The Acceptability and Usefulness of Cognitive Stimulation Therapy for Older Adults with Dementia: A Narrative Review
Table 1
Overview of the studies reviewed in this paper.
Study
Purpose
Design and sample
Outcome measures
Results
Conclusion(s)
Spector et al. [10], “Efficacy of an Evidence-Based Cognitive Stimulation Therapy Intervention for People with Dementia: Randomised Controlled Trial”
To test the hypothesis that CST for older people with dementia would benefit cognition and quality of life
Single-blind, multicentre RCT with baseline, postintervention, and follow-up assessments
Intervention = 115 Controls = 86
Mini-Mental State Examination (MMSE); Quality of Life-Alzheimer’s Disease (QoL-AD); Alzheimer’s Disease Assessment Scale-Cognition (ADAS-Cog); Clifton Assessment Procedures for the Elderly Behaviour Rating Scale (CAPE-BRS); Clinical Dementia Rating (CDR); Cornell Scale for Depression in Dementia; Holden Communication Scale (HCS); Rating Anxiety in Dementia (RAID)
Intervention group had significantly improved relative to the control group on the following: MMSE () ADAS-Cog () QoL-AD ()
The results compare favourably with trials of drugs for dementia CST groups may have worthwhile benefits for many people with dementia
Woods et al. [11], “Improved Quality of Life and Cognitive Stimulation in Dementia”
To examine whether or not improvement in QoL following CST is mediated by change in cognitive function To identify whether there are any specific domains of QoL which change in response to CST
Uses data from study by Spector et al. [10] Statistical Analysis on association between baseline quality of life and clinical and demographic variables; predictors of change in quality of life between baseline and follow-up; change in quality of life in relation to change in other clinical variables; change in quality of life and cognitive change-mediation analysis
Improvement in QoL was associated with being female, low quality of life at baseline, reduced depression, and increased cognitive function Changes in cognitive function mediated the effects of treatment in improving QoL
QoL in dementia appears to be independent of level of cognitive function, and interventions aimed at improving cognitive function can, nonetheless, have a direct effect on QoL
Knapp et al. [13], “Cognitive Stimulation Therapy for People with Dementia: Cost Effectiveness Analysis”
To investigate the cost effectiveness of an evidence-based CST program for people with dementia as part of RCTs
Multi-centre RCT with baseline, post-intervention and follow-up assessments
Intervention = 91 Controls = 70
MMSE QoL-AD ADAS-Cog Client Service Receipt Inventory (CSRI) Unit cost Cost of CST
CST has benefits for cognition and QoL in dementia, and costs were not different between the groups.
CST for people with dementia has effectiveness advantages over and may be more cost-effective than treatment as usual
Spector et al. [7], “Cognitive Stimulation Therapy (CST): Effects on Different Areas of Cognitive Function for People with Dementia”
To investigate the effects of CST on specific areas of cognition by an analysis of the subsections of the ADAS-Cog
Uses data from study by Spector et al. (2003).
Uses data from study by Spector et al. (2003) on these measures: MMSE ADAS-Cog
There was a significant difference between treatment and control groups in total ADAS-Cog score () and in the language subscale () There were no significant changes in memory and orientation or praxis
CST appears to have particular effects in promoting language function
Spector et al. [12], “The impact of CST Groups on People with Dementia: Views from Participants, Their Carers, and Group Facilitators”
To investigate whether improvements found in clinical trials were also noted by people with dementia, their carers, and group facilitators in everyday life
Qualitative interviews and focus groups
Dementia = 17 Carer = 14 Facilitator = 7
Framework Analysis.
2 main themes: (i) “Positive experiences of being in the group” (ii) “Changes experienced in everyday life” Overall experience was seen as being emotionally positive and most participants reported some cognitive benefits
Findings supported previous quantitative findings, as well as providing information about the personal experience of CST
Orrell et al. [14], “Individual Cognitive Stimulation Therapy for Dementia (iCST): Study Protocol for a Randomized Controlled Trial”
To develop and evaluate a home-based individual cognitive stimulation therapy (iCST) program for people with dementia which can be delivered by their family carer
Multi-centre, single blind, randomized, two-treatment arm (iCST over 25 weeks versus treatment as usual, or TAU), controlled clinical trial
iCST = 153 TAU = 153
ADAS-Cog QoL-AD Health Survey Short Form-12 (SF-12)
Trial is ongoing
Many people with dementia are unable to access psychological interventions and hence, the development of a home-based individual version of CST will provide an easy to use, widely available therapy package
Aguirre et al. [9], “Cognitive stimulation Therapy (CST) for People with Dementia—Who Benefits Most?”
