Group-based cognitive stimulation therapy (CST) for people with dementia

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Responds to queries received from Swedish healthcare and social service providers, or governmental organisations. Queries have a limited scope and the process is designed to enable a more rapid response, typically within two to three months. Reports are based on systematic reviews, that are identified through structured searches and critically appraised for risk of bias.

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Published: Report no: ut202607 Registration no: SBU 2026/34

Question

What effect does manualized cognitive stimulation therapy (CST) in a group setting have for people with dementia?

PICO

  • Population: People with all types of mild to moderate dementia
  • Intervention: Manualized cognitive stimulation therapy (CST) in a group setting
  • Comparison: Other treatment, or no treatment
  • Outcome: Cognitive function, social interaction, dementia symptoms, quality of life, mood, depression, effects on caregivers/relatives, memory function, time orientation, communication, and similar outcomes

Method

A systematic literature search was performed using the following databases: Medline, Scopus and INAHTA database for HTA reports.
Two authors independently assessed the abstracts of all identified studies.
Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.

Identified literature

One relevant systematic review with low to moderate risk of bias was identified [1]. The results and conclusions are presented in Table 1. In 11 relevant systematic reviews, the risk of bias was considered to be high, therefore the results and conclusions are not reported [2-12].

Table 1 Systematic reviews with low/moderate risk of bias.

CI = confidence interval; PwD = people with dementia; QoL = Quality of Life; RCT = randomised controlled trial; WMD = weigthed mean difference
Included studies Population, Intervention, Control Outcome and Results
Chen et al, 2022 [1]
Effectiveness of cognitive stimulation therapy (CST) on cognition, quality of life and neuropsychiatric symptoms for patients living with dementia: A meta-analysis
10 RCTs
 
Setting:
UK: 3 studies
Italy: 3 studies
Portugal: 1 study
Japan: 1 study
Ireland: 1 study
China: 1 study		 Population:
People with dementia 

Intervention:
Use of CST in group following Spector’s protocol.
Participants had to receive continuous,
planned, and regular CST led by a professional researcher or specialist. 

Control:
Usual care/usual activities sessions		 PRIMARY OUTCOMES:
Cognitive function using the
MMSE (Mini-Mental State Examination)
(based on 8 studies, n=1022)
Statistically significant positive effect
WMD: 1.98
(95% CI, 1.24­ to 2.72, P<0.01) 

Cognitive function using the
ADAS-Cog (Alzheimer’s
Disease Assessment Scale-Cognitive)
(7 studies, n=1048)
No statistically significant effect
WMD: 0.55
(95% CI, –3.04 to 4.14, P=0.76) 

Quality of life using the QOL-AD
(Quality of Life —Alzheimer's Disease)
(7 studies, n=968)
Statistically significant positive effect
WMD: 3.12
(95% CI, 2.52 to 3.72, P<0.01) 

Neuropsychiatric symptoms
using the NPI (Neuropsychiatric Inventory)
(2 studies, n=260)
No statistically significant effect
WMD: 0.23
(95% CI, –2.62 to 3.07, P=0.88) 

SECONDARY OUTCOMES:
Depression using the GDS
(Geriatric Depression Scale) and
 CSDD (Cornell Scale for Depression in Dementia)
(5 studies, n=670)
No statistically significant effect
WMD: –0.12
(95% CI, –0.29 to 0.04, P=0.15)

Anxiety using the RAID
(Rating Anxiety in Dementia)
(2 studies, n=228)
No statistically significant effect
WMD: –1.05
(95% CI, –3.85 to 1.75, P=0.46)

Language ability using the NLT
(Narrative Language Test)
(2 studies, n=260)
Statistically significant positive effect
WMD: 2.71
(95% CI, 1.07 to 4.35, P<0.01) 

Activities of daily living using the DAD
(Disability Assessment for Dementia)
(3 studies, n=299)
Statistically significant positive effect
WMD: 7.27
(95% CI, 0.97 to 13.56, P<0.01)
Authors' conclusion:
”CST improved the cognitive ability, QoL, language and activities of daily living of PwD. However, the effect of neuropsychiatric symptoms on PwD requires further exploration […] Only 10 original studies were included in this meta-analysis, which is too few to draw definitive conclusions”

