Depression, anxiety, and mental state in patients with early-stage dementia: comparison of reminiscence therapy and cognitive stimulation therapy

Demir, Zeynep Gümüş; Doğan, Idil Arasan; Keskin, Remziye; Koyutürk, Defne Demet

doi:10.1590/1980-5764-DN-2025-0354

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Original Article • Dement. neuropsychol. 20 • 2026 • https://doi.org/10.1590/1980-5764-DN-2025-0354 linkcopy

Depression, anxiety, and mental state in patients with early-stage dementia: comparison of reminiscence therapy and cognitive stimulation therapy

Depressão, ansiedade e estado mental em pacientes com demência em estágio inicial: comparação entre a terapia de reminiscência e a terapia de estimulação cognitiva

Authorship SCIMAGO INSTITUTIONS RANKINGS

Psychosocial interventions may differentially target affective and cognitive symptoms in mild dementia, yet comparative evidence in long-term care is limited.

Objective: To compare the effects of Reminiscence Therapy (RT) and Cognitive Stimulation Therapy (CST) on depression, anxiety, and cognitive functioning in older adults with mild dementia living in long-term care facilities.

Methods: A quasi-experimental, quantitative study was conducted with 24 participants diagnosed with mild dementia, allocated equally to RT (n=12) and CST (n=12). Thirteen were male and eleven were female. Data were collected using a Sociodemographic Information Form, the Geriatric Depression Scale, the Beck Anxiety Inventory, and the Standardized Mini-Mental State Examination. Both groups received 10 weekly sessions lasting 90 minutes each.

Results: Distinct patterns emerged between the interventions. RT was more effective for emotional symptoms: depressive symptoms decreased significantly (t(11)=8.26, p<0.001) and anxiety also improved (t(11)=10.41, p<0.001). CST led to greater gains in cognitive performance (t(11)=-2.42, p=0.034) while also reducing depressive (t(11)=3.08, p=0.010) and anxiety symptoms (t(11)=5.05, p<0.001). These differential effects suggest unique therapeutic mechanisms.

Conclusion: Both RT and CST may provide valuable psychosocial benefits for older adults with mild dementia. The findings highlight the need for individualized intervention strategies that consider each person’s emotional and cognitive profiles when designing mental health care plans in long-term care settings.

Keywords:
Dementia; Depression; Anxiety; Cognition; Therapeutics

Reminiscence Therapy Program	Subject
Session 1	• Welcome and introduction of the session host • Explanation of group rules • Self-awareness, awareness of others, and identification of goals and process • Self-introduction of each participant, with support if needed • Sharing names, nicknames (if any), place and date of birth, occupations, and hobbies • Summarizing activities and discussing group interactions
Session 2	• Welcome and introduction of the session host • Reminder of group rules • Reviewing what was discussed in the previous week • Promoting hopefulness and life review • Recalling school memories; for those who cannot recall, supporting recall through group prompts • Summarizing activities and discussing interactions
Session 3	• Welcome and introduction of the session host • Reminder of group rules • Reviewing what was discussed in the previous week • Recalling childhood games, with supportive cues for those who have difficulty remembering • Summarizing activities and discussing interactions • Discussing the place and conditions in which participants live, comparing past and present
Session 4	• Welcome and introduction of the session host • Reviewing what was discussed in the previous week • Discussing national and religious holidays; using related photographs as visual aids • Supporting personal memory within this context • Summarizing activities and discussing interactions
Session 5	• Welcome and introduction of the session host • Reviewing what was discussed in the previous week • Discussing relationships and marriage • Married participants sharing memories from their wedding ceremonies • Participants who are single may share memories of past relationships or personal reflections on the topic • Summarizing activities and discussing interactions
Session 6	• Welcome and introduction of the session host • Reviewing what was discussed in the previous week • Discussing an object participants carry with them or particularly like. • Summarizing activities and discussing interactions • Announcement to bring photographs to the next session
Session 7	• Welcome and introduction of the session host • Reviewing what was discussed in the previous week • Displaying and discussing the photograph each participant brought, including the person in the photo and the associated memory • Discussing meaningful life events and their personal impact • Summarizing activities and discussing interactions
Session 8	• Welcome and introduction of the session host • Reviewing what was discussed in the previous week • Sharing favorite music and artists; listening to the selected songs and, if possible, singing together • Discussing the artist and the significance of the song • Summarizing activities and discussing interactions
Session 9	• Welcome and introduction of the session host • Reviewing what was discussed in the previous week • Discussing family life and relationships with family members • Using the “Circle” technique from the Interpersonal Therapeutic Approach during discussion • Summarizing activities and discussing interactions • Discussing materials needed for the closing party the following week
Session 10	• Welcome and introduction of the session host • Reviewing what was discussed in the previous week • Organizing a closing party using the materials available • Sharing memories of simultaneous or individual celebrations • Reviewing what was completed throughout the ten-week program • Closing remarks and final announcement

