Kognitiv stimuleringsterapi (CST) i grupp för personer med demenssjukdom

Sammanställning av systematiska översikter från SBU:s upplysningstjänst

Publikationstyp: SBU:s upplysningstjänst Rapport ut202607Publicerad: 24 maj 2026

Fråga

Vilken effekt har manualbaserad kognitiv stimuleringsterapi (CST) i grupp för personer med demenssjukdom?

Frågeställare: Demenscentrum

Denna publikation innehåller:

En sammanställning av systematiska översikter som svarar på en specifik fråga från beslutsfattare inom hälso- och sjukvård eller socialtjänst

SBU använder en noggrann process för att säkerställa att vårt resultat är vetenskapligt väl underbyggt. För den här rapporten har vi gjort följande:

Tagit fram ett underlag i flera steg:

Gjort en strukturerad litteratursökning
Granskat om studierna vi hittat är relevanta
Granskat om det finns metodbrister i de systematiska översikterna som skulle kunna påverka resultaten och ge risk för snedvridning

I rapporten redovisar vi översiktsförfattarna slutsatser, men vi gör ingen egen sammanvägning av resultat.

Följande personer har granskat och bedömt rapporten:

Intern sakkunnig
Enhetschef

Sammanfattning

Kunskapsläget

Vi har identifierat en systematisk översikt som vi bedömer vara tillräckligt välgjord för att vi ska presentera resultaten.
Översiktsförfattarna undersökte effekten av manualbaserad CST (kognitiv stimuleringsterapi) i grupp på i första hand kognitiv funktion, livskvalitet och neuropsykiatriska symtom hos personer med demenssjukdom.
Översiktsförfattarna baserar sitt resultat på tio primärstudier, men studierna var generellt små och saknade långtidsuppföljning.
Översiktsförfattarna drar slutsatsen att manualbaserad CST tycks ha en positiv effekt jämfört med kontrollgrupp på bland annat kognitiv funktion, men att fler och större studier behövs för att säkrare kunna uttala sig om effekterna, framför allt på längre sikt.

Vad betyder det här?

Det finns en systematisk översikt som undersökt effekten av manualbaserad CST i grupp. Översiktsförfattarna drar slutsatsen att personer med demens som genomför den här formen av CST uppvisar förbättrad kognitiv funktion, högre livskvalitet samt ökad förmåga att utföra aktiviteter i dagliga livet (ADL-förmåga), jämfört med en kontrollgrupp som ägnar dig åt andra aktiviteter. Däremot ser man ingen effekt på flera neuropsykiatriska symtom associerade med demens.

Bakgrund

Det finns många olika typer av demenssjukdomar, och cirka 130 000–150 000 personer i Sverige lever med någon typ av demenssjukdom. Gemensamt för alla demenssjukdomar är att nervceller i hjärnan dör, vilket leder till nedsatt kognitiv förmåga hos den sjuke. Det innebär bland annat sämre minne, svårare att planera, svårigheter att förstå sin omgivning och med tiden minskad förmåga att klara vardagliga saker. Risken att få demens ökar med åldern, och symtomen blir gradvis värre över tid [1]. Det finns inget botemedel mot demens. Behandlingen, som ibland kan bestå av läkemedel, går ut på att bromsa sjukdomsförloppet och stötta den sjuke och dess anhöriga i att bibehålla funktioner och hantera de symtom som uppstår.

Det finns flera olika interventioner för personer med demenssjukdom som syftar till att stärka den kognitiva funktionen. Kognitiv stimulans (CS) är ett samlingsnamn för aktiviteter och samtal, ofta i grupp, som ska förbättra den sjukes kognitiva och sociala förmåga. I slutet av 1990-talet utvecklades i Storbritannien ett manualbaserat grupprogram med sådana aktiviteter, kallat kognitiv stimuleringsterapi (CST). Programmet består av 14 träffar med olika innehåll, till exempel minnesträning, spel i grupp och samtal om aktuella händelser. I dag ingår CST i de nationella riktlinjerna för demensvård i Storbritannien. CST används också i många andra länder, både i sin ursprungsform och i anpassade varianter [2].

Frågeställning

Upplysningstjänsten har tillsammans med frågeställaren formulerat frågan enligt följande PICO¹:

Population: Personer med alla former av mild eller medelsvår demenssjukdom
Intervention: Manualbaserad CST i grupp
Control: Annan, eller ingen behandling
Outcome: Kognitiv funktion, socialt samspel, demenssymtom, livskvalitet, humör, depression, effekt på närstående/anhörig som vårdar, minnesfunktion, tidsuppfattning, kommunikation och liknande utfall

Vi inkluderar systematiska översikter publicerade i vetenskapliga tidskrifter samt systematiska översikter från myndigheter och HTA-organisationer, som har publicerats på engelska eller ett av de skandinaviska språken.

^1. PICO är en förkortning för patient/population/problem, intervention (insats, behandling)/, comparison/control (jämförelseintervention (insats, behandling)) och outcome (utfallsmått).

