Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. In a world searching for medications to reverse or halt the progression of dementia, psychosocial approaches can be overlooked but remain a key part of the support offered to help people live as well as they can with the condition. These approaches include cognitive rehabilitation, and in June 2023, we published a new Cochrane review of its effects. Here's lead author, Aleksandra Kudlicka from the University of Exeter in the UK, to explain the therapy and summarize the review findings.

Aleksandra: Cognitive rehabilitation aims to reduce the impact of cognitive impairments on everyday life. It's typically a highly personalized problem-solving programme designed to help a person with mild-to-moderate dementia engage in everyday activities and maintain as much independence and quality of life as possible. A key element is focusing on a specific area that the individual identified as personally relevant and important to them. Examples include knowing what is planned for the day or using a mobile phone to stay in touch with family members. The work could include using compensatory techniques to modify tasks or the environment by making activities more manageable. It might involve procedural learning to develop new habits and routines and might also use enhanced learning techniques to improve recall of crucial information.
Our review evaluates existing evidence on the effects of cognitive rehabilitation on the specific activities targeted in the intervention for individuals with mild-to-moderate dementia. We also looked at functional ability and wellbeing more generally across specific secondary outcomes for them and their care partners.
We identified six randomized trials that involved just over 1,700 people with mild or moderate dementia. The mean age ranged from 76 to 80 and the most common diagnosis was Alzheimer's disease.  Our analysis found consistent large positive effects of cognitive rehabilitation on people's ability to carry out the activities targeted in the intervention. These gains were evident at the end of treatment and in the medium-term follow-up assessment, both when rated by the person with dementia themself and by their care partners or other informants.
We also found positive effects on the overall level of self-efficacy for people with dementia and some improvements in quality of life in care partners, but these effects were smaller and there were only negligible effects for most of the secondary outcomes.
To conclude, we can say with a good degree of confidence that people with mild or moderate dementia can make reliable improvements in functioning in relation to their personal goals. Therefore, anyone exploring options for developing post-diagnostic support in dementia services may want to consider cognitive rehabilitation as an option. What we need next is more research and implementation work to strengthen the evidence base and to help us understand the mechanisms by which cognitive rehabilitation works and how to harvest its potential so that it can bring a wider change to a person's life.

Mike: Thank you for listening to this summary of the review, and we hope it's shed some light on this important topic. If you would like to learn more about the existing evidence and watch for an update if new research becomes available, the review is available online. Just go to Cochrane Library dot com and search 'cognitive rehabilitation and dementia' to see a link to it.