Practical cognitive stimulation strategies for older adults with depression

Neuropsychologist Estefanía Lesser explains to us the benefits of cognitive stimulation for older adults with depression, as well as the most effective strategies.

Introduction

In the first part of this article we analyzed how depression in old age affects cognitive functions and why cognitive stimulation represents a key strategy for its management. Below, we explore the specific benefits of this intervention, practical strategies and the essential role of the therapeutic team. 

Benefits of cognitive stimulation for the older adult with depression

The cognitive stimulation produces positive effects across multiple dimensions of functioning in the older adult with depression, especially when carried out systematically and within an interdisciplinary approach. The benefits are not limited to the cognitive domain but also extend to emotional and social well-being. 

Cognitive benefits of cognitive stimulation for the older adult with depression

• Improvement of memory: Advances are observed in working memory, verbal memory and recognition, functions especially sensitive to aging and depression (Jean et al., 2010; Gates et al., 2011).
• Increase in attention and concentration: Regular participation in mental exercises stimulates sustained and selective attention, which facilitates the performance of daily activities (Kinsella et al., 2009).
• Stimulation of language and verbal fluency: Activities such as reading, guided conversation and naming exercises help preserve linguistic and communicative skills (Crespo et al., 2012).
• Strengthening reasoning and cognitive flexibility: Problem solving and training of executive functions increase adaptability and decision-making (Reijnders et al., 2013).

Emotional and social benefits of cognitive stimulation for the older adult with depression

• Reduction of social isolation: Participating in group or interactive sessions stimulates interpersonal contact, strengthening the sense of belonging and motivation (Bahar-Fuchs et al., 2013).
• Increase in self-esteem and sense of accomplishment: Overcoming cognitive challenges gives the older adult a more positive self-perception, which is essential to counteract the hopelessness associated with depression (Cummings et al., 2019).

Recommended frequency and duration of cognitive stimulation programs for the older adult with depression

The benefits of cognitive stimulation are more evident when applied with structure, continuity and personalization. The literature suggests:

• Optimal frequency: 2 to 3 times per week.
• Duration per session: between 45 and 60 minutes.
• Total program duration: a minimum of 12 weeks to observe significant effects, although long-term interventions are recommended to sustain results (Olazarán et al., 2010; Sitzer et al., 2006).

Programs should be adapted to the level of impairment and the patient’s emotional state, as well as integrated with other psychotherapeutic or pharmacological interventions when required.

Effective cognitive stimulation strategies for older adults with depression 

Cognitive stimulation strategies should be personalized, meaningful and adapted to the older adult’s level of functioning and emotional state. Below are widely used techniques, along with their cognitive benefits and emotional impact:

1. Structured mental games (crosswords, Sudokus, word searches, memory-type games):
   • Cognitive benefits: They improve sustained attention, working memory and logical reasoning.
   • Emotional impact: They foster motivation, reduce boredom and reinforce the sense of competence and achievement (Jean et al., 2010; Reijnders et al., 2013).
2. Time orientation and spatial exercises (identify the date, season, location, context):
   • Cognitive benefits: They reinforce situational awareness and reduce disorientation.
   • Emotional impact: They increase the sense of control and reduce anxiety in new or confusing contexts (Bahar-Fuchs et al., 2013).
3. Use of external aids and visual reminders (planners, calendars, notes, alarms, reminder boards):
   • Cognitive benefits: They promote functional autonomy and prospective memory.
   • Emotional impact: They decrease frustration and reinforce day-to-day security (Crespo et al., 2012).
4. Reminiscence therapies (use of photographs, old music, personal objects, life stories):
   • Cognitive benefits: They stimulate autobiographical memory and verbal recall.
   • Emotional impact: They promote personal identity, strengthen emotional bonds and reduce isolation (Woods et al., 2018).
5. Guided reading and functional writing (summaries, free writing, reading aloud, journals): 
   • Cognitive benefits: They reinforce language, reading comprehension and written expression.
   • Emotional impact: They encourage creativity, self-expression and reflective thinking (Gates et al., 2011).

These activities should be carried out in non-threatening contexts, valuing the patient’s interests to facilitate adherence and avoid feelings of failure.

