained operators acted as facilitators". |
| Other bias ‐ treatment manual | Low risk | Adapted for Italy from Spector 2006 manual |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 225 (149F/76M) 'Major neurocognitive disorder' DSM‐V mild‐to‐moderate range (no information regarding medication) Mean MMSE 20.1 (SD 4.0) Age 83.6 (SD 8.1; range 50‐99) 16 residential homes and day‐centres | |
| Interventions | Cognitive stimulation groups (N = 123) Usual treatment group sessions (N = 102) | |
| Outcomes | Cognition: ADAS‐Cog; MMSE Language: Narrative Language Test Quality of life: QoL‐AD (self‐report) Mood: Cornell Scale for Depression in Dementia ADL: Disability Assessment for Dementia (DAD) Behaviour problems: NPI | |
| Notes | 45 minutes, twice a week, for 7 weeks; 3‐month follow‐up | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | "Covariate adaptive randomization was used at each participating centre". |
| Allocation concealment (selection bias) | Unclear risk | No information provided as to who carried out the randomisation or the process used for concealment of allocation |
| Blinding of outcome assessment (detection bias) | Low risk | "Conducted by trained psychologists who did not participate in the treatment program, and they had no information on participants’ group allocation". |
| Incomplete outcome data (attrition bias) | Low risk | Low attrition at post‐treatment; reasons given for those dropping out; data sought for all participants irrespective of compliance |
| Selective reporting (reporting bias) | Low risk | All outcomes reported |
| Other bias ‐ training and supervision | Low risk | One‐day training for at least one facilitator of each group, plus experience of dementia care and group facilitation skills |
| Other bias ‐ treatment manual | Low risk | Italian version of 'Making a difference' manual used (Spector 2006) |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 54 (29F/25M) Probable AD, on stable dose of donepezil for at least 3 months Mean MMSE 20.87 (SD 3.55, range 12‐28) Age 76.4 (SD 7.9; range 54‐91) Living at home initially | |
| Interventions | Cognitive stimulation + donepezil Donepezil only | |
| Outcomes | Cognition: MMSE; ADAS‐Cog ADL: Texas Functional Living Scale Behavioural problems: NPI ‐ Irritability and Apathy Quality of Life: QoL‐AD Global functioning: CBIC Verbalisation: Composite discourse score Carer distress ‐ derived from the NPI 10‐month follow‐up data available | |
| Notes | 90 minutes, once a week, for 8 weeks | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Remote telephone randomisation, using a SAS procedure |
| Allocation concealment (selection bias) | Low risk | Independent randomisation procedure |
| Blinding of outcome assessment (detection bias) | Low risk | All raters underwent extensive training; assessors blinded to group allocation |
| Incomplete outcome data (attrition bias) | Low risk | Intention‐to‐treat analysis used. 24% attrition rate at end of study |
| Selective reporting (reporting bias) | Low risk | Data on all measures reported |
| Other bias ‐ training and supervision | Low risk | Programme led by trained speech therapist, assisted by three Master’s level speech language |
| Other bias ‐ treatment manual | Low risk | No indication of a manual, but a clear structure to follow was evident. |
| Study characteristics | ||
| Methods | Cluster‐RCT | |
| Participants | N = 30 (22F/8M) Early‐to‐moderate dementia (any type) Global Deterioration Scale stages 4 to 6 Mean MoCA 7.9 (SD 4.4) Age 83.2 (SD 7.2) 73.3% had received either only a primary education or no education (73.3%). Two daycare centres | |
| Interventions | Cognitive stimulating play intervention Control ‐ social activities (reading newspapers, watching TV) | |
| Outcomes | Cognitive: Montreal Cognitive Assessment (MoCA); Fuld Object Memory Evaluation; Modified Verbal Fluency Test | |
| Notes | 45‐60 minutes, once a week, for 8 weeks | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Cluster‐randomised, but only 2 clusters, so chance of comparable groups was less, and there was a significant baseline difference on the MoCA cognitive assessment. |
| Allocation concealment (selection bias) | Low risk | Randomisation carried out by independent researcher |
| Blinding of outcome assessment (detection bias) | Low risk | Data collection and entry undertaken by a blinded research assistant |
| Incomplete outcome data (attrition bias) | Low risk | Some attrition due to sickness, 3/18 from cognitive stimulation and 1/12 from control, but used ITT analysis |
| Selective reporting (reporting bias) | Low risk | All outcomes reported |
| Other bias ‐ training and supervision | Low risk | Training provided by co‐ordinator |
| Other bias ‐ treatment manual | Low risk | Clear structure for the approach and example session outline provided |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 27 (14F/13M) Dementia ‐ MMSE 10‐23 MMSE: 16.9 (SD 5.0) Age: 79.8 (SD 5.6) Groups ran in 2 long‐term care facilities and a private nursing home | |
| Interventions | Cognitive stimulation (N = 14) No treatment (N = 13) | |
| Outcomes | Cognition: MMSE; ADAS‐Cog Quality of life: QoL‐AD Mood: Geriatric Depression Scale (14‐item); RAID (Rating of Anxiety in Dementia) Behaviour: Behaviour Rating Scale (CAPE) Clinical Dementia Rating (sum of boxes) | |
| Notes | 45 minutes, 2 times a week for 7 weeks | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Stated that participants were randomly assigned. Author confirmed computerised randomisation and random number tables were used. |
| Allocation concealment (selection bias) | Unclear risk | Unclear who carried out randomisation and whether this was independent |
| Blinding of outcome assessment (detection bias) | Low risk | Tests administered by staff blind to group membership |
| Incomplete outcome data (attrition bias) | Low risk | No attrition reported |
| Selective reporting (reporting bias) | Low risk | Data for all measures reported |
| Other bias ‐ training and supervision | Unclear risk | Sessions led by occupational therapists and activity coordinator ‐ training/supervision unclear |
| Other bias ‐ treatment manual | Low risk | Used Spector 2006 manual |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 47 (22F/25M) DSM‐IV criteria for dementia of any type (62% Alzheimer's or mixed) 62% receiving dementia medications Mean MMSE 22.8 (SD 3.4) Age 77.3 (SD 7.0) Living in the community | |
| Interventions | CST groups + carer training (N = 21) CST groups (N = 24) Waiting‐list controls (N = 23) | |
| Outcomes | Cognitive: MMSE, ADAS‐Cog Quality of Life: QoL‐AD Quality of Caregiver‐Patient Relationship (QCPR) | |
| Notes | Comparison of interest was CST groups versus controls; 45 minutes, once a week for 14 weeks. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | "Participants were randomized using the block method to achieve equal group sizes using Random Allocation Software". |
| Allocation concealment (selection bias) | Low risk | Although randomisation appeared to have preceded baseline assessment, it seemed to be independent of assessment. |
| Blinding of outcome assessment (detection bias) | Low risk | Assessors clearly blinded |
| Incomplete outcome data (attrition bias) | Low risk | 3/24 withdrew from CST and 2/24 from controls, but ITT analysis used (LOCF). 1 person withdrew from controls before assessment, and was not included, but probably minimal effect. |
| Selective reporting (reporting bias) | Low risk | All outcomes reported |
| Other bias ‐ training and supervision | Unclear risk | Groups run by clinicians ‐ no mention of training or supervision |
| Other bias ‐ treatment manual | Low risk | The study followed the standardised CST manual (Spector 2006). |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 33 (16F/17M) DSM‐V criteria for dementia Mean MMSE 21.7 (SD 3.5; range 14‐27) Age 81.9 (SD 10.3; range 56‐98) Care homes | |
| Interventions | Individual CST (delivered by researchers) (N = 17) Treatment‐as‐usual (N = 16) | |
| Outcomes | Cognition: SMMSE, ADAS‐Cog Well‐being and Quality of Life: QoL‐AD (self‐report), QoL‐AD (proxy), Positive Psychology Outcome Measure (PPOM), Engagement and Independence in Dementia Questionnaire (EID‐Q) | |
| Notes | 45 minutes, 2 times a week for 7 weeks | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Participants were randomly allocated by an independent web‐based randomiser to receive either iCST or TAU within the care home, with a 1:1 ratio. |
| Allocation concealment (selection bias) | Low risk | Randomisation conducted independently |
| Blinding of outcome assessment (detection bias) | Low risk | Researchers conducting follow‐up assessments were blinded to group allocation. Some risk for proxy QoL‐AD |
| Incomplete outcome data (attrition bias) | Unclear risk | The treatment of missing data was unclear, with some imputation, some items omitted and some participants excluded for some measures. |
| Selective reporting (reporting bias) | Low risk | All outcome measures mentioned in methods were reported. |
| Other bias ‐ training and supervision | Unclear risk | All sessions conducted by members of the research team, also described as 'professionals', but no specific mention of their training or supervision |
| Other bias ‐ treatment manual | Low risk | Adapted from CST (Spector 2006) and iCST manuals (Yates 2014) |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 96 (80F/16M) (For 6‐month evaluation, N = 139 (115F/24M)) ICD‐10 criteria for primary degenerative dementia (vascular and secondary dementia excluded) 13.5% receiving anti‐dementia medication Mean MMSE 14.6 (SD 5.4) Age 85.1 (SD 5.1) Nursing homes | |
| Interventions | MAKS groups (motor stimulation, practice in activities of daily living, and cognitive stimulation) (N = 50; 6 months N = 71) Treatment‐as‐usual (N = 46; 6 months N = 68) | |
| Outcomes | Cognition: ADAS‐Cog* ADL: Erlangen Test of Activities of Daily Living (E‐ADL)*; Barthel Index**; NOSGER ADL** and IADL subscales** Behaviour: Nurses’ Observation Scale for Geriatric Patients (NOSGER)** Mood: NOSGER Mood subscale** Problem Behaviour: NOSGER Challenging behaviour subscale** Social Interaction: NOSGER Social Behaviour subscale** Care requirements: Resource Utilization in Dementia—Formal Care (RUD‐FOCA)** (*10‐month follow‐up data provided; **Data after 6 months of intervention only) | |
| Notes | 2 hours, 6 times a week for 12 months | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated randomisation used |
| Allocation concealment (selection bias) | Unclear risk | Not clear who carried out the randomisation, or how independent they were. The randomisation appears to be carried out before baseline assessment, but evaluators were blinded, so this should not introduce bias. |
| Blinding of outcome assessment (detection bias) | Low risk | Evaluators were independent and blinded to treatment allocation. |
| Incomplete outcome data (attrition bias) | High risk | Per protocol analysis only has extractable data (although ITT analysis was also done). 38% lost for per protocol analysis |
| Selective reporting (reporting bias) | Low risk | All outcomes reported (time points varied) |
| Other bias ‐ training and supervision | Low risk | Three days of training provided and compliance checked three times at each nursing home throughout study. |
| Other bias ‐ treatment manual | Low risk | "Therapists and aides received a standardized handbook from the central study site describing in detail the steps to be taken on each day of therapy." Handbook developed specifically for the study |
| Study characteristics | ||
| Methods | iRCT | |
| Participants | N = 67 (46F/21M) Diagnosis of mild dementia, using DSM‐5 criteria (MMSE 19‐24) Mean MMSE 22.6 (SD 0.9) Age 77.7 (SD 8.2) Outpatients | |
| Interventions | 'SADEM' cognitive stimulation groups (N = 39) Treatment‐as‐usual (N = 28) | |
| Outcomes | Cognition: ADAS‐Cog; MMSE; Syndrom‐Kurztest (SKT); verbal fluency (semantic and phonological) Mood: CESD‐R, Center for Epidemiologic Studies Depression Scale‐Revised ADL: Rapid Disabilty Rating Scale (RDRS) Behaviour: Blessed Dementia Rating Scale Behaviour problems: NPI Caregiver outcomes (N.B. No data available for these): Zarit Burden Interview; Beck Depression Inventory; Beck Anxiety Inventory | |
| Notes | 90 minutes, 2 times a week, for 48 weeks; 12‐month follow‐up | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | The exact randomisation method was unclear. |
| Allocation concealment (selection bias) | Low risk | Randomisation performed by independent researcher |
| Blinding of outcome assessment (detection bias) | Low risk | Evaluators blind to treatment allocation |
| Incomplete outcome data (attrition bias) | Low risk | At end of intervention period attrition was low, and intention‐to‐treat analysis was used. |
| Selective reporting (reporting bias) | High risk | The results for caregiver outcomes do not appear to be reported. The results for people with dementia appear to include scales not mentioned in the Methods section. |
| Other bias ‐ training and supervision | Low risk | Some indication training was provided. |
| Other bias ‐ treatment manual | Low risk | Paper reported a detailed manual was used for the intervention. |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 59 (36F/23M) Formal diagnosis of a neurocognitive disorder according to DSM‐5 criteria (51% Alzheimer's disease) No details available regarding AChEI medication Mean MMSE: 23.2 (SD 3.2) Age 78.9 (SD; 7.5; range 65‐98) Community | |
| Interventions | Home‐based Individual cognitive stimulation delivered by clinical psychologist (N = 30) Treatment‐as‐usual (N = 29) | |
| Outcomes | Cognition: MoCA, MMSE Quality of life: QoL‐AD (self‐report) Mood: GDS‐15 ADL: adapted Lawton‐Brody Index | |
| Notes | 45 minutes, once a week, for 47 weeks | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | "Non‐stratified permuted block randomization process" carried out by blinded investigator using computer software |
| Allocation concealment (selection bias) | Low risk | "Allocation was unknown to participants and the therapist until the intervention started". |
| Blinding of outcome assessment (detection bias) | Low risk | Evaluator blinded to participant allocation |
| Incomplete outcome data (attrition bias) | Unclear risk | Relatively high level of attrition (8/30 in intervention group), but lengthy treatment period (47 weeks) and reasons given. Similar attrition in control group |
| Selective reporting (reporting bias) | Low risk | Results for all outcomes cited in Methods section were reported. |
| Other bias ‐ training and supervision | Low risk | Experienced therapist received additional training. |
| Other bias ‐ treatment manual | Low risk | The study protocol provided a detailed account of the activities for each session. |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 53 (37F/16M) Probable Alzheimer's Disease (NINCDS and ADRDA criteria) All participants receiving 'pharmacotherapy' for dementia Mean MMSE 18.0 (SD 5.8) Age 78.5 (SD 1.5; range 61‐94) Community residents attending dementia centre | |
| Interventions | Multi‐domain cognitive stimulation (N = 32) Control group (N = 21) | |
| Outcomes | Cognition: CERAD (Korean version), including word fluency; short Boston naming test; tests of praxis, recall and recognition; MMSE Mood: Geriatric Depression Scale Quality of Life: QoL‐AD (Korean version) (self‐rated and proxy) Clinical Dementia Rating Scale | |
| Notes | 1 hour, 5 times a week for 6 months | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Description of randomisation unclear ('using random numbering') |
| Allocation concealment (selection bias) | Unclear risk | No mention of randomisation being carried out independently |
| Blinding of outcome assessment (detection bias) | Unclear risk | No information about blinding |
| Incomplete outcome data (attrition bias) | High risk | No attrition from intervention group; 34% attrition from control group |
| Selective reporting (reporting bias) | Low risk | All outcome measures mentioned in methods were reported. |
| Other bias ‐ training and supervision | Low risk | "Implementation and management of the cognitive intervention program were carried out by two skilled and professionally educated occupational therapists." |
| Other bias ‐ treatment manual | Low risk | Clear structure for the intervention |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 61 Parkinson's disease dementia (PDD); dementia with Lewy bodies (DLB) according to standard clinical diagnostic criteria Median age (whole sample) 75 (range 55‐90) Community | |
| Interventions | Individual cognitive stimulation adapted for Parkinson's disease (delivered by informal carers) (CST‐PD) (N = 31) Treatment‐as‐usual controls (N = 30) | |
| Outcomes | Cognition: ACE‐III; Dementia Cognitive Fluctuation Scale Quality of Life: EQ‐5D; Parkinson's Disease Questionnaire‐39 Quality of relationship: Relationship Satisfaction Scale Mood: Hospital Anxiety & Depression Scale; Lille Apathy Rating Scale; Brief Resilience Scale ADL: The Pill Questionnaire (specific ADL task) Interpersonal Reactivity Index Behaviour problems: NPI Caregiver outcomes: Hospital Anxiety & Depression Scales; EQ‐5D; Short Form‐12 Health Survey (SF‐12); Relationship Satisfaction Scale; Dyadic Relationship Scale; Zarit Burden Interview; Relatives Stress Scale; Family Caregiving Role Scale; Brief Resilience Scale | |
| Notes | 30 minutes, 2‐3 times a week for 12 weeks Study also included mild cognitive impairment in Parkinson's disease (PD‐MCI); study authors have provided data for PDD and DLB separately for this review. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | "an independent arbiter, applied a single‐stratum, blocked randomization to CST‐PD or TAU at a 1:1 level by participant–dyad". |
| Allocation concealment (selection bias) | Low risk | Independent process: "A tamper proof process of single‐strata, blocked randomisation will be applied and communicated via telephone and confirmatory email by an independent arbiter" (trial protocol). |
| Blinding of outcome assessment (detection bias) | Low risk | Clearly blinded:"'Procedures were in place to conceal the allocation from the independent, blinded outcome raters". |
| Incomplete outcome data (attrition bias) | Unclear risk | In the additional data provided by the study authors for e.g. the main cognition outcome (ACE‐III), 10/28 were missing at post‐treatment (cf. 3/28 for the control group). Analyses were for complete case only, so unclear what effect this might have |
| Selective reporting (reporting bias) | Low risk | Results for all outcomes were reported. |
| Other bias ‐ training and supervision | Low risk | Care partners received training and support to deliver the intervention. |
| Other bias ‐ treatment manual | Low risk | Manual developed (from iCST manual, Yates 2014) for the study |
| Study characteristics | ||
| Methods | Cluster‐RCT | |
| Participants | N = 105 (66F/39M) People with dementia with symptoms of agitation or depression Mean MMSE 14.9 (SD 3.7) Age 79.5 (SD 7.7) Long‐term care institutions | |
| Interventions | Cognitive stimulation (N = 30) Reminiscence therapy (N = 43) Treatment‐as‐usual control (N = 32) | |
| Outcomes | Cognition: MMSE Quality of Life: QoL‐AD Three‐month follow‐up | |
| Notes | 50 minutes, once a week for 10 weeks; cognitive stimulation versus control was relevant comparison for this review. Analysable data requested ‐ not received | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Long‐term care institutions randomly assigned into the different groups through a randomised block technique ‐ but no information about block size and sequence |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information regarding concealment |
| Blinding of outcome assessment (detection bias) | Unclear risk | No mention of blinding |
