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Cginitive Stimulation Therapy can be as good as medication in dementia
Sep 6, 2003, 20:30, Reviewed by: Dr.
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By Ashwin, UK Correspondent,
Cognitive stimulation therapy (CST) seems to be as effective as the drugs used to treat people with dementia
Published in the September issue of the British Journal of Psychiatry, a new study has found that CST appears to improve both cognitive function and quality of life
Psychological treatments for dementia have been in use for nearly half a century, but reliable studies on their effectiveness have been few. A recent review found that a treatment called reality orientation led to significant improvements in both cognition and behaviour, but identified the need for large, well-designed multi-centre trials
The results of this review were used to develop a programme of evidence-based therapy focused on cognitive stimulation.
This study, a multi-centre, randomised controlled trial, recruited 201 older people with dementia in the London area attending day centres or living in residential homes. 115 people were randomised to the CST intervention group, and 86 to the control group
The 14-session CST programme ran twice a week for 45 minutes per session over seven weeks. Topics included using money, word games, the present day and famous faces. A �reality orientation board� was included, which displayed both personal and orientation information to provide a focus. This reminded people of the name and nature of their group, and created continuity
Each session began with a warm-up activity, such as a soft ball game, and multi-sensory stimulation was introduced where possible. Sessions encouraged the use of information processing rather than factual knowledge
97 participants in the treatment group and 70 in the control group were followed up. None of the participants had been prescribed drugs for the treatment of dementia
At follow-up the treatment group had significantly improved compared with the control group on three measures � the Mini-Mental State Examination; and the Alzheimer�s Disease Cognition Scales for Cognition and Quality of Life
The authors comment that generalised cognitive benefits result from inclusion in the programme. However, such groups probably need to be ongoing, at least weekly, to increase the chance of the relative benefits being sustained
There were also positive trends in communication in the treatment group, a factor that may be likely to deteriorate in people moving into residential care. This improvement may have been due to the small group context of the CST programme, which was new to the participants and perhaps exercised long-unused communication skills
Women reacted more favourably to the programme than men. This may have been because for men, being in the minority in most groups could have created discomfort and a reluctance to communicate
The results of this seven-week study compared favourably with those of 24- to 30-week trials of drugs for dementia. Some caution is required when comparing results, however, as the drug trials were for Alzheimer�s disease only, and drug and psychological therapies are very different forms of treatment
This is the first study to show improvements in quality of life in people participating in such a programme. The findings suggest that reality orientation groups, which are widely used in the UK and internationally, are likely to be beneficial
Future research needs to identify the most effective ways of teaching care staff to implement this programme; the possible benefits of longer-term CST; and the potential effects of combining CST with drug therapy
- Royal College of Psychiatrists
British Journal of Psychiatry
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