Cognitive rehabilitation for people with mild to moderate dementia

Background Cognitive impairments affect functional ability in people with dementia. Cognitive rehabilitation (CR) is a personalised, solution‐focused approach that aims to enable people with mild‐to‐moderate dementia to manage everyday activities and maintain as much independence as possible. Objectives To evaluate the effects of CR on everyday functioning and other outcomes for people with mild‐to‐moderate dementia, and on outcomes for care partners. To identify and explore factors that may be associated with the efficacy of CR. Search methods We searched the Cochrane Dementia and Cognitive Improvement Group Specialised Register, which contains records from MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, and other clinical trial databases, and grey literature sources. The most recent search was completed on 19 October 2022. Selection criteria We included randomised controlled trials (RCTs) comparing CR with control conditions and reporting relevant outcomes for the person with dementia and/or the care partner. Data collection and analysis We extracted relevant data from published manuscripts and contacted trial authors if necessary. Within each of the comparisons, we pooled data for each outcome of interest and conducted inverse‐variance, random‐effects meta‐analyses. We evaluated the certainty of the evidence using GRADEpro GDT. Main results We identified six eligible RCTs published in English between 2010 and 2022, which together included 1702 participants. The mean age of participants ranged from 76 to 80 and the proportion of male participants was between 29.4% and 79.3%. Most participants, in the studies where the type of dementia was reported, had a diagnosis of Alzheimer’s disease (AD; n = 1002, 58.9% of the whole sample, 81.2% of the participants for whom the specific diagnosis was reported). Risk of bias in the individual studies was relatively low. The exception was a high risk of bias in relation to blinding of participants and practitioners, which is not usually feasible with psychosocial interventions. Our primary outcome of everyday functioning was operationalised in the included studies as goal attainment in relation to activities targeted in the intervention. For our main comparison of CR with usual care, we pooled data for goal attainment evaluated from three perspectives (self‐rating of performance, informant rating of performance, and self‐rating of satisfaction with performance) at end of treatment and at medium‐term follow‐up (3 to 12 mon