| Incomplete outcome data (attrition bias) | High risk | Participants excluded if attended < 70% of sessions i.e. per protocol analysis ‐ 13% of cognitive stimulation group excluded at post‐test; 15% excluded at follow‐up |
| Selective reporting (reporting bias) | Low risk | All outcome measures mentioned in Methods were reported. |
| Other bias ‐ training and supervision | Low risk | Researcher attended a training course in CST. |
| Other bias ‐ treatment manual | Low risk | Clear structure ‐ followed CST manual, but fewer sessions and adapted content to make more culturally relevant |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 60 (30F/30M) Typical Alzheimer's disease in accordance with International Working Group‐2 diagnostic criteria All receiving AChEI medication Mean MMSE 16.9 (SD 4.3) Age ‐ no information provided Community residents | |
| Interventions | CST groups based on Roy's adaptation model (RAM) (N = 30) Treatment‐as‐usual controls (N = 30) | |
| Outcomes | Cognition: Standardised MMSE Quality of Life: QoL‐AD Coping and Adaptation Processing Scale (CAPS) | |
| Notes | 45 minutes, twice a week for 7 weeks | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Electronic randomisation programme used |
| Allocation concealment (selection bias) | Unclear risk | No information about allocation concealment and independence of randomisation |
| Blinding of outcome assessment (detection bias) | High risk | "Pre‐test and post‐test data were collected and RAM‐based CST was applied by the same person". |
| Incomplete outcome data (attrition bias) | Low risk | Attrition reported as zero and no cases were excluded from analysis |
| Selective reporting (reporting bias) | Low risk | All outcome measures mentioned in methods were reported. |
| Other bias ‐ training and supervision | Unclear risk | Intervention delivered by first author of the paper but little information about receiving training in CST |
| Other bias ‐ treatment manual | Low risk | Based on the manualised CST programme (Spector 2006) |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 20 (15F/5M) Alzheimer's dementia according to DSM‐5 criteria All receiving AChEI medication Mean MMSE 17.9 (SD 3.9) Age 81.9 (SD 5.5; range 66‐89) Community ‐ daycare centre | |
| Interventions | Cognitive stimulation groups (N = 10) Treatment‐as‐usual controls (N = 10) | |
| Outcomes | Cognition: ADAS‐Cog; MMSE; WAIS‐III, Wechsler Memory Scale III and Neuropsychological test battery (32 tests in total), including verbal fluency, digit span, Boston Naming Test | |
| Notes | 60 minutes, three times a week for 6 months | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Sequence of block randomisation was described. |
| Allocation concealment (selection bias) | Unclear risk | No information about blinding at point of randomisation |
| Blinding of outcome assessment (detection bias) | Unclear risk | No information about blinding of outcome assessments |
| Incomplete outcome data (attrition bias) | Unclear risk | There was no indication of attrition, despite being a 6‐month intervention study. |
| Selective reporting (reporting bias) | Low risk | All outcome measures mentioned in methods were reported. |
| Other bias ‐ training and supervision | Unclear risk | Little to no information about who delivered the intervention |
| Other bias ‐ treatment manual | Low risk | Intervention was extracted from a manualised, Spanish cognitive psychostimulation therapy (cuadernos de repaso). |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 14 (8F/6M) Alzheimer's Disease, according to National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer’s Disease and Related Disorders Association (NINCDS‐ADRDA) criteria All receiving a stable dose regimen of memantine and/or cholinesterase inhibitors and/or antidepressants Mean MMSE 17.8 (SD 2.8) Age 72.6 (SD 9.5) Community (gymnasium) | |
| Interventions | Cognitive stimulation/physical activity groups (N = 7) Treatment‐as‐usual (N = 7) | |
| Outcomes | Cognition: MMSE; Frontal Assessment Battery Clinical Dementia Rating ADL: Katz ADL scale; Lawton & Brody Instrumental Activities of Daily Living scale Mood: Cornell Scale for Depression in Dementia; Hamilton Anxiety Rating Scale | |
| Notes | 120 minutes, five times a week for 3 months | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | "Randomly assigned to the active treatment group or to the usual care as control group according to a list of randomly generated sequence of numbers." |
| Allocation concealment (selection bias) | Unclear risk | No indication of who carried out randomisation or their independence |
| Blinding of outcome assessment (detection bias) | Low risk | Examiners blinded |
| Incomplete outcome data (attrition bias) | Unclear risk | No mention of attrition ‐ none reported over 3‐month period? |
| Selective reporting (reporting bias) | Low risk | All outcomes appear to be reported. |
| Other bias ‐ training and supervision | Low risk | Training and supervision provided |
| Other bias ‐ treatment manual | Low risk | There was a clear structure, though no indication of a manual as such. |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 30 (gender not specified) Alzheimer’s disease (N = 16); vascular dementia (N = 13); mixed dementia (N = 1) according to DSM‐IV‐TR criteria Mean MMSE 19.5 (SD 3.4) Age 83.7 (SD 4.6) Nursing home | |
| Interventions | Cognitive stimulation groups (N = 10) Occupational therapy 'Placebo' groups (N = 10) Treatment‐as‐usual control (N = 10) | |
| Outcomes | Cognition: MMSE; Esame Neuropsicologico Breve 2 (ENB2) (comprises 14 subtests including digit span, verbal fluency and Trail Making Test); Clinical Dementia Rating Mood: Geriatric Depression Scale (GDS‐30) ADL: ADL scale Behaviour problems: Behavioral Pathology in Alzheimer’s Disease Rating Scale (Behave‐AD scale) | |
| Notes | 60 minutes, five times a week for 8 weeks. Relevant comparison for this review was cognitive stimulation versus treatment‐as‐usual. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Allocation appears to be simple randomisation using 'a simple computerized randomization technique', but no further details given |
| Allocation concealment (selection bias) | Unclear risk | No mention of who carried out randomisation |
| Blinding of outcome assessment (detection bias) | Low risk | Blinded rater |
| Incomplete outcome data (attrition bias) | Low risk | Full information provided ‐ no participants lost to follow‐up, no participants excluded from analyses |
| Selective reporting (reporting bias) | High risk | No information was reported on some outcome measures despite being included in the methods (e.g. ADL, GDS‐30). |
| Other bias ‐ training and supervision | Unclear risk | No mention of training |
| Other bias ‐ treatment manual | Unclear risk | Although structure was outlined, exact content of exercises was unclear ‐ did not appear to be a treatment manual as such |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 47 (29F/18M) Clinical diagnosis of dementia according to DSM‐IV criteria (MMSE 10‐24) All participants receiving AChEI medication Clinical Dementia Rating: 23 mild; 24 moderate Age 77.8 (SD; 8.4; range 60‐91) Outpatients | |
| Interventions | Cognitive stimulation groups (N = 23) Treatment‐as‐usual (N = 24) | |
| Outcomes | Cognition: ADAS‐Cog Quality of life: QoL‐AD (self‐report and proxy) Mood: Cornell Scale for Depression in Dementia ADL: ADCS‐ADL scale Caregiver outcomes: Zarit Burden Interview | |
| Notes | 45 minutes, 2 times a week, for 7 weeks (both weekly sessions on same day, separated by short break) | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Used a random list generated by a computer program; stratified by dementia severity |
| Allocation concealment (selection bias) | Unclear risk | Not detailed who carried out the randomisation, and whether external to the study |
| Blinding of outcome assessment (detection bias) | Low risk | Outcome assessments carried out by researchers blind to the intervention |
| Incomplete outcome data (attrition bias) | Low risk | Data provided for intention‐to‐treat analysis; reasons for dropouts described |
| Selective reporting (reporting bias) | Low risk | Results for all outcomes reported |
| Other bias ‐ training and supervision | Low risk | Facilitators trained by International CST centre |
| Other bias ‐ treatment manual | Low risk | Used Brazilian CST manual, adapted from Spector 2006 |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 71 (60F/11M) Mild‐to‐moderate dementia according to ICD‐10 criteria Mean MMSE 16.9 (SD 4.5; range 10‐24) Age 86.4 (SD 4.5; range 74‐102) Nursing homes | |
| Interventions | Cognitive stimulation groups 'NEUROvitalis senseful' (N = 36) Treatment‐as‐usual control group (N = 35) | |
| Outcomes | Cognition: ADAS‐Cog Quality of Life: QoL‐AD (self‐report and proxy) ADL: ADCS‐ADL Behaviour problems: NPI‐NH Six‐week follow‐up data provided | |
| Notes | 60 minutes, twice a week for 8 weeks | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Used computer generated random numbers |
| Allocation concealment (selection bias) | Unclear risk | "The randomization process was then realized by a member of the research group who was blinded to the participants". Not clear how independent this process was? |
| Blinding of outcome assessment (detection bias) | Low risk | Assessors for ADAS‐Cog and QoL‐AD blind to group assignment and not involved in any other part of the study. Group secrecy emphasised |
| Incomplete outcome data (attrition bias) | Low risk | Details of attrition provided and followed ITT principle (also per protocol analysis) |
| Selective reporting (reporting bias) | Low risk | All outcome measures mentioned in methods were reported. |
| Other bias ‐ training and supervision | Unclear risk | Facilitator was researcher experienced in conducting non‐pharmacological interventions, but no details of training or supervision |
| Other bias ‐ treatment manual | Low risk | "Every session was described in detail in a manual, including advice for instructions." |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 156 (113F/43M) Probable Alzheimer's Disease, on donepezil for at least 3 months MMSE 20.1 (SD 3.1) Age 75.8 (SD 7.1) Living at home | |
| Interventions | Individual RO (delivered by family caregiver) + donepezil (N = 79) Donepezil only (N = 77) | |
| Outcomes | Cognition: MMSE; ADAS‐Cog ADL: Barthel; Lawton & Brody IADL scale Behaviour problems: NPI Family caregiver outcomes: Hamilton anxiety and depression scales; Caregiver Burden Inventory; SF‐36 | |
| Notes | 30 minutes, 3 times a week, for 25 weeks; plus informal contacts 2 or 3 times a day | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computerised block randomisation process |
| Allocation concealment (selection bias) | Unclear risk | No information regarding the independence of the randomisation process |
| Blinding of outcome assessment (detection bias) | Low risk | Assessments made by blind assessors |
| Incomplete outcome data (attrition bias) | Low risk | Attrition data reported with reasons: 9 from RO group, 10 from control group i.e. 12%. Intention‐to‐treat analysis |
| Selective reporting (reporting bias) | Low risk | Data for all outcome measures reported |
| Other bias ‐ training and supervision | Low risk | Family caregivers trained by a multidisciplinary team including physicians, psychologists and therapists. Training included a simulated therapy session. |
| Other bias ‐ treatment manual | Low risk | The family caregivers were also provided with a manual of instruction on the therapy and specific schedules for each session. |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 356 (165 F/191 M) Mild‐to‐moderate dementia according to DSM‐IV criteria 76% receiving AChEI medication Mean MMSE 21.2 (SD 4.3) Age 78.2 (SD 7.5) Community | |
| Interventions | Individual cognitive stimulation (delivered by informal caregivers) (N = 180) Treatment‐as‐usual controls (N = 176) | |
| Outcomes | Cognition: ADAS‐Cog; MMSE Quality of Life: QoL‐AD (self‐report and proxy); DEMQOL (self‐report and proxy) Quality of relationship: Quality of the Carer‐Patient Relationship Scale (QCPR) ADL: Bristol ADL Scale Mood: GDS‐15 Behaviour problems: NPI Caregiver outcomes: Short Form‐12 Health Survey (physical (PCS) and mental (MCS) components); Hospital Anxiety & Depression Scale (HADS); EQ‐5D‐3L; Resilience Scale‐14; NPI carer distress; QCPR | |
| Notes | 30 minutes, 3 times a week, for 25 weeks Imputed adjusted means used in meta‐analysis | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | "Randomisation was completed using a dynamic adapative allocation method, with an overall allocation ratio of 1: 1. Random allocation was stratified by site and receipt of acetylcholinesterase inhibitors (AChEIs)." |
| Allocation concealment (selection bias) | Low risk | Randomisation database held at trials unit; only unblinded researchers informed of allocation |
| Blinding of outcome assessment (detection bias) | Low risk | Assessors blinded |
| Incomplete outcome data (attrition bias) | Low risk | Full details given on attrition. ITT analyses used |
| Selective reporting (reporting bias) | Low risk | Results given for all planned outcomes |
| Other bias ‐ training and supervision | Low risk | Carers all received training in delivering iCST and support throughout study. |
| Other bias ‐ treatment manual | Low risk | Carers all received standardised training package and manual (Yates 2014). |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 236 (150 F/86 M) Dementia according to DSM‐IV criteria (31% Alzheimer's disease) 32% receiving AChEI medication Mean MMSE 17.8 (SD 5.5) Age 83.1 (SD; 7.6) Nine care homes and nine community settings | |
| Interventions | Maintenance cognitive stimulation groups (following 7 weeks of twice‐weekly cognitive stimulation groups) (N = 123) Treatment‐as‐usual controls (following 7 weeks of twice‐weekly cognitive stimulation groups) (N = 113) | |
| Outcomes | Cognition: ADAS‐Cog; MMSE Quality of life: QoL‐AD (self‐report and proxy); DEMQOL Mood: Cornell Scale for Depression in Dementia; RAID ADL: ADCS‐ADL scale Behaviour problems: NPI Caregiver outcomes: SF‐12 | |
| Notes | 45 minutes, once a week, for 24 weeks No data were imputed for those cases in which all assessments were missing (see page 30, SHIELD report). Adjusted means used for meta‐analysis | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | "The random allocation sequence was computer‐generated and in the ratio of 1:1." Carried out by clinical trials unit |
| Allocation concealment (selection bias) | Low risk | Only intervention researcher informed of allocation by clinical trials unit |
| Blinding of outcome assessment (detection bias) | Low risk | Blinded researchers completed interviews and questionnaires. Proxy measures completed by carers/care staff not blinded |
| Incomplete outcome data (attrition bias) | Low risk | Attrittion rates and reasons given, analysis by treatment allocated |
| Selective reporting (reporting bias) | Low risk | Results given for all planned outcomes |
| Other bias ‐ training and supervision | Low risk | "All facilitators had at least 1 year of experience in dementia care, and had attended the 1‐day CST training course." |
| Other bias ‐ treatment manual | Low risk | Published treatment manual |
| Study characteristics | ||
| Methods | Stepped wedge design | |
| Participants | N = 34 (29F/5M) Dementia according to DSM‐IV criteria None receiving AChEI medication Mean Clinical Dementia Rating 1.65 (range 1‐2) Median age 80 (IQR 76.5‐85.3) Community | |
| Interventions | Cognitive stimulation groups (N = 16) Wait‐list controls (N = 18) | |
| Outcomes | Cognition: ADAS‐Cog Quality of life: World Health Organization Quality of Life assessment (WHOQOL) Mood: Hospital Anxiety & Depression Scales ADL: World Health Organization Disability Assessment Schedule (WHODAS 2.0) Behaviour problems: NPI Caregiver outcomes: WHOQOL; Zarit Burden Inventory; Hospital Anxiety & Depression Scales; NPI Caregiver distress | |
| Notes | 45 minutes, twice a week, for 7 weeks Relevant comparison was at assessment 8 weeks after baseline, where those who received cognition stimulation could be compared with the wait‐list controls, who had received treatment‐as‐usual. Only ADAS‐Cog data were available for this comparison. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Cluster‐randomised. Simple randomisation with random number generator |
| Allocation concealment (selection bias) | Low risk | Randomisation carried out by independent statistician, blinded to participant allocation |
| Blinding of outcome assessment (detection bias) | Low risk | Outcome assessors were blind to group allocation and did not deliver the CST sessions; participants reminded not to disclose |
| Incomplete outcome data (attrition bias) | Low risk | Intention‐to‐treat protocol ‐ no attrition in relation to comparison of immediate and delayed start groups |
| Selective reporting (reporting bias) | High risk | Although all outcome measures were reported for the comparison of interest (between immediate and delayed start CST groups), only data on ADAS‐Cog provided |
| Other bias ‐ training and supervision | Low risk | Facilitators received training on CST in the UK and had been involved in the adaptation and pilot of adapted CST for Sub‐Saharan Africa. |
| Other bias ‐ treatment manual | Low risk | Published manual ‐ adapted from CST manual |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 61 (19F/42M) Dementia of any type according to DSM‐IV criteria 71% receiving AChEI medication Age 73.0 (SD 7.7; range: 50–89) Community | |
| Interventions | Individual cognitive stimulation therapy (iCST) app, delivered by family caregiver (N = 31) Treatment‐as‐usual controls (N = 30) | |
| Outcomes | Cognition: ADAS‐Cog Quality of Life: QoL‐AD (self‐report and proxy); EQ‐5D Quality of relationship: Quality of the Carer‐Patient Relationship Scale (QCPR) ADL: Bristol ADL Scale Mood: Cornell Scale for Depression in Dementia (CSDD) (self‐ and proxy‐rated) Behaviour problems: NPI Caregiver outcomes: Hospital Anxiety & Depression Scale (HADS); EQ‐5D; QCPR | |
| Notes | Recommended 30 minutes, 2‐3 times a week, for 11 weeks | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | On‐line central randomisation service used for block randomisation |
| Allocation concealment (selection bias) | Low risk | Steps taken to ensure allocation concealment appropriate |
| Blinding of outcome assessment (detection bias) | Low risk | Blinded researcher carried out all post‐baseline outcome assessments. |
| Incomplete outcome data (attrition bias) | Low risk | Intention‐to‐treat analyses and reasons for attrition explained |
| Selective reporting (reporting bias) | Low risk | All outcomes cited in Methods section were reported. |
| Other bias ‐ training and supervision | Low risk | Training and support provided for carers implementing the intervention |
| Other bias ‐ treatment manual | Low risk | App based closely on conventional iCST manual (Yates 2014) |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 86 (61F/25M) Alzheimer‐type dementia (severe dementia excluded) MMSE 21.9 (6.3) Age 77.0 (SD 7.5) Attending daycare centre | |
| Interventions | 1) Cognitive stimulation + donepezil (N = 20) 2) Donepezil only (N = 30) 3) Cognitive stimulation only 4) No treatment | |
| Outcomes | Cognition: MMSE, ADAS‐Cog Mood: GDS‐30 12‐month and 24‐month data reported | |
| Notes | 45 minutes, 5 times a week for 24 months 'No treatment' group were not part of the randomisation process. Comparison of interest to this review was cognitive stimulation + donepezil versus donepezil alone. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Randomisation by registration order: "subjects were randomly distributed in groups at the time they arrived at the Centre". |
