Most people diagnosed with mild cognitive impairment (MCI) are eager to embrace whatever medications, treatments and therapies might help them stave off further decline. MCI, as you may already know, is a state of cognitive impairment beyond the kinds of memory loss typically associated with aging but not so severe as to interfere significantly with the activities of daily life.
One approach, known as cognitive stimulation therapy (CST), is primarily used for people with mild to moderate dementia but has also shown efficacy in those with MCI. Its goals include the following:
This form of therapy was developed in the 1990s and early 2000s by psychologists in the UK who were looking for an alternative to medications for combatting cognitive decline. They developed a program in which people would meet for facilitated group sessions twice weekly for seven weeks.
These groups, usually consisting of 10 or fewer patients, strive to establish a close-knit, club-like vibe. Some give themselves quirky or special names such as the Manhattan Memory Mavens or The Cool Kids. At the front of the room sits a “reality orientation board” displaying the date, day, time, place, and the names of all the participants present that day. Often, meetings start with an opening song and a simple warmup activity such as recalling the day and time as a group.
Each session follows a theme such as Favorite Foods, In the News, Movies Old and New, Musical Tastes, or Childhood Then and Now. By getting people to talk about the way things were, the facilitator is hoping to help them establish a link between past and present. Beyond simple conversation, most groups incorporate gentle game play, low-impact physical activity, music, dance, and small group projects with the overarching goal of stimulating the five senses, exercising memory and cognition, and providing fun, joy, and social connection. Examples could include:
Most cognitive stimulation therapy groups still conduct twice-weekly, seven-week programs, sticking with the therapy’s original design, but experience and research have shown that many people benefit from continuing afterward with once-a-week maintenance sessions.
CST should not be confused with reality orientation therapy, despite borrowing from it and incorporating it into some of its elements. The idea behind reality orientation therapy is that cognition may be preserved by repeatedly exposing dementia patients to basic information about their surroundings, orienting them in terms of person, place, and time. While once a popular therapeutic modality unto itself, today reality orientation therapy survives primarily as a set of practices carefully incorporated into other forms of therapy (The “reality orientation board” mentioned above, displayed prominently during CST sessions, is one such example). Part of the reason reality orientation therapy has declined in popularity is the potential for caregivers to inadvertently upset dementia patients by insisting upon a version of reality that is distressing to them. Generally, however, mild dementia patients and people with MCI can often benefit by having their caregivers use phrases such as, “It’s a cold February 16th here in Downers Grove, Illinois,” or, each time upon entering a room, “Hi, Tom, it’s me, Sharon.”
CST has repeatedly proven to be an effective method of improving various aspects of cognition and quality of life. Although not all studies have found associations between CST and improvements in every possible measure of cognition, none show it to be useless, and certainly none show it to be harmful. One of the earliest studies of the effectiveness of CST was a 2003 paper published in the British Journal of Psychiatry. It divided 201 older participants into a seven-week CST group and a control group. The researchers found that those who underwent CST outperformed the control group in several commonly used measures of cognition including the Mini Mental State Examination, the Alzheimer’s Disease Assessment Scale for Cognition, and the Alzheimer’s Disease Quality of Life Scale. “The results compare favorably with trials of drugs for dementia,” the authors concluded.
In 2013, a study published in the journal International Psychogeriatrics found that, possibly because of its emphasis on social interaction, CST was particularly beneficial in areas of cognition most closely associated with language.
A 2024 systematic review and meta-analysis that examined data from 53 trials concluded that, while more study is needed to clarify the efficacy of specific protocols, “both individual and group cognitive stimulation [therapy] were reported as effective in supporting cognitive functions in people living with dementia at any degree of severity.”
If you’d like to find a cognitive stimulation therapy group in your area, ask at your local hospital or at your primary care provider’s office. You may also inquire at nursing homes and eldercare facilities. If none of that turns anything up, go online and search for a psychologist or other licensed professional who specializes in dementia and is specifically trained in cognitive stimulation therapy.
Because cognitive stimulation therapy is still relatively new, you may find that no one in your area is providing it. In that case, you might consider doing individual therapy at home. Research on iCST, as it is known, shows that its results are less impressive for the individual than for group CST, but that it can also be beneficial to caregivers of dementia patients. Before attempting iCST in your home, see if there’s a training program in your area so that you can become versed in its techniques. If not, try taking an online course (a simple Google search yields several options).
