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Professional & Specialists (includes volunteers)

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Aim

The literature regarding the effectiveness of CST for individuals with dementia will be critically evaluated.

Learning outcomes

After completing the module, you will know:

  • How CST was evaluated,
  • Which are the main results of CST evaluation?

Introduction

Several studies have been conducted to evaluate the effectiveness and the usefulness of CST internationally. The literature search showed that more than 120 papers have been written, concerning CST evaluation, of which 8 were randomized-controlled trials (RCTs) that provide higher levels of evidence since randomization allows for equal distribution of variables of interest. Some of these surveys were conducted in UK, Hong Kong, Japan, Tanzania and Portugal. Below the common results among these surveys are presented [1,2].

3.5.1 Cognitive improvement

Based on various systematic reviews, an indication of improved cognition was found using CST. The commonly used tools are the Mini Mental State Examination (MMSE) and the Alzheimer’s Disease Assessment Scale-Cognition (ADAS-Cog), which ask a number of questions to ascertain cognitive status of people with dementia. More precisely, these tests primarily investigate memory and orientation, but also language and visuospatial abilities and include items such as word recalling, naming, commands, constructional praxis, ideational praxis, orientation, word recognition, spoken language, comprehension, word-finding, and remembering instructions. Results indicated that the items “commands” and “spoken language” showed significant difference favouring the intervention group against the team that receiving a different kind of therapy.

Besides language, study by Hall et al. also found that people with dementia who underwent CST had remarkably improved in memory, comprehension of syntax, and orientation.  In addition, the research by Aguirre et al., pointed out the influence of demographic variables on the effects of CST on cognition of people with dementia. The research outcomes showed that age and gender are two significant predictors of the outcome of the study. There was a greater effect found among older participants in the study (older than 80 years) as compared to the participants from younger age group. Furthermore, female participants showed greater cognitive improvement compared to male participants [3,4].

3.5.2 Quality of life

A person’s well-being is considered as a key issue in many aspects of dementia care. Besides the significant improvement in cognitive function, CST intervention offers to individuals with dementia, an enhancement in the quality of their lives (QoL). More specifically, 201 people with dementia living in residential homes or attending day centers were assessed using the Quality of Life-Alzheimer’s Disease scale (QOL-AD) measuring the level of cognition, mood, communication, and dependency to the carer. The impressive results showed that the improvement of QoL had a significant positive correlation with lower levels of dependency and depression, as well as with greater willingness to engage in conversation and communication [4,5].

3.5.3 Cost-effectiveness

Cost-effectiveness analyses were conducted in conjunction with researchers at the London School of Economics and Political Science (LSE) for the CST trials. These studies found that CST is more cost-effective than usual care, especially when looking at benefits in cognition and quality of life considering also the low cost of CST [5].

Synopsis

Key points:

  • CST evaluation showed changes and more specifically an improvement in thinking skills, in the quality of patients’ daily life, and offers value for money.

1. List of references

  1. Toh, M., H., Ghazali, E., S., Subramaniam, P. (2016). The acceptability and usefulness of CST for older adults with dementia: A narrative review. https://www.hindawi.com/journals/ijad/2016/5131570/
  2. Quayhagen, M., P., Quayhagen, M., Corbeil, R., R. et al. (2000). Coping with dementia: evaluation of four nonpharmacologic interventions. International Psychogeriatrics, vol. 12, no. 2, pp. 249–265.
  3. T., Shazli, G., Ponnusamy, S. (2016). The acceptability and usefulness of CST for older adults with dementia: a narrative review. International Journal of Alzheimer’s Disease. https://www.hindawi.com/journals/ijad/2016/5131570/
  4. Frieri, L. (2010). Critical Review: Effectiveness of cognitive stimulation therapy groups for individuals with dementia. https://www.uwo.ca/fhs/lwm/teaching/EBP/2009-10/Frieri.pdf
  5. Woods, B., Spector, A et al. (2006). Improved quality of life and cognitive stimulation therapy in dementia. https://pubmed.ncbi.nlm.nih.gov/16777649/
  6. MODEM, Cognitive stimulation therapy. https://toolkit.modem-dementia.org.uk/wp-content/uploads/2016/04/CST-Intervention-Summary.pdf

2. Further reading