Resultat

Vi inkluderade en systematisk översikt med måttlig risk för bias [3]. Det innebär att vi anser att den är tillräckligt välgjord för att presentera resultaten. Vi identifierade också elva översikter som var relevanta för frågan men som vi bedömde ha hög risk för bias [4-14]. Eftersom hög risk för bias innebär en betydande risk för att resultaten är missvisande presenterar vi inga resultat eller slutsatser från de översikterna.

Sökning och urval av studier, samt bedömning av risk för bias beskrivs i metodavsnittet. Resultaten har inte analyserats utifrån svenska förhållanden.

Chen och medförfattare publicerade år 2022 en systematisk översikt om effekten av manualbaserad CST (kognitiv stimuleringsterapi) i grupp för personer med demenssjukdom [3]. Översikten undersökte primärt utfallen kognitiv funktion, livskvalitet och neuropsykiatriska symptom. De sekundära utfallen som undersöktes var depression, ångest, språkförmåga och förmågan att klara aktiviteter i dagliga livet (ADL). Översiktsförfattarna inkluderade tio randomiserade kontrollerade studier (RCT-studier) i översikten, med totalt 1 274 deltagare. Studierna hade mellan 35 och 358 deltagare var. I studierna jämfördes manualbaserad CST i grupp med de vanliga aktiviteter som personerna annars deltog i, till exempel på äldreboenden eller i dagverksamheter. Studierna bedömdes ha låg eller måttlig risk för bias. Översiktsförfattarna rapporterade inte när studierna har mätt effekterna, men nämnde att det saknas studier med längre uppföljningstid.

Resultaten av metaanalyserna visade att manualbaserad CST i grupp har en statistiskt signifikant effekt på kognitiv förmåga, livskvalitet, språkförmåga och ADL-förmåga hos personer med demenssjukdom. Översiktsförfattarna bedömde inte hur tillförlitliga resultaten är, men påpekar att vissa resultat bör tolkas med försiktighet eftersom de bygger på få studier med få deltagare. Alla utfall analyserades med metaanalyser (Tabell 1).

Inkluderade översikter beskrivs i Tabell 1 nedan.

Tabell 1. Systematiska översikter med måttlig risk för bias/Table 1 Systematic reviews with moderate risk of bias.
Included studies	Population, Intervention, Control	Outcome and Results
CI = confidence interval; PwD = people with dementia; QoL = Quality of Life; RCT = randomised controlled trial; WMD = weigthed mean difference
Chen et al, 2022 [3] 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) (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”

SBU:s kommentarer

Det finns flera systematiska översikter om interventioner som kallas kognitiv stimulans (CS) eller liknande. Dessa interventioner är dock inte alltid manualbaserade eller genomförs i grupp. De kan likna manualbaserad CST (kognitiv stimuleringsterapi), men skiljer sig åt i innehåll, längd, intensitet och utförande. I denna rapport har vi endast inkluderat översikter som specifikt undersökt manualbaserad CST i grupp.

Metod

Sökning

Upplysningstjänsten gör en systematisk sökning i minst två vetenskapliga databaser. Fullständig sökdokumentation finns i Bilaga 1.

Urval

Bedömning av vilka artiklar som är relevanta sker i två steg och utgår från frågeställningen.

Två utredare läser titel och sammanfattning av alla identifierade artiklar från sökningen, och gör en oberoende bedömning av artiklarnas relevans.
Artiklarna som valts ut i steg 1 läses i fulltext av två utredare, som gör en oberoende bedömning av artiklarnas relevans.

Skillnader i bedömningarna löses genom diskussion.

Flödesschema för urval av artiklar finns i Bilaga 2. Om artiklar har granskats i fulltext, finns de artiklar som inte bedömts vara relevanta listade i Bilaga 3.

Bedömning av risk för bias

Risk för bias i relevanta systematiska översikter bedöms av två utredare, oberoende av varandra. Skillnader i bedömningarna löses genom diskussion.

Vid bedömning används granskningsmallen SnabbSTAR2. SnabbSTAR2 har fem steg, där översikter som uppfyller de krav som ställs i steg 1–4 bedöms ha måttlig risk för bias, och om 1–5 är uppfyllda bedöms risken för bias vara låg.

En översikt som har brister i stegen 1–4 bedöms ha hög risk för bias och redovisas inte eftersom resultaten kan vara missvisande.

I de fall vi har identifierat relevanta artiklar och gjort en bedömning av risk för bias, redovisas detta i Bilaga 4. Granskningsmallen SnabbSTAR2 med manual finns tillgänglig på vår hemsida.

Vetenskapliga kunskapsluckor

Om sammanställd forskning av god kvalitet saknas registreras det som en vetenskaplig kunskapslucka i SBU:s databas över vetenskapliga kunskapsluckor. Kunskapsluckan kan bestå i att forskning helt saknas, att primärstudier finns men att det inte finns någon systematisk översikt, eller att de existerande systematiska översikterna inte bedöms leva upp till kraven för låg eller måttlig risk för bias.