| Allocation concealment (selection bias) | Unclear risk | Not clear if randomisation was independent |
| Blinding of outcome assessment (detection bias) | Low risk | Spanish paper stated "Evaluator was blind to treatment allocation". |
| Incomplete outcome data (attrition bias) | Low risk | Attrition reported: 6/20 in CS + donepezil group; 10/30 in donepezil alone group i.e. 32% over 2‐year period |
| Selective reporting (reporting bias) | Low risk | Data for all measures reported |
| Other bias ‐ training and supervision | Unclear risk | Spanish paper stated that groups were led by an independent member of the research team ‐ training and supervision unclear |
| Other bias ‐ treatment manual | Low risk | Clear structure for the cognitive stimulation approach, seven areas of stimulation; two levels of difficulty in relation to questions asked concerning images on TV screen |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 35 Diagnosis of dementia according to DSM‐IV criteria MMSE 13.1 (SD 4.4) Age 85.7 (SD 6.7) Living at home: 12; living in residential home: 23 | |
| Interventions | Cognitive stimulation (N = 21) Treatment‐as‐usual (N = 14) | |
| Outcomes | Cognition: MMSE; ADAS‐Cog Communication: Holden Communication Scale Mood: Cornell Scale for Depression in Dementia; RAID Behaviour: Behaviour Rating Scale (CAPE). Family caregivers: Relatives Stress Scale; GHQ | |
| Notes | 45 minutes, 2 times a week, for 7 weeks | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomly allocated to either group by drawing names from a sealed container |
| Allocation concealment (selection bias) | Unclear risk | Randomly allocated to either group by drawing names from a sealed container ‐ would have been preferable for randomisation to have been carried out independently |
| Blinding of outcome assessment (detection bias) | High risk | At least some of the assessments were carried out by staff aware of group allocation. |
| Incomplete outcome data (attrition bias) | Low risk | Attrition reported (with reasons): 4 in CS group, 4 in control group i.e. 23% |
| Selective reporting (reporting bias) | Low risk | Data from all measures reported |
| Other bias ‐ training and supervision | Unclear risk | Groups led by a member of the research team, with a member of staff as co‐facilitator ‐ training and supervision unclear |
| Other bias ‐ treatment manual | Low risk | Manual (Spector 2006) developed through this study |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 201 (158F/43M) Dementia (DSM‐IV criteria) ‐ MMSE 10‐24 MMSE: 14.4 (SD 3.8) Age: 85.3 (SD 7.0) Groups ran in 18 residential homes; 5 day‐centres | |
| Interventions | Cognitive stimulation (N = 115) Treatment‐as‐usual (N = 86) | |
| Outcomes | Cognition: MMSE; ADAS‐Cog Quality of life: QoL‐AD Communication: Holden Communication Scale Mood: Cornell Scale for Depression in Dementia Behaviour: Behaviour Rating Scale (CAPE) | |
| Notes | 45 minutes, 2 times a week, for 7 weeks | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomly allocated to either group by drawing names from a sealed container |
| Allocation concealment (selection bias) | Unclear risk | Randomly allocated to either group by drawing names from a sealed container ‐ would have been preferable for randomisation to have been carried out independently |
| Blinding of outcome assessment (detection bias) | Low risk | Cognitive assessments and quality of life interview conducted by a blind assessor |
| Incomplete outcome data (attrition bias) | Low risk | 34/201 did not complete study (18 CS/16 controls); 17% attrition; 'intention to treat analysis' |
| Selective reporting (reporting bias) | Low risk | Data from all measures reported |
| Other bias ‐ training and supervision | Unclear risk | Groups led by a member of the research team with a member of staff as co‐facilitator; training and supervision unclear |
| Other bias ‐ treatment manual | Low risk | Manual developed for this study (Spector 2006) |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 31 (18F/13M) 'Dementia' ‐ MMSE 5‐25 4/31 receiving donepezil MMSE: 15.5 (SD 5.8) Age: 86.2 (SD 7.8) Geriatric health service facility (inpatient) | |
| Interventions | Group exercise and cognitive stimulation (N = 16) Treatment‐as‐usual (N = 15) | |
| Outcomes | Cognition: MMSE Quality of life: QoL‐D (short version, proxy completed) Social interaction: nurses’ observation scale of geriatric patients (NOSGER) sub‐item ‘social behaviour’ Apathy scale ADL: Barthel Index Behaviour problems: Dementia Behavior Disturbance Scale | |
| Notes | 45 minutes, 2 times a week, for 8 weeks | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | No detail of how randomisation was carried out |
| Allocation concealment (selection bias) | Unclear risk | No information as to who carried out the randomisation or whether an external person was involved |
| Blinding of outcome assessment (detection bias) | Unclear risk | Although observational ratings made by staff not involved in the intervention, not clear whether assessors were blinded or not |
| Incomplete outcome data (attrition bias) | Unclear risk | 33% of participants in control group dropped out (compared with 6% in intervention group) ‐ unclear what effect this may have had on results |
| Selective reporting (reporting bias) | Low risk | Results reported for all outcomes mentioned in Methods section |
| Other bias ‐ training and supervision | Unclear risk | Although staff had at least 5 years experience of group interventions in this context, arrangements for specific training/supervision in the intervention used here not described |
| Other bias ‐ treatment manual | Unclear risk | Although the Japanese version of the CST manual was referenced, the current study appears to include additional components. |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 55 Mild Alzheimer's disease according to NINCDS‐ADRDA and DSM‐IV‐TR criteria All receiving AChEI medication for at least two years Mean MMSE 23.0 (SD 1.3) Age 73.7 (SD 5.3) Community | |
| Interventions | Individual cognitive stimulation delivered by psychologists (N = 17) Individual cognitive training delivered by psychologists (N = 17) Treatment‐as‐usual controls (N = 21) | |
| Outcomes | Cognition: MMSE; CAM‐COG; Boston Naming Test; Pyramids and Palm Trees Test; Rivermead Behavioural Memory Test | |
| Notes | 90 minutes, 3 times a week, for 4 months Data for post‐treatment assessment requested ‐ not received; only 8‐month follow‐up data available | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | "Participants were...randomly allocated by lot into the three conditions". |
| Allocation concealment (selection bias) | Unclear risk | No detail provided on the randomisation process |
| Blinding of outcome assessment (detection bias) | Low risk | Clinicians conducting assessments were blinded. |
| Incomplete outcome data (attrition bias) | High risk | Per protocol analysis ‐ 4/21 dropped out from cognitive stimulation group; 0/21 from control group |
| Selective reporting (reporting bias) | Unclear risk | Very little reported of results at post‐treatment ‐ nearly all data seems to be from 12‐month follow‐up. |
| Other bias ‐ training and supervision | Low risk | "Four licensed psychologists, who had sufficient clinical experience in providing cognitive remediation programmes to an aging population administered the programmes." Activities according to specialisation |
| Other bias ‐ treatment manual | High risk | No indication of a manual or a particular structure for the cognitive stimulation |
| Study characteristics | ||
| Methods | RCT | |
| Participants | N = 101 (81F/20M) Mild dementia according to DSM‐V criteria Mean MMSE 20.7 (SD 2.3) Age 80.2 (SD 6.4) Community | |
| Interventions | Cognitive stimulation plus Tai Chi groups (N = 51) Treatment‐as‐usual controls (N = 50) | |
| Outcomes | Cognition: MMSE; Mattis Dementia Rating Scale | |
| Notes | 60 minutes, twice a week, for 7 weeks | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | "The randomization and group assignment process was conducted using computer software." |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information about concealment |
| Blinding of outcome assessment (detection bias) | Low risk | Blinded assessor |
| Incomplete outcome data (attrition bias) | Low risk | "Intention‐ to‐treat principle using last observation carried forward (LOCF) analysis for any missing data." Attrition rates given |
| Selective reporting (reporting bias) | Low risk | All outcome measures mentioned in methods were reported. |
| Other bias ‐ training and supervision | Low risk | Training and supervision given and checks on adherence |
| Other bias ‐ treatment manual | Low risk | Standardised manual produced and structure described. |
ACE‐III: Addenbrooke’s Cognitive Examination ‐III
AChEI: Acetylcholinesterase inhibitor
AD: Alzheimer’s disease
ADAS‐COG: Alzheimer's Disease Assessment Scale ‐ Cognitive Subscale
ADCS‐ADL: Alzheimer’s Dementia Cooperative Study ‐ Activities of Daily Living Inventory
ADL: Activities of Daily Living
ADRDA: Alzheimer’s Disease and Related Disorders Association
ApoE: apolipoprotein E
Behave‐AD: Behavioral Pathology in Alzheimer’s Disease Rating Scale
CAM‐COG(‐DS): Cambridge Cognitive Examination adapted for individuals with Down Syndrome
CAPE: Clifton Assessment Procedures for the Elderly
CBIC: Clinician's Interview‐Based Impression of Change
CDR: Clinical Dementia Rating
CERAD: Consortium to Establish a Registry for Alzheimer's Disease test
CESD‐R: Center for Epidemiologic Studies Depression Scale‐Revised
CS: cognitive stimulation
CSDD: Cornell Scale for Depression in Dementia
CSDS: Cognitive Scale for Down Syndrome
CST: cognitive stimulation therapy
CST‐PD: cognitive stimulation therapy – Parkinson’s disease
DAD: Disability Assessment for Dementia
DEMQOL: Dementia Quality of Life Instrument
DLB: dementia with Lewy bodies
DSM(‐III/‐IV(‐TR)/‐5/‐V): Diagnostic and Statistical Manual of Mental Disorders (‐III/‐IV(‐TR)/‐5/‐V)
E‐ADL: Erlangen Test of Activities of Daily Living
ECA: ‘Echelle comportementale adaptive’ (behaviour adaption scale)
EID‐Q: Engagement and Independence in Dementia Questionnaire
ENB2: Esame Neuropsicologico Breve 2
EQ‐5D(‐3L): EuroQol 5 dimension scale (‐3 level)
GDS(‐15/‐30): Geriatric Depression Scale (‐15/‐30 item)
GHQ: General Health Questionnaire
HADS: Hospital Anxiety and Depression Scale
IADL: Instrumental Activities of Daily Living
ICD‐10: International Classification of Diseases ‐10
IQR: interquartile range
ITT: intention to treat
LOCF: last observation carried forward
MAKS: motor stimulation; activities of daily living; cognitive stimulation; spiritual element
MCI: mild cognitive impairment
MCS: mental component score
MoCA: Montreal Cognitive Assessment
MMSE: Mini‐Mental State Examination
NINCDS: National Institute of Neurological and Communicative Diseases and Stroke
NOSGER: Nurses’ Observation Scale for Geriatric Patients
NPI(‐NH): Neuropsychiatric Inventory (‐Nursing Home)
PCS: physical component score
PDD: Parkinson's disease dementia
PPOM: Positive Psychology Outcome Measure
QCPR: Quality of Caregiver‐Patient Relationship
QOL‐AD): Quality of Life ‐ Alzheimer’s disease
QOL‐D: Quality of Life in dementia
RAID: Rating of Anxiety in Dementia
RAM: Roy’s adaptation model
RBANS: Repeatable Battery for the Assessment of Neuropsychological Status
RCT: randomised controlled trial
RDRS: Rapid Disability Rating Scale
RO: reality orientation
ROT: reality orientation therapy
RUD‐FOCA: Resource Utilization in Dementia—Formal Care
SADEM: study on ageing and dementia in Mexico
SAS: Statistical Analysis System
SCIDS: Sense of Competence In Dementia Care Staff Scale
SDAT: senile dementia of the Alzheimer’s type
SF(‐12/‐36): Short Form‐12/36 Health Survey
SKT: Syndrom‐Kurztest
SMMSE: Standardised Mini‐Mental State Examination
TAU: treatment as usual
WAIS‐III: Wechsler Adult Intelligence Scale ‐ III
WHODAS: World Health Organization Disability Assessment Schedule
WHOQOL: World Health Organization Quality of Life assessment
Characteristics of excluded studies [ordered by study ID]
| Study | Reason for exclusion |
| No separate data for people with dementia (MCI) | |
| No data for people with dementia | |
| No data for people with dementia | |
| Intervention did not meet the inclusion criteria for cognitive stimulation. Diagnoses varied, not purely dementia | |
| Multi‐component intervention | |
| Unclear diagnostic criteria: "moderate‐to‐severe impairment of cognitive function" | |
| Intervention described did not meet the inclusion criteria for cognitive stimulation; better fit for cognitive training | |
| Did not not include a measure of cognitive function | |
| Included both people with dementia and with MCI ‐ results not given separately | |
| No data provided for people with dementia (MCI) | |
| Intervention allocation not randomised | |
| Intervention allocation not randomised | |
| Intervention described did not meet the inclusion criteria for cognitive stimulation but for cognitive training. Diagnoses varied, not purely dementia | |
| Did not report an RCT | |
| Intervention described did not meet the inclusion criteria for cognitive stimulation | |
| Intervention described did not meet the inclusion criteria for cognitive stimulation | |
| Did not report results from an RCT | |
| Cognitive stimulation (delivered for 30 minutes a day, 6 days a week by family caregivers) confounded with cognitive training‐spaced retrieval and face name associations | |
| Intervention allocation not randomised | |
| Intervention did not meet the inclusion criteria for cognitive stimulation. Diagnoses varied, not purely dementia | |
| Intervention did not meet the inclusion criteria for cognitive stimulation | |
| Intervention did not meet the inclusion criteria for cognitive stimulation | |
| Intervention did not meet the inclusion criteria for cognitive stimulation | |
| Intervention did not meet the inclusion criteria for cognitive stimulation | |
| No mention of randomisation; available only as a conference abstract | |
| Non‐randomised allocation; comparison was with an active treatment group. | |
| Non‐randomised allocation; comparison was with an active treatment group. | |
| In Spanish ‐ only the abstract was in English | |
| Unclear diagnostic criteria: "Elderly patients with cognitive disturbances" | |
| No data for people with a dementia diagnosis | |
| Eligible study, but no extractable data provided. Only data available were for a composite cognitive and behavioural scale. | |
| Around 25% of participants appeared not to have dementia; other diagnoses included schizophrenia, epilepsy and ruptured aneurysm. | |
| Intervention did not meet the inclusion criteria for cognitive stimulation | |
| Intervention did not meet the inclusion criteria for cognitive stimulation | |
| Intervention did not meet the inclusion criteria for cognitive stimulation | |
| No separate data for people with dementia (MCI) | |
| Eligible study, but no extractable data available | |
| Study sample was people with dementia AND superimposed delirium. | |
| Diagnoses varied, not purely dementia. Not clear that participants were randomised to the intervention and control groups | |
| Allocation of patients to treatment was not random for various practical reasons. | |
| No data for people with dementia (MCI) | |
| No data for people with dementia (MCI) | |
| Intervention did not not meet definition of cognitive stimulation. | |
| Delirium superimposed on dementia | |
| Allocation to intervention and control not random | |
| Data not available for people with dementia ‐ included MCI | |
| Non‐randomised study | |
| No cognitive outcome measure | |
| Intervention allocation not randomised | |
| Not a randomised control trial | |
| Intervention did not meet the inclusion criteria for cognitive stimulation ‐ related to 'snoezelen'. | |
| Intervention did not meet the inclusion criteria for cognitive stimulation. | |
| No data for people with dementia ‐ combined with MCI | |
| Intervention did not meet the inclusion criteria for cognitive stimulation. Diagnoses varied, not dementia | |
| Intervention met criteria for cognitive training rather than cognitive stimulation. | |
| Not cognitive stimulation ‐ described cognitive training | |
| 12/84 participants with diagnoses of MCI; results not presented separately for those with Alzheimer's disease. Interventions included additional elements as physical exercise. | |
| Did not meet definition of cognitive stimulation | |
| Intervention allocation not randomised | |
| Allocation to intervention and control groups not random for maintenance study | |
| Intervention allocation not randomised | |
| Comparison was with alternate treatment. | |
| Although intervention was described as cognitive stimulation, it appeared to focus on specific cognitive modalities, and so fits better with cognitive training definition. | |
| Although intervention was described as cognitive stimulation, it appeared to focus on specific cognitive modalities, and so fits better with cognitive training definition. | |
| Not an RCT | |
| No indication of random allocation to groups | |
| Comparison of RO plus music versus RO. No control groups without RO | |
| Comparison was with alternative treatment. | |
| Not an RCT and intervention did not meet the criteria for inclusion under cognitive stimulation. | |
| Intervention did not meet inclusion criteria for cognitive stimulation. | |
| Intervention did not meet the inclusion criteria for cognitive stimulation. | |
| Did not report on a study intervention. No RCT | |
| Not cognitive stimulation | |
| No data for people with dementia (MCI) | |
| No control group | |
| Intervention did not meet the inclusion criteria for cognitive stimulation. | |
| The intervention combined elements of Reality Orientation (RO) and reminiscence. The RO element appeared to be only an orientation board, used to reinforce orientation for time, place and person. The reminiscence element appears to be predominant, with a variety of reminiscence‐based triggers, and so the study would be a better fit for a review of reminiscence work with people with dementia. | |
| Multi‐component intervention | |
| Allocation to groups was not entirely random. For the comparison of interest, integrated psychostimulation programme versus medication only control, allocation was clearly non‐random. | |
| Intervention did not meet the inclusion criteria for cognitive stimulation; participants included with other diagnosis than dementia | |
| Not RCT | |
| Intervention allocation not randomised | |
| Intervention allocation not randomised | |
| Unclear diagnostic criteria: "Demented/organic" | |
| Participants included with MCI, not dementia | |
| Did not report an intervention study | |
| Not an RCT; compared two wards; not cognitive stimulation; involved environmental modification and informal RO | |
| Unclear diagnostic criteria: "Significant memory impairment" | |
| Intervention allocation not randomised | |
| No data for people diagnosed with dementia | |
| Allocation non‐randomised | |
| Not an RCT; compared residents at one home with those in another | |
| Did not report an intervention study |
MCI: mild cognitive impairment
RCT: randomised controlled trial
RO: reality orientation
Characteristics of ongoing studies [ordered by study ID]
| Study name | Evaluation on the effect of maintenance cognitive stimulation therapy for dementia patients |
| Methods | Random allocation to groups |
| Participants | Participants "should meet the diagnostic criteria for 10/66 dementia and be evaluated as mild dementia or moderate dementia by using the Clinical Dementia Rating (CDR)"' |
| Interventions | Maintenance cognitive stimulation (planned sample size 55) Treatment‐as‐usual (planned sample size 55) |
| Outcomes | Cognitive function Quality of life of person with dementia Caregiver burden Quality of life of caregiver |
