Cognitive Stimulation Therapy

BackgroundPsychological treatments for dementia are widely used in the UK and internationally, but only rarely have they been standardised, adequately evaluated or systematically implemented. There is increasing recognition that psychosocial interventions may have similar levels of effectiveness to medication, and both can be used in combination. Cognitive Stimulation Therapy (CST) is a 7-week cognitive-based approach for dementia that has been shown to be beneficial for cognition and quality of life and is cost-effective, but there is less conclusive evidence for the effects of CST over an extended period.Methods/DesignThis multi-centre, pragmatic randomised controlled trial (RCT) to assess the effectiveness and cost-effectiveness of Maintenance CST groups for dementia compares a intervention group who receive CST for 7 weeks followed by the Maintenance CST programme once a week for 24 weeks with the control group who receive CST for 7 weeks, followed by treatment as usual for 24 weeks.The primary outcome measures are quality of life of people with dementia assessed by the QoL-AD and cognition assessed by the ADAS-Cog. Secondary outcomes include the person with dementia's mood, behaviour, activities of daily living, ability to communicate and costs; as well as caregiver health-related quality of life. Using a 5% significance level, comparison of 230 participants will yield 80% power to detect a standardised difference of 0.39 on the ADAS-Cog between the groups. The trial includes a cost-effectiveness analysis from a public sector perspective.DiscussionA pilot study of longer-term Maintenance CST, offering 16 weekly sessions of maintenance following the initial CST programme, previously found a significant improvement in cognitive function (MMSE) for those on the intervention group. The study identified the need for a large-scale, multi-centre RCT to define the potential longer-term benefits of continuing the therapy. This study aims to provide definitive evidence of the potential efficacy of maintenance CST and establish how far the long-term benefits can be compared with antidementia drugs such as cholinesterase inhibitors.Trial RegistrationISRCTN26286067

Cognitive Stimulation Therapy (CST) is a cost-effective non-pharmacological intervention for dementia developed in the United Kingdom. Though CST has been adopted and implemented all over the world, there has not been a study to evaluate its effectiveness across multiple counties. This study analyzes existing data from CST groups in USA, Hong Kong, and Brazil to evaluate the primary outcomes CST for persons with dementia. Paired sample t-tests were conducted to evaluate the effect of CST on cognition, quality of life, physical function, and depression across the countries. Among the USA CST groups (N=288), significant t-test were calculated for cognition, t(261) = -7.412, p< 0.01, quality of life, t(199) = -8.707, p< 0.01, and depression, t(254) = 6.347, p< 0.01. A non-significant t-test was calculated for physical function, t(103) = 1.262, p=0.21. Among the Hong Kong CST groups (N=408), significant t-tests were calculated for cognition, t(204) = 3.125, p< 0.01, depression, t(236) = 3.084, p< 0.01. However, non-significant t-tests were calculated for quality of life, t(376) = -0.614, p=0.539, physical function, t(84) = -0.888, p=0.377. On the other hand, among Brazil CST groups (N=47), significant t-test was calculated for cognition, t(46) = -2.961, p< 0.01. However, non-significant t-tests were calculated for quality of life, t(46) = -1.760, p=0.085, physical function, t(46) = -0.250, p=0.804, and depression, t(46) = 0.345, p=0.690. There are cultural and demographic factors that influence the effectiveness of interventions like CST. As CST is being implemented as a cost-effective non-pharmacological intervention for dementia and Alzheimer’s worldwide, its cultural applicability is worth exploring.

Clinical guidelines recommend personalized activities and group cognitive stimulation therapy (CST) for promoting cognition, independence, and well-being in persons with dementia. Constructive engagement (CE), the state of being occupied positively in purposeful activities, is theoretically an essential process in personalized activities and CST. However, whether CE develops over time and what contributes to it are unknown. We investigated changes in CE during CST and its contributors. This is a mixed-methods study. We used time sampling to record the time proportion of persons with dementia (n=113) spent in constructive, passive, non-task-related engagement and non-engagement during early, middle, and late phases in a 14-session group CST. We tested changes in time proportion between phases using repeated analysis of variance (ANOVA). We analyzed qualitative interviews of CST facilitators (n=12) thematically to explore contributors to CE. Persons with dementia spent 51% and 46% of their time in constructive and passive engagement, respectively. Time of engagement in non-task-related activities and non-engagement was minimal. CE remained stable at around 50% of activity time throughout the intervention course, except for a slight increase from the early to middle phase (48% to 55%, F (2224)=3.779, p<0.05). Age (r=-0.26, p<0.01), cognitive function (r=-0.29, p<0.01), and activities of daily living (r=0.20, p<0.05) at baseline were significantly correlated with CE, but gender and education were not. Contributors to CE include (1) tailoring activities, (2) using group dynamics, and (3) promoting positive experiences. Group CST engages persons with dementia well, regardless of their differences in gender and literacy levels. CE remained relatively stable during CST, and younger, more physically and cognitively able people showed slightly greater CE. In group-based interventions, facilitators' skills and techniques could enhance CE. Future studies may focus on how CE as a plausible change mechanism further improves the intervention outcomes of persons with dementia. Cognitive stimulation therapy (CST) is a non-pharmacological intervention that involves group-based activities and exercises to improve cognition and quality of life for persons with dementia, but the specific mechanisms behind it are not yet fully understood.This study is the first to investigate constructive engagement (CE), which describes active involvement in meaningful activities or complex interventions, specifically CST, for persons with dementia.CST engages them well, regardless of gender and literacy differences. CE time increases at the early intervention phase and stabilizes later on. CE occupies around half of the intervention time throughout CST, which can still be further increased by activity design and facilitators' skills.