Databasen över vetenskapliga kunskapsluckor kan nås via: https://www.sbu.se/sv/kunskapsluckor-sok/

Projektgrupp

Detta svar är sammanställt av Karin Olsson (utredare), Lisa Andersson (utredare), Laura Lintamo (utredare) Sara Fundell (projektadministratör), Emma Wojda (enhetschef) samt Göran Bertilsson (intern sakkunnig) vid SBU.

Referenser

Om demenssjukdomar. Stockholm: Socialstyrelsen. [accessed May 19]. Available from: https://kunskapsguiden.se/omraden-och-teman/aldre/demenssjukdomar/om-demenssjukdomar/
Woods B, Rai HK, Elliott E, Aguirre E, Orrell M, Spector A. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev. 2023;1(1):CD005562. Available from: https://doi.org/10.1002/14651858.CD005562.pub3
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
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
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
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
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
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
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
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
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
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
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
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

Bilaga 1 Dokumentation av sökstrategier

Upplysningstjänsten har gjort sökningar i databaserna Medline (Ovid), Scopus samt i INAHTA¹:s databas för HTA²-rapporter. Vi har även handsökt publikationer på webbsidor för regionala HTA-organisationer och myndigheter.

Sökningen har begränsats till systematiska översikter.

Nedan redovisas sökningen som gjorts i de vetenskapliga databaserna.

^1. International Network of Agencies for Health Technology Assessment (INAHTA)

^2. Utvärdering av hälso- och sjukvårdens (och i SBU:s fall socialtjänstens) metoder (engelska: Health Technology Assessment)

Medline via OvidSP 13 Feb 2026

Title: CST and dementia
Search terms		Items found
/ = 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
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
Search terms		Items found
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
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

Bilaga 2 Flödesschema för urval av artiklar

Av 1 409 referenser från databassökningen granskades 99 i fulltext. Tolv av dessa artiklar inkluderades 1 som hade låg till måttlig risk för bias och 11 hög.