| Starting date | 01/03/2018 |
| Contact information | Peking University Sixth Hospital; Dr H Chen [email protected] |
| Notes |
| Study name | Feasibility Randomised Controlled Trial (RCT) of Advanced Cognitive Stimulation Therapy (ACST) for people with moderate to severe dementia |
| Methods | RCT |
| Participants | People with severe dementia (SMMSE 5‐12); DSM‐IV criteria |
| Interventions | ACST (planned sample size 16) Treatment‐as‐usual (planned sample size 16) |
| Outcomes | Cognition: SMMSE Quality of life: QoL‐AD Communication: Holden Communication Scale Behaviour that challenges: NPI Engagement: Group Observational Measurement of Engagement Tool Overall well‐being: Adapted Greater Cincinnati Chapter Well‐Being Observation Tool |
| Starting date | 01/03/2021 |
| Contact information | University College London: Dr E Hui [email protected] |
| Notes | 14 group sessions, twice weekly for 7 weeks |
| Study name | Virtual individual Cognitive Stimulation Therapy: a proof of concept study (V‐iCST) |
| Methods | RCT |
| Participants | DSM‐IV dementia diagnosis |
| Interventions | Virtual iCST (planned sample size 17) Treatment‐as‐usual (planned sample size 17) |
| Outcomes | Cognition: MoCA BLIND; ADAS‐Cog Quality of life: QoL‐AD Mood: GDS‐15 Communication: Holden Communication Scale Engagement: Adapted Greater Cincinnati Chapter Well‐Being Observation Tool |
| Starting date | 01/04/2021 |
| Contact information | University College London: Prof. A. Spector [email protected] |
| Notes | Two 45‐minute sessions per week for 7 weeks |
ACST: advanced cognitive stimulation therapy
ADAS‐Cog: Alzheimer's Disease Assessment Scale ‐ Cognitive Subscale
CDR: Clinical Dementia Rating
DSM‐IV: Diagnostic and Statistical Manual of Mental Disorders IV
GDS‐15: Geriatric Depression Scale – 15 items
MoCA BLIND: Montreal Cognitive Assessment Blind version
NPI: Neuropsychiatric Inventory
QoL‐AD: Quality of Life – Alzheimer’s Disease
SMMSE: Standardised Mini‐Mental State Examination
V‐iCST: virtual individual cognitive stimulation therapy
Data and analyses
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Cognition Show forest plot | 34 | 2340 | Std. Mean Difference (IV, Random, 95% CI) | 0.40 [0.25, 0.55] |
| Analysis 1.1  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 1: Cognition | ||||
| 1.1.1 ADAS‐Cog | 21 | 1742 | Std. Mean Difference (IV, Random, 95% CI) | 0.30 [0.15, 0.46] |
| 1.1.2 Global cognitive score (includes MMSE & CERAD) | 1 | 56 | Std. Mean Difference (IV, Random, 95% CI) | 0.63 [0.09, 1.17] |
| 1.1.3 MMSE | 6 | 262 | Std. Mean Difference (IV, Random, 95% CI) | 0.52 [0.25, 0.79] |
| 1.1.4 Mattis Dementia Rating Scale | 1 | 101 | Std. Mean Difference (IV, Random, 95% CI) | 1.32 [0.89, 1.75] |
| 1.1.5 Esame Neuropsicologico Breve 2 (ENB2) | 1 | 20 | Std. Mean Difference (IV, Random, 95% CI) | 0.99 [0.05, 1.93] |
| 1.1.6 Montreal Cognitive Assessment (MoCA) | 2 | 76 | Std. Mean Difference (IV, Random, 95% CI) | 0.91 [0.22, 1.60] |
| 1.1.7 ACE‐III | 1 | 43 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.28 [‐0.89, 0.33] |
| 1.1.8 CAM‐COG‐DS | 1 | 40 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.14 [‐0.76, 0.48] |
| 1.2 MMSE Show forest plot | 25 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| Analysis 1.2  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 2: MMSE | ||||
| 1.2.1 One to twelve months of CS | 25 | 1893 | Mean Difference (IV, Random, 95% CI) | 1.99 [1.24, 2.74] |
| 1.2.2 24 months of CS | 1 | 29 | Mean Difference (IV, Random, 95% CI) | 5.99 [‐1.58, 13.56] |
| 1.3 ADAS‐Cog Show forest plot | 21 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| Analysis 1.3  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 3: ADAS‐Cog | ||||
| 1.3.1 One to 12 months of CS | 21 | 1742 | Mean Difference (IV, Random, 95% CI) | 2.42 [1.21, 3.63] |
| 1.3.2 24 months of CS | 1 | 29 | Mean Difference (IV, Random, 95% CI) | 11.94 [‐0.97, 24.85] |
| 1.4 Quality of Life: self‐report Show forest plot | 18 | 1584 | Std. Mean Difference (IV, Random, 95% CI) | 0.25 [0.07, 0.42] |
| Analysis 1.4  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 4: Quality of Life: self‐report | ||||
| 1.4.1 QoL‐AD | 17 | 1541 | Std. Mean Difference (IV, Random, 95% CI) | 0.26 [0.07, 0.44] |
| 1.4.2 EQ‐5D | 1 | 43 | Std. Mean Difference (IV, Random, 95% CI) | 0.03 [‐0.58, 0.63] |
| 1.5 Quality of Life: proxy‐rated Show forest plot | 11 | 988 | Std. Mean Difference (IV, Random, 95% CI) | 0.21 [0.00, 0.42] |
| Analysis 1.5  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 5: Quality of Life: proxy‐rated | ||||
| 1.5.1 QoL‐AD proxy | 10 | 963 | Std. Mean Difference (IV, Random, 95% CI) | 0.20 [‐0.02, 0.41] |
| 1.5.2 QoL‐D | 1 | 25 | Std. Mean Difference (IV, Random, 95% CI) | 0.52 [‐0.29, 1.34] |
| 1.6 Communication and social interaction Show forest plot | 7 | 702 | Std. Mean Difference (IV, Random, 95% CI) | 0.53 [0.36, 0.70] |
| Analysis 1.6  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 6: Communication and social interaction | ||||
| 1.6.1 Holden Communication Scale | 3 | 299 | Std. Mean Difference (IV, Random, 95% CI) | 0.40 [0.15, 0.65] |
| 1.6.2 Narrative language ‐ communicative abilities | 2 | 259 | Std. Mean Difference (IV, Random, 95% CI) | 0.64 [0.38, 0.89] |
| 1.6.3 NOSGER ‐ Social Behaviour | 2 | 144 | Std. Mean Difference (IV, Random, 95% CI) | 0.71 [0.16, 1.26] |
| 1.7 Mood: Self‐reported Show forest plot | 10 | 787 | Std. Mean Difference (IV, Random, 95% CI) | 0.11 [‐0.08, 0.31] |
| Analysis 1.7  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 7: Mood: Self‐reported | ||||
| 1.7.1 Geriatric Depression Scale (GDS‐30) One to twelve months of CS | 4 | 213 | Std. Mean Difference (IV, Random, 95% CI) | 0.28 [‐0.02, 0.58] |
| 1.7.2 Geriatric Depression Scale (14 item) One to twelve months of CS | 1 | 26 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.39 [‐1.16, 0.39] |
| 1.7.3 Geriatric Depression Scale (GDS‐15) One to twelve months of CS | 2 | 402 | Std. Mean Difference (IV, Random, 95% CI) | 0.22 [‐0.43, 0.88] |
| 1.7.4 HADS ‐ Depression | 1 | 34 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.34 [‐1.04, 0.37] |
| 1.7.5 CESD‐R | 1 | 60 | Std. Mean Difference (IV, Random, 95% CI) | 0.21 [‐0.31, 0.73] |
| 1.7.6 Cornell Scale for Depression in Dementia (self‐report) | 1 | 52 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.02 [‐0.56, 0.52] |
| 1.8 Anxiety: Interviewer/staff‐rated Show forest plot | 6 | 410 | Std. Mean Difference (IV, Random, 95% CI) | 0.11 [‐0.09, 0.30] |
| Analysis 1.8  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 8: Anxiety: Interviewer/staff‐rated | ||||
| 1.8.1 Hamilton Anxiety Rating Scale | 1 | 14 | Std. Mean Difference (IV, Random, 95% CI) | 0.84 [‐0.27, 1.95] |
| 1.8.2 NPI ‐ anxiety subscale | 1 | 39 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.07 [‐0.69, 0.56] |
| 1.8.3 Rating of Anxiety in Dementia (RAID) | 4 | 357 | Std. Mean Difference (IV, Random, 95% CI) | 0.10 [‐0.11, 0.31] |
| 1.9 Mood: Interviewer/staff‐rated Show forest plot | 11 | 1011 | Std. Mean Difference (IV, Random, 95% CI) | 0.35 [0.09, 0.61] |
| Analysis 1.9  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 9: Mood: Interviewer/staff‐rated | ||||
| 1.9.1 Cornell Scale for Depression in Dementia | 9 | 877 | Std. Mean Difference (IV, Random, 95% CI) | 0.36 [0.05, 0.67] |
| 1.9.2 NOSGER ‐ Mood | 1 | 119 | Std. Mean Difference (IV, Random, 95% CI) | 0.35 [‐0.02, 0.71] |
| 1.9.3 Montgomery‐Asberg Depression Rating Scale | 1 | 15 | Std. Mean Difference (IV, Random, 95% CI) | 0.31 [‐0.72, 1.33] |
| 1.10 Quality of Relationship: self‐report Show forest plot | 4 | 492 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.01 [‐0.27, 0.25] |
| Analysis 1.10  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 10: Quality of Relationship: self‐report | ||||
| 1.10.1 QCPR | 3 | 455 | Std. Mean Difference (IV, Random, 95% CI) | 0.08 [‐0.15, 0.31] |
| 1.10.2 Relationship Satisfaction Scale | 1 | 37 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.37 [‐1.03, 0.29] |
| 1.11 ADL scales Show forest plot | 7 | 360 | Std. Mean Difference (IV, Random, 95% CI) | 0.19 [‐0.03, 0.41] |
| Analysis 1.11  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 11: ADL scales | ||||
| 1.11.1 Stewart ADL scale | 1 | 23 | Std. Mean Difference (IV, Random, 95% CI) | 0.25 [‐0.57, 1.08] |
| 1.11.2 Barthel ADL scale | 3 | 249 | Std. Mean Difference (IV, Random, 95% CI) | 0.16 [‐0.11, 0.43] |
| 1.11.3 Erlangen Test of ADL | 1 | 61 | Std. Mean Difference (IV, Random, 95% CI) | 0.29 [‐0.21, 0.80] |
| 1.11.4 Katz ADL scale | 2 | 27 | Std. Mean Difference (IV, Random, 95% CI) | 0.12 [‐0.63, 0.88] |
| 1.12 Instrumental ADL Show forest plot | 13 | 1318 | Std. Mean Difference (IV, Random, 95% CI) | 0.15 [0.04, 0.26] |
| Analysis 1.12  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 12: Instrumental ADL | ||||
| 1.12.1 Lawton Brody Instrumental ADL | 3 | 197 | Std. Mean Difference (IV, Random, 95% CI) | 0.17 [‐0.11, 0.45] |
| 1.12.2 Disability Assessment for Dementia | 2 | 179 | Std. Mean Difference (IV, Random, 95% CI) | 0.23 [‐0.07, 0.52] |
| 1.12.3 NOSGER IADL subscale | 1 | 119 | Std. Mean Difference (IV, Random, 95% CI) | 0.42 [0.06, 0.79] |
| 1.12.4 Bristol Activities of Daily Living Scale (BADLS) | 2 | 408 | Std. Mean Difference (IV, Random, 95% CI) | 0.05 [‐0.15, 0.24] |
| 1.12.5 Alzheimer's Disease Cooperative Study ‐ ADL Scale | 4 | 355 | Std. Mean Difference (IV, Random, 95% CI) | 0.10 [‐0.11, 0.31] |
| 1.12.6 Rapid Disability Rating Scale | 1 | 60 | Std. Mean Difference (IV, Random, 95% CI) | 0.33 [‐0.19, 0.85] |
| 1.13 Behaviour that challenges Show forest plot | 12 | 1340 | Std. Mean Difference (IV, Random, 95% CI) | 0.18 [‐0.01, 0.38] |
| Analysis 1.13  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 13: Behaviour that challenges | ||||
| 1.13.1 NPI | 8 | 1137 | Std. Mean Difference (IV, Random, 95% CI) | 0.13 [‐0.10, 0.36] |
| 1.13.2 NPI ‐ Agitation | 1 | 39 | Std. Mean Difference (IV, Random, 95% CI) | 0.00 [‐0.63, 0.63] |
| 1.13.3 NOSGER ‐ Challenging Behaviour | 1 | 119 | Std. Mean Difference (IV, Random, 95% CI) | 0.32 [‐0.04, 0.68] |
| 1.13.4 Behave‐AD | 1 | 20 | Std. Mean Difference (IV, Random, 95% CI) | 1.30 [0.32, 2.29] |
| 1.13.5 Dementia Behaviour Disturbance Scale (DBD) | 1 | 25 | Std. Mean Difference (IV, Random, 95% CI) | 0.19 [‐0.61, 0.99] |
| 1.14 Behaviour, General Rating Scales Show forest plot | 6 | 505 | Std. Mean Difference (IV, Random, 95% CI) | 0.35 [0.13, 0.58] |
| Analysis 1.14  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 14: Behaviour, General Rating Scales | ||||
| 1.14.1 CAPE Behaviour Rating Scale | 4 | 326 | Std. Mean Difference (IV, Random, 95% CI) | 0.21 [‐0.01, 0.43] |
| 1.14.2 NOSGER | 1 | 119 | Std. Mean Difference (IV, Random, 95% CI) | 0.65 [0.28, 1.02] |
| 1.14.3 Blessed Dementia Rating Scale | 1 | 60 | Std. Mean Difference (IV, Random, 95% CI) | 0.51 [‐0.02, 1.03] |
| 1.15 Caregiver outcome ‐ anxiety Show forest plot | 5 | 600 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.00 [‐0.19, 0.19] |
| Analysis 1.15  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 15: Caregiver outcome ‐ anxiety | ||||
| 1.15.1 Hamilton Anxiety Scale | 2 | 150 | Std. Mean Difference (IV, Random, 95% CI) | 0.18 [‐0.33, 0.68] |
| 1.15.2 Hospital Anxiety & Depression Scale ‐ Anxiety | 3 | 450 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.06 [‐0.33, 0.21] |
| 1.16 Caregiver outcome ‐ depressed mood Show forest plot | 8 | 664 | Std. Mean Difference (IV, Random, 95% CI) | 0.05 [‐0.10, 0.21] |
| Analysis 1.16  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 16: Caregiver outcome ‐ depressed mood | ||||
| 1.16.1 Hospital Anxiety & Depression Scales ‐ depression | 4 | 490 | Std. Mean Difference (IV, Random, 95% CI) | 0.02 [‐0.16, 0.20] |
| 1.16.2 Hamilton Depression Scale | 1 | 137 | Std. Mean Difference (IV, Random, 95% CI) | 0.03 [‐0.30, 0.37] |
| 1.16.3 Beck Depression Inventory | 1 | 14 | Std. Mean Difference (IV, Random, 95% CI) | 1.04 [‐0.10, 2.18] |
| 1.16.4 Montgomery‐Asberg Depression Rating Scale | 1 | 13 | Std. Mean Difference (IV, Random, 95% CI) | 0.19 [‐0.91, 1.28] |
| 1.16.5 General Health Questionnaire (GHQ‐12) | 1 | 10 | Std. Mean Difference (IV, Random, 95% CI) | 0.94 [‐0.41, 2.29] |
| 1.17 Caregiver outcome ‐ caregiving stress/burden (2) Show forest plot | 6 | 288 | Std. Mean Difference (IV, Random, 95% CI) | 0.09 [‐0.14, 0.32] |
| Analysis 1.17  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 17: Caregiver outcome ‐ caregiving stress/burden (2) | ||||
| 1.17.1 Caregiver Burden Inventory | 2 | 151 | Std. Mean Difference (IV, Random, 95% CI) | 0.12 [‐0.50, 0.75] |
| 1.17.2 Relative's Stress Scale | 1 | 10 | Std. Mean Difference (IV, Random, 95% CI) | 0.35 [‐0.91, 1.60] |
| 1.17.3 Zarit Burden Inventory | 2 | 87 | Std. Mean Difference (IV, Random, 95% CI) | 0.14 [‐0.28, 0.57] |
| 1.17.4 Caregiver Burden Scale | 1 | 40 | Std. Mean Difference (IV, Random, 95% CI) | 0.23 [‐0.40, 0.85] |
| 1.18 Caregiver outcome ‐ caregiving stress/burden (1) Show forest plot | 6 | 286 | Std. Mean Difference (IV, Random, 95% CI) | 0.09 [‐0.15, 0.32] |
| Analysis 1.18  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 18: Caregiver outcome ‐ caregiving stress/burden (1) | ||||
| 1.18.1 Caregiver Burden Inventory | 2 | 151 | Std. Mean Difference (IV, Random, 95% CI) | 0.12 [‐0.50, 0.75] |
| 1.18.2 Relative's Stress Scale | 2 | 50 | Std. Mean Difference (IV, Random, 95% CI) | 0.19 [‐0.37, 0.75] |
| 1.18.3 Zarit Burden Inventory | 1 | 45 | Std. Mean Difference (IV, Random, 95% CI) | 0.12 [‐0.47, 0.70] |
| 1.18.4 Caregiver Burden Scale | 1 | 40 | Std. Mean Difference (IV, Random, 95% CI) | 0.23 [‐0.40, 0.85] |
| 1.19 Caregiver outcome ‐ health‐related quality of life Show forest plot | 5 | 651 | Std. Mean Difference (IV, Random, 95% CI) | 0.17 [‐0.14, 0.49] |
| Analysis 1.19  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 19: Caregiver outcome ‐ health‐related quality of life | ||||
| 1.19.1 EQ‐5D | 4 | 514 | Std. Mean Difference (IV, Random, 95% CI) | 0.24 [‐0.18, 0.65] |
| 1.19.2 SF‐36 | 1 | 137 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.02 [‐0.35, 0.32] |
| 1.20 Caregiver outcome ‐ SF‐12 Show forest plot | 3 | Std. Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| Analysis 1.20  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 20: Caregiver outcome ‐ SF‐12 | ||||
| 1.20.1 SF‐12 PCS | 3 | 461 | Std. Mean Difference (IV, Random, 95% CI) | 0.07 [‐0.11, 0.25] |
| 1.20.2 SF12 ‐ MCS | 3 | 461 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.05 [‐0.23, 0.13] |
| 1.21 Caregiver outcome ‐ quality of relationship Show forest plot | 3 | 367 | Std. Mean Difference (IV, Random, 95% CI) | 0.06 [‐0.26, 0.37] |
| Analysis 1.21  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 21: Caregiver outcome ‐ quality of relationship | ||||
| 1.21.1 QCPR | 2 | 325 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.07 [‐0.29, 0.15] |
| 1.21.2 Relationship Satisfaction Scale | 1 | 42 | Std. Mean Difference (IV, Random, 95% CI) | 0.53 [‐0.10, 1.15] |
| 1.22 Caregiver outcome ‐ resilience Show forest plot | 2 | 399 | Std. Mean Difference (IV, Random, 95% CI) | 0.06 [‐0.13, 0.26] |
| Analysis 1.22  Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 22: Caregiver outcome ‐ resilience | ||||
| 1.22.1 Brief Resilience Scale (Wagnild ‐ RS14) | 1 | 356 | Std. Mean Difference (IV, Random, 95% CI) | 0.08 [‐0.13, 0.29] |
| 1.22.2 Brief Resilience Scale (Smith and colleagues) | 1 | 43 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.07 [‐0.68, 0.53] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Cognition ‐ modality Show forest plot | 34 | 2340 | Std. Mean Difference (IV, Random, 95% CI) | 0.40 [0.25, 0.55] |
| Analysis 2.1  Comparison 2: Cognitive stimulation versus no cognitive stimulation (modality): post‐treatment, Outcome 1: Cognition ‐ modality | ||||
| 2.1.1 One to twelve months of group CS | 27 | 1637 | Std. Mean Difference (IV, Random, 95% CI) | 0.43 [0.26, 0.59] |
| 2.1.2 One to twelve months of individual CS | 7 | 703 | Std. Mean Difference (IV, Random, 95% CI) | 0.30 [‐0.03, 0.64] |
| 2.2 MMSE ‐ modality Show forest plot | 25 | 1893 | Mean Difference (IV, Random, 95% CI) | 1.99 [1.24, 2.74] |
| Analysis 2.2  Comparison 2: Cognitive stimulation versus no cognitive stimulation (modality): post‐treatment, Outcome 2: MMSE ‐ modality | ||||
| 2.2.1 One to twelve months of group CS | 21 | 1325 | Mean Difference (IV, Random, 95% CI) | 2.16 [1.58, 2.74] |
| 2.2.2 One to twelve months of individual CS | 4 | 568 | Mean Difference (IV, Random, 95% CI) | 1.18 [‐0.91, 3.28] |
| 2.3 ADAS‐Cog ‐ modality Show forest plot | 21 | 1742 | Mean Difference (IV, Random, 95% CI) | 2.42 [1.21, 3.63] |
| Analysis 2.3  Comparison 2: Cognitive stimulation versus no cognitive stimulation (modality): post‐treatment, Outcome 3: ADAS‐Cog ‐ modality | ||||
| 2.3.1 One to twelve months of group CS | 17 | 1168 | Mean Difference (IV, Random, 95% CI) | 2.66 [1.12, 4.20] |
| 2.3.2 One to twelve months of individual CS | 4 | 574 | Mean Difference (IV, Random, 95% CI) | 1.92 [‐0.00, 3.85] |
| 2.4 Quality of Life: self‐report Show forest plot | 18 | 1584 | Std. Mean Difference (IV, Random, 95% CI) | 0.25 [0.07, 0.42] |
| Analysis 2.4  Comparison 2: Cognitive stimulation versus no cognitive stimulation (modality): post‐treatment, Outcome 4: Quality of Life: self‐report | ||||
| 2.4.1 One to twelve months of group CS | 13 | 1058 | Std. Mean Difference (IV, Random, 95% CI) | 0.28 [0.05, 0.52] |
| 2.4.2 One to twelve months of individual CS | 5 | 526 | Std. Mean Difference (IV, Random, 95% CI) | 0.11 [‐0.09, 0.30] |
| 2.5 Quality of Life: proxy‐rated Show forest plot | 11 | 988 | Std. Mean Difference (IV, Random, 95% CI) | 0.21 [0.00, 0.42] |
| Analysis 2.5  Comparison 2: Cognitive stimulation versus no cognitive stimulation (modality): post‐treatment, Outcome 5: Quality of Life: proxy‐rated | ||||
| 2.5.1 One to twelve months of group CS | 7 | 511 | Std. Mean Difference (IV, Random, 95% CI) | 0.26 [‐0.06, 0.58] |
| 2.5.2 One to twelve months of individual CS | 4 | 477 | Std. Mean Difference (IV, Random, 95% CI) | 0.18 [‐0.11, 0.47] |
| 2.6 Mood: self‐reported Show forest plot | 10 | 787 | Std. Mean Difference (IV, Random, 95% CI) | 0.11 [‐0.08, 0.31] |
| Analysis 2.6  Comparison 2: Cognitive stimulation versus no cognitive stimulation (modality): post‐treatment, Outcome 6: Mood: self‐reported | ||||
| 2.6.1 One to twelve months of group cognitive stimulation | 6 | 299 | Std. Mean Difference (IV, Random, 95% CI) | 0.20 [‐0.06, 0.45] |
| 2.6.2 One to twelve months of individual cognitive stimulation | 4 | 488 | Std. Mean Difference (IV, Random, 95% CI) | 0.04 [‐0.28, 0.35] |
| 2.7 Instrumental ADL Show forest plot | 13 | 1318 | Std. Mean Difference (IV, Random, 95% CI) | 0.15 [0.04, 0.26] |
| Analysis 2.7  Comparison 2: Cognitive stimulation versus no cognitive stimulation (modality): post‐treatment, Outcome 7: Instrumental ADL | ||||
| 2.7.1 One to twelve months of group cognitive stimulation | 8 | 687 | Std. Mean Difference (IV, Random, 95% CI) | 0.20 [0.05, 0.35] |
| 2.7.2 One to twelve months of individual cognitive stimulation | 5 | 631 | Std. Mean Difference (IV, Random, 95% CI) | 0.10 [‐0.06, 0.25] |
| 2.8 Behaviour that challenges Show forest plot | 12 | 1340 | Std. Mean Difference (IV, Random, 95% CI) | 0.18 [‐0.01, 0.38] |
| Analysis 2.8  Comparison 2: Cognitive stimulation versus no cognitive stimulation (modality): post‐treatment, Outcome 8: Behaviour that challenges | ||||
| 2.8.1 One to twelve months of group cognitive stimulation | 8 | 754 | Std. Mean Difference (IV, Random, 95% CI) | 0.33 [0.11, 0.54] |
| 2.8.2 One to twelve months of individual cognitive stimulation | 4 | 586 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.04 [‐0.28, 0.19] |
| 2.9 Caregiver outcome ‐ depressed mood Show forest plot | 8 | 664 | Std. Mean Difference (IV, Random, 95% CI) | 0.05 [‐0.10, 0.21] |
