Cognitive Stimulation Therapy

Cognitive stimulation therapy may work in large part because it helps increase a participant’s “cognitive reserve.” This term refers to the brain’s ability to use multiple neurological pathways to achieve functions like reasoning or recall of memories.

People who more frequently perform cognitively demanding activities may have more complex networks of connections between brain areas, as well as a greater total volume of brain matter. This can make it easier for their brains to “reroute” around damaged or atrophied regions, helping to improve their mental faculties despite the neurological effects of conditions like Alzheimer’s disease. The stimulating activities involved in CST may promote the formation of new neurological connections, increasing participants’ cognitive reserve and slowing their loss of function.

The fact that cognitive stimulation therapy (CST) commonly involves interacting with a group of peers may also be a helpful driver of results. Studies indicate that greater variety and depth of social relationships are associated with reduced dementia risk, suggesting that making interpersonal connections might also be a significant part of maintaining cognitive health.

In addition to its cognitive benefits, the social activity provided by cognitive stimulation therapy (CST) could be beneficial for helping individuals with mild to moderate dementia preserve their quality of life. Participants and caregivers often report that their group therapy sessions help decrease feelings of loneliness by providing a venue for socializing. This may help reduce the distress,¹ confusion, depression, and anger that commonly go hand-in-hand with dementia.

In most cases, CST is conducted in small groups of individuals with mild to moderate dementia, with a single facilitator leading 10 or fewer participants through a series of activities intended to be enjoyable and mentally engaging. Sessions take place twice a week, and the standard course of therapy involves 14 sessions. Some treatment facilities or providers may also offer Maintenance Cognitive Stimulation Therapy, which extends the treatment to 16 weeks or 32 sessions. 

CST sessions are conducted by a trained facilitator such as a nurse, social worker, occupational therapist, or any other professional with experience caring for people with dementia. Each session begins with a short warm-up activity, such as a ball-passing game or a song, to energize participants and help them transition into the process. The facilitator may refer to a “Reality Orientation Board,” a display showing details such as the date, time, season, weather, and location, and encourage participants to discuss current events and provide details about their lives.

Following the introduction and warm-up, the facilitator may coach participants through various cognitively stimulating activities. An individual session may often focus on a specific theme, such as geography or teamwork. The particular program may be tailored to the group participants, but common activities include:

• Group singing, dancing, or music-making
• Physical games
• Recollections of personal memories
• Creative activities such as painting or building with blocks
• Matching games involving shapes or sounds
• Food preparation and communal eating
• Knowledge-testing activities such as trivia
• Categorizing activities, such as brainstorming lists of objects
• Facial recognition games
• Number games
• Simulated transactions or money-changing

Facilitators typically strive to encourage bonding, fun, and relaxation. Participants are often invited to create a group name to build camaraderie and investment. A sense of continuity may be maintained by using the same warm-up and closing activities in each session and instituting a “theme song” for the group.

The evidence for the benefits of CST may be most beneficial for individuals with mild to moderate dementia. This may be due to the difficulty of communicating with and directing adults with severe dementia, making it difficult for them to participate in group activities effectively. 

The benefits that appear to be best supported by the research are improvements in cognitive functions like focused thought and memory for those living with mild to moderate dementia. There are likely also positive effects on mood, well-being, daily functioning, and overall quality of life, but the evidence for these is currently weaker.

Certain demographic factors may also play a role in the effectiveness of cognitive stimulation therapy. Some studies have found that the benefits may be more effective for older participants and that women may benefit more than men. Quality-of-life effects may be more profound for patients in care homes, while those living in the community may show more significant reductions in behavioral challenges.

More research may be needed to determine how effective CST can be for different forms of dementia. It’s been most widely studied in the most common types of dementia: Alzheimer’s disease and vascular dementia. Less evidence exists for the potential benefits of CST in rarer conditions such as Lewy body dementia or frontotemporal dementia.

Early scientific investigations into CST focused on confirming its effectiveness and determining how to deliver it most efficiently. With evidence mounting that this treatment provides some tangible benefits to cognitive function, more attention is being paid to how it achieves these effects. 

For example, a 2021 paper published in Brain Science showed evidence that CST helps preserve brain structure and total brain matter volume. These differences were observed within the collection of interconnected brain regions known as the default mode network, which is thought to be involved in functions such as episodic memory, abstract thought, and maintaining a sense of individual identity. The findings suggest that one effect of CST may be reinforcing participants’ awareness of their identities and personal histories.

Other researchers are developing novel ways to deliver the benefits of cognitive stimulation therapy. One area of interest is individual CST or iCST, which provides therapy in a one-on-one format rather than in groups. This may make it possible to continue treatment for extended periods, primarily when delivered by family caregivers with an ongoing relationship with the recipients. A 2023 study reported significant improvements in cognitive skills and symptoms of depression from a 47-week course of individualized CST. 

Some studies have also indicated that iCST may help enhance the relationship between people living with dementia and the people caring for them. A 2022 paper in the International Journal of Geriatric Psychiatry noted that family caregivers reported fewer depressive symptoms and better quality of life when regularly providing this treatment. Because CST focuses on providing an enjoyable, relaxing, cooperative experience, it may help to foster a sense that patients and their care providers are working together. 

Locating a nearby provider or care center offering cognitive stimulation therapy may require a referral from a healthcare professional. Talking to a primary care physician or a senior care specialist may be a helpful first step, as they may be aware of local care options. Searching for memory clinics or memory care facilities can also be a helpful approach, as these institutions may offer group CST sessions.

Some nonprofit organizations like the Alzheimer’s Association or USAging also provide referral services or resource locators. These can be useful ways to find specialized care related to aging, cognitive health, and dementia. Interested individuals may be able to locate CST providers through these portals.

It’s also increasingly common to find individual and group therapy, potentially including cognitive stimulation therapy, through online providers such as BetterHelp. Online therapy has a strong track record, with numerous controlled trials demonstrating that it can work just as well as in-person psychiatric care. Though few studies have been published on internet-enabled CST, interest in this approach is growing among researchers and clinicians. Many believe it could be an effective, convenient, and cost-effective way to bring the benefits of cognitive stimulation therapy to those who would otherwise have difficulty obtaining treatment.