Cognitive Stimulation Therapy Program	Subject
Session 1	• Welcome and introduction of the session host • Explanation of group rules • The practitioner writes the date on the board (day, month, year). • Writing the season and weather on the board • Generating name options for the group and reaching a consensus • Distributing a sheet with flowers drawn on it and asking participants to color according to their emotions. • Discussing the meaning of the chosen colors • Determining a group song and singing it together • Group photograph session
Session 2	• Welcome • Joint reminder of group rules • The practitioner writes the date on the board (day, month, year). • Writing the season and weather on the board • Using a cloth ball, participants describe themselves it is thrown to them. • Singing the group song together • Group photograph session
Session 3	• Welcome • Joint reminder of group rules • The practitioner writes the date on the board (day, month, year). • Writing the season and weather on the board • Using a cloth ball, participants describe happy and unhappy times when he ball is thrown to them. • Throwing the ball into a basket and recalling each scored number • Singing the group song together • Group photograph session
Session 4	• Welcome • Joint reminder of group rules • The practitioner writes the date on the board (day, month, year). • Writing the season and weather on the board • Distributing papers for writing memories of childhood and youth; group discussion afterward • Drawing the environment/room where participants lived while growing up and discussing the drawings • Singing the group song together • Group photograph session
Session 5	• Welcome • Joint reminder of group rules • The practitioner writes the date on the board (day, month, year). • Writing the season and weather on the board • Preparing a dinner menu from items placed on the table • Each participant describes their experience in detail • Singing the group song together • Group photograph session
Session 6	• Welcome • Joint reminder of group rules • The practitioner writes the date on the board (day, month, year). • Writing the season and weather on the board • Discussing a written narrative by collecting input from each participant • Discussing gender roles • Discussing behaviors of younger and older generations • Planting plants and assigning each participant responsibility for monitoring growth, recording the planting date • Singing the group song together • Group photograph session
Session 7	• Welcome • Joint reminder of group rules • The practitioner writes the date on the board (day, month, year). • Writing the season and weather on the board • Analyzing and discussing photographs of notable individuals, historical sites, and landscapes • Each participant describes details in the photographs (e.g., similarities, differences, colors, theme, etc.) • Participants draw pictures of places they have previously visited before and discuss the memories. • Singing the group song together • Group photograph session
Session 8	• Welcome • Joint reminder of group rules • The practitioner writes the date on the board (day, month, year). • Writing the season and weather on the board • Writing incomplete sentences and asking participants to complete them • Sharing experiences regarding what made them happy or unhappy during the week • Singing the group song together • Group photograph session
Session 9	• Welcome • Joint reminder of group rules • The practitioner writes the date on the board (day, month, year). • Writing the season and weather on the board • Finding and placing appropriate shapes on the floor • Working with clay dough to create figures based on model images; labeling the work with the creator’s name and planning to bring it in the next session • Announcement to bring the grown plant to the next session • Singing the group song together • Group photograph session
Session 10	• Welcome • Joint reminder of group rules • The practitioner writes the date on the board (day, month, year). • Writing the season and weather on the board • Group discussion reviewing activities carried out across all sessions, written on the board • Reviewing the grown plant • Displaying the clay figures on a table • Digital sharing of the photo album created across sessions; printed albums are distributed to participants • Singing the group song together • Ending the program with closing remarks and well-wishes

Dependent Variables	Reminiscence therapy group (n=12)		Cognitive stimulation therapy group (n=12)		t	p-value
Dependent Variables	$\bar{X}$	SS	$\bar{X}$	SS	t	p-value
Geriatric Depression Scale (pre-test)	6.75	2.14	8.25	2.90	-1.44	0.163
Standardized Mini-Mental Test (pre-test)	20.33	2.19	19.75	1.96	0.69	0.499
Beck Anxiety Inventory (pre-test)	14.00	2.98	14.33	3.47	-0.25	0.803

Dependent Variables	Pre-test (n=12)		Post-test (n=12)		t	p-value
Dependent Variables	$\bar{X}$	SS	$\bar{X}$	SS	t	p-value
Geriatric Depression Scale	6.75	2.14	4.17	1.59	8.26	<0.001***
Standardized Mini-Mental Test	20.33	2.19	20.50	2.24	-1.48	0.166
Beck Anxiety Inventory	14.00	2.98	6.00	1.35	10.41	<0.001***

Dependent variables	Pre-test (n=12)		Post-test (n=12)		t	p-value
Dependent variables	$\bar{X}$	SS	$\bar{X}$	SS	t	p-value
Geriatric Depression Scale	8.25	2.90	6.00	2.30	3.08	0.010**
Standardized Mini-Mental Test	19.75	1.96	20.58	1.78	-2.42	0.034*
Beck Anxiety Inventory	14.33	3.47	8.42	2.75	5.05	<0.001***

Dependent Variables	Reminiscence therapy group (n=12)		Cognitive stimulation therapy group (n=12)		t	p-value
Dependent Variables	$\bar{X}$	SS	$\bar{X}$	SS	t	p-value
Geriatric Depression Scale (post-test)	4.17	1.59	6.00	2.30	-2.28	0.033*
Standardized Mini-Mental Test (post-test)	20.50	2.24	20.58	1.78	-0.10	0.920
Beck Anxiety Inventory (post-test)	6.00	1.35	8.42	2.75	-2.74	0.012*

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[TFN1] Notes: ***p<0.001; **p<0.01; *p<0.05. Test Used: Independent Samples t-Test.