Improving cognitive and functional outcomes in rural older adults living with dementia through paper-and-pencil...

Dementia is a significant global public health concern. Accessible interventions are essential for supporting cognitive function and independent living, particularly in underserved rural areas. This study aimed to examine the effectiveness of paper-and-pencil cognitive training in improving cognitive function and instrumental activities of daily living (ADL) among older adults with dementia in rural communities. A cluster randomized trial was conducted with one 50-minute session and a weekly home assignment over a 12-week period. Findings demonstrated large effect sizes for changes in overall cognition and Stroop color-word interference test accuracy, with 43.5 % to 84.6 % of participants in the intervention group showing reliable improvement compared to 8.3 % to 22.2 % in the control group. A significant group-by-time interaction was observed for instrumental ADL, with moderate effect size. These results highlight the potential for accessible, low-tech, non-pharmacological cognitive interventions to support older adults living with dementia in resource-limited rural settings.