| Analysis 2.9  Comparison 2: Cognitive stimulation versus no cognitive stimulation (modality): post‐treatment, Outcome 9: Caregiver outcome ‐ depressed mood | ||||
| 2.9.1 One to twelve months of group cognitive stimulation | 3 | 37 | Std. Mean Difference (IV, Random, 95% CI) | 0.68 [0.00, 1.36] |
| 2.9.2 One to twelve months of individual cognitive stimulation | 5 | 627 | Std. Mean Difference (IV, Random, 95% CI) | 0.02 [‐0.14, 0.18] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Cognition Show forest plot | 27 | 1637 | Std. Mean Difference (IV, Random, 95% CI) | 0.43 [0.26, 0.59] |
| Analysis 3.1  Comparison 3: Group cognitive stimulation versus no cognitive stimulation (number of sessions): post‐treatment, Outcome 1: Cognition | ||||
| 3.1.1 20 or more group sessions of CS during one to twelve months | 12 | 615 | Std. Mean Difference (IV, Random, 95% CI) | 0.42 [0.16, 0.67] |
| 3.1.2 Less than 20 group sessions of CS during one to twelve months | 15 | 1022 | Std. Mean Difference (IV, Random, 95% CI) | 0.43 [0.22, 0.65] |
| 3.2 ADAS‐Cog Show forest plot | 17 | 1168 | Mean Difference (IV, Random, 95% CI) | 2.66 [1.12, 4.20] |
| Analysis 3.2  Comparison 3: Group cognitive stimulation versus no cognitive stimulation (number of sessions): post‐treatment, Outcome 2: ADAS‐Cog | ||||
| 3.2.1 20 or more group sessions of CS during one to twelve months | 7 | 418 | Mean Difference (IV, Random, 95% CI) | 4.18 [‐0.28, 8.64] |
| 3.2.2 Less than 20 group sessions of CS during one to twelve months | 10 | 750 | Mean Difference (IV, Random, 95% CI) | 2.52 [1.22, 3.83] |
| 3.3 MMSE Show forest plot | 21 | 1325 | Mean Difference (IV, Random, 95% CI) | 2.16 [1.58, 2.74] |
| Analysis 3.3  Comparison 3: Group cognitive stimulation versus no cognitive stimulation (number of sessions): post‐treatment, Outcome 3: MMSE | ||||
| 3.3.1 20 or more group sessions of CS during one to twelve months | 11 | 554 | Mean Difference (IV, Random, 95% CI) | 2.51 [1.20, 3.83] |
| 3.3.2 Less than 20 group sessions of CS during one to twelve months | 10 | 771 | Mean Difference (IV, Random, 95% CI) | 2.11 [1.51, 2.72] |
| 3.4 Quality of Life: self‐report Show forest plot | 13 | 1058 | Mean Difference (IV, Random, 95% CI) | 1.97 [0.47, 3.47] |
| Analysis 3.4  Comparison 3: Group cognitive stimulation versus no cognitive stimulation (number of sessions): post‐treatment, Outcome 4: Quality of Life: self‐report | ||||
| 3.4.1 20 or more group sessions of CS during one to twelve months | 4 | 281 | Mean Difference (IV, Random, 95% CI) | 1.33 [‐1.14, 3.79] |
| 3.4.2 Less than 20 group sessions of CS during one to twelve months | 9 | 777 | Mean Difference (IV, Random, 95% CI) | 2.24 [0.13, 4.36] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Cognition (3 levels) Show forest plot | 27 | 1637 | Std. Mean Difference (IV, Random, 95% CI) | 0.43 [0.26, 0.59] |
| Analysis 4.1  Comparison 4: Group cognitive stimulation versus no cognitive stimulation (frequency): post‐treatment, Outcome 1: Cognition (3 levels) | ||||
| 4.1.1 Three or more group sessions of CS per week during one to twelve months | 8 | 328 | Std. Mean Difference (IV, Random, 95% CI) | 0.46 [0.22, 0.69] |
| 4.1.2 Two group sessions of CS per week during one to twelve months | 13 | 955 | Std. Mean Difference (IV, Random, 95% CI) | 0.52 [0.28, 0.76] |
| 4.1.3 One group session of CS per week during one to twelve months | 6 | 354 | Std. Mean Difference (IV, Random, 95% CI) | 0.04 [‐0.17, 0.25] |
| 4.2 Cognition (2 levels) Show forest plot | 27 | 1637 | Std. Mean Difference (IV, Random, 95% CI) | 0.43 [0.26, 0.59] |
| Analysis 4.2  Comparison 4: Group cognitive stimulation versus no cognitive stimulation (frequency): post‐treatment, Outcome 2: Cognition (2 levels) | ||||
| 4.2.1 Two or more group sessions of CS per week during one to twelve months | 21 | 1283 | Std. Mean Difference (IV, Random, 95% CI) | 0.51 [0.34, 0.69] |
| 4.2.2 One group session of CS per week during one to twelve months | 6 | 354 | Std. Mean Difference (IV, Random, 95% CI) | 0.04 [‐0.17, 0.25] |
| 4.3 ADAS‐Cog (3 levels) Show forest plot | 17 | 1168 | Mean Difference (IV, Random, 95% CI) | 2.66 [1.12, 4.20] |
| Analysis 4.3  Comparison 4: Group cognitive stimulation versus no cognitive stimulation (frequency): post‐treatment, Outcome 3: ADAS‐Cog (3 levels) | ||||
| 4.3.1 Three or more group sessions of CS per week during one to twelve months | 3 | 131 | Mean Difference (IV, Random, 95% CI) | 6.68 [‐0.57, 13.92] |
| 4.3.2 Two group sessions of CS per week during one to twelve months | 9 | 713 | Mean Difference (IV, Random, 95% CI) | 3.10 [1.24, 4.96] |
| 4.3.3 One group session of CS per week during one to twelve months | 5 | 324 | Mean Difference (IV, Random, 95% CI) | 0.09 [‐2.28, 2.46] |
| 4.4 ADAS‐Cog (2 levels) Show forest plot | 17 | 1168 | Mean Difference (IV, Random, 95% CI) | 2.66 [1.12, 4.20] |
| Analysis 4.4  Comparison 4: Group cognitive stimulation versus no cognitive stimulation (frequency): post‐treatment, Outcome 4: ADAS‐Cog (2 levels) | ||||
| 4.4.1 Two or more group sessions of CS per week during one to twelve months | 12 | 844 | Mean Difference (IV, Random, 95% CI) | 3.41 [1.58, 5.24] |
| 4.4.2 One group session of CS per week during one to twelve months | 5 | 324 | Mean Difference (IV, Random, 95% CI) | 0.09 [‐2.28, 2.46] |
| 4.5 MMSE (3 levels) Show forest plot | 21 | 1325 | Mean Difference (IV, Random, 95% CI) | 2.16 [1.58, 2.74] |
| Analysis 4.5  Comparison 4: Group cognitive stimulation versus no cognitive stimulation (frequency): post‐treatment, Outcome 5: MMSE (3 levels) | ||||
| 4.5.1 Three or more group sessions of CS per week during one to twelve months | 7 | 267 | Mean Difference (IV, Random, 95% CI) | 2.66 [1.09, 4.23] |
| 4.5.2 Two group sessions of CS per week during one to twelve months | 10 | 784 | Mean Difference (IV, Random, 95% CI) | 2.40 [1.66, 3.13] |
| 4.5.3 One group session of CS per week during one to twelve months | 4 | 274 | Mean Difference (IV, Random, 95% CI) | 0.92 [‐0.07, 1.90] |
| 4.6 MMSE (2 levels) Show forest plot | 21 | 1325 | Mean Difference (IV, Random, 95% CI) | 2.16 [1.58, 2.74] |
| Analysis 4.6  Comparison 4: Group cognitive stimulation versus no cognitive stimulation (frequency): post‐treatment, Outcome 6: MMSE (2 levels) | ||||
| 4.6.1 Two or more group sessions of CS per week during one to twelve months | 17 | 1051 | Mean Difference (IV, Random, 95% CI) | 2.42 [1.80, 3.03] |
| 4.6.2 One group session of CS per week during one to twelve months | 4 | 274 | Mean Difference (IV, Random, 95% CI) | 0.92 [‐0.07, 1.90] |
| 4.7 Quality of Life: self‐report Show forest plot | 13 | 1058 | Mean Difference (IV, Random, 95% CI) | 1.97 [0.47, 3.47] |
| Analysis 4.7  Comparison 4: Group cognitive stimulation versus no cognitive stimulation (frequency): post‐treatment, Outcome 7: Quality of Life: self‐report | ||||
| 4.7.1 Two or more group sessions of CS per week during one to twelve months | 9 | 747 | Mean Difference (IV, Random, 95% CI) | 2.40 [0.48, 4.33] |
| 4.7.2 One group session per week of CS during one to twelve months | 4 | 311 | Mean Difference (IV, Random, 95% CI) | 1.47 [‐0.06, 3.01] |
| 4.8 Mood: interviewer/staff‐rated Show forest plot | 10 | 959 | Std. Mean Difference (IV, Random, 95% CI) | 0.40 [0.14, 0.67] |
| Analysis 4.8  Comparison 4: Group cognitive stimulation versus no cognitive stimulation (frequency): post‐treatment, Outcome 8: Mood: interviewer/staff‐rated | ||||
| 4.8.1 Two or more group sessions of CS per week during one to twelve months | 7 | 695 | Std. Mean Difference (IV, Random, 95% CI) | 0.41 [0.07, 0.75] |
| 4.8.2 One group session per week of CS during one to twelve months | 3 | 264 | Std. Mean Difference (IV, Random, 95% CI) | 0.42 [‐0.10, 0.94] |
| 4.9 Anxiety ‐ interviewer/staff‐rated Show forest plot | 6 | 410 | Std. Mean Difference (IV, Random, 95% CI) | 0.11 [‐0.09, 0.30] |
| Analysis 4.9  Comparison 4: Group cognitive stimulation versus no cognitive stimulation (frequency): post‐treatment, Outcome 9: Anxiety ‐ interviewer/staff‐rated | ||||
| 4.9.1 Two or more group sessions of CS per week during one to twelve months | 5 | 211 | Std. Mean Difference (IV, Random, 95% CI) | 0.23 [‐0.04, 0.51] |
| 4.9.2 One group session per week of CS during one to twelve months | 1 | 199 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.02 [‐0.30, 0.26] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 5.1 Cognition Show forest plot | 23 | 1056 | Std. Mean Difference (IV, Random, 95% CI) | 0.63 [0.33, 0.93] |
| Analysis 5.1  Comparison 5: Cognitive stimulation versus no cognitive stimulation (setting): post‐treatment, Outcome 1: Cognition | ||||
| 5.1.1 Community | 15 | 642 | Std. Mean Difference (IV, Random, 95% CI) | 0.66 [0.33, 0.99] |
| 5.1.2 Care home | 9 | 414 | Std. Mean Difference (IV, Random, 95% CI) | 0.60 [‐0.01, 1.20] |
| 5.2 ADAS‐Cog Show forest plot | 13 | 587 | Mean Difference (IV, Random, 95% CI) | 3.16 [1.85, 4.47] |
| Analysis 5.2  Comparison 5: Cognitive stimulation versus no cognitive stimulation (setting): post‐treatment, Outcome 2: ADAS‐Cog | ||||
| 5.2.1 Community | 9 | 328 | Mean Difference (IV, Random, 95% CI) | 4.49 [2.18, 6.80] |
| 5.2.2 Care home | 5 | 259 | Mean Difference (IV, Random, 95% CI) | 1.15 [‐1.71, 4.01] |
| 5.3 MMSE Show forest plot | 17 | 708 | Mean Difference (IV, Random, 95% CI) | 2.57 [1.87, 3.27] |
| Analysis 5.3  Comparison 5: Cognitive stimulation versus no cognitive stimulation (setting): post‐treatment, Outcome 3: MMSE | ||||
| 5.3.1 Community | 11 | 489 | Mean Difference (IV, Random, 95% CI) | 2.72 [1.85, 3.59] |
| 5.3.2 Care home | 6 | 219 | Mean Difference (IV, Random, 95% CI) | 2.16 [0.83, 3.48] |
| 5.4 Quality of Life: self‐report Show forest plot | 9 | 373 | Mean Difference (IV, Random, 95% CI) | 2.98 [0.06, 5.90] |
| Analysis 5.4  Comparison 5: Cognitive stimulation versus no cognitive stimulation (setting): post‐treatment, Outcome 4: Quality of Life: self‐report | ||||
| 5.4.1 Community | 6 | 239 | Mean Difference (IV, Random, 95% CI) | 4.33 [‐0.75, 9.42] |
| 5.4.2 Care home | 3 | 134 | Mean Difference (IV, Random, 95% CI) | 1.17 [‐1.44, 3.78] |
| 5.5 Quality of Life: proxy‐rated Show forest plot | 5 | 207 | Std. Mean Difference (IV, Random, 95% CI) | 0.50 [0.05, 0.94] |
| Analysis 5.5  Comparison 5: Cognitive stimulation versus no cognitive stimulation (setting): post‐treatment, Outcome 5: Quality of Life: proxy‐rated | ||||
| 5.5.1 Community | 3 | 114 | Std. Mean Difference (IV, Random, 95% CI) | 0.74 [‐0.02, 1.49] |
| 5.5.2 Care home | 2 | 93 | Std. Mean Difference (IV, Random, 95% CI) | 0.21 [‐0.21, 0.62] |
| 5.6 Mood: self‐reported Show forest plot | 6 | 299 | Std. Mean Difference (IV, Random, 95% CI) | 0.20 [‐0.06, 0.45] |
| Analysis 5.6  Comparison 5: Cognitive stimulation versus no cognitive stimulation (setting): post‐treatment, Outcome 6: Mood: self‐reported | ||||
| 5.6.1 One to twelve months of group cognitive stimulation: community | 3 | 163 | Std. Mean Difference (IV, Random, 95% CI) | 0.24 [‐0.07, 0.56] |
| 5.6.2 One to twelve months of group cognitive stimulation: care home | 3 | 136 | Std. Mean Difference (IV, Random, 95% CI) | 0.16 [‐0.48, 0.79] |
| 5.7 Mood: Interviewer/staff‐rated Show forest plot | 5 | 237 | Std. Mean Difference (IV, Random, 95% CI) | 0.50 [0.21, 0.79] |
| Analysis 5.7  Comparison 5: Cognitive stimulation versus no cognitive stimulation (setting): post‐treatment, Outcome 7: Mood: Interviewer/staff‐rated | ||||
| 5.7.1 One to twelve months of group cognitive stimulation: community | 3 | 79 | Std. Mean Difference (IV, Random, 95% CI) | 0.82 [0.36, 1.29] |
| 5.7.2 One to twelve months of group cognitive stimulation: care home | 2 | 158 | Std. Mean Difference (IV, Random, 95% CI) | 0.34 [0.02, 0.65] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 6.1 Cognition Show forest plot | 27 | 1637 | Std. Mean Difference (IV, Random, 95% CI) | 0.43 [0.26, 0.59] |
| Analysis 6.1  Comparison 6: Group cognitive stimulation versus no treatment post‐treatment (Active control group), Outcome 1: Cognition | ||||
| 6.1.1 Alternate activity control group | 5 | 322 | Std. Mean Difference (IV, Random, 95% CI) | 0.59 [0.37, 0.82] |
| 6.1.2 Treatment‐as‐usual control group | 22 | 1315 | Std. Mean Difference (IV, Random, 95% CI) | 0.41 [0.22, 0.60] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 7.1 Cognition Show forest plot | 23 | 1418 | Std. Mean Difference (IV, Random, 95% CI) | 0.43 [0.24, 0.62] |
| Analysis 7.1  Comparison 7: Group cognitive stimulation versus no cognitive stimulation post‐treatment (dementia severity), Outcome 1: Cognition | ||||
| 7.1.1 Mild impairment | 10 | 640 | Std. Mean Difference (IV, Random, 95% CI) | 0.71 [0.47, 0.95] |
| 7.1.2 Moderate impairment | 13 | 778 | Std. Mean Difference (IV, Random, 95% CI) | 0.21 [0.03, 0.39] |
| 7.2 MMSE Show forest plot | 21 | 1325 | Mean Difference (IV, Random, 95% CI) | 2.16 [1.58, 2.74] |
| Analysis 7.2  Comparison 7: Group cognitive stimulation versus no cognitive stimulation post‐treatment (dementia severity), Outcome 2: MMSE | ||||
| 7.2.1 Mild impairment | 10 | 676 | Mean Difference (IV, Random, 95% CI) | 2.59 [1.87, 3.31] |
| 7.2.2 Moderate impairment | 11 | 649 | Mean Difference (IV, Random, 95% CI) | 1.42 [0.78, 2.07] |
| 7.3 ADAS‐Cog Show forest plot | 14 | 979 | Mean Difference (IV, Random, 95% CI) | 2.52 [0.59, 4.46] |
| Analysis 7.3  Comparison 7: Group cognitive stimulation versus no cognitive stimulation post‐treatment (dementia severity), Outcome 3: ADAS‐Cog | ||||
| 7.3.1 Mild impairment | 6 | 373 | Mean Difference (IV, Random, 95% CI) | 4.98 [1.95, 8.00] |
| 7.3.2 Moderate impairment | 8 | 606 | Mean Difference (IV, Random, 95% CI) | 1.10 [‐0.29, 2.48] |
| 7.4 Quality of life (self‐report) Show forest plot | 11 | 903 | Mean Difference (IV, Random, 95% CI) | 2.41 [0.66, 4.17] |
| Analysis 7.4  Comparison 7: Group cognitive stimulation versus no cognitive stimulation post‐treatment (dementia severity), Outcome 4: Quality of life (self‐report) | ||||
| 7.4.1 Mild impairment | 3 | 276 | Mean Difference (IV, Random, 95% CI) | 1.54 [0.07, 3.00] |
| 7.4.2 Moderate impairment | 8 | 627 | Mean Difference (IV, Random, 95% CI) | 3.07 [0.77, 5.36] |
| 7.5 Quality of life (proxy rated) Show forest plot | 5 | 359 | Std. Mean Difference (IV, Random, 95% CI) | 0.45 [‐0.01, 0.90] |
| Analysis 7.5  Comparison 7: Group cognitive stimulation versus no cognitive stimulation post‐treatment (dementia severity), Outcome 5: Quality of life (proxy rated) | ||||
| 7.5.1 Moderate impairment | 5 | 359 | Std. Mean Difference (IV, Random, 95% CI) | 0.45 [‐0.01, 0.90] |
| 7.6 Mood: self‐reported Show forest plot | 6 | 299 | Std. Mean Difference (IV, Random, 95% CI) | 0.20 [‐0.06, 0.45] |
| Analysis 7.6  Comparison 7: Group cognitive stimulation versus no cognitive stimulation post‐treatment (dementia severity), Outcome 6: Mood: self‐reported | ||||
| 7.6.1 Mild impairment | 4 | 220 | Std. Mean Difference (IV, Random, 95% CI) | 0.30 [0.01, 0.60] |
| 7.6.2 Moderate impairment | 2 | 79 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.05 [‐0.53, 0.42] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 8.1 Cognition ‐ 6 to 12‐week follow‐up Show forest plot | 3 | 242 | Std. Mean Difference (IV, Random, 95% CI) | 0.34 [‐0.11, 0.80] |
| Analysis 8.1  Comparison 8: Cognitive stimulation versus no cognitive stimulation: follow‐up, Outcome 1: Cognition ‐ 6 to 12‐week follow‐up | ||||
| 8.1.1 Three months follow‐up MMSE | 1 | 23 | Std. Mean Difference (IV, Random, 95% CI) | 0.90 [0.03, 1.78] |
| 8.1.2 Six week follow‐up ADAS‐Cog | 1 | 68 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.07 [‐0.54, 0.41] |
| 8.1.3 Three‐months follow‐up ADAS‐Cog | 1 | 151 | Std. Mean Difference (IV, Random, 95% CI) | 0.44 [0.11, 0.77] |
| 8.2 Cognition ‐ 8 to 12‐month follow‐up Show forest plot | 4 | 194 | Std. Mean Difference (IV, Random, 95% CI) | 0.13 [‐0.16, 0.42] |
| Analysis 8.2  Comparison 8: Cognitive stimulation versus no cognitive stimulation: follow‐up, Outcome 2: Cognition ‐ 8 to 12‐month follow‐up | ||||
| 8.2.1 Ten ‐ twelve months follow‐up ADAS‐Cog | 3 | 156 | Std. Mean Difference (IV, Random, 95% CI) | 0.23 [‐0.09, 0.55] |
| 8.2.2 Eight months follow‐up CAM‐COG | 1 | 38 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.25 [‐0.90, 0.39] |
| 8.3 Cognition: MMSE ‐ Three‐month follow‐up Show forest plot | 2 | 210 | Mean Difference (IV, Random, 95% CI) | 3.16 [‐0.99, 7.31] |
| Analysis 8.3  Comparison 8: Cognitive stimulation versus no cognitive stimulation: follow‐up, Outcome 3: Cognition: MMSE ‐ Three‐month follow‐up | ||||
| 8.4 Cognition: MMSE ‐ 8 to 12‐month follow‐up Show forest plot | 3 | 142 | Mean Difference (IV, Random, 95% CI) | 0.53 [‐0.63, 1.70] |
| Analysis 8.4  Comparison 8: Cognitive stimulation versus no cognitive stimulation: follow‐up, Outcome 4: Cognition: MMSE ‐ 8 to 12‐month follow‐up | ||||
| 8.5 Quality of Life: self‐report & proxy measures Show forest plot | 3 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| Analysis 8.5  Comparison 8: Cognitive stimulation versus no cognitive stimulation: follow‐up, Outcome 5: Quality of Life: self‐report & proxy measures | ||||
| 8.5.1 Six to twelve week follow‐up QoL‐AD | 2 | 254 | Mean Difference (IV, Random, 95% CI) | 0.36 [‐2.47, 3.20] |
| 8.5.2 Six week follow‐up QoL‐AD proxy | 1 | 68 | Mean Difference (IV, Random, 95% CI) | ‐0.30 [‐3.15, 2.55] |
| 8.5.3 Ten months follow‐up QoL‐AD | 1 | 54 | Mean Difference (IV, Random, 95% CI) | 2.15 [‐1.12, 5.42] |
| 8.5.4 Ten months follow‐up QoL‐AD proxy | 1 | 54 | Mean Difference (IV, Random, 95% CI) | ‐0.28 [‐3.14, 2.58] |
| 8.6 Communication and social interaction Show forest plot | 2 | Std. Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| Analysis 8.6  Comparison 8: Cognitive stimulation versus no cognitive stimulation: follow‐up, Outcome 6: Communication and social interaction | ||||
| 8.6.1 Twelve week follow‐up Narrative Language ‐ communicative abilities | 1 | 182 | Std. Mean Difference (IV, Random, 95% CI) | 0.33 [0.04, 0.63] |
| 8.6.2 Ten month follow‐up 'Relevance of discourse' | 1 | 54 | Std. Mean Difference (IV, Random, 95% CI) | 0.15 [‐0.38, 0.69] |
| 8.7 Mood Show forest plot | 2 | Std. Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| Analysis 8.7  Comparison 8: Cognitive stimulation versus no cognitive stimulation: follow‐up, Outcome 7: Mood | ||||
| 8.7.1 Twelve week follow‐up: interviewer / staff‐rated | 1 | 187 | Std. Mean Difference (IV, Random, 95% CI) | 0.54 [0.24, 0.83] |
| 8.7.2 Twelve month follow‐up: self‐report | 1 | 50 | Std. Mean Difference (IV, Random, 95% CI) | 0.36 [‐0.23, 0.94] |
| 8.8 ADL/IADL scales Show forest plot | 5 | Std. Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| Analysis 8.8  Comparison 8: Cognitive stimulation versus no cognitive stimulation: follow‐up, Outcome 8: ADL/IADL scales | ||||
| 8.8.1 Six to twelve weeks follow‐up IADL scales | 2 | 176 | Std. Mean Difference (IV, Random, 95% CI) | 0.12 [‐0.19, 0.42] |
| 8.8.2 Ten to twelve months follow‐up ADL / IADL scales | 3 | 156 | Std. Mean Difference (IV, Random, 95% CI) | 0.40 [0.07, 0.72] |
| 8.9 Behaviour that challenges Show forest plot | 4 | Std. Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| Analysis 8.9  Comparison 8: Cognitive stimulation versus no cognitive stimulation: follow‐up, Outcome 9: Behaviour that challenges | ||||
| 8.9.1 Six to twelve weeks follow‐up NPI | 2 | 255 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.19 [‐0.06, 0.44] |
| 8.9.2 Ten to twelve months follow‐up NPI severity | 2 | 104 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.43 [0.03, 0.83] |
| 8.9.3 Ten‐month follow up NPI (Caregiver Distress) | 1 | 54 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.41 [‐0.13, 0.95] |
Study flow diagram
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Forest plot of comparison: 1 Cognitive stimulation versus no cognitive stimulation, outcome: Cognition.