Bilaga 3 Exkluderade artiklar

Artiklar som exkluderats efter fulltextläsning på grund av att de inte är relevanta för den här rapportens frågeställning.
Articles excluded after full text assessment of relevance.
Excluded articles	Reason for exclusion
Systematic reviews
Abraha I, Rimland JM, Trotta FM, Dell'Aquila G, Cruz-Jentoft A, Petrovic M, et al. Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series. BMJ Open. 2017;7(3):e012759. Available from: https://doi.org/10.1136/bmjopen-2016-012759	Wrong study design
Aguirre E, Woods RT, Spector A, Orrell M. Cognitive stimulation for dementia: a systematic review of the evidence of effectiveness from randomised controlled trials. Ageing Res Rev. 2013;12(1):253–62. Available from: https://doi.org/10.1016/j.arr.2012.07.001	Wrong intervention
Bahar-Fuchs A, Martyr A, Goh AM, Sabates J, Clare L. Cognitive training for people with mild to moderate dementia. Cochrane Database Syst Rev. 2019;3(3):CD013069. Available from: https://doi.org/10.1002/14651858.CD013069.pub2	Wrong intervention
Bates J, Boote J, Beverley C. Psychosocial interventions for people with a milder dementing illness: a systematic review. J Adv Nurs. 2004;45(6):644–58. Available from: https://doi.org/10.1046/j.1365-2648.2003.02959.x	Wrong intervention
Beyene DA, Berha AB. Management Practice and Clinical Outcomes of Dementia in Sub-Saharan Africa: A Systematic Review. Behav Neurol. 2023;2023:2307443. Available from: https://doi.org/10.1155/2023/2307443	No synthesis
Burley CV, Burns K, Lam BCP, Brodaty H. Nonpharmacological approaches reduce symptoms of depression in dementia: A systematic review and meta-analysis. Ageing Res Rev. 2022;79:101669. Available from: https://doi.org/10.1016/j.arr.2022.101669	Wrong intervention
Butler M, McCreedy E, Nelson VA, Desai P, Ratner E, Fink HA, et al. Does Cognitive Training Prevent Cognitive Decline?: A Systematic Review. Ann Intern Med. 2018;168(1):63–8. Available from: https://doi.org/10.7326/M17-1531	Wrong intervention
Butler R, Radhakrishnan R. Dementia. BMJ clinical evidence. 2012;2012.	Wrong intervention
Cabrera E, Sutcliffe C, Verbeek H, Saks K, Soto-Martin M, Meyer G, et al. Non-pharmacological interventions as a best practice strategy in people with dementia living in nursing homes. A systematic review. Eur Geriatr Med. 2015;6(2):134–50. Available from: https://doi.org/10.1016/j.eurger.2014.06.003	Wrong intervention
Cai Y, Li L, Xu C, Wang Z. The Effectiveness of Non-Pharmacological Interventions on Apathy in Patients With Dementia: A Systematic Review of Systematic Reviews. Worldviews Evid Based Nurs. 2020;17(4):311–8. Available from: https://doi.org/10.1111/wvn.12459	Wrong study design
Calderone A, Marra A, De Luca R, Latella D, Corallo F, Quartarone A, et al. Multisensory Stimulation in Rehabilitation of Dementia: A Systematic Review. Biomedicines. 2025;13(1). Available from: https://doi.org/10.3390/biomedicines13010149	Wrong intervention
Cao Y, Wang N, Zhang Q, Shen N, Bai J, Luo X, et al. Effects of cognitive stimulation therapy on patients with dementia: An umbrella review of systematic reviews and meta-analyses. Exp Gerontol. 2023;177:112197. Available from: https://doi.org/10.1016/j.exger.2023.112197	Wrong study design
Carrion C, Aymerich M, Bailles E, Lopez-Bermejo A. Cognitive psychosocial intervention in dementia: a systematic review. Dement Geriatr Cogn Disord. 2013;36(5-6):363–75. Available from: https://doi.org/10.1159/000354365	Wrong intervention
Carrion C, Folkvord F, Anastasiadou D, Aymerich M. Cognitive Therapy for Dementia Patients: A Systematic Review. Dement Geriatr Cogn Disord. 2018;46(1-2):1–26. Available from: https://doi.org/10.1159/000490851	Wrong intervention
Castro CB, Costa LM, Dias CB, Chen J, Hillebrandt H, Gardener SL, et al. Multi-Domain Interventions for Dementia Prevention - A Systematic Review. J Nutr Health Aging. 2023;27(12):1271–80. Available from: https://doi.org/10.1007/s12603-023-2046-2	Wrong intervention
Chan JYC, Chan TK, Kwok TCY, Wong SYS, Lee ATC, Tsoi KKF. Cognitive training interventions and depression in mild cognitive impairment and dementia: a systematic review and meta-analysis of randomized controlled trials. Age Ageing. 2020;49(5):738–47. Available from: https://doi.org/10.1093/ageing/afaa063	Wrong intervention
Chandler MJ, Parks AC, Marsiske M, Rotblatt LJ, Smith GE. Everyday Impact of Cognitive Interventions in Mild Cognitive Impairment: a Systematic Review and Meta-Analysis. Neuropsychol Rev. 2016;26(3):225–51. Available from: https://doi.org/10.1007/s11065-016-9330-4	Wrong intervention
Chen LH, Lee OL, Lee YW, Ng ST, Ngai SYE, Pau YHZ, et al. Effectiveness of cognitive stimulation for individuals with mild cognitive impairment: a systematic review and meta-analysis. BMJ Open. 2025;15(6):e090767. Available from: https://doi.org/10.1136/bmjopen-2024-090767	Wrong intervention