Objectives: Cognitive stimulation therapy (CST) is a brief, non-pharmacological intervention for people with dementia, with an established evidence base for improving cognition and quality of life. It is widely implemented in National Health Service (NHS) settings, but little is known about its naturalistic use. The aim of this survey was to identify and explore inclusion criteria, dose and quality of CST across services in Great Britain (England, Scotland and Wales).Methods: All NHS memory clinics and services for people with dementia were contacted and asked to complete a mixed methods online survey on CST delivery in their service. Questions were centred on who provided CST, who received CST, the dose of CST and any outcomes that were routinely measured.Results: A total of 57/186 services responded, giving a response rate of 30.7%. While the majority reported offering CST (87.7%), there was variability in how this was delivered. Differing inclusion criteria included the use of varying cognitive and behavioural outcome measures, and CST was reported as being offered once and twice weekly. Services also differed in how they evaluated the quality of CST and how this evidence was incorporated for future sessions.Conclusion: While there was a low response rate, this survey indicates that there is significant variability in how CST is used in clinical practice, with many trusts not adhering to the evidence base. To ensure that people with dementia are consistently offered evidence-based, high-quality CST across NHS settings, further standardisation of inclusion criteria, dose and outcomes is needed.

Cognitive stimulation therapy (CST) is a psychosocial group treatment for people with dementia. The aims of this project were to (a) evaluate the effectiveness of a one-day training workshop; (b) measure the uptake of CST following the workshops; and (c) explore the barriers of implementing CST. Ten workshops were conducted. Attendees completed a self-evaluation at the end of the training day and were later invited to complete an online survey enquiring about implementation. Two hundred and fourteen workshop attendees completed the self-evaluation. The mean self-rated knowledge and skills for conducting and facilitating CST (1 = No skills, 5 = Very good skills) was 2.3 (SD = 1.2) and 4.3 (SD = 0.7) before and after the workshop, respectively (p = 0.000). The mean self-rated confidence for applying learning to conducting and facilitating CST was 4.2 (SD = 0.7) (1 = Not confident, 5 = Very confident). There were 11 CST programmes started after the workshops and another 10 sites were in the process of starting CST programmes. The main barriers of implementation were lack of staff time/funding and problems of finding suitable participants with dementia. The one-day training workshop is an effective method to disseminate CST. Addressing the barriers identified could improve the adoption of CST in practice.

Impact of Exercise and Cognitive Stimulation Therapy on Physical Function, Cognition and Muscle Mass in Pre-Frail Older Adults in the Primary Care Setting: A Cluster Randomized Controlled Trial

Objectives To explore the effectiveness of an adapted 14-week cognitive stimulation therapy (CST) protocol on psychoaffective symptoms and quality of life (QOL) for people living with mild dementia. Method The sample for this pragmatic study were people with dementia who underwent CST between May 2016 and September 2022 during routine healthcare. Measures of participants’ psychoaffective symptoms and QOL were administered before CST (‘baseline’) and following CST (‘post-intervention’). The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety symptoms, depression symptoms, and their sum score (referred to as HADS-total). The Quality of Life-Alzheimer’s Disease (QOL-AD) scale was used to measure participants’ quality of life (both patient and carer ratings were available). Change in these outcomes was assessed using linear mixed models. Results Two hundred and twenty-five participants attended ≥1 session of adapted CST (84% attended at least 9/14 sessions, considered ‘high’ adherence). The mean change [95% confidence interval] in HADS-total scores indicated improvement (−0.9; [−1.9, −0.0]). Mean scores on the other outcomes showed neither improvement nor worsening. Conclusion Overall, this pragmatic study shows that an adapted 14-week face-to-face CST protocol is effective in improving mental health in people with mild dementia and has the potential to be widely implemented within routine healthcare.