References

  1. Chen X. Effectiveness of cognitive stimulation therapy (CST) on cognition, quality of life and neuropsychiatric symptoms for patients living with dementia: A meta-analysis. Geriatr Nurs. 2022;47:201–10. Available from: https://doi.org/10.1016/j.gerinurse.2022.07.012
  2. Cafferata RMT, Hicks B, von Bastian CC. Effectiveness of cognitive stimulation for dementia: A systematic review and meta-analysis. Psychol Bull. 2021;147(5):455–76. Available from: https://doi.org/10.1037/bul0000325
  3. Cammisuli DM, Danti S, Bosinelli F, Cipriani G. Non-pharmacological interventions for people with Alzheimer's Disease: A critical review of the scientific literature from the last ten years. Eur Geriatr Med. 2016;7(1):57–64. Available from: https://doi.org/10.1016/j.eurger.2016.01.002
  4. Chen J, Duan Y, Li H, Lu L, Liu J, Tang C. Different durations of cognitive stimulation therapy for Alzheimer's disease: a systematic review and meta-analysis. Clin Interv Aging. 2019;14:1243–54. Available from: https://doi.org/10.2147/CIA.S210062
  5. Cooper C, Mukadam N, Katona C, Lyketsos CG, Ames D, Rabins P, et al. Systematic review of the effectiveness of non-pharmacological interventions to improve quality of life of people with dementia. Int Psychogeriatr. 2012;24(6):856–70. Available from: https://doi.org/10.1017/S1041610211002614
  6. Desai R, Leung WG, Fearn C, John A, Stott J, Spector A. Effectiveness of Cognitive Stimulation Therapy (CST) for mild to moderate dementia: A systematic literature review and meta-analysis of randomised control trials using the original CST protocol. Ageing Res Rev. 2024;97:102312. Available from: https://doi.org/10.1016/j.arr.2024.102312
  7. Jimenez-Palomares M, Montero-Barrero O, Garrido-Ardila EM, Gibello-Rufo A, Gonzalez-Sanchez B, Rodriguez-Mansilla J. Cognitive Stimulation in Older Adults with Dementia: A Systematic Review. J Clin Med. 2025;14(20). Available from: https://doi.org/10.3390/jcm14207225
  8. Lu YT, Zhang X, Cheng J. Meta-analysis of the effect of cognitive stimulation therapy on cognitive function in patients with Alzheimer's disease. World J Psychiatry. 2025;15(4):102542. Available from: https://doi.org/10.5498/wjp.v15.i4.102542
  9. Luo G, Zhang J, Song Z, Wang Y, Wang X, Qu H, et al. Effectiveness of non-pharmacological therapies on cognitive function in patients with dementia-A network meta-analysis of randomized controlled trials. Front Aging Neurosci. 2023;15:1131744. Available from: https://doi.org/10.3389/fnagi.2023.1131744
  10. Luxton D, Thorpe N, Crane E, Warne M, Cornwall O, El-Dalil D, et al. Systematic review of the efficacy of pharmacological and non-pharmacological interventions for improving quality of life of people with dementia. Br J Psychiatry. 2026;228(1):55–67. Available from: https://doi.org/10.1192/bjp.2025.11
  11. Saragih ID, Tonapa SI, Saragih IS, Lee BO. Effects of cognitive stimulation therapy for people with dementia: A systematic review and meta-analysis of randomized controlled studies. Int J Nurs Stud. 2022;128:104181. Available from: https://doi.org/10.1016/j.ijnurstu.2022.104181
  12. Sun Y, Zhang X, Wang Z. Comparative Effectiveness of 3 Settings of Cognitive Stimulation Therapy on Cognition and Quality of Life for People With Dementia: A Systematic Review and Network Meta-analysis. J Am Med Dir Assoc. 2022;23(3):461–7 e11. Available from: https://doi.org/10.1016/j.jamda.2021.11.015

Search strategies

Medline via OvidSP 13 Feb 2026

Title: CST and dementia
/ = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. exp Dementia/ or Delirium/ or Cognitive Dysfunction/ or Wernicke Encephalopathy/ or Amnesia/ or Cognition Disorders/ or Alzheimer Disease/ or Huntington Disease/ 343 136
2. (dement* or alzheimer* or amentia* or pseudodement* or mild cognitive impairment or (lewy* adj2 bod*) or mild neurocognitive disorder* or cognitive dysfunction* or memory impairment* or deliri* or (chronic adj2 cerebrovascular) or huntington* or binswanger* or korsako*).ti,ab,kf,bt. 425 752
3. 1 or 2  
Intervention:
4. (CST or cognitiv* therap* or cognitiv* stimul* or memory group* or memory support or (memory adj3 therap*) or (memory adj3 stimulat*) or cognitive psycho-stimulation or cognitive psychostimulation).ti,ab,kf,bt. 16 517
Study types:
5. (Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or (((systematic or realist or integrative or mixed method* or umbrella) adj4 (review)) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/) 597 995
Final result
6. 3 AND 4 AND 5 222

Scopus via scopus.com 13 Feb 2026

Title: CST and dementia
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); ALL = All fields; W/n = Within. Proximity operator retrieving terms within n words from each other; PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. TITLE-ABS-KEY ((dement* OR alzheimer* OR amentia* OR pseudodement* OR "mild cognitive impairment" OR (lewy* W/1 bod*) OR "mild neurocognitive disorder*" OR "cognitive dysfunction*" OR "memory impairment*" OR deliri* OR (chronic W/1 cerebrovascular) OR huntington* OR binswanger* OR korsako*)) 655 051
Intervention:
2. TITLE-ABS-KEY ("cst" OR "cognitive stimulation therapy" OR (cognitiv* W/1 therap*) OR (cognitiv* W/1 stimul*) OR memory group* OR (memory W/2 support*) OR (memory W/2 therap*) OR (memory W/2 stimulat*) OR "cognitive psycho-stimulation" OR "cognitive psychostimulation") 199 004
Study types: systematic reviews and meta-analysis / randomized controlled trials
3. TITLE-ABS-KEY (((systematic OR realist OR integrative OR “mixed method*” or umbrella) W/3 review) OR "meta analy*" OR metaanaly*) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”)) 899 881
Final result
4. 1 AND 2 AND 2 1 187
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