Forest plot of comparison: 1 Cognitive stimulation versus no cognitive stimulation, outcome: ADAS‐Cog
Forest plot of comparison: 1 Cognitive stimulation versus no cognitive stimulation, outcome: MMSE
Forest plot of comparison: 1 Cognitive stimulation versus no cognitive stimulation, outcome: self‐report QoL
Forest plot of comparison: 1 Cognitive stimulation versus no cognitive stimulation: post‐treatment, outcome: Comunication and social interaction
Forest plot of comparison: 1 Cognitive stimulation versus no cognitive stimulation, outcome: self‐reported depression
Forest plot of comparison: 1 Cognitive stimulation versus no cognitive stimulation: post‐treatment, outcome: Mood: Staff‐reported
Forest plot of comparison: 1 Cognitive stimulation versus no cognitive stimulation, outcome: ADL
Forest plot of comparison: 1 Cognitive stimulation versus no cognitive stimulation, outcome: Instrumental ADL
Forest plot of comparison: 1 Cognitive stimulation versus no cognitive stimulation: post‐treatment, outcome: Behaviour that challenges
Funnel plot of comparison: 1 Cognitive stimulation versus no cognitive stimulation: post‐treatment, outcome: 1.1 Cognition
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 1: Cognition
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 2: MMSE
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 3: ADAS‐Cog
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 4: Quality of Life: self‐report
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 5: Quality of Life: proxy‐rated
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 6: Communication and social interaction
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 7: Mood: Self‐reported
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 8: Anxiety: Interviewer/staff‐rated
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 9: Mood: Interviewer/staff‐rated
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 10: Quality of Relationship: self‐report
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 11: ADL scales
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 12: Instrumental ADL
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 13: Behaviour that challenges
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 14: Behaviour, General Rating Scales
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 15: Caregiver outcome ‐ anxiety
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 16: Caregiver outcome ‐ depressed mood
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 17: Caregiver outcome ‐ caregiving stress/burden (2)
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 18: Caregiver outcome ‐ caregiving stress/burden (1)
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 19: Caregiver outcome ‐ health‐related quality of life
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 20: Caregiver outcome ‐ SF‐12
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 21: Caregiver outcome ‐ quality of relationship
Comparison 1: Cognitive stimulation versus no cognitive stimulation: post‐treatment, Outcome 22: Caregiver outcome ‐ resilience
Comparison 2: Cognitive stimulation versus no cognitive stimulation (modality): post‐treatment, Outcome 1: Cognition ‐ modality
Comparison 2: Cognitive stimulation versus no cognitive stimulation (modality): post‐treatment, Outcome 2: MMSE ‐ modality
Comparison 2: Cognitive stimulation versus no cognitive stimulation (modality): post‐treatment, Outcome 3: ADAS‐Cog ‐ modality
Comparison 2: Cognitive stimulation versus no cognitive stimulation (modality): post‐treatment, Outcome 4: Quality of Life: self‐report
Comparison 2: Cognitive stimulation versus no cognitive stimulation (modality): post‐treatment, Outcome 5: Quality of Life: proxy‐rated
Comparison 2: Cognitive stimulation versus no cognitive stimulation (modality): post‐treatment, Outcome 6: Mood: self‐reported
Comparison 2: Cognitive stimulation versus no cognitive stimulation (modality): post‐treatment, Outcome 7: Instrumental ADL
Comparison 2: Cognitive stimulation versus no cognitive stimulation (modality): post‐treatment, Outcome 8: Behaviour that challenges
Comparison 2: Cognitive stimulation versus no cognitive stimulation (modality): post‐treatment, Outcome 9: Caregiver outcome ‐ depressed mood
Comparison 3: Group cognitive stimulation versus no cognitive stimulation (number of sessions): post‐treatment, Outcome 1: Cognition
Comparison 3: Group cognitive stimulation versus no cognitive stimulation (number of sessions): post‐treatment, Outcome 2: ADAS‐Cog
Comparison 3: Group cognitive stimulation versus no cognitive stimulation (number of sessions): post‐treatment, Outcome 3: MMSE
Comparison 3: Group cognitive stimulation versus no cognitive stimulation (number of sessions): post‐treatment, Outcome 4: Quality of Life: self‐report
Comparison 4: Group cognitive stimulation versus no cognitive stimulation (frequency): post‐treatment, Outcome 1: Cognition (3 levels)
Comparison 4: Group cognitive stimulation versus no cognitive stimulation (frequency): post‐treatment, Outcome 2: Cognition (2 levels)
Comparison 4: Group cognitive stimulation versus no cognitive stimulation (frequency): post‐treatment, Outcome 3: ADAS‐Cog (3 levels)
Comparison 4: Group cognitive stimulation versus no cognitive stimulation (frequency): post‐treatment, Outcome 4: ADAS‐Cog (2 levels)
Comparison 4: Group cognitive stimulation versus no cognitive stimulation (frequency): post‐treatment, Outcome 5: MMSE (3 levels)
Comparison 4: Group cognitive stimulation versus no cognitive stimulation (frequency): post‐treatment, Outcome 6: MMSE (2 levels)
Comparison 4: Group cognitive stimulation versus no cognitive stimulation (frequency): post‐treatment, Outcome 7: Quality of Life: self‐report
Comparison 4: Group cognitive stimulation versus no cognitive stimulation (frequency): post‐treatment, Outcome 8: Mood: interviewer/staff‐rated
Comparison 4: Group cognitive stimulation versus no cognitive stimulation (frequency): post‐treatment, Outcome 9: Anxiety ‐ interviewer/staff‐rated
Comparison 5: Cognitive stimulation versus no cognitive stimulation (setting): post‐treatment, Outcome 1: Cognition
Comparison 5: Cognitive stimulation versus no cognitive stimulation (setting): post‐treatment, Outcome 2: ADAS‐Cog
Comparison 5: Cognitive stimulation versus no cognitive stimulation (setting): post‐treatment, Outcome 3: MMSE
Comparison 5: Cognitive stimulation versus no cognitive stimulation (setting): post‐treatment, Outcome 4: Quality of Life: self‐report
Comparison 5: Cognitive stimulation versus no cognitive stimulation (setting): post‐treatment, Outcome 5: Quality of Life: proxy‐rated
Comparison 5: Cognitive stimulation versus no cognitive stimulation (setting): post‐treatment, Outcome 6: Mood: self‐reported
Comparison 5: Cognitive stimulation versus no cognitive stimulation (setting): post‐treatment, Outcome 7: Mood: Interviewer/staff‐rated
Comparison 6: Group cognitive stimulation versus no treatment post‐treatment (Active control group), Outcome 1: Cognition
Comparison 7: Group cognitive stimulation versus no cognitive stimulation post‐treatment (dementia severity), Outcome 1: Cognition
Comparison 7: Group cognitive stimulation versus no cognitive stimulation post‐treatment (dementia severity), Outcome 2: MMSE
Comparison 7: Group cognitive stimulation versus no cognitive stimulation post‐treatment (dementia severity), Outcome 3: ADAS‐Cog
Comparison 7: Group cognitive stimulation versus no cognitive stimulation post‐treatment (dementia severity), Outcome 4: Quality of life (self‐report)
Comparison 7: Group cognitive stimulation versus no cognitive stimulation post‐treatment (dementia severity), Outcome 5: Quality of life (proxy rated)
Comparison 7: Group cognitive stimulation versus no cognitive stimulation post‐treatment (dementia severity), Outcome 6: Mood: self‐reported
Comparison 8: Cognitive stimulation versus no cognitive stimulation: follow‐up, Outcome 1: Cognition ‐ 6 to 12‐week follow‐up
Comparison 8: Cognitive stimulation versus no cognitive stimulation: follow‐up, Outcome 2: Cognition ‐ 8 to 12‐month follow‐up
Comparison 8: Cognitive stimulation versus no cognitive stimulation: follow‐up, Outcome 3: Cognition: MMSE ‐ Three‐month follow‐up
Comparison 8: Cognitive stimulation versus no cognitive stimulation: follow‐up, Outcome 4: Cognition: MMSE ‐ 8 to 12‐month follow‐up
Comparison 8: Cognitive stimulation versus no cognitive stimulation: follow‐up, Outcome 5: Quality of Life: self‐report & proxy measures
Comparison 8: Cognitive stimulation versus no cognitive stimulation: follow‐up, Outcome 6: Communication and social interaction
Comparison 8: Cognitive stimulation versus no cognitive stimulation: follow‐up, Outcome 7: Mood
Comparison 8: Cognitive stimulation versus no cognitive stimulation: follow‐up, Outcome 8: ADL/IADL scales
Comparison 8: Cognitive stimulation versus no cognitive stimulation: follow‐up, Outcome 9: Behaviour that challenges
| Cognitive stimulation compared to no cognitive stimulation (post‐treatment) in people with dementia | ||||||
| Patient or population: people with dementia | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with no cognitive stimulation (post‐treatment) | Risk with cognitive stimulation | |||||
| Cognition | SMD 0.4 SD higher | ‐ | 2340 | ⊕⊕⊕⊝ | Cognitive stimulation probably results in a small increase in cognition. | |
| Quality of Life: self‐report | SMD 0.25 SD higher | ‐ | 1584 | ⊕⊕⊕⊝ | Cognitive stimulation probably results in a slight increase in self‐reported quality of life. | |
| Communication and social interaction | SMD 0.53 SD higher | ‐ | 702 | ⊕⊕⊕⊕ | Cognitive stimulation results in an increase in communication and social interaction. | |
| Mood: self‐reported | SMD 0.11 SD higher | ‐ | 787 | ⊕⊕⊕⊕ | Cognitive stimulation results in a slight improvement in self‐reported mood. | |
| Mood: interviewer/staff‐rated Assessed with Cornell Scale for Depression in Dementia; NOSGER‐Mood subscale; Montgomery‐Asberg Depression Rating Scale | SMD 0.35 SD higher | ‐ | 1011 | ⊕⊕⊝⊝ | Cognitive stimulation may result in a slight improvement in mood rated by an interviewer or by staff. | |
| Instrumental ADL | SMD 0.15 SD higher | ‐ | 1318 | ⊕⊕⊕⊕ | Cognitive stimulation results in a slight increase in Instrumental ADL. | |
| Behaviour that challenges | SMD 0.18 SD higher | ‐ | 1340 | ⊕⊕⊕⊝ | Cognitive stimulation probably results in a slight improvement in behaviour that challenges. | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| a Downgraded one point for inconsistency as moderate heterogeneity was present. b Downgraded one point for inconsistency as substantial heterogeneity was present. c Downgraded one point for imprecision as 95% CIs included both a clinically important and a negligible benefit. | ||||||
| Group cognitive stimulation compared to no cognitive stimulation (post‐treatment) in people with dementia | ||||||
| Patient or population: people with dementia | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with no cognitive stimulation (post‐treatment) | Risk with group cognitive stimulation | |||||
| Cognition | SMD 0.43 SD higher | ‐ | 1637 | ⊕⊕⊕⊝ | Group cognitive stimulation probably results in a small increase in cognition. | |
| Quality of Life: self‐report | SMD 0.28 SD higher | ‐ | 1058 | ⊕⊕⊝⊝ | Group cognitive stimulation may result in a slight increase in self‐reported quality of life. | |
| Communication and social interaction | SMD 0.53 SD higher | ‐ | 702 | ⊕⊕⊕⊕ | Group cognitive stimulation results in an increase in communication and social interaction. | |
| Mood: self‐reported | SMD 0.2 SD higher | ‐ | 299 | ⊕⊕⊕⊝ | Group cognitive stimulation probably results in a slight improvement in self‐reported mood. | |
| Mood: interviewer/staff‐rated | SMD 0.4 SD higher | ‐ | 959 | ⊕⊕⊕⊝ | Group cognitive stimulation probably results in a small improvement in interviewer/staff‐rated mood. | |
| Instrumental ADL | SMD 0.2 SD higher | ‐ | 687 | ⊕⊕⊕⊕ | Group cognitive stimulation results in a slight increase in Instrumental ADL. | |
| Behaviour that challenges | SMD 0.33 SD higher | ‐ | 754 | ⊕⊕⊕⊝ | Group cognitive stimulation probably results in a slight improvement in behaviour that challenges. | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| a Downgraded one point for inconsistency as moderate heterogeneity was present. b Downgraded one point for inconsistency as substantial heterogeneity was present. c Downgraded one point for imprecision as 95% CIs included both a clinically important and a negligible effect. d Downgraded one point for imprecision as fewer than 400 participants. | ||||||
| Domain | Risk of bias judgement | ||
|---|---|---|---|
| Selection bias | Low | High | Unclear |
| Random sequence generation | Assigned if simple randomisation was used (e.g. computer‐generated random sequence, coin tossing). | Assigned if study reported an inadequate randomisation method (e.g. using date of birth or odd/even numbers). | Assigned if there was insufficient detail to judge the risk of bias as low or high. |
| Assigned if restricted randomisation was used (e.g. block randomisation, provided that within groups randomisation was not affected). | |||
| Allocation Concealment | Assigned if there was evidence of concealed allocation sequence in which allocations could not have been foreseen in advance of, or during, enrolment. | Assigned if those enrolling participants were aware of the group (or period in a cross‐over trial) to which the next enrolled participant would be allocated. | Assigned if there was insufficient detail to judge the risk of bias as low or high. |
| Detection bias | Low | High | Unclear |
| Blinding of outcome assessors (blinding of participants and facilitators is not possible in psychosocial interventions). | Assigned if outcome assessors were blind to treatment allocation. | Assigned if the outcome assessors were aware of treatment allocation (e.g. if the cognitive stimulation group leader was also an outcome assessor). | Assigned if there was insufficient detail to judge the risk of bias as low or high. |
| Attrition bias | Low | High | Unclear |
| Incomplete outcome data | Assigned if the study reported levels of attrition, reasons for attrition and how missing data were dealt with. Assigned if the impact of missing data was not believed to alter the conclusions and there were acceptable reasons for the missing data. | Assigned if there was inadequate information regarding the level of attrition in each group, reasons for attrition and if missing data were not handled correctly. | Assigned if there was insufficient detail to judge the risk of bias as low or high. |
| Reporting bias | Low | High | Unclear |
| Selective reporting | Assigned if study reported results of all outcome measures that were detailed in the methods section. If a study protocol was available, low risk of bias was assigned if the outcome assessments reported in the trial paper matched those detailed in the protocol. | Assigned if study did not report results of all outcome measures that were detailed in the methods section. Assigned if all outcome measures detailed in the protocol (if available) were not reported in the study. | Assigned if there was insufficient detail to judge the risk of bias as low or high. |
| Other bias | Low | High | Unclear |
| Availability of training and supervision | Assigned if cognitive stimulation sessions were facilitated by people who had received some form of training to ensure the necessary principles of cognitive stimulation were adhered to. The definition of training was inclusive and could range from a brief session to a longer, more intensive course. This also applied to interventions delivered by trained family carers. The opportunity for facilitators to access appropriate supervision was also desirable. | Assigned if there was no evidence of facilitator training or supervision. | Assigned if there was insufficient detail to judge the risk of bias as low or high. |
| Availability of manual, structure or protocol | Assigned if there was evidence of a documented intervention protocol, structure or manual outlining the content of each session to ensure the principles of cognitive stimulation were adhered to. | Assigned if there was no evidence of a treatment protocol, structure or manual for facilitators to follow. | Assigned if there was insufficient detail to judge the risk of bias as low or high. |
| Study ID | Intervention/modality | Setting | Frequency (per week) | Duration (weeks) | Total number of sessions | Session length (minutes) | MMSE Mean (SD) | Follow‐up? | Age Mean (SD) | Relevant sample size intervention/control |
| Individual iCST adapted from ‘Making a Difference’ manuals delivered by paid staff or family/friends | Mixed community/supported housing/residential care, UK | 2 | 20 | 40 | 30 | N/A | None | 60.4 (8.2) | 20/20 | |
| CST groups using Portugese version of 'Making a Difference' manual | Mixed day‐centre/residential settings, Portugal | 2 | 7 | 14 | 45 | N/A | None | 83.6 (7.6) | 55/50 | |
| RO group sessions | Institution, Italy | 3 | 12 | 36 | 60 | 20.6 (4.9) | 3‐month | 84.5 (6.4) | 13/10 | |
| RO group sessions | Nursing home, Italy | 5 | 4 | 20 | 60 | 20.7 (3.0) | None | 80.0 (7.4) | 71 /16 | |
| ‘Cognitive rehabilitation’ group sessions/carer support group | Outpatients, Brazil | 1 | 20 | 20 | 90 | 22.3 (3.6) | None | 73.7 (6.6) | 6/7 | |
| Cognitive stimulation groups | Outpatients, France | 2 | 5 | 10 | 60 | 21.5 | None | 77.1 (7.1) | 29/27 | |
| Cognitive stimulation groups | Outpatients, all on AChEIs/memantine, Germany | 1 | 26 | 20 | 120 | 24.9 (1.6) | None | 75.9 (8.1) | 8/7 | |
