Table 37: Overall Summary Statement of the Benefit and Risk for Patient-Directed Initiatives^*.

Intervention	Target Population	1° or 2° Prevention	Overall Quality (GRADE)	Benefits	Risks/Burden	Overall Strength of Recommendation (GRADE)
Physical exercise	Seniors with mild to moderate dementia	2°	Moderate	Improvement in functional, cognitive, and behavioural outcomes	Short-term follow-up and heterogeneity in studies Unclear if leads to delayed institutionalization	Moderate
Physical exercise	Seniors with good cognitive functioning (no dementia)	1°	High/Moderate	Reduced risk of subsequent cognitive decline	Unknown if leads to delayed diagnosis of dementia or institutionalization	High/Moderate
Short-term Cognitive decline
Short-term Incidence of dementia			High/Moderate	Decreased incidence of dementia	Unknown if leads to delayed institutionalization	High/Moderate
Long-term Incidence of dementia			Moderate	Decreased incidence of dementia	Unknown if leads to delayed institutionalization	Moderate
Nonpharmacologic and nonexercise interventions	Seniors with mild to moderate dementia	2°	Very low	None	Intervention not offer significant benefit (possible type 2 error) Unclear if leads to delayed institutionalization	Very low
Cognitive training
Cognitive stimulation therapy (CST)			Moderate/Low	Increased cognition and quality of life	Unclear how CST compares with past terminologies and methodologies Short-term results Role and extent of maintenance Unclear how CST may impact functional dependence Unclear if leads to delayed institutionalization	Low
Nonpharmacologic and nonexercise interventions	Seniors with good cognitive functioning (no dementia)	1°	Low	Cognitive improvements sustained after 5 years, but none of these improvements had effects beyond the specific cognitive domains of the intervention)	Results addressing functional outcomes unclear Need more than 5-year follow-up No evidence to determine if cognitive training leads to delayed diagnosis of dementia delayed institutionali zation.	Very low

^*1° indicates primary;2°, secondary; CST, cognitive stimulation therapy; IADL, instrumental activities of daily living; RCT, randomized controlled trial.