Cognitive stimulation games for Alzheimer’s: where does chess fit in?
Cognitive stimulation games for Alzheimer’s are activities that call on memory, attention and language, offered mainly at the mild and moderate stages. A Cochrane review of 37 trials concludes there is a small benefit from structured programmes. Full chess is rarely suitable, but simplified forms can appeal to former players.
Cognitive stimulation: structured activities that call on memory, attention, language and reasoning, offered in a group or individually, notably to people with mild to moderate dementia. It differs from cognitive training, which repeats exercises targeting a single function.
Cognitive stimulation games for Alzheimer’s: what the research says
Cognitive stimulation is one of the few non-drug interventions evaluated in genuine randomised trials. The reference synthesis is the Cochrane review updated in 2023.
Woods et al., 2023 (Cochrane) · Cochrane Database of Systematic Reviews · DOI 10.1002/14651858.CD005562.pub3
Cognitive stimulation to improve cognitive functioning in people with dementia
- Who
- 37 trials, 2,766 people with mild to moderate dementia
- Type
- Systematic review of randomised trials · level of evidence: Moderate to high
- Result
- Cognitive stimulation (generally about twenty group sessions over around ten weeks) probably brings a small cognitive benefit, equivalent to about six months of decline avoided, as well as effects on communication and mood.
- What the study does not say
- Few data on long programmes; chess is not studied as such.
Three practical lessons emerge. First, the benefit is small but real, and comes with effects on mood, communication and social exchange. Second, the programmes evaluated are regular and collective: about two sessions a week over several weeks, in a small group. Finally, the activities are varied (discussion, word games, categorisation, memories, board games): no single game is “the” right game.
In France, the Haute Autorité de santé (the national health authority) published a guide in May 2018 on the care pathway for patients with a neurocognitive disorder associated with Alzheimer’s disease or a related illness. It stresses non-drug interventions from the first signs, to preserve independence and well-being, and puts the general practitioner at the centre of the pathway. Family associations, such as France Alzheimer, also offer activities and support groups for carers.
For chess in particular, the literature is thin: the review by Lillo-Crespo and colleagues (2019) concludes that the game seems more promising for prevention than after diagnosis, for want of trials in people with the illness. The population studies are detailed on the page chess and Alzheimer’s.
Which game for which stage of the illness
The table below gives guidance for running activities, not prescriptions: each person has their own history, tastes and abilities, which vary from one day to the next.
| Game | Functions used | Equipment | Independence required | Best-suited stage (guide) |
|---|---|---|---|---|
| Full chess | Planning, sustained attention, working memory | Chessboard, legible pieces | High | People with no or very mild impairment, former players |
| Simplified chess (mini-games, problems) | Recognition, attention, procedural memory | Chessboard, a few pieces | Medium, with a helper | Mild, sometimes moderate in former players |
| Draughts | Attention, simple anticipation | Draughtboard, pieces | Medium | Mild to moderate |
| Dominoes | Matching, counting, taking turns | Dominoes with large spots | Low to medium | Mild to moderate |
| Mahjong (simple version) | Visual recognition, categorisation | Tiles | Medium | Mild, in people who already know it |
| Memory | Short-term visual memory | Pairs of pictures (familiar photos possible) | Low | Mild to moderate, with few pairs |
| Lotto | Listening, number recognition, attention | Cards, counters | Low | Moderate, and in a group |
At the severe stage, stimulation works more through the senses (music, touch, familiar objects) than through the rules of a game. Handling beautiful wooden pieces, putting them away in their box or setting up the board can remain a pleasant moment for a former player, even without a game.
Simplified chess: six exercise ideas
For a person who used to play chess, the full game often becomes too demanding with the illness. Reduced forms keep the pleasure of the pieces and the board.
- Naming and placing the pieces. Set up the starting position together, naming each piece. It is an exercise in long-term memory, often well preserved in former players.
- The pawn battle. Each side has only its eight pawns; the first to bring a pawn to the last rank wins. A short rule, a short game.
- King and pawns. Add the kings: you must protect your own while advancing. A step towards the full game.
- Mate in one. A simple position, only one right answer. Choose positions where the solution is visible, so the session ends on a success.
- Replaying a famous game. The facilitator reads out the moves, the person moves the pieces. No calculation, but attention and enjoyment.
- The four-hand game. Two teams of two players: the conversation counts as much as the move.
Free, or almost free, games
There is no shortage of free cognitive stimulation games: a pack of cards, family photos turned into a Memory game, a lotto made with cut-out pictures, a large-print crossword grid. The old chessboard from the attic will do too. What matters, more than the equipment, is having a partner and holding sessions regularly.
For daily use, large, contrasting pieces, a board that does not slide and games that are easy to grasp for less dexterous hands make things easier. For variety, Le Palais des Échecs also offers wooden draughts, dominoes and mahjong sets, which are pleasant to handle.
Stimulating without setting up for failure
The question “how do you stimulate someone with Alzheimer’s?” often comes up among carers. Experienced facilitators share a few principles.
- Aim for success. A session should end on a success. If the person makes a mistake, rephrase, help, and do not correct sharply.
- Start from their history. A former chess, belote or dominoes player will find familiar gestures more easily than a new game.
- Choose the right time. Many people are more available in the morning; end-of-day tiredness makes games difficult.
- Keep it short. Twenty to thirty minutes is often enough. It is better to stop while it is still enjoyable.
- Accept “house rules”. If the person makes an illegal move, it does not matter: the aim is the shared moment, not the perfect game.
What games do not do
- They do not slow the illness enough to replace medical follow-up or prescribed treatments.
- They are not a test: failing at a game says nothing precise about how the illness is progressing.
- Imposing a game that puts the person in difficulty can be more anxiety-inducing than stimulating.
To go further: running a chess workshop in a care home and understanding cognitive reserve.
Frequently asked questions
How do you stimulate someone with Alzheimer’s?
With activities that are meaningful to them and that they can succeed at: simplified familiar games, music, memories, everyday tasks. Short, regular, group sessions are the ones best evaluated in cognitive stimulation trials.
Which exercise for Alzheimer’s?
There is no single exercise. The programmes evaluated combine discussion, word games, categorisation, reminiscence and board games. Adapted physical activity is also recommended for general health.
Which games work the memory?
Memory, lotto, dominoes, card games and, for former players, simplified forms of chess. The important thing is to adjust the difficulty so that the person succeeds.
What is cognitive stimulation?
These are structured activities that call on memory, attention, language and reasoning, often in a small group. According to the 2023 Cochrane review, it brings a small cognitive benefit in people with mild to moderate dementia.