Cognitive Stimulation Therapy (CST) is an evidence-based, non-pharmacological intervention for older adults with mild to moderate dementia. While CST has been adapted in various ways, this study explored the impact of adding a spiritual dimension to CST. Participants (N = 34) were divided into spiritual and traditional CST groups based on their residence. After a 14-session intervention involving interactive conversations, the spiritual CST group showed significantly lower depression scores (M = 2.7) compared to traditional CST (M = 6.5). With the global increase in dementia-related disorders, non-pharmacological interventions like CST offer crucial support for addressing memory loss. Social workers are uniquely positioned to deliver CST to diverse populations who value spirituality or faith in their daily lives.

BackgroundThe “Cogs Club” is a multi‐modal intervention based on the Cognitive Stimulation Therapy (CST, Spector A.).CST is cost‐effective for people with mild‐to‐moderate dementia and is recommended in the UK by NICE. CST, in our adaptative model, is related to other psycho‐social activities (OT, music, physical activity). Cogs Club changes a traditional session of about an hour into 4 hours of activities.Objectives: the aim of this study is to verify the efficacy of this muldimodal psychosocial interventionMethodthe project is promoted by the local Alzhemer’s associations situated in Modena (Italy) and conducted by 3 professionals (a psychologist, an OT and a fisioterapist) who provide scheduled interventions ad : cognitive stimulation therapy (CST), occupational therapy and physical activities with music. Partecipants who took part in the study (n° 26 people with mild‐ moderate Alzheimer’s dementia, M9: F17, mean age 78.23 ±5.11 years, education: 7.2 ± 3.86 years) were submitted at T0 (basal evaluation) and T1 (after 3 months) to an assessment composed by ACE‐R, GDS‐15, DAD, QoL‐AD and ZBI. People with sensorial deficit, motor or behaviour disorder was excluded.Resultat T1 all indicators (cognitive: MMSE 22,6 vs 23,4, p 0,096; ACE – R 63,54 vs 65,96 p 0,066; functional: DAD 0,68 vs 0,69, p 0,103; emotional‐affective : GDS 5,35 vs 4,12 p 0,039 and quality of life : QoL AD pz 31,5 vs 33,38, p 0.129; Qol AD cg: 29,04 vs 30,96, p 0,459) of the PWD have improved even if only the depression is of clinical relevance. Regarding the caregiver we found an improvement in their quality of life even with an increase in perceived care stress (Zarit 34,09 vs 36,65, p 0,098).Conclusionthe purpose of the project is also to create a context for the socialisation and a net of formal and informal connection to people with mild‐ moderate dementia who traditionally don’t ask to access health services. The main goal is to delay as much as possible the development of the disability but further studies are necessary to encourage this preliminary results.

Introduction: Dementia and cognitive impairment are major causes of admission to Nursing Homes. These conditions also lead to caregiver burden and decrease quality of life. Cognitive Stimulation Therapy (CST) is an evidence-based psychosocial intervention for people with dementia, recommended and implemented in many countries, including Brazil.Objectives: The aim of the current study is to explore the feasibility and preliminary results of CST protocol in nursing homes for elders with cognitive impairment or dementia in Brazil.Methods: Older adults with cognitive impairment were invited to participate in this study. Thirteen participants from two nursing homes were assessed at baseline with the Cambridge Cognitive Examination (CAMCOG), Cornell Scale for Depression in Dementia (CSDD), Pfeffer Functional Activities Questionnaire, Katz Activities of Daily Living Scale, Quality of Life in Alzheimer’s Disease (Qol-AD) and Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB). They were assigned to Usual Care/Waiting List and followed up for 7 weeks, being reassessed at the end of this period. Then, they underwent 14 CST sessions throughout 7 weeks and were reassessed at the end of the protocol. Repeated Measures ANOVA was selected to assess differences in time. This study was approved by the Ethics committee of the Federal University of Minas Gerais.Results: There were no dropouts from the study, the CST protocol has shown to be feasible to be implemented in nursing homes. We found that the CST protocol had no statistically significant impact in CDR-SOB (F = 1.21, p = 0.315), CSDD (F = 1.61, p = 0.221), CAMCOG (F = 0.914, p = 0.414), but showed a statistically significant change in the Qol-AD scale (F = 3.618, p = 0.042). However, Mauchly’s test of sphericity is violated, and since it may lead to increased type I error, it is still premature to define a positive outcome.Conclusions: These preliminary results are consistent with the previous literature, suggesting that the CST could be a useful psychosocial intervention to improve the quality of life of people with dementia living in nursing homes. Nevertheless, more participants need to be enrolled to address further consistent.