Chow G, Gan JKE, Chan JKY, Wu XV, Klainin-Yobas P. Effectiveness of psychosocial interventions among older adults with mild cognitive impairment: a systematic review and meta-analysis. Aging Ment Health. 2021;25(11):1986–97. Available from: https://doi.org/10.1080/13607863.2020.1839861	Wrong intervention
Clarkson P, Hughes J, Xie C, Larbey M, Roe B, Giebel CM, et al. Overview of systematic reviews: Effective home support in dementia care, components and impacts-Stage 1, psychosocial interventions for dementia. J Adv Nurs. 2017;73(12):2845–63. Available from: https://doi.org/10.1111/jan.13362	Wrong study design
Coley N, Giulioli C, Aisen PS, Vellas B, Andrieu S. Randomised controlled trials for the prevention of cognitive decline or dementia: A systematic review. Ageing Res Rev. 2022;82:101777. Available from: https://doi.org/10.1016/j.arr.2022.101777	Wrong intervention
Cooper C, Li R, Lyketsos C, Livingston G. Treatment for mild cognitive impairment: systematic review. Br J Psychiatry. 2013;203(3):255–64. Available from: https://doi.org/10.1192/bjp.bp.113.127811	Wrong intervention
Dou J, Zhang H, Fu X, Yang Y, Gao X. Optimal dose and type of non-pharmacological treatments to improve cognitive function in people with Alzheimer's disease: a systematic review and network meta-analysis. Aging Ment Health. 2025;29(2):228–37. Available from: https://doi.org/10.1080/13607863.2024.2379427	Wrong intervention
Duan Y, Lu L, Chen J, Wu C, Liang J, Zheng Y, et al. Psychosocial interventions for Alzheimer's disease cognitive symptoms: a Bayesian network meta-analysis. BMC Geriatr. 2018;18(1):175. Available from: https://doi.org/10.1186/s12877-018-0864-6	Wrong intervention
Eaglestone G, Gkaintatzi E, Jiang H, Stoner C, Pacella R, McCrone P. Cost-Effectiveness of Non-pharmacological Interventions for Mild Cognitive Impairment and Dementia: A Systematic Review of Economic Evaluations and a Review of Reviews. Pharmacoecon Open. 2023;7(6):887–914. Available from: https://doi.org/10.1007/s41669-023-00440-z	Wrong outcomes
Fisher E, Chick I, Fossey J, Spector A. Barriers and Facilitators to Implementing Cognitive Stimulation and Reminiscence Therapy for Dementia in Care Homes: Systematic Review. Int J Geriatr Psychiatry. 2025;40(7):e70124. Available from: https://doi.org/10.1002/gps.70124	Wrong study design
Folkerts AK, Roheger M, Franklin J, Middelstädt J, Kalbe E. Cognitive interventions in patients with dementia living in long-term care facilities: Systematic review and meta-analysis. Arch Gerontol Geriatr. 2017;73:204–21. Available from: https://doi.org/10.1016/j.archger.2017.07.017	Wrong intervention
Forte G, Favieri F, Corbo I, Chirico I, Chattat R, Vedova AMD, et al. Evaluating the Effectiveness of Cognitive Interventions for Healthy and Mild Cognitive Impairment Adults: A Comprehensive Umbrella Meta-Analysis. J Aging Res. 2025;2025(1):4397025. Available from: https://doi.org/10.1155/jare/4397025	Wrong study design
Forte L, Despini G, Quartarone M, Calabrese L, Brigiano M, Trolese S, et al. Cognitive and Non-Cognitive Predictors of Response to Cognitive Stimulation Interventions in Dementia: A Systematic Review Aiming for Personalization. Behav Sci (Basel). 2025;15(8). Available from: https://doi.org/10.3390/bs15081069	Relevant results not analysed separately
Fukushima RLM, do Carmo EG, Pedroso RDV, Micali PN, Donadelli PS, Fuzaro GJ, et al. Effects of cognitive stimulation on neuropsychiatric symptoms in elderly with Alzheimer's disease: A systematic review. Dement Neuropsychol. 2016;10(3):178–84. Available from: https://doi.org/10.1590/S1980-5764-2016DN1003003	Wrong intervention
Garrido-Pedrosa J, Sala I, Obradors N. Effectiveness of cognition-focused interventions in activities of daily living performance in people with dementia: A systematic review. Br J Occup Ther. 2017;80(7):397–408. Available from: https://doi.org/10.1177/0308022617698166	Wrong intervention
Gavelin HM, Lampit A, Hallock H, Sabates J, Bahar-Fuchs A. Cognition-Oriented Treatments for Older Adults: a Systematic Overview of Systematic Reviews. Neuropsychol Rev. 2020;30(2):167–93. Available from: https://doi.org/10.1007/s11065-020-09434-8	Wrong study design
Gheysari F, Mazaheri M. The Effectiveness of Computerized and Classical Cognitive Interventions on the Cognitive Functions of Iranian Older Adults: A Systematic Review and Meta-Analysis. Salmand. 2025;20(2):0–. Available from: https://doi.org/10.32598/sija.2024.3272.2	Wrong intervention
Giaquinto F, Iaia M, Rizzi E, Macchitella L, Romano DL, Tosi G, et al. Cognitive training for Alzheimer's disease and other forms of dementia: Insights from a systematic review and Bayesian meta-analysis. J Alzheimers Dis. 2025;105(4):1252–74. Available from: https://doi.org/10.1177/13872877251334795	Wrong intervention
Gibbor L, Yates L, Volkmer A, Spector A. Cognitive stimulation therapy (CST) for dementia: a systematic review of qualitative research. Aging Ment Health. 2021;25(6):980–90. Available from: https://doi.org/10.1080/13607863.2020.1746741	Wrong study design
