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3.3 Cognitive therapies and rehabilitation

Cognitive stimulation, cognitive training and cognitive rehabilitation.

There are three main non-drug treatments used to improve or maintain memory and thinking: cognitive stimulation, cognitive training, and cognitive rehabilitation. The word ‘cognitive’ relates to thinking processes in the brain.  

The Canadian consensus conference on dementia and its treatment provided recommendations on the use of non-drug approaches for person with dementia and their care partners. You can read this here, on page 8, Table 7.

Cognitive stimulation therapy

Cognitive stimulation therapy is a program of activities which encourage people with dementia to use different parts of their brain. 

These activities may include conversations or mental or physical games. They are usually run by a health provider in small groups over six to eight weeks. Many research studies have shown cognitive stimulation therapy improves memory and thinking, and people who partake in the activities usually enjoy them.Each session has it’s own discussion topic such as current affairs, food, or movies, along with puzzles, games, and activities related to the topic. These sessions are suitable for people living with mild to moderate dementia.  

Despite the research evidence and clinical recommendations behind cognitive stimulation therapy, programs are rarely offered in Canada. You may be lucky and find a group in your area. You can ask your family doctor, nurse practitioner, or specialist whether cognitive stimulation therapy is offered near you.  

Research suggests that regularly doing a variety of mentally challenging activities in a group can improve memory and thinking for people with dementia. 

Cognitive training or brain training

‘Brain training’ involves mental exercises to improve different aspects of memory and thinking. Mental exercises are usually presented on a computer, sometimes in the form of a game. It is not clear whether brain training helps people with dementia. Some studies found that it improves memory and thinking, while others have not. Doing brain training frequently each week may have a greater effect. In addition, people may only improve on the tasks they train on (e.g., if you practice remembering shopping lists, this will improve, but your word finding may not). 

Some people with dementia who practice brain training feel it helps them. However, there is no evidence that these programs improve memory and thinking for people with dementia and we do not specifically endorse them. You can try some for free, but ongoing access requires a monthly payment or the purchase of a lifetime package. 

There are options for do-it-yourself brain training! Activities that might boost brain function include:   

Jigsaw puzzles – Can help to organise visual information, interpret patterns, and understand how objects fit together.  

Music – Listening to music, singing in a choir, or learning to play a musical instrument have all been shown to help brain function and creative thinking or problem solving. You don’t have to become an expert and there are many groups that don’t require any previous musical training.  

Learning to dance (or juggle) – Learning a physical skill such as dancing or juggling challenges the brain and can help with memory and pattern recall. These activities are good for balance and can promote physical exercise and socialisation as well.  

Card games – Studies have found that playing card games has the potential to increase your brain power and can help boost memory and thinking. Solitaire is a great solo option. Start with familiar card games and progress from there.  

Socialize – Keeping socially active is important for mental wellbeing, and it can help with attention and memory. Talking with other people helps to interpret situations from different perspectives.  

Most of these activities, like joining a choir or playing cards, will give you lots of benefits and you will have fun too!  

Cognitive rehabilitation

Cognitive rehabilitation focuses on the individual. Treatment may consist of developing new ways to do daily tasks. If the person’s goal is to cook a hot meal, an occupational therapist may help them improve their attention using computer games, simplify recipes to shorten cooking time, or use other memory aids like an alarm for an unattended stove. These are just a few of the tools used in cognitive rehabilitation.  

Cognitive rehabilitation has been used to treat people with speech and language difficulties, mild cognitive impairment, and mild forms of dementia. This treatment can take a lot of time so it is worth talking with an occupational therapist to see if the person you are caring for may benefit from cognitive rehabilitation. Your family doctor or nurse practitioner can refer you to an outpatient rehabilitation clinic or a private clinic for an initial assessment.