Cognitive Stimulation Therapy

There are a number of interventions or approaches to help people with dementia improve their memory and thinking skills to enable them to cope better with memory loss.

One of the interventions for which there is most evidence in terms of clinical and costeffectiveness is Cognitive Stimulation Therapy (CST). Key points:

• CST has been found to help the memory and thinking skills of people with mild to moderate dementia. Studies have mainly been conducted with people with Alzheimer’s disease or mixed dementia, but CST would be relevant to all.
• People with dementia who took part in the therapy group reported improved quality of life
• CST was found to be a cost-effective intervention and offers value for money
• National Institute for Health and Care Excellence (NICE) and Social Care Institute for Excellence (SCIE) guidance (2006) recommend that people with mild to moderate dementia should be given the opportunity to take part in a CST programme.

CST involves 14 sessions of structured 45-minute group therapy sessions. Sessions run twice a week over 7 weeks and each one covers a different theme. To make sure that there is continuity between the sessions they include the same structure, such as the warm-up activity, a song and a ‘reality orientation board’ at the beginning of every session which has information on the group, details including date, time, place, weather. Members give their group a name and sessions cover a range of activities to stimulate thinking, memory and to connect with others such as by:

• discussing current news stories
• listening to music or singing
• playing word games
• doing a practical activity such as baking which involves measuring ingredients and following a recipe.

The sessions are intended for people with mild to moderate dementia. They are designed to be relaxed, fun and to create opportunities for people to learn, express their views and work with others in a sociable setting.

A training manual and DVD have been developed with guidance on how to plan and run the sessions and different ways to check progress. The manual has been translated and adapted for other cultures and countries. There is a maintenance programme of CST that can be followed after the initial seven weeks of the CST programme. Maintenance CST (MCST) consists of an additional 24 weekly sessions that follow the same structure and principles as the CST programme, with a specific theme including orientation-based activity, refreshments and a group song. Some regional branches of Age UK have been following the MCST guidelines.

Most people taking part in CST find it useful and many people with dementia commented that it was fun. MCST helped improve the quality of life of those taking part: this was observed from self-reports by people with dementia at 6 months, and also from reports by their family or other carers at 3 months.

CST is now also being used globally, with work ongoing in at least 29 countries. The International CST Centre was set up to co-ordinate this work and it is directed by Prof Aimee Spector. Other aims of the centre are to:

• Share information and encourage collaboration between professionals and consumers internationally
• Bring people together for annual CST conferences / training days.