Background
GREAT Cognitive Rehabilitation is an evidence-based programme developed specifically to help people with mild and moderate dementia, and their families. The aim is to enable people to function as well as possible in the everyday activities that are important to them. It is based on many years of research and cognitive rehabilitation has been recommended for people with dementia and their families for example in the UK NICE dementia guideline and by MSNAP.
How was GREAT Cognitive Rehabilitation developed?
GREAT has been adapted from a well-established approach for people who have cognitive impairment as a result of a brain injury. Initially the approach was adapted through working with individuals and then in a small-scale, single-site randomised controlled trial. Positive results led to a large-scale clinical trial called GREAT which stands for “Goal-oriented cognitive Rehabilitation in Early-stage Alzheimer’s and related dementias: a multi-centre single-blind randomised controlled Trial”. The study involved nearly 500 people with dementia and care partners, and demonstrated the positive effects of the approach, showing that it enabled people to function better in relation to the goals targeted in therapy. As part of the programme, the team developed the Bangor Goal-Setting Interview to assess how well therapy goals were achieved.
Can GREAT be offered in NHS services?
Following on from the trial, GREAT into Practice was an implementation project where researchers worked with NHS Trusts and practitioners to deliver GREAT cognitive rehabilitation as part of their clinical services.
The team worked with 11 NHS and private care providers, provided cognitive rehabilitation training to nearly100 practitioners and recorded intervention outcomes for 54 people with dementia. Despite a shorter 6-session protocol and the involvement of staff with diverse levels of experience, the outcomes proved even better than in the original trial. In addition, people receiving cognitive rehabilitation expressed high levels of satisfaction with the intervention, and practitioners felt more positive about their work. A linked study in a group of 4 care homes showed that people living in residential care could equally benefit from GREAT Cognitive Rehabilitation.
What support is available for practitioners and service providers wanting to offer GREAT Cognitive Rehabilitation?
The project team developed an e-learning course designed to provide practitioners with the skills to deliver GREAT Cognitive Rehabilitation to people with mild-to-moderate dementia. The GREAT goal-oriented cognitive rehabilitation (GREAT CR) eLearning course is available on the NHS Learning Hub for people with an NHS or UK University email address registered for a free account and is available to all including overseas users on the GREAT Cognitive Rehabilitation website. See below for more details. The team also produced two handbooks for practitioners which can be accessed as part of the e-learning course, and guidance on implementation for provider organisations.
How can people living with dementia and their families find out more?
This short animation explains the GREAT cognitive rehabilitation approach. Working with a group of people with dementia, the team co-produced a self-help guide for people with dementia based on principles of cognitive rehabilitation, called My Life, My Goals. This offers hope that it is possible to find ways of managing difficulties and live a good life with dementia. It is available on the Living With Dementia Toolkit. It can be used by individuals and families, and by practitioners to support people they are working with.
Next steps
GREAT Cognitive Rehabilitation could form a valuable component of post-diagnostic support offered by NHS memory services or social care providers and dementia care services should now increase their capacity to offer cognitive rehabilitation to people with dementia. More information about rehabilitation for people living with dementia can be found in the World Alzheimer Report 2025 ‘Reimagining Life with Dementia: The Power of Rehabilitation’.
GREAT Cognitive Rehabilitation has been introduced in Norway and Ireland. The team is open to any collaborations that can help to make rehabilitation more widely available for people living with dementia.
Further reading
Further information
More about the GREAT Cognitive Rehabilitation e-learning course
Featuring research evidence, real-life stories, videos and quizzes, this is an interactive way to learn the skills needed to offer GREAT CR to people with dementia and their families.
GREAT goal-oriented cognitive rehabilitation (GREAT CR) is a personalised intervention that supports functional ability for people with mild-to-moderate dementia. It helps people maintain independence by more effectively managing the impact of dementia on their ability to engage in everyday activities. GREAT CR is conducted in people’s own homes over several sessions with a practitioner, who works with the person and the care partner to identify realistic and meaningful goals, plan ways of addressing these, and support goal attainment. GREAT stands for goal-oriented rehabilitation in early-stage Alzheimer’s and other dementias.
The course includes:
• The principles of GREAT CR
• How to work with clients to formulate individual rehabilitation goals
• How to apply a range of rehabilitative strategies to enable people to attain their goals
• How to evaluate client progress and make adaptations where needed
• Access to a handbook and other resources to use in your work with clients.
The GREAT goal-oriented cognitive rehabilitation eLearning course is suitable for health and social care practitioners, assistants and trainees who support people with dementia, including occupational therapists, nurses and psychologists. Managers who lead services where practitioners work in this way may also find the course useful.
If you have an NHS or University email address. you can sign up to the free course here. If not, you can find it on the GREAT Cognitive Rehabilitation website.
Resources
- GREAT goal-oriented cognitive rehabilitation (GREAT CR) eLearning course Download