| CST groups using ‘Making a Difference’ manual | Residential homes, Italy | 2 | 7 | 14 | 45 | 18.2 (3.4) | None | 87.4 (5.4) | 20/19 | |
| CST groups using Italian version of 'Making a Difference' manual | Residential homes and day‐centres, Italy | 2 | 7 | 14 | 45 | 20.1 (4.0) | 3‐month follow‐up | 83.6 (8.1) | 123/102 | |
| Cognitive‐communication stimulation groups | Outpatients – all on donepezil, USA | 1 | 8 | 8 | 90 | 20.9 (3.6) | 6‐month and 10‐month follow‐up | 76.4 (7.9) | 26/28 | |
| Cognitive stimulating play intervention groups | 2 daycare centres, Hong Kong | 1 | 8 | 8 | 45‐60 | (MoCA 7.9 (4.4)) | None | 83.2 (7.2) | 18/12 | |
| CST Groups using ‘Making a Difference’ manual | Long‐term care, nursing home, Ireland | 2 | 7 | 14 | 45 | 16.9 (5.0) | None | 79.8 (5.6) | 14/13 | |
| CST Groups using ‘Making a Difference’ manual | Community, UK | 1 | 14 | 14 | 45 | 22.8 (3.4) | None | 77.3 (7.0) | 24/23 | |
| Individual iCST adapted from ‘Making a Difference’ manuals delivered by researchers | Care homes, UK | 2 | 7 | 14 | 45 | 21.7 (3.5) | None | 81.9 (10.3) | 17/16 | |
| ‘MAKS’ groups | Nursing homes, Germany | 6 | 52 | 300 | 120 | 14.6 (5.4) | 10‐month follow‐up | 85.1 (5.1) | 71/68 (6 months) 50/46 (12 months) | |
| 'SADEM' cognitive stimulation groups | Outpatients, Mexico | 2 | 48 | 96 | 90 | 22.6 (0.9) | 12‐month follow‐up | 77.7 (8.2) | 39/28 | |
| Home‐based individual cognitive stimulation delivered by clinical psychologist | Community, Portugal | 1 | 47 | 47 | 45 | 23.2 (3.2) | None | 78.9 (7.5) | 30/29 | |
| Multi‐domain cognitive stimulation groups | Community – all receiving pharmacotherapy, South Korea | 5 | 26 | 130 | 60 | 18.0 (5.8) | None | 78.5 (1.5) | 32/21 | |
| Individual cognitive stimulation delivered by informal carers (CST‐PD) | Community, UK | 2‐3 | 12 | 24‐36 | 30 | N/A | None | Median 75 (range 55‐90) | 31 /30 | |
| Cognitive stimulation groups | Long‐term care institutions, Taiwan | 1 | 10 | 10 | 50 | 14.9 (3.7) | 3‐month follow‐up | 79.5 (7.7) | 30/32 | |
| RAM‐based CST groups (using ‘Making a Difference’ themes and structure) | Community ‐ all receiving AChEIs, Turkey | 2 | 7 | 14 | 45 | 16.9 (4.3) | None | Not stated | 30/30 | |
| Cognitive stimulation groups | Community (daycare centre) ‐ all receiving AChEIs, Spain | 3 | 26 | 78 | 60 | 17.9 (3.9) | None | 81.9 (5.5) | 10/10 | |
| Cognitive stimulation and physical activity groups | Community (gymnasium) ‐ all receiving AChEIs/memantine/anti‐depressants, Italy | 5 | 12 | 60 | 120 | 17.8 (2.8) | None | 72.6 (9.5) | 7/7 | |
| Cognitive stimulation groups | Nursing home, Italy | 5 | 8 | 40 | 60 | 19.5 (3.4) | None | 83.7 (4.6) | 10/10 | |
| CST groups using Brazilian version of 'Making a Difference' manual | Outpatients ‐ all receiving AChEIs, Brazil | 2 (but both sessions on same day) | 7 | 14 | 45 | N/A | None | 77.8 (8.4) | 23/24 | |
| NEUROvitalis senseful cognitive stimulation groups | Nursing homes, Germany | 2 | 8 | 16 | 60 | 16.9 (4.5) | 6‐week follow‐up | 86.4 (4.5) | 36/35 | |
| Individual reality orientation delivered by family carers | Community – all on donepezil, Italy | 3 | 25 | 75 | 30 | 20.1 (3.1) | None | 75.8 (7.1) | 79/77 | |
| Individual cognitive stimulation delivered by informal carers; ‘Making a Difference’ manual | Community, UK | 3 | 25 | 75 | 30 | 21.2 (4.3) | None | 78.2 (7.5) | 180/176 | |
| Maintenance cognitive stimulation groups; ‘Making a Difference’ manual | Care homes and community, UK | 1 | 24 | 24 | 45 | 17.8 (5.5) | None | 83.1 (7.6) | 123/113 | |
| Cognitive stimulation groups using adapted ‘Making a Difference’ manual | Community, Tanzania | 2 | 7 | 14 | 45 | Mean Clinical Dementia Rating 1.65 | 8‐week follow‐up (uncontrolled) | Median 80 (IQR 76.5,85.3) | 16/18 | |
| Individual cognitive stimulation app delivered by informal carers based on 'Making a Difference' manual | Community, UK | 2‐3 | 11 | 22‐33 | 30 | N/A | None | 73.0 (7.7) | 31/30 | |
| Cognitive stimulation groups using computer‐controlled visual stimuli on TV screen | Community – all on donepezil, Spain | 5 | 52 and 104 | 250 and 500 | 45 | 21.9 (6.3) | None | 77.0 (7.5) | 20/30 | |
| Cognitive stimulation groups using ‘Making a Difference’ manual | Mixed community & care home, UK | 2 | 7 | 14 | 45 | 13.1 (4.4) | None | 85.7 (6.7) | 21 /14 | |
| Cognitive stimulation groups using ‘Making a Difference’ manual | Mixed community & care home, UK | 2 | 7 | 14 | 45 | 14.4 (3.8) | None | 85.3 (7.0) | 115/86 | |
| Group exercise and cognitive stimulation | Residential geriatric rehabilitation facility | 2 | 8 | 16 | 45 | 15.5 (5.8) | None | 86.2 (7.8) | 16/15 | |
| Individual cognitive stimulation delivered by psychologists | Community – all receiving AChEIs, Greece | 3 | 16 | 48 | 90 | 23.0 (1.3) | 8‐month follow‐up | 73.7 (5.3) | 17/21 | |
| Cognitive stimulation groups plus Tai Chi (using adapted ‘Making a Difference’ manual) | Community, Hong Kong | 2 | 7 | 14 | 60 | 20.7 (2.3) | None | 80.2 (6.4) | 51/50 | |
| AChEI: acetylcholinesterase Inhibitor CST: cognitive stimulation therapy CST‐PD: cognitive stimulation therapy – Parkinson’s Disease iCST: individual cognitive stimulation therapy IQR: interquartile range MAKS: motor stimulation; activities of daily living; cognitive stimulation; spiritual element MMSE: Mini Mental State Examination MoCA: Montreal Cognitive Assessment N/A: not applicable RAM: Roy’s adaptation model RO: reality orientation SADEM: study on ageing and dementia in Mexico | ||||||||||
| Cognition | Effect size (SMD) | 95% CI | I2 | Number of studies | Number of participants | Quality of the evidence |
| Cognitive stimulation (CS) | 0.40 | 0.25, 0.55 | 62% | 34 | 2340 | Moderate |
| Group CS | 0.43 | 0.26, 0.59 | 56% | 27 | 1637 | Moderate |
| Individual CS | 0.30 | ‐0.03, 0.64 | 72% | 7 | 703 | Low |
| 20 or more group sessions | 0.42 | 0.16, 0.67 | 46% | 12 | 615 | Moderate |
| Fewer than 20 group sessions | 0.43 | 0.22, 0.65 | 61% | 19 | 1022 | Moderate |
| 3 or more group sessions per week | 0.46a | 0.22, 0.69 | 0% | 8 | 328 | Moderate |
| 2 or more group sessions per week | 0.51b | 0.34, 0.69 | 51% | 21 | 1283 | Moderate |
| 1 group session per week | 0.04c | ‐0.17, 0.25 | 0% | 6 | 354 | Low |
| Community setting (group CS) | 0.66 | 0.33, 0.99 | 77% | 15 | 642 | Moderate |
| Care home setting (group CS) | 0.60 | ‐0.01, 1.20 | 87% | 9 | 323 | Very low |
| Mild dementia severity | 0.71d | 0.47, 0.95 | 43% | 10 | 640 | Moderate |
| Moderate dementia severity | 0.21 | 0.03, 0.39 | 28% | 13 | 778 | High |
| Active control | 0.59 | 0.37, 0.82 | 0% | 5 | 322 | Moderate |
| Treatment‐as‐usual | 0.41 | 0.22, 0.60 | 61% | 22 | 1315 | Moderate |
| a3 group sessions > 1 group session (P = 0.01). b2 or more > 1 group session (P = 0.0007). c2 group sessions > 1 group session (P = 0.003). dMild dementia severity > moderate dementia severity (P = 0.001). All other subgroup comparisons shown were not statistically significant. | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Cognition Show forest plot | 34 | 2340 | Std. Mean Difference (IV, Random, 95% CI) | 0.40 [0.25, 0.55] |
| 1.1.1 ADAS‐Cog | 21 | 1742 | Std. Mean Difference (IV, Random, 95% CI) | 0.30 [0.15, 0.46] |
| 1.1.2 Global cognitive score (includes MMSE & CERAD) | 1 | 56 | Std. Mean Difference (IV, Random, 95% CI) | 0.63 [0.09, 1.17] |
| 1.1.3 MMSE | 6 | 262 | Std. Mean Difference (IV, Random, 95% CI) | 0.52 [0.25, 0.79] |
| 1.1.4 Mattis Dementia Rating Scale | 1 | 101 | Std. Mean Difference (IV, Random, 95% CI) | 1.32 [0.89, 1.75] |
| 1.1.5 Esame Neuropsicologico Breve 2 (ENB2) | 1 | 20 | Std. Mean Difference (IV, Random, 95% CI) | 0.99 [0.05, 1.93] |
| 1.1.6 Montreal Cognitive Assessment (MoCA) | 2 | 76 | Std. Mean Difference (IV, Random, 95% CI) | 0.91 [0.22, 1.60] |
| 1.1.7 ACE‐III | 1 | 43 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.28 [‐0.89, 0.33] |
| 1.1.8 CAM‐COG‐DS | 1 | 40 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.14 [‐0.76, 0.48] |
| 1.2 MMSE Show forest plot | 25 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.2.1 One to twelve months of CS | 25 | 1893 | Mean Difference (IV, Random, 95% CI) | 1.99 [1.24, 2.74] |
| 1.2.2 24 months of CS | 1 | 29 | Mean Difference (IV, Random, 95% CI) | 5.99 [‐1.58, 13.56] |
| 1.3 ADAS‐Cog Show forest plot | 21 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.3.1 One to 12 months of CS | 21 | 1742 | Mean Difference (IV, Random, 95% CI) | 2.42 [1.21, 3.63] |
| 1.3.2 24 months of CS | 1 | 29 | Mean Difference (IV, Random, 95% CI) | 11.94 [‐0.97, 24.85] |
| 1.4 Quality of Life: self‐report Show forest plot | 18 | 1584 | Std. Mean Difference (IV, Random, 95% CI) | 0.25 [0.07, 0.42] |
| 1.4.1 QoL‐AD | 17 | 1541 | Std. Mean Difference (IV, Random, 95% CI) | 0.26 [0.07, 0.44] |
| 1.4.2 EQ‐5D | 1 | 43 | Std. Mean Difference (IV, Random, 95% CI) | 0.03 [‐0.58, 0.63] |
| 1.5 Quality of Life: proxy‐rated Show forest plot | 11 | 988 | Std. Mean Difference (IV, Random, 95% CI) | 0.21 [0.00, 0.42] |
| 1.5.1 QoL‐AD proxy | 10 | 963 | Std. Mean Difference (IV, Random, 95% CI) | 0.20 [‐0.02, 0.41] |
| 1.5.2 QoL‐D | 1 | 25 | Std. Mean Difference (IV, Random, 95% CI) | 0.52 [‐0.29, 1.34] |
| 1.6 Communication and social interaction Show forest plot | 7 | 702 | Std. Mean Difference (IV, Random, 95% CI) | 0.53 [0.36, 0.70] |
| 1.6.1 Holden Communication Scale | 3 | 299 | Std. Mean Difference (IV, Random, 95% CI) | 0.40 [0.15, 0.65] |
| 1.6.2 Narrative language ‐ communicative abilities | 2 | 259 | Std. Mean Difference (IV, Random, 95% CI) | 0.64 [0.38, 0.89] |
| 1.6.3 NOSGER ‐ Social Behaviour | 2 | 144 | Std. Mean Difference (IV, Random, 95% CI) | 0.71 [0.16, 1.26] |
| 1.7 Mood: Self‐reported Show forest plot | 10 | 787 | Std. Mean Difference (IV, Random, 95% CI) | 0.11 [‐0.08, 0.31] |
| 1.7.1 Geriatric Depression Scale (GDS‐30) One to twelve months of CS | 4 | 213 | Std. Mean Difference (IV, Random, 95% CI) | 0.28 [‐0.02, 0.58] |
| 1.7.2 Geriatric Depression Scale (14 item) One to twelve months of CS | 1 | 26 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.39 [‐1.16, 0.39] |
| 1.7.3 Geriatric Depression Scale (GDS‐15) One to twelve months of CS | 2 | 402 | Std. Mean Difference (IV, Random, 95% CI) | 0.22 [‐0.43, 0.88] |
| 1.7.4 HADS ‐ Depression | 1 | 34 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.34 [‐1.04, 0.37] |
| 1.7.5 CESD‐R | 1 | 60 | Std. Mean Difference (IV, Random, 95% CI) | 0.21 [‐0.31, 0.73] |
| 1.7.6 Cornell Scale for Depression in Dementia (self‐report) | 1 | 52 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.02 [‐0.56, 0.52] |
| 1.8 Anxiety: Interviewer/staff‐rated Show forest plot | 6 | 410 | Std. Mean Difference (IV, Random, 95% CI) | 0.11 [‐0.09, 0.30] |
| 1.8.1 Hamilton Anxiety Rating Scale | 1 | 14 | Std. Mean Difference (IV, Random, 95% CI) | 0.84 [‐0.27, 1.95] |
| 1.8.2 NPI ‐ anxiety subscale | 1 | 39 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.07 [‐0.69, 0.56] |
| 1.8.3 Rating of Anxiety in Dementia (RAID) | 4 | 357 | Std. Mean Difference (IV, Random, 95% CI) | 0.10 [‐0.11, 0.31] |
| 1.9 Mood: Interviewer/staff‐rated Show forest plot | 11 | 1011 | Std. Mean Difference (IV, Random, 95% CI) | 0.35 [0.09, 0.61] |
| 1.9.1 Cornell Scale for Depression in Dementia | 9 | 877 | Std. Mean Difference (IV, Random, 95% CI) | 0.36 [0.05, 0.67] |
| 1.9.2 NOSGER ‐ Mood | 1 | 119 | Std. Mean Difference (IV, Random, 95% CI) | 0.35 [‐0.02, 0.71] |
| 1.9.3 Montgomery‐Asberg Depression Rating Scale | 1 | 15 | Std. Mean Difference (IV, Random, 95% CI) | 0.31 [‐0.72, 1.33] |
| 1.10 Quality of Relationship: self‐report Show forest plot | 4 | 492 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.01 [‐0.27, 0.25] |
| 1.10.1 QCPR | 3 | 455 | Std. Mean Difference (IV, Random, 95% CI) | 0.08 [‐0.15, 0.31] |
| 1.10.2 Relationship Satisfaction Scale | 1 | 37 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.37 [‐1.03, 0.29] |
| 1.11 ADL scales Show forest plot | 7 | 360 | Std. Mean Difference (IV, Random, 95% CI) | 0.19 [‐0.03, 0.41] |
| 1.11.1 Stewart ADL scale | 1 | 23 | Std. Mean Difference (IV, Random, 95% CI) | 0.25 [‐0.57, 1.08] |
| 1.11.2 Barthel ADL scale | 3 | 249 | Std. Mean Difference (IV, Random, 95% CI) | 0.16 [‐0.11, 0.43] |
| 1.11.3 Erlangen Test of ADL | 1 | 61 | Std. Mean Difference (IV, Random, 95% CI) | 0.29 [‐0.21, 0.80] |
| 1.11.4 Katz ADL scale | 2 | 27 | Std. Mean Difference (IV, Random, 95% CI) | 0.12 [‐0.63, 0.88] |
| 1.12 Instrumental ADL Show forest plot | 13 | 1318 | Std. Mean Difference (IV, Random, 95% CI) | 0.15 [0.04, 0.26] |
| 1.12.1 Lawton Brody Instrumental ADL | 3 | 197 | Std. Mean Difference (IV, Random, 95% CI) | 0.17 [‐0.11, 0.45] |
| 1.12.2 Disability Assessment for Dementia | 2 | 179 | Std. Mean Difference (IV, Random, 95% CI) | 0.23 [‐0.07, 0.52] |
| 1.12.3 NOSGER IADL subscale | 1 | 119 | Std. Mean Difference (IV, Random, 95% CI) | 0.42 [0.06, 0.79] |
| 1.12.4 Bristol Activities of Daily Living Scale (BADLS) | 2 | 408 | Std. Mean Difference (IV, Random, 95% CI) | 0.05 [‐0.15, 0.24] |
| 1.12.5 Alzheimer's Disease Cooperative Study ‐ ADL Scale | 4 | 355 | Std. Mean Difference (IV, Random, 95% CI) | 0.10 [‐0.11, 0.31] |
| 1.12.6 Rapid Disability Rating Scale | 1 | 60 | Std. Mean Difference (IV, Random, 95% CI) | 0.33 [‐0.19, 0.85] |
| 1.13 Behaviour that challenges Show forest plot | 12 | 1340 | Std. Mean Difference (IV, Random, 95% CI) | 0.18 [‐0.01, 0.38] |
| 1.13.1 NPI | 8 | 1137 | Std. Mean Difference (IV, Random, 95% CI) | 0.13 [‐0.10, 0.36] |
| 1.13.2 NPI ‐ Agitation | 1 | 39 | Std. Mean Difference (IV, Random, 95% CI) | 0.00 [‐0.63, 0.63] |
| 1.13.3 NOSGER ‐ Challenging Behaviour | 1 | 119 | Std. Mean Difference (IV, Random, 95% CI) | 0.32 [‐0.04, 0.68] |
| 1.13.4 Behave‐AD | 1 | 20 | Std. Mean Difference (IV, Random, 95% CI) | 1.30 [0.32, 2.29] |
| 1.13.5 Dementia Behaviour Disturbance Scale (DBD) | 1 | 25 | Std. Mean Difference (IV, Random, 95% CI) | 0.19 [‐0.61, 0.99] |
| 1.14 Behaviour, General Rating Scales Show forest plot | 6 | 505 | Std. Mean Difference (IV, Random, 95% CI) | 0.35 [0.13, 0.58] |
| 1.14.1 CAPE Behaviour Rating Scale | 4 | 326 | Std. Mean Difference (IV, Random, 95% CI) | 0.21 [‐0.01, 0.43] |
| 1.14.2 NOSGER | 1 | 119 | Std. Mean Difference (IV, Random, 95% CI) | 0.65 [0.28, 1.02] |
| 1.14.3 Blessed Dementia Rating Scale | 1 | 60 | Std. Mean Difference (IV, Random, 95% CI) | 0.51 [‐0.02, 1.03] |
| 1.15 Caregiver outcome ‐ anxiety Show forest plot | 5 | 600 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.00 [‐0.19, 0.19] |
| 1.15.1 Hamilton Anxiety Scale | 2 | 150 | Std. Mean Difference (IV, Random, 95% CI) | 0.18 [‐0.33, 0.68] |
| 1.15.2 Hospital Anxiety & Depression Scale ‐ Anxiety | 3 | 450 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.06 [‐0.33, 0.21] |
| 1.16 Caregiver outcome ‐ depressed mood Show forest plot | 8 | 664 | Std. Mean Difference (IV, Random, 95% CI) | 0.05 [‐0.10, 0.21] |
| 1.16.1 Hospital Anxiety & Depression Scales ‐ depression | 4 | 490 | Std. Mean Difference (IV, Random, 95% CI) | 0.02 [‐0.16, 0.20] |
| 1.16.2 Hamilton Depression Scale | 1 | 137 | Std. Mean Difference (IV, Random, 95% CI) | 0.03 [‐0.30, 0.37] |
| 1.16.3 Beck Depression Inventory | 1 | 14 | Std. Mean Difference (IV, Random, 95% CI) | 1.04 [‐0.10, 2.18] |
| 1.16.4 Montgomery‐Asberg Depression Rating Scale | 1 | 13 | Std. Mean Difference (IV, Random, 95% CI) | 0.19 [‐0.91, 1.28] |
| 1.16.5 General Health Questionnaire (GHQ‐12) | 1 | 10 | Std. Mean Difference (IV, Random, 95% CI) | 0.94 [‐0.41, 2.29] |
| 1.17 Caregiver outcome ‐ caregiving stress/burden (2) Show forest plot | 6 | 288 | Std. Mean Difference (IV, Random, 95% CI) | 0.09 [‐0.14, 0.32] |
| 1.17.1 Caregiver Burden Inventory | 2 | 151 | Std. Mean Difference (IV, Random, 95% CI) | 0.12 [‐0.50, 0.75] |
| 1.17.2 Relative's Stress Scale | 1 | 10 | Std. Mean Difference (IV, Random, 95% CI) | 0.35 [‐0.91, 1.60] |
| 1.17.3 Zarit Burden Inventory | 2 | 87 | Std. Mean Difference (IV, Random, 95% CI) | 0.14 [‐0.28, 0.57] |
| 1.17.4 Caregiver Burden Scale | 1 | 40 | Std. Mean Difference (IV, Random, 95% CI) | 0.23 [‐0.40, 0.85] |
| 1.18 Caregiver outcome ‐ caregiving stress/burden (1) Show forest plot | 6 | 286 | Std. Mean Difference (IV, Random, 95% CI) | 0.09 [‐0.15, 0.32] |
| 1.18.1 Caregiver Burden Inventory | 2 | 151 | Std. Mean Difference (IV, Random, 95% CI) | 0.12 [‐0.50, 0.75] |
| 1.18.2 Relative's Stress Scale | 2 | 50 | Std. Mean Difference (IV, Random, 95% CI) | 0.19 [‐0.37, 0.75] |
| 1.18.3 Zarit Burden Inventory | 1 | 45 | Std. Mean Difference (IV, Random, 95% CI) | 0.12 [‐0.47, 0.70] |
| 1.18.4 Caregiver Burden Scale | 1 | 40 | Std. Mean Difference (IV, Random, 95% CI) | 0.23 [‐0.40, 0.85] |
| 1.19 Caregiver outcome ‐ health‐related quality of life Show forest plot | 5 | 651 | Std. Mean Difference (IV, Random, 95% CI) | 0.17 [‐0.14, 0.49] |
| 1.19.1 EQ‐5D | 4 | 514 | Std. Mean Difference (IV, Random, 95% CI) | 0.24 [‐0.18, 0.65] |
| 1.19.2 SF‐36 | 1 | 137 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.02 [‐0.35, 0.32] |
| 1.20 Caregiver outcome ‐ SF‐12 Show forest plot | 3 | Std. Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.20.1 SF‐12 PCS | 3 | 461 | Std. Mean Difference (IV, Random, 95% CI) | 0.07 [‐0.11, 0.25] |
| 1.20.2 SF12 ‐ MCS | 3 | 461 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.05 [‐0.23, 0.13] |
| 1.21 Caregiver outcome ‐ quality of relationship Show forest plot | 3 | 367 | Std. Mean Difference (IV, Random, 95% CI) | 0.06 [‐0.26, 0.37] |
| 1.21.1 QCPR | 2 | 325 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.07 [‐0.29, 0.15] |
| 1.21.2 Relationship Satisfaction Scale | 1 | 42 | Std. Mean Difference (IV, Random, 95% CI) | 0.53 [‐0.10, 1.15] |
