Summary of findings 1. Cognitive stimulation compared to no cognitive stimulation (post‐treatment) in people with dementia.
| Cognitive stimulation compared to no cognitive stimulation (post‐treatment) in people with dementia | ||||||
| Patient or population: people with dementia Setting: care homes and long‐term care facilities; community settings including daycare and outpatients Intervention: cognitive stimulation Comparison: no cognitive stimulation (post‐treatment) | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with no cognitive stimulation (post‐treatment) | Risk with cognitive stimulation | |||||
| Cognition Assessed with various brief cognitive tests including: ADAS‐Cog, MMSE, Global Cognitive Score, Mattis Dementia Rating Scale, MoCA, ACE‐III, CAM‐COG DS, ENB2 | SMD 0.4 SD higher (0.25 higher to 0.55 higher) | ‐ | 2340 (34 RCTs) | ⊕⊕⊕⊝ Moderate a | Cognitive stimulation probably results in a small increase in cognition. | |
| Quality of Life: self‐report Assessed with: QoL‐AD (17 studies) and EQ‐5D (1 study) | SMD 0.25 SD higher (0.07 higher to 0.42 higher) | ‐ | 1584 (18 RCTs) | ⊕⊕⊕⊝ Moderate a | Cognitive stimulation probably results in a slight increase in self‐reported quality of life. | |
| Communication and social interaction Assessed with: Holden Communication Scale; NOSGER Social Behaviour subscale; Narrative language ‐ communicative abilities | SMD 0.53 SD higher (0.36 higher to 0.7 higher) | ‐ | 702 (7 RCTs) | ⊕⊕⊕⊕ High | Cognitive stimulation results in an increase in communication and social interaction. | |
| Mood: self‐reported Assessed with: Geriatric Depression Scale (14; 15 and 30‐item versions); HADS Depression Scale; CESD‐R; Cornell Scale for Depression in Dementia (self‐report) | SMD 0.11 SD higher (0.08 lower to 0.31 higher) | ‐ | 787 (10 RCTs) | ⊕⊕⊕⊕ High | 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 (0.09 higher to 0.61 higher) | ‐ | 1011 (11 RCTs) | ⊕⊕⊝⊝ Low bc | Cognitive stimulation may result in a slight improvement in mood rated by an interviewer or by staff. | |
| Instrumental ADL Assessed with: Lawton Brody IADL scale; Disability Assessment for Dementia; NOSGER IADL subscale; Bristol Activities of Daily Living Scale; ADCS‐ADL scale; Rapid Disability Rating Scale | SMD 0.15 SD higher (0.04 higher to 0.26 higher) | ‐ | 1318 (13 RCTs) | ⊕⊕⊕⊕ High | Cognitive stimulation results in a slight increase in Instrumental ADL. | |
| Behaviour that challenges Assessed with: NPI; NPI‐Agitation subscale; NOSGER‐Challenging Behaviour subscale; BEHAVE‐AD; Dementia Behaviour Disturbance Scale | SMD 0.18 SD higher (0.01 lower to 0.38 higher) | ‐ | 1340 (12 RCTs) | ⊕⊕⊕⊝ Moderate b | 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). ADL: activities of daily living; CI: confidence interval; OR: odds ratio; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
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.