Effects of cognitive stimulation on cognition, well-being and neuropsychiatric symptoms in older adults across the cognitive spectrum: Exploratory study of the "MentHA COG" programme
Authors: Santos Pedro Machado dos , Silva Cláudia Ribeiro da , Oliveira Célia , Afonso Rosa Marina , Barbosa Maria Miguel , Amaral Ana Saraiva , O'Caoimh Rónán 
Published: November 2023

Abstract
Background
As populations age, the prevalence of cognitive impairment is increasing, challenging healthcare systems worldwide. Neurocognitive disorders (NCD) impair cognition and ultimately function. Research shows that cognitive stimulation (CS) is effective as an non-pharmacological intervention to improve cognition and wellbeing in people with NCD. Few programmes, designed to address different mental health problems across a spectrum of cognitive impairment, are available.
Objective
This exploratory study aims (i) to develop a new CS programme for older adults with subjective cognitive complaints (SCC), minor or major NCD, with and without previous mental disorders, and (ii) to assess its effects on cognition, well-being and neuropsychiatric symptoms.
Methods
Different stakeholders in the field of mental health and ageing, using a person-centered consensus approach developed a new programme following a literature review. MentHA COG includes 14 structured thematic CS activities, delivered in facilitated 90-minute sessions, offered twice-weekly for 7 weeks in groups of 5-8. A quasi-experimental study examining the effects of MentHA COG, after 2 and 6 months was conducted. Cognitive performance, subjective well-being, depression, and anxiety were measured using the “Addenbrooke's Cognitive Examination - Revised” and four complementary subtests (Gnosis, Proverbs interpretation and Token orders and nominations) adapted for the "Lisbon Battery for the Assessment of Dementia”, the “Reduced Version of the Positive and Negative Affect Schedule”, and the “Hospital Anxiety and Depression Scale”, respectively.
Results
In total, 47 participants aged 59-94 years were included in three groups: those with Major NCD (ACE-R≤68; n=25), Minor NCD (ACE-R 69-79; n=16) and a group with SCC (ACE-R> 80; n=6). ACE-R scores increased in each group at 6-months with large effect sizes found (Cohen's d≥0.80); the largest relative increase in mean scores was for those with a major NCD (52.71 to 59.00 points). Listening comprehension and immediate auditory memory were the cognitive domains most likely to show statistically significant improvements in those with Major NCD, after 2 (p<0.001) and 6 months (p=0.01). There were also improvements in mean scores with large effect sizes in subjective well-being and neuropsychiatric symptoms for all groups. Pre-existing psychiatric conditions did not influence outcomes.
Conclusions
MentHA COG improved cognition at 6-months for older adults across the cognitive spectrum, improving subjective well-being and anxiety and depression symptoms. This is the first study of this new programme that promotes the inclusion of people with a psychiatric diagnosis, whose pre- existing conditions did not influence their response. Although further research is required, this study suggests that CS programmes such as MentHA COG can offer a low-cost, efficacious, non- pharmacological intervention for patients with cognitive disorders.