Gomez-Soria I, Iguacel I, Aguilar-Latorre A, Peralta-Marrupe P, Latorre E, Zaldivar JNC, et al. Cognitive stimulation and cognitive results in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr. 2023;104:104807. Available from: https://doi.org/10.1016/j.archger.2022.104807	Wrong intervention
Gomez-Soria I, Iguacel I, Cuenca-Zaldivar JN, Aguilar-Latorre A, Peralta-Marrupe P, Latorre E, et al. Cognitive stimulation and psychosocial results in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr. 2023;115:105114. Available from: https://doi.org/10.1016/j.archger.2023.105114	Relevant results not analysed separately
Gomez-Soria I, Peralta-Marrupe P, Calatayud-Sanz E, Latorre E. Efficacy of cognitive intervention programs in amnesic mild cognitive impairment: A systematic review. Arch Gerontol Geriatr. 2021;94:104332. Available from: https://doi.org/10.1016/j.archger.2020.104332	Wrong intervention
Guicheteau J, Seven US, Boes J, Monsef I, Kopke S, Folkerts AK, et al. Characteristics of complex non-pharmacological interventions for cognitive stimulation in people with mild to moderate dementia in nursing homes: A systematic review. Geriatr Nurs. 2025;66(Pt A):103586. Available from: https://doi.org/10.1016/j.gerinurse.2025.103586	No synthesis
Guzzon A, Rebba V, Paccagnella O, Rigon M, Boniolo G. The value of supportive care: A systematic review of cost-effectiveness of nonpharmacological interventions for dementia. PLoS ONE. 2023;18(5 May). Available from: https://doi.org/10.1371/journal.pone.0285305	Wrong outcomes
Herrera Montoya V, Santos de Carvalho RL, Bertrand E, Naylor R, Spector A, Mograbi DC. Barriers and Facilitators for the Adaptation and Implementation of Cognitive Stimulation Therapy: A Systematic Review. J Geriatr Psychiatry Neurol. 2026:8919887261416029. Available from: https://doi.org/10.1177/08919887261416029	Wrong study design
Hindle JV, Petrelli A, Clare L, Kalbe E. Nonpharmacological enhancement of cognitive function in Parkinson's disease: a systematic review. Mov Disord. 2013;28(8):1034–49. Available from: https://doi.org/10.1002/mds.25377	Wrong intervention
Huntley J, Gould RL, Liu K, Smith M, Howard RJ. Do cognitive interventions improve general cognition in dementia? A meta-analysis and meta-regression. BMJ Open. 2015;5(4). Available from: https://doi.org/10.1136/bmjopen-2014-005247	Wrong intervention
James T, Mukadam N, Sommerlad A, Guerra Ceballos S, Livingston G. Culturally tailored therapeutic interventions for people affected by dementia: a systematic review and new conceptual model. Lancet Healthy Longev. 2021;2(3):e171–e9. Available from: https://doi.org/10.1016/S2666-7568(21)00001-5	Wrong intervention
Jean L, Bergeron ME, Thivierge S, Simard M. Cognitive intervention programs for individuals with mild cognitive impairment: systematic review of the literature. Am J Geriatr Psychiatry. 2010;18(4):281–96. Available from: https://doi.org/10.1097/JGP.0b013e3181c37ce9	Wrong intervention
Jin B, Xv Y, Zhang B, Qiao L, Liu H. Comparative efficacy and acceptability of treatments for depressive symptoms in cognitive impairment: A systematic review and Bayesian network meta-analysis. Front Aging Neurosci. 2022;14:1037414. Available from: https://doi.org/10.3389/fnagi.2022.1037414	Wrong intervention
Kim K, Han JW, So Y, Seo J, Kim YJ, Park JH, et al. Cognitive Stimulation as a Therapeutic Modality for Dementia: A Meta-Analysis. Psychiatry Investig. 2017;14(5):626–39. Available from: https://doi.org/10.4306/pi.2017.14.5.626	Wrong intervention
Kim Y, Cho E. Non-pharmacological Intervention for Wandering Behavior in Dementia: A Systematic Review and Meta-analysis. J Korean Gerontol Nurs. 2022;24(3):321–34. Available from: https://doi.org/10.17079/jkgn.2022.24.3.321	Wrong language
Kurz AF, Leucht S, Lautenschlager NT. The clinical significance of cognition-focused interventions for cognitively impaired older adults: a systematic review of randomized controlled trials. Int Psychogeriatr. 2011;23(9):1364–75. Available from: https://doi.org/10.1017/S1041610211001001	Wrong intervention
Lauritzen J, Nielsen LM, Kvande ME, Brammer Damsgaard J, Gregersen R. Carers' experience of everyday life impacted by people with dementia who attended a cognitive stimulation therapy (CST) group intervention: a qualitative systematic review. Aging Ment Health. 2023;27(2):343–9. Available from: https://doi.org/10.1080/13607863.2022.2046699	Wrong study design
Liang J-H, Li J-Y, Jia R-X, Wang Y-Q, Wu R-K, Zhang H-B, et al. Comparison of Cognitive Intervention Strategies for Older Adults With Mild to Moderate Alzheimer's Disease: A Bayesian Meta-analytic Review. J Am Med Dir Assoc. 2019;20(3):347–55. Available from: https://doi.org/10.1016/j.jamda.2018.09.017	Wrong intervention
Liang JH, Lin L, Wang YQ, Jia RX, Qu XY, Li J, et al. Non-pharmacological therapeutic strategy options for patients with dementia based on cognitive function-A Bayesian network meta-analysis of randomized controlled trials. Ageing Res Rev. 2019;56:100965. Available from: https://doi.org/10.1016/j.arr.2019.100965	Wrong intervention