| 1.22 Caregiver outcome ‐ resilience Show forest plot | 2 | 399 | Std. Mean Difference (IV, Random, 95% CI) | 0.06 [‐0.13, 0.26] |
| 1.22.1 Brief Resilience Scale (Wagnild ‐ RS14) | 1 | 356 | Std. Mean Difference (IV, Random, 95% CI) | 0.08 [‐0.13, 0.29] |
| 1.22.2 Brief Resilience Scale (Smith and colleagues) | 1 | 43 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.07 [‐0.68, 0.53] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Cognition ‐ modality Show forest plot | 34 | 2340 | Std. Mean Difference (IV, Random, 95% CI) | 0.40 [0.25, 0.55] |
| 2.1.1 One to twelve months of group CS | 27 | 1637 | Std. Mean Difference (IV, Random, 95% CI) | 0.43 [0.26, 0.59] |
| 2.1.2 One to twelve months of individual CS | 7 | 703 | Std. Mean Difference (IV, Random, 95% CI) | 0.30 [‐0.03, 0.64] |
| 2.2 MMSE ‐ modality Show forest plot | 25 | 1893 | Mean Difference (IV, Random, 95% CI) | 1.99 [1.24, 2.74] |
| 2.2.1 One to twelve months of group CS | 21 | 1325 | Mean Difference (IV, Random, 95% CI) | 2.16 [1.58, 2.74] |
| 2.2.2 One to twelve months of individual CS | 4 | 568 | Mean Difference (IV, Random, 95% CI) | 1.18 [‐0.91, 3.28] |
| 2.3 ADAS‐Cog ‐ modality Show forest plot | 21 | 1742 | Mean Difference (IV, Random, 95% CI) | 2.42 [1.21, 3.63] |
| 2.3.1 One to twelve months of group CS | 17 | 1168 | Mean Difference (IV, Random, 95% CI) | 2.66 [1.12, 4.20] |
| 2.3.2 One to twelve months of individual CS | 4 | 574 | Mean Difference (IV, Random, 95% CI) | 1.92 [‐0.00, 3.85] |
| 2.4 Quality of Life: self‐report Show forest plot | 18 | 1584 | Std. Mean Difference (IV, Random, 95% CI) | 0.25 [0.07, 0.42] |
| 2.4.1 One to twelve months of group CS | 13 | 1058 | Std. Mean Difference (IV, Random, 95% CI) | 0.28 [0.05, 0.52] |
| 2.4.2 One to twelve months of individual CS | 5 | 526 | Std. Mean Difference (IV, Random, 95% CI) | 0.11 [‐0.09, 0.30] |
| 2.5 Quality of Life: proxy‐rated Show forest plot | 11 | 988 | Std. Mean Difference (IV, Random, 95% CI) | 0.21 [0.00, 0.42] |
| 2.5.1 One to twelve months of group CS | 7 | 511 | Std. Mean Difference (IV, Random, 95% CI) | 0.26 [‐0.06, 0.58] |
| 2.5.2 One to twelve months of individual CS | 4 | 477 | Std. Mean Difference (IV, Random, 95% CI) | 0.18 [‐0.11, 0.47] |
| 2.6 Mood: self‐reported Show forest plot | 10 | 787 | Std. Mean Difference (IV, Random, 95% CI) | 0.11 [‐0.08, 0.31] |
| 2.6.1 One to twelve months of group cognitive stimulation | 6 | 299 | Std. Mean Difference (IV, Random, 95% CI) | 0.20 [‐0.06, 0.45] |
| 2.6.2 One to twelve months of individual cognitive stimulation | 4 | 488 | Std. Mean Difference (IV, Random, 95% CI) | 0.04 [‐0.28, 0.35] |
| 2.7 Instrumental ADL Show forest plot | 13 | 1318 | Std. Mean Difference (IV, Random, 95% CI) | 0.15 [0.04, 0.26] |
| 2.7.1 One to twelve months of group cognitive stimulation | 8 | 687 | Std. Mean Difference (IV, Random, 95% CI) | 0.20 [0.05, 0.35] |
| 2.7.2 One to twelve months of individual cognitive stimulation | 5 | 631 | Std. Mean Difference (IV, Random, 95% CI) | 0.10 [‐0.06, 0.25] |
| 2.8 Behaviour that challenges Show forest plot | 12 | 1340 | Std. Mean Difference (IV, Random, 95% CI) | 0.18 [‐0.01, 0.38] |
| 2.8.1 One to twelve months of group cognitive stimulation | 8 | 754 | Std. Mean Difference (IV, Random, 95% CI) | 0.33 [0.11, 0.54] |
| 2.8.2 One to twelve months of individual cognitive stimulation | 4 | 586 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.04 [‐0.28, 0.19] |
| 2.9 Caregiver outcome ‐ depressed mood Show forest plot | 8 | 664 | Std. Mean Difference (IV, Random, 95% CI) | 0.05 [‐0.10, 0.21] |
| 2.9.1 One to twelve months of group cognitive stimulation | 3 | 37 | Std. Mean Difference (IV, Random, 95% CI) | 0.68 [0.00, 1.36] |
| 2.9.2 One to twelve months of individual cognitive stimulation | 5 | 627 | Std. Mean Difference (IV, Random, 95% CI) | 0.02 [‐0.14, 0.18] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Cognition Show forest plot | 27 | 1637 | Std. Mean Difference (IV, Random, 95% CI) | 0.43 [0.26, 0.59] |
| 3.1.1 20 or more group sessions of CS during one to twelve months | 12 | 615 | Std. Mean Difference (IV, Random, 95% CI) | 0.42 [0.16, 0.67] |
| 3.1.2 Less than 20 group sessions of CS during one to twelve months | 15 | 1022 | Std. Mean Difference (IV, Random, 95% CI) | 0.43 [0.22, 0.65] |
| 3.2 ADAS‐Cog Show forest plot | 17 | 1168 | Mean Difference (IV, Random, 95% CI) | 2.66 [1.12, 4.20] |
| 3.2.1 20 or more group sessions of CS during one to twelve months | 7 | 418 | Mean Difference (IV, Random, 95% CI) | 4.18 [‐0.28, 8.64] |
| 3.2.2 Less than 20 group sessions of CS during one to twelve months | 10 | 750 | Mean Difference (IV, Random, 95% CI) | 2.52 [1.22, 3.83] |
| 3.3 MMSE Show forest plot | 21 | 1325 | Mean Difference (IV, Random, 95% CI) | 2.16 [1.58, 2.74] |
| 3.3.1 20 or more group sessions of CS during one to twelve months | 11 | 554 | Mean Difference (IV, Random, 95% CI) | 2.51 [1.20, 3.83] |
| 3.3.2 Less than 20 group sessions of CS during one to twelve months | 10 | 771 | Mean Difference (IV, Random, 95% CI) | 2.11 [1.51, 2.72] |
| 3.4 Quality of Life: self‐report Show forest plot | 13 | 1058 | Mean Difference (IV, Random, 95% CI) | 1.97 [0.47, 3.47] |
| 3.4.1 20 or more group sessions of CS during one to twelve months | 4 | 281 | Mean Difference (IV, Random, 95% CI) | 1.33 [‐1.14, 3.79] |
| 3.4.2 Less than 20 group sessions of CS during one to twelve months | 9 | 777 | Mean Difference (IV, Random, 95% CI) | 2.24 [0.13, 4.36] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Cognition (3 levels) Show forest plot | 27 | 1637 | Std. Mean Difference (IV, Random, 95% CI) | 0.43 [0.26, 0.59] |
| 4.1.1 Three or more group sessions of CS per week during one to twelve months | 8 | 328 | Std. Mean Difference (IV, Random, 95% CI) | 0.46 [0.22, 0.69] |
| 4.1.2 Two group sessions of CS per week during one to twelve months | 13 | 955 | Std. Mean Difference (IV, Random, 95% CI) | 0.52 [0.28, 0.76] |
| 4.1.3 One group session of CS per week during one to twelve months | 6 | 354 | Std. Mean Difference (IV, Random, 95% CI) | 0.04 [‐0.17, 0.25] |
| 4.2 Cognition (2 levels) Show forest plot | 27 | 1637 | Std. Mean Difference (IV, Random, 95% CI) | 0.43 [0.26, 0.59] |
| 4.2.1 Two or more group sessions of CS per week during one to twelve months | 21 | 1283 | Std. Mean Difference (IV, Random, 95% CI) | 0.51 [0.34, 0.69] |
| 4.2.2 One group session of CS per week during one to twelve months | 6 | 354 | Std. Mean Difference (IV, Random, 95% CI) | 0.04 [‐0.17, 0.25] |
| 4.3 ADAS‐Cog (3 levels) Show forest plot | 17 | 1168 | Mean Difference (IV, Random, 95% CI) | 2.66 [1.12, 4.20] |
| 4.3.1 Three or more group sessions of CS per week during one to twelve months | 3 | 131 | Mean Difference (IV, Random, 95% CI) | 6.68 [‐0.57, 13.92] |
| 4.3.2 Two group sessions of CS per week during one to twelve months | 9 | 713 | Mean Difference (IV, Random, 95% CI) | 3.10 [1.24, 4.96] |
| 4.3.3 One group session of CS per week during one to twelve months | 5 | 324 | Mean Difference (IV, Random, 95% CI) | 0.09 [‐2.28, 2.46] |
| 4.4 ADAS‐Cog (2 levels) Show forest plot | 17 | 1168 | Mean Difference (IV, Random, 95% CI) | 2.66 [1.12, 4.20] |
| 4.4.1 Two or more group sessions of CS per week during one to twelve months | 12 | 844 | Mean Difference (IV, Random, 95% CI) | 3.41 [1.58, 5.24] |
| 4.4.2 One group session of CS per week during one to twelve months | 5 | 324 | Mean Difference (IV, Random, 95% CI) | 0.09 [‐2.28, 2.46] |
| 4.5 MMSE (3 levels) Show forest plot | 21 | 1325 | Mean Difference (IV, Random, 95% CI) | 2.16 [1.58, 2.74] |
| 4.5.1 Three or more group sessions of CS per week during one to twelve months | 7 | 267 | Mean Difference (IV, Random, 95% CI) | 2.66 [1.09, 4.23] |
| 4.5.2 Two group sessions of CS per week during one to twelve months | 10 | 784 | Mean Difference (IV, Random, 95% CI) | 2.40 [1.66, 3.13] |
| 4.5.3 One group session of CS per week during one to twelve months | 4 | 274 | Mean Difference (IV, Random, 95% CI) | 0.92 [‐0.07, 1.90] |
| 4.6 MMSE (2 levels) Show forest plot | 21 | 1325 | Mean Difference (IV, Random, 95% CI) | 2.16 [1.58, 2.74] |
| 4.6.1 Two or more group sessions of CS per week during one to twelve months | 17 | 1051 | Mean Difference (IV, Random, 95% CI) | 2.42 [1.80, 3.03] |
| 4.6.2 One group session of CS per week during one to twelve months | 4 | 274 | Mean Difference (IV, Random, 95% CI) | 0.92 [‐0.07, 1.90] |
| 4.7 Quality of Life: self‐report Show forest plot | 13 | 1058 | Mean Difference (IV, Random, 95% CI) | 1.97 [0.47, 3.47] |
| 4.7.1 Two or more group sessions of CS per week during one to twelve months | 9 | 747 | Mean Difference (IV, Random, 95% CI) | 2.40 [0.48, 4.33] |
| 4.7.2 One group session per week of CS during one to twelve months | 4 | 311 | Mean Difference (IV, Random, 95% CI) | 1.47 [‐0.06, 3.01] |
| 4.8 Mood: interviewer/staff‐rated Show forest plot | 10 | 959 | Std. Mean Difference (IV, Random, 95% CI) | 0.40 [0.14, 0.67] |
| 4.8.1 Two or more group sessions of CS per week during one to twelve months | 7 | 695 | Std. Mean Difference (IV, Random, 95% CI) | 0.41 [0.07, 0.75] |
| 4.8.2 One group session per week of CS during one to twelve months | 3 | 264 | Std. Mean Difference (IV, Random, 95% CI) | 0.42 [‐0.10, 0.94] |
| 4.9 Anxiety ‐ interviewer/staff‐rated Show forest plot | 6 | 410 | Std. Mean Difference (IV, Random, 95% CI) | 0.11 [‐0.09, 0.30] |
| 4.9.1 Two or more group sessions of CS per week during one to twelve months | 5 | 211 | Std. Mean Difference (IV, Random, 95% CI) | 0.23 [‐0.04, 0.51] |
| 4.9.2 One group session per week of CS during one to twelve months | 1 | 199 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.02 [‐0.30, 0.26] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 5.1 Cognition Show forest plot | 23 | 1056 | Std. Mean Difference (IV, Random, 95% CI) | 0.63 [0.33, 0.93] |
| 5.1.1 Community | 15 | 642 | Std. Mean Difference (IV, Random, 95% CI) | 0.66 [0.33, 0.99] |
| 5.1.2 Care home | 9 | 414 | Std. Mean Difference (IV, Random, 95% CI) | 0.60 [‐0.01, 1.20] |
| 5.2 ADAS‐Cog Show forest plot | 13 | 587 | Mean Difference (IV, Random, 95% CI) | 3.16 [1.85, 4.47] |
| 5.2.1 Community | 9 | 328 | Mean Difference (IV, Random, 95% CI) | 4.49 [2.18, 6.80] |
| 5.2.2 Care home | 5 | 259 | Mean Difference (IV, Random, 95% CI) | 1.15 [‐1.71, 4.01] |
| 5.3 MMSE Show forest plot | 17 | 708 | Mean Difference (IV, Random, 95% CI) | 2.57 [1.87, 3.27] |
| 5.3.1 Community | 11 | 489 | Mean Difference (IV, Random, 95% CI) | 2.72 [1.85, 3.59] |
| 5.3.2 Care home | 6 | 219 | Mean Difference (IV, Random, 95% CI) | 2.16 [0.83, 3.48] |
| 5.4 Quality of Life: self‐report Show forest plot | 9 | 373 | Mean Difference (IV, Random, 95% CI) | 2.98 [0.06, 5.90] |
| 5.4.1 Community | 6 | 239 | Mean Difference (IV, Random, 95% CI) | 4.33 [‐0.75, 9.42] |
| 5.4.2 Care home | 3 | 134 | Mean Difference (IV, Random, 95% CI) | 1.17 [‐1.44, 3.78] |
| 5.5 Quality of Life: proxy‐rated Show forest plot | 5 | 207 | Std. Mean Difference (IV, Random, 95% CI) | 0.50 [0.05, 0.94] |
| 5.5.1 Community | 3 | 114 | Std. Mean Difference (IV, Random, 95% CI) | 0.74 [‐0.02, 1.49] |
| 5.5.2 Care home | 2 | 93 | Std. Mean Difference (IV, Random, 95% CI) | 0.21 [‐0.21, 0.62] |
| 5.6 Mood: self‐reported Show forest plot | 6 | 299 | Std. Mean Difference (IV, Random, 95% CI) | 0.20 [‐0.06, 0.45] |
| 5.6.1 One to twelve months of group cognitive stimulation: community | 3 | 163 | Std. Mean Difference (IV, Random, 95% CI) | 0.24 [‐0.07, 0.56] |
| 5.6.2 One to twelve months of group cognitive stimulation: care home | 3 | 136 | Std. Mean Difference (IV, Random, 95% CI) | 0.16 [‐0.48, 0.79] |
| 5.7 Mood: Interviewer/staff‐rated Show forest plot | 5 | 237 | Std. Mean Difference (IV, Random, 95% CI) | 0.50 [0.21, 0.79] |
| 5.7.1 One to twelve months of group cognitive stimulation: community | 3 | 79 | Std. Mean Difference (IV, Random, 95% CI) | 0.82 [0.36, 1.29] |
| 5.7.2 One to twelve months of group cognitive stimulation: care home | 2 | 158 | Std. Mean Difference (IV, Random, 95% CI) | 0.34 [0.02, 0.65] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 6.1 Cognition Show forest plot | 27 | 1637 | Std. Mean Difference (IV, Random, 95% CI) | 0.43 [0.26, 0.59] |
| 6.1.1 Alternate activity control group | 5 | 322 | Std. Mean Difference (IV, Random, 95% CI) | 0.59 [0.37, 0.82] |
| 6.1.2 Treatment‐as‐usual control group | 22 | 1315 | Std. Mean Difference (IV, Random, 95% CI) | 0.41 [0.22, 0.60] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 7.1 Cognition Show forest plot | 23 | 1418 | Std. Mean Difference (IV, Random, 95% CI) | 0.43 [0.24, 0.62] |
| 7.1.1 Mild impairment | 10 | 640 | Std. Mean Difference (IV, Random, 95% CI) | 0.71 [0.47, 0.95] |
| 7.1.2 Moderate impairment | 13 | 778 | Std. Mean Difference (IV, Random, 95% CI) | 0.21 [0.03, 0.39] |
| 7.2 MMSE Show forest plot | 21 | 1325 | Mean Difference (IV, Random, 95% CI) | 2.16 [1.58, 2.74] |
| 7.2.1 Mild impairment | 10 | 676 | Mean Difference (IV, Random, 95% CI) | 2.59 [1.87, 3.31] |
| 7.2.2 Moderate impairment | 11 | 649 | Mean Difference (IV, Random, 95% CI) | 1.42 [0.78, 2.07] |
| 7.3 ADAS‐Cog Show forest plot | 14 | 979 | Mean Difference (IV, Random, 95% CI) | 2.52 [0.59, 4.46] |
| 7.3.1 Mild impairment | 6 | 373 | Mean Difference (IV, Random, 95% CI) | 4.98 [1.95, 8.00] |
| 7.3.2 Moderate impairment | 8 | 606 | Mean Difference (IV, Random, 95% CI) | 1.10 [‐0.29, 2.48] |
| 7.4 Quality of life (self‐report) Show forest plot | 11 | 903 | Mean Difference (IV, Random, 95% CI) | 2.41 [0.66, 4.17] |
| 7.4.1 Mild impairment | 3 | 276 | Mean Difference (IV, Random, 95% CI) | 1.54 [0.07, 3.00] |
| 7.4.2 Moderate impairment | 8 | 627 | Mean Difference (IV, Random, 95% CI) | 3.07 [0.77, 5.36] |
| 7.5 Quality of life (proxy rated) Show forest plot | 5 | 359 | Std. Mean Difference (IV, Random, 95% CI) | 0.45 [‐0.01, 0.90] |
| 7.5.1 Moderate impairment | 5 | 359 | Std. Mean Difference (IV, Random, 95% CI) | 0.45 [‐0.01, 0.90] |
| 7.6 Mood: self‐reported Show forest plot | 6 | 299 | Std. Mean Difference (IV, Random, 95% CI) | 0.20 [‐0.06, 0.45] |
| 7.6.1 Mild impairment | 4 | 220 | Std. Mean Difference (IV, Random, 95% CI) | 0.30 [0.01, 0.60] |
| 7.6.2 Moderate impairment | 2 | 79 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.05 [‐0.53, 0.42] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 8.1 Cognition ‐ 6 to 12‐week follow‐up Show forest plot | 3 | 242 | Std. Mean Difference (IV, Random, 95% CI) | 0.34 [‐0.11, 0.80] |
| 8.1.1 Three months follow‐up MMSE | 1 | 23 | Std. Mean Difference (IV, Random, 95% CI) | 0.90 [0.03, 1.78] |
| 8.1.2 Six week follow‐up ADAS‐Cog | 1 | 68 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.07 [‐0.54, 0.41] |
| 8.1.3 Three‐months follow‐up ADAS‐Cog | 1 | 151 | Std. Mean Difference (IV, Random, 95% CI) | 0.44 [0.11, 0.77] |
| 8.2 Cognition ‐ 8 to 12‐month follow‐up Show forest plot | 4 | 194 | Std. Mean Difference (IV, Random, 95% CI) | 0.13 [‐0.16, 0.42] |
| 8.2.1 Ten ‐ twelve months follow‐up ADAS‐Cog | 3 | 156 | Std. Mean Difference (IV, Random, 95% CI) | 0.23 [‐0.09, 0.55] |
| 8.2.2 Eight months follow‐up CAM‐COG | 1 | 38 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.25 [‐0.90, 0.39] |
| 8.3 Cognition: MMSE ‐ Three‐month follow‐up Show forest plot | 2 | 210 | Mean Difference (IV, Random, 95% CI) | 3.16 [‐0.99, 7.31] |
| 8.4 Cognition: MMSE ‐ 8 to 12‐month follow‐up Show forest plot | 3 | 142 | Mean Difference (IV, Random, 95% CI) | 0.53 [‐0.63, 1.70] |
| 8.5 Quality of Life: self‐report & proxy measures Show forest plot | 3 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 8.5.1 Six to twelve week follow‐up QoL‐AD | 2 | 254 | Mean Difference (IV, Random, 95% CI) | 0.36 [‐2.47, 3.20] |
| 8.5.2 Six week follow‐up QoL‐AD proxy | 1 | 68 | Mean Difference (IV, Random, 95% CI) | ‐0.30 [‐3.15, 2.55] |
| 8.5.3 Ten months follow‐up QoL‐AD | 1 | 54 | Mean Difference (IV, Random, 95% CI) | 2.15 [‐1.12, 5.42] |
| 8.5.4 Ten months follow‐up QoL‐AD proxy | 1 | 54 | Mean Difference (IV, Random, 95% CI) | ‐0.28 [‐3.14, 2.58] |
| 8.6 Communication and social interaction Show forest plot | 2 | Std. Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 8.6.1 Twelve week follow‐up Narrative Language ‐ communicative abilities | 1 | 182 | Std. Mean Difference (IV, Random, 95% CI) | 0.33 [0.04, 0.63] |
| 8.6.2 Ten month follow‐up 'Relevance of discourse' | 1 | 54 | Std. Mean Difference (IV, Random, 95% CI) | 0.15 [‐0.38, 0.69] |
| 8.7 Mood Show forest plot | 2 | Std. Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 8.7.1 Twelve week follow‐up: interviewer / staff‐rated | 1 | 187 | Std. Mean Difference (IV, Random, 95% CI) | 0.54 [0.24, 0.83] |
| 8.7.2 Twelve month follow‐up: self‐report | 1 | 50 | Std. Mean Difference (IV, Random, 95% CI) | 0.36 [‐0.23, 0.94] |
| 8.8 ADL/IADL scales Show forest plot | 5 | Std. Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 8.8.1 Six to twelve weeks follow‐up IADL scales | 2 | 176 | Std. Mean Difference (IV, Random, 95% CI) | 0.12 [‐0.19, 0.42] |
| 8.8.2 Ten to twelve months follow‐up ADL / IADL scales | 3 | 156 | Std. Mean Difference (IV, Random, 95% CI) | 0.40 [0.07, 0.72] |
| 8.9 Behaviour that challenges Show forest plot | 4 | Std. Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 8.9.1 Six to twelve weeks follow‐up NPI | 2 | 255 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.19 [‐0.06, 0.44] |
| 8.9.2 Ten to twelve months follow‐up NPI severity | 2 | 104 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.43 [0.03, 0.83] |
| 8.9.3 Ten‐month follow up NPI (Caregiver Distress) | 1 | 54 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.41 [‐0.13, 0.95] |