Complementary support: mindfulness

Although it does not constitute a cognitive stimulation strategy in the strict sense, the practice of mindfulness can play a relevant role as a complementary technique. Mindfulness has been shown to improve emotional self-regulation, sustained attention and stress management capacity, which can enhance the older adult’s willingness to participate in cognitive activities (Lenze et al., 2014; Geiger et al., 2016).

• Emotional impact: Reduction of mild depressive symptoms, improved mood and increased perceived well-being.
• Suggested application: brief sessions of guided meditation, mindful breathing or body-scan exercises integrated into the routine.

It is essential that activities are meaningful and adapted to the patient’s interests to avoid frustrations and increase adherence. 

Multidisciplinary approach in cognitive stimulation for older adults with depression 

The therapeutic approach for older adults with depression and cognitive alterations should be carried out using a multidisciplinary approach, in which different professionals act in a coordinated manner to intervene in the multiple dimensions of the patient’s functioning.

Below are the specific functions of each team member:

• Neuropsychologists: They are responsible for the comprehensive assessment of cognitive functions using standardized tests. They develop an individualized cognitive profile that allows designing stimulation plans tailored to the detected deficits. In addition, they apply specific cognitive rehabilitation techniques and monitor neuropsychological changes (Ardila & Ostrosky-Solís, 2018).
• Clinical psychologists: They focus on the management of emotional, behavioral and motivational aspects of the older adult with depression. They use psychotherapeutic interventions, mainly from the cognitive-behavioral approach, to reduce affective symptoms and strengthen adherence to stimulation programs (Areán et al., 2010). Unlike the neuropsychologist, their work is not centered on cognitive performance but on overall psychological well-being.
• Psychiatrists: They participate in the diagnostic and pharmacological evaluation of the patient. In cases of major depression or psychiatric comorbidities, they are key to establishing and adjusting psychopharmacological treatments that facilitate the patient’s participation in other interventions (Jeste et al., 1999).
• Occupational therapists: Intervene on activities of daily living (ADLs), aiming to preserve or recover functional autonomy. They apply structured activities that integrate cognitive stimulation with practical skills, reinforcing the connection between cognitive training and everyday functionality (Padilla, 2011).
• Speech-language therapists: They evaluate and treat language, communication and swallowing disorders, functions that directly impact the older adult’s quality of life and social interaction. Good communication strengthens self-esteem, participation and motivation to get involved in cognitive activities (Cummings, 2019).
• Physiotherapists: They improve mobility, balance and overall physical condition. This not only prevents falls and promotes independence, but also contributes to executive and emotional functioning, since physical exercise is associated with improvements in attention, processing speed and mood (Forbes et al., 2015).

The follow-up of the process is carried out through periodic meetings of the interdisciplinary team, where progress is evaluated, therapeutic objectives are adjusted and cognitive stimulation strategies are redesigned according to the patient’s clinical, emotional and functional status.

Conclusion

Depression in older adults is a common, often underdiagnosed condition that affects both emotional state and cognitive functioning. Alterations in attention, memory and executive functions not only reduce quality of life but can also mimic more severe impairment, as occurs in depressive pseudodementia. This reinforces the need for precise clinical and neuropsychological assessments.

In this context, cognitive stimulation for older adults is consolidated as an effective therapeutic tool to prevent, treat and compensate for the cognitive and functional effects of depression in old age. Its usefulness goes beyond the neuropsychological domain, positively impacting the older person’s self-esteem, sense of purpose, motivation and social relationships.

The implementation of these cognitive stimulation strategies for older adults with depression requires a multidisciplinary approach, in which each professional — neuropsychologists, clinical psychologists, occupational therapists, speech-language therapists, physiotherapists and psychiatrists — contributes a specific and complementary perspective.

Finally, considering older adults as active participants in their cognitive stimulation process is key to promoting healthier, more autonomous and dignified aging. Integrating these interventions into routine clinical care represents an ethical and social commitment to a population that has often been made invisible in its cognitive and emotional needs.

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“This article has been translated. Link to the original article in Spanish:”
Estrategias prácticas de estimulación cognitiva para adultos mayores con depresión