Liang JH, Shen WT, Li JY, Qu XY, Li J, Jia RX, et al. The optimal treatment for improving cognitive function in elder people with mild cognitive impairment incorporating Bayesian network meta-analysis and systematic review. Ageing Res Rev. 2019;51:85–96. Available from: https://doi.org/10.1016/j.arr.2019.01.009	Wrong intervention
Livingston G, Johnston K, Katona C, Paton J, Lyketsos CG, Old Age Task Force of the World Federation of Biological P. Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia. Am J Psychiatry. 2005;162(11):1996–2021. Available from: https://doi.org/10.1176/appi.ajp.162.11.1996	Wrong intervention
Mamayson RF, Lacanaria MGC. Effects of Cognitively Stimulating Activities on the Cognitive Functioning of Older People with Mild Cognitive Impairment: A Meta-analysis. Acta Med Philippina. 2024;58(6):14–23. Available from: https://doi.org/10.47895/amp.vi0.7162	Wrong intervention
Martin M, Clare L, Altgassen AM, Cameron MH, Zehnder F. Cognition-based interventions for healthy older people and people with mild cognitive impairment. Cochrane Database Syst Rev. 2011;1(1):CD006220. Available from: https://doi.org/10.1002/14651858.CD006220.pub2	Wrong intervention
McDermott O, Charlesworth G, Hogervorst E, Stoner C, Moniz-Cook E, Spector A, et al. Psychosocial interventions for people with dementia: a synthesis of systematic reviews. Aging Ment Health. 2019;23(4):393–403. Available from: https://doi.org/10.1080/13607863.2017.1423031	Wrong study design
Meyer C, O'Keefe F. Non-pharmacological interventions for people with dementia: A review of reviews. Dementia (London). 2020;19(6):1927–54. Available from: https://doi.org/10.1177/1471301218813234	Wrong study design
Nimmons D, Aker N, Burnand A, Jordan KP, Cooper C, Davies N, et al. Clinical effectiveness of pharmacological and non-pharmacological treatments for the management of anxiety in community dwelling people living with dementia: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2024;157:105507. Available from: https://doi.org/10.1016/j.neubiorev.2023.105507	Wrong intervention
Olazaran J, Reisberg B, Clare L, Cruz I, Pena-Casanova J, Del Ser T, et al. Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy. Dement Geriatr Cogn Disord. 2010;30(2):161–78. Available from: https://doi.org/10.1159/000316119	Wrong intervention
Oltra-Cucarella J, Ferrer-Cascales R, Clare L, Morris SB, Espert R, Tirapu J, et al. Differential effects of cognition-focused interventions for people with Alzheimer's disease: A meta-analysis. Neuropsychology. 2018;32(6):664–79. Available from: https://doi.org/10.1037/neu0000449	Wrong intervention
Oltra-Cucarella J, Pérez-Elvira J, Espert R, McCormick AS. Are cognitive interventions effective in Alzheimer's disease? A controlled meta-analysis of the effects of bias. Neuropsychology. 2016;30(5):631–52. Available from: https://doi.org/10.1037/neu0000283	Wrong intervention
Orgeta V, McDonald KR, Poliakoff E, Hindle JV, Clare L, Leroi I. Cognitive training interventions for dementia and mild cognitive impairment in Parkinson’s disease. Cochrane Database Syst Rev. 2020;2020(2). Available from: https://doi.org/10.1002/14651858.CD011961.pub2	Wrong intervention
Paggetti A, Druda Y, Sciancalepore F, Della Gatta F, Ancidoni A, Locuratolo N, et al. The efficacy of cognitive stimulation, cognitive training, and cognitive rehabilitation for people living with dementia: a systematic review and meta-analysis. Geroscience. 2025;47(1):409–44. Available from: https://doi.org/10.1007/s11357-024-01400-z	Wrong intervention
Pigott JS, Armstrong M, Tabassum N, Davies N, Schrag A. Effectiveness and Feasibility of Nonpharmacological Interventions for People With Parkinson's Disease and Cognitive Impairment on Patient-Centred Outcomes: Systematic Review and Meta-Analysis. Parkinsons Dis. 2024;2024:3654652. Available from: https://doi.org/10.1155/2024/3654652	Wrong intervention
Polack S, Bell G, Silarova B, Hebditch M, Tingle A, Sommerlad A, et al. Non-Pharmacological Interventions for People With Dementia Who Live Alone: A Systematic Review. Int J Geriatr Psychiatry. 2025;40(3). Available from: https://doi.org/10.1002/gps.70059	Relevant results not analysed separately
Raimo S, Cropano M, Gaita M, Maggi G, Cavallo ND, Roldan-Tapia MD, et al. The Efficacy of Cognitive Training on Neuropsychological Outcomes in Mild Cognitive Impairment: A Meta-Analysis. Brain Sci. 2023;13(11). Available from: https://doi.org/10.3390/brainsci13111510	Wrong intervention
Rao S, Hassan I, Khan A, editors. Effects of Individual Cognitive Stimulation Therapy and Group Cognitive Stimulation Therapy on People with Dementia: A PRISMA- Guided Systematic Review. Proceedings - 2023 Congress in Computer Science, Computer Engineering, and Applied Computing, CSCE 2023; 2023.	Wrong publication type
Scott J, Clare L. Do people with dementia benefit from psychological interventions offered on a group basis? Clin Psychol Psychother. 2003;10(3):186–96. Available from: https://doi.org/10.1002/cpp.369	Wrong study design
