As population longevity increases, living with cognitive disorders during a significant part of the remaining lifespan becomes a strong possibility for the majority of older adults. Therefore, the development of treatment strategies to address the principal causes of cognitive and functional decline is a healthcare priority. The aims of medical and psychological therapies vary according to clinical severity. In the stages of mild cognitive impairment and early dementia, maintaining personal independence and enjoyment of life is a major objective from individual, societal, and economical perspectives (Neugroschl and Wang, 2011; Mokhtari et al., 2012). Current anti-dementia drugs contribute to this goal to a very limited extent. In individuals with mild cognitive impairment these compounds do not prevent the onset of dementia (Raschetti et al., 2007), and in those diagnosed with early dementia, these compounds delay the worsening of symptoms only for several months (Kurz and Lautenschlager, 2010). Drugs with novel mechanisms of action are being developed for Alzheimer's disease and other neurodegenerative conditions. These have the potential to slow down the progression of pathology and expand the number of years for which patients remain at mild levels of cognitive and functional impairment. It is less likely that these treatments will stop cognitive and functional decline completely (Kurz and Perneczky, 2011). Therefore, psychosocial interventions are urgently needed in addition to current and future pharmacotherapy. At any level of cognitive and functional impairment the role of psychosocial interventions is to strengthen and make the best use of preserved skills in order to attain or maintain optimal levels of activity, participation, and interpersonal relationships. In contrast to drugs, psychosocial treatments primarily operate at the behavioral level. Some attempt to restore functions through cognitive, social, or physical activity, while others attempt to minimize disability through compensatory cognitive, behavioral, or environmental strategies. Recent research has shown that psychosocial interventions may increase regional cortical thickness or modify the pattern of neuronal network activation (Draganski and May, 2008; van Paasschen et al., 2009; Voss et al., 2010; Erickson et al., 2011). These neurobiological effects clearly demonstrate that brain plasticity persists into old age, but the relationship to behavioral gains and the importance for the prevention of cognitive decline (Lautenschlager et al., 2012; Steffener and Stern, 2012; Valenzuela et al., 2012) are currently unclear.
