Reconstructing Social Connection Interventions for People with Dementia: Preserving Core Active Components While Reducing Cognitive and Implementation Burdens

Social connection has been consistently associated with slower decline in cognitive and functional abilities, reduced behavioral and psychological symptoms of dementia (BPSD), and delayed institutionalization in people with dementia, as demonstrated by multiple longitudinal and epidemiological studies (Crooks et al., 2008; Röhr et al., 2020). However, conventional interventions that promote social participation and interaction are often designed on the assumption that individuals retain sufficient motivation, attention, executive function, and interpersonal coordination skills—capacities that are typically compromised in people with dementia, making implementation and continuation of such interventions difficult. Consequently, interventions that are theoretically effective often fail to function adequately in real-world clinical and care settings. This paper aims to reconceptualize social connection interventions for people with dementia by systematically distinguishing between “core active components that drive therapeutic effects” and “ancillary elements that impose excessive cognitive or operational burdens.” Based on an integration of observational studies, intervention research, and neuropsychiatric evidence, we propose an implementation-adapted model comprising three minimal components: (1) brief daily face-to-face interactions lasting approximately 5–10 minutes; (2) support to ensure at least weekly contact with someone outside the household; and (3) person-centered communication that emphasizes name usage, eye contact, and affirmative responses. These components do not directly modify the neurodegenerative pathology of dementia. However, they hold essential value in mitigating “accelerating factors” of disease progression—such as social isolation, apathy, depression, and BPSD (Kitwood, 1997; Tible et al., 2017). As a low-cost, non-pharmacological intervention that prioritizes feasibility, safety, and sustainability, this model is considered to have high practical utility for both clinical practice and long-term care policy.