To investigate which factors may predict response to CST
Pre and Post Intervention assessment
all participants received intervention for 7 weeks
ADAS-Cog QoL-AD Dementia Quality of Life (DEMQOL) Neuropsychiatric Inventory (NPI) Alzheimer’s Disease Cooperative Study-Activities of Daily Living Inventory (ADCS-ADL)
Benefits of CST were independent of whether people were taking acetylcholinesterase inhibitor (AChEI) medication Increasing age and female gender were associated with cognitive benefits Care home residents improved more than community residents on quality of life, but the community sample seemed to benefit more in relation to behaviour problems
CST should enhance the benefits for people with dementia who are male and those younger than 80 years
Hall et al. [8], “Cognitive Stimulation Therapy (CST): Neuropsychological Mechanisms of Change”
To examine the effects of CST on specific cognitive domains and explore the neuropsychological processes underpinning any effects
One group pretest-posttest design
all participants received intervention for 7 weeks
MMSE Wechsler Memory Scale-III (i) Information and Orientation (ii) Logical Memory (iii) Visual Reproduction (iv) Digit Span Token Test Boston Naming Test-2 (BNT-2) D-KEFS Verbal Fluency Trail Making
Significant improvement before and after CST group on measures of delayed verbal recall (WMS III logical memory subtest, delayed), visual memory (WMS III visual reproduction subtest, delayed), orientation (WMS III information and orientation subscale), and auditory comprehension (Token Test) No significant changes on measures of naming (Boston Naming Test-2), attention (Trail Making Test A/Digit Span), executive function (DKEFS verbal fluency/Trail Making Test B), praxis (WMS III visual reproduction, immediate), or on a general cognitive screen (MMSE)
Memory, comprehension of syntax, and orientation appear to be the cognitive domains most impacted by CST
Yamanaka et al. [15], “Effects of Cognitive Stimulation Therapy Japanese Version (CST-J) for People with Dementia: A Single-Blind, Controlled Clinical Trial”
To develop the Japanese version of group CST (CST-J) and examine the effects of the program for Japanese people with mild-to-moderate dementia in long-term residential care settings
Single-blind, controlled clinical trials
Intervention = 26 Controls = 30
MMSE Neurobehavioral Cognitive Status Examination (COGNISTAT) QoL-AD EQ-5D Face scale
Significant improvements in COGNISTAT and MMSE for treatment group compared with the control group () EQ-5D was significant () and the QoL-AD showed a positive trend () when rated by care workers. Nonparametrical analysis: improvements in the face scale for mood when rated by both the participants () and the care workers ()
The CST-J shows promising improvements in cognition, mood, and aspects of QOL for people with dementia in Japanese care settings A large RCT is now needed
Aguirre et al. [23], “The Effects of a Cognitive Stimulation Therapy (CST) Intervention for People with Dementia on Family Caregivers’ Health”
To investigate the effect of CST on family caregivers general health status of people with dementia living in the community attending the CST intervention
Caregiver of people with dementia who attends standard CST intervention plus either maintenance CST or TAU. Pre and Post Intervention assessment (3 and 6 months follow up)
EQ-5D SF-12
No evidence for a benefit on the family caregiver outcome measures of the intervention before and after CST groups No significant differences between intervention and control groups for any of the variables considered at any time point
CST’s benefit for people with dementia that may not carry over to family carers Future studies need to further explore and compare the effects that CST might bring to family caregivers of people with dementia attending CST
Dotchin et al. [16], “Cognitive Stimulation Therapy (CST) as a Sustainable Intervention for Dementia in Low-Resource Settings: A Pilot Study in Nigeria and Tanzania as Part of the Idea (Identification and Interventions for Dementia in Elderly Africans) Project”
To conduct a pilot study of CST in two sites in Sub- Saharan Africa (SSA) in order to assess feasibility and likely utility of this method of intervention
Pilot study (Pre and Post Intervention assessment)
ADAS-COG (adapted) WHO-QOL BREV QOL-AD Hospital anxiety and depression scale (HADS) NPI World Health Organisation Disability Assessment Scale (WHO-DAS) Barthel index
Feedback from both participants and carers was overwhelmingly positive There were no significant differences in cognitive domains noted as measured by the ADAS-COG, although numbers in this pilot were likely to be too small to detect a difference Provisional results indicate small improvements in the primary outcome measure of quality of life
Initial pilot testing indicates that CST is a feasible intervention for dementia and may result in quality of life improvements for patients and carers in both sites
Yates et al. [21], “Service Users’ Involvement in the Development of Individual Cognitive Stimulation Therapy (iCST) for Dementia: A Qualitative Study”
To gain insight into perceptions of mental stimulation from the point of view of carers and people with dementia To ensure that the materials are easy to use, clear, and appropriately tailored to the needs of people with dementia and their carers To assess the feasibility of the intervention
Focus groups and Interviews
Dementia = 28 Carer = 24
Focus group in semistructured style guided by a series of predetermined focus points and questions (manual, workbook, activity, and feasibility) Interviews with people with dementia involved completing 2 iCST activities followed by discussion about their perception towards the activities Interviews with carers were to identify any practical issues that might affect the delivery of the program and to gather data about the quality and appropriateness of the activities and manuals
The importance of mental stimulation was emphasized by carers and people with dementia People with dementia saw activities as a way of “keeping up to date” and spending time in a meaningful way Carers reported benefits such as improved quality of life, mood, and memory The concept of iCST was well received, and both carers and people with dementia responded positively to the first drafts of materials Feasibility issues, such as finding time to do sessions, were identified
The feedback from the focus groups and interviews will be used to further develop and refine the iCST program materials in preparation for a field testing phase prior to a large scale randomized controlled trial (RCT)