Cognitive Stimulation Therapy is a well-established, cognition-based intervention for people with mild to moderate dementia. However, it can be difficult for older people with dementia, particularly those living alone, to access Cognitive Stimulation Therapy groups in the community. Television offers familiar technology with potential to transmit material similar to that used in Cognitive Stimulation Therapy groups. Consequently, an interactive pilot television episode of Cognitive Stimulation Therapy was devised that adheres to the key principles and session themes of group Cognitive Stimulation Therapy. Consideration was given to the suitability of resources, on-screen visual cues, time given for the person with dementia viewing to process, consider and answer questions, possible interactions with the audience, and the grading of activities. The aim of the pilot episode was to be accessible in the home of the person with dementia, by themselves or with a caregiver, with the potential for enjoyment and cognitive stimulation similar to that seen in group Cognitive Stimulation Therapy.

Study Highlights the Most Effective Treatments of NPS of Dementia

In recent years, there has been an increase in the recognition and use of psychosocial interventions for dementia. This has coincided with an increase in high-quality research in the area, and restrictions in the use of drug therapies for Alzheimer’s disease in the UK. Cognitive stimulation therapy (CST) is a brief group treatment for people with mild-to-moderate dementia, based on the theoretical concepts of reality orientation and cognitive stimulation. It involves 14 sessions of themed activities which typically run twice a week over a 7-week period. A multicenter, randomized controlled trial showed significant benefits in cognition and participant-rated quality of life when comparing CST versus no treatment. These benefits in cognition were comparable to those gained through medication, and CST also proved to be cost-effective. Influenced by this research, the latest guidelines released by NICE recommended cognitive stimulation only as an intervention for treating the cognitive symptoms of dementia. This perspective describes how CST was developed and evaluated, its use in clinical settings and issues for future investigation, such as individualized CST.

Access to psychosocial interventions for people with dementia, such as Cognitive Stimulation Therapy (CST), has been restricted during the COVID-19 pandemic. Some services have shifted to provision via videoconferencing, but the prevalence of this is unknown. This audit aimed to understand provision of virtual CST (vCST) within National Health Service (NHS) memory clinics throughout the UK and Channel Islands and investigate plans for ongoing CST provision. A cross-sectional survey was circulated to NHS memory clinics, which included closed and open-ended questions to generate quantitative and qualitative data. Thirty-three memory clinics responded to the survey. During the pandemic, 55% of respondents offered vCST, whereas 45% offered no CST. Of those offering vCST, 80% plan to continue with a hybrid model of separate face-to-face and vCST groups, whilst 20% intend to deliver face-to-face CST only. Reported positive aspects of vCST were participant and staff enjoyment, perceived improved digital confidence in participants, and improved accessibility for those who cannot attend face-to-face groups. Negative aspects related to digital poverty, limited digital literacy, support needed from carers, the impact of sensory impairment on engagement, and staff time commitment. Virtual CST has been a feasible alternative to face-to-face services during the pandemic but should not completely replace in-person groups. A hybrid approach would increase accessibility for all. Future research should explore efficacy of vCST and seek to understand patterns of exclusion from such digital interventions.

Introduction. Cognitive stimulation therapy (CST) used worldwide to treat cognitive impairment has recently attracted interest of Russian medical and scientific minds. However, when applied to Russian-speaking patients with dementia, CST requires adaptation. Aim. To evaluate the effectiveness and safety of the Russian-language version of CST for Russian-speaking patients with Alzheimer’s disease at the stage of moderate dementia.Materials and мethods. 8 participants involved into the trial were residents of social care center ZILANT diagnosed as dementia patients with Alzheimer’s, aged 76 ± 10.8 years, with the median MMSE score identified 17 ± 5.0. Before implementing the main course of CST developed by E. Spector et al we translated and localized it for Russian patients. The patients undergoing CST were assessed for the state of cognitive functions, everyday activity, mental symptoms, as well as enjoyment and involvement. One of the recruited patients was excluded due to restlessness and anxiety.Results. Seven patients had significantly improved on ADAS-Cog scale (p = 0.002), Lowton&amp;Brody and ADCS-ADL. The NPI scale indicated a reduction in symptoms of delirium and apathy which contributed to a reduction in antipsychotic dosages and a corresponding decrease in caregiver’s distress. The most striking indicator of CST effectiveness was improvements in the patient’s mood and satisfaction, which we view significant in everyday life and as an indicator of CST safety.Conclusion. The Russian-language version of CST proved effective and safe for moderate dementia patients with Alzheimer’s and can be recommended for implementing in clinical practice. This opens up prospects for studying CST as part of various drug strategies in treatment of dementia of various origins.