Spector A, Orrell M, Hall L. Systematic review of neuropsychological outcomes in dementia from cognition-based psychological interventions. Dement Geriatr Cogn Disord. 2012;34(3-4):244–55. Available from: https://doi.org/10.1159/000343931	Wrong intervention
Stoner CR, Lakshminarayanan M, Durgante H, Spector A. Psychosocial interventions for dementia in low- and middle-income countries (LMICs): a systematic review of effectiveness and implementation readiness. Aging Ment Health. 2021;25(3):408–19. Available from: https://doi.org/10.1080/13607863.2019.1695742	No synthesis
Vedel I, Sheets D, McAiney C, Clare L, Brodaty H, Mann J, et al. CCCDTD5: Individual and community-based psychosocial and other non-pharmacological interventions to support persons living with dementia and their caregivers. Alzheimers Dement (N Y). 2020;6(1):e12086. Available from: https://doi.org/10.1002/trc2.12086	Wrong study design
Vilela VC, Pacheco RL, Latorraca COC, Pachito DV, Riera R. What do Cochrane systematic reviews say about non-pharmacological interventions for treating cognitive decline and dementia? Sao Paulo Med J. 2017;135(3):309–20. Available from: https://doi.org/10.1590/1516-3180.2017.0092060617	Wrong study design
Wang C, Yu JT, Wang HF, Tan CC, Meng XF, Tan L. Non-pharmacological interventions for patients with mild cognitive impairment: a meta-analysis of randomized controlled trials of cognition-based and exercise interventions. J Alzheimers Dis. 2014;42(2):663–78. Available from: https://doi.org/10.3233/JAD-140660	Wrong intervention
Wang Y-Q, Jia R-X, Liang J-H, Li J, Qian S, Li J-Y, et al. Effects of non-pharmacological therapies for people with mild cognitive impairment. A Bayesian network meta-analysis. Int J Geriatr Psychiatry. 2020;35(6):591–600. Available from: https://doi.org/10.1002/gps.5289	Wrong intervention
Wang YY, Wang XX, Chen L, Liu Y, Li YR. A systematic review and network meta-analysis comparing various non-pharmacological treatments for older people with mild cognitive impairment. Asian J Psychiatr. 2023;86:103635. Available from: https://doi.org/10.1016/j.ajp.2023.103635	Wrong intervention
Wang Y-Y, Yang L, Zhang J, Zeng X-T, Wang Y, Jin Y-H. The Effect of Cognitive Intervention on Cognitive Function in Older Adults With Alzheimer's Disease: A Systematic Review and Meta-Analysis. Neuropsychol Rev. 2022;32(2):247–73. Available from: https://doi.org/10.1007/s11065-021-09486-4	Wrong intervention
Warner JP, Butler R, Gupta S. Dementia. BMJ Clin Evid. 2010;2010.	Wrong intervention
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Whitty E, Mansour H, Aguirre E, Palomo M, Charlesworth G, Ramjee S, et al. Efficacy of lifestyle and psychosocial interventions in reducing cognitive decline in older people: Systematic review. Ageing Res Rev. 2020;62:101113. Available from: https://doi.org/10.1016/j.arr.2020.101113	Wrong intervention
Wong YL, Cheng CPW, Wong CSM, Wong SN, Wong HL, Tse S, et al. Cognitive Stimulation for Persons with Dementia: a Systematic Review and Meta-Analysis. East Asian Arch Psychiatry. 2021;31(3):55–66. Available from: https://doi.org/10.12809/eaap2102	Wrong intervention
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Xiang C, Zhang Y. Comparison of Cognitive Intervention Strategies for Individuals With Alzheimer's Disease: A Systematic Review and Network Meta-analysis. Neuropsychol Rev. 2024;34(2):402–16. Available from: https://doi.org/10.1007/s11065-023-09584-5	Wrong intervention
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Yuill N, Hollis V. A systematic review of cognitive stimulation therapy for older adults with mild to moderate dementia: an occupational therapy perspective. Occup Ther Int. 2011;18(4):163–86. Available from: https://doi.org/10.1002/oti.315	Wrong intervention
Yun S, Ryu S. The Effects of Cognitive-Based Interventions in Older Adults: A Systematic Review and Meta-Analysis. Iran J Public Health. 2022;51(1):1–11. Available from: https://doi.org/10.18502/ijph.v51i1.8286	Wrong intervention

Bilaga 4 Risk för bias hos relevanta systematiska översikter

Study	Step 1	Step 2	Step 3	Step 4	Step 5	Overall
= Critical; = High; = Moderate; = Low; = Not assessed
Cafferata 2021
Cammisuli 2016
Chen 2019
Chen 2022
Cooper 2012
Desai 2024
Jiminez-Palomares 2025
Lu 2025
Luo 2023
Luxton 2026
Saragih 2022
Sun 2022

The assessment tool is comprised of five steps based on the items in AMSTAR. To be assessed as low risk of bias, a systematic review has to fulfil all requirements for step 1 to 5. A systematic review is of moderate risk of bias if it fulfils all the requirements up to step 4. Systematic reviews that do not meet the requirements in one of the steps 1-4 are considered high risk of bias.

Risk-of-bias plot generated using robvis: McGuinness, LA, Higgins, JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Syn Meth. 2020; 1- 7. https://doi.org/10.1002/jrsm.1411

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