Cognitive Stimulation Therapy

A short video clip showing how Cognitive Stimulation Therapy is incorporated into Alzheimer Scotland's supports.

Cognitive Stimulation at Alzheimer Scotland

The NHS Institute for Health Research (2014) explains that Cognitive Stimulation Therapy (CST) is usually delivered to small groups of around 5-7 people, with fourteen 45 minute sessions delivered over seven weeks. The aim of CST is to create opportunities for group members to participate in activities designed to encourage thought processes, the use of memory and social interaction (NHS Institute for Health Research 2014). A different topic is focused on each week, however there is also an element of continuity to the design of the sessions (NHS Institute for Health Research 2014). Continuity is achieved by including some form of warm-up activity at the beginning of each session, the use of music and having a reality orientation board on display throughout the duration of the group (NHS Institute for Health Research 2014). The NHS Institute for Health Research (2014) explain that reality orientation boards used during CST groups should contain information about the group (for example the name, members or purpose), the date and the weather. Time should also be made during each session for group members to socialize and the groups should be kept relatively informal, creating a relaxed, safe and open environment (NHS Institute for Health Research 2014).

Spector et al (2003) completed a UK-based randomized control trail (RCT) with the aim of determining the impact that participation in CST has on cognition and quality of life for people living with dementia. The study was undertaken across 23 centres, consisting of 18 care homes and 5 day centres. Participants were randomly split into intervention and control groups, with a final number of 97 participants in treatment groups and 70 in control groups (Spector et al 2003).

Spector et al (2003) delivered the CST groups included in their study in a style consistent with the guidelines described by the NHS Institute for Health Research (2014). Participants of each group decided upon their own unique group name, which was displayed on a reality orientation board along with the current date and day. Sessions always opened with a warm-up exercise which was a gentle, non-cognitively demanding game, such as throwing a soft ball to one another. The groups typically lasted around 45 minutes and ran twice per week over 14 weeks (Spector et al 2003). Each session was based on a specific theme and activities aimed to encourage participants to use “information processing rather than factual knowledge. For example, in the ‘faces’ activity, people were asked, ‘who looks the youngest?’, ‘what do these people have in common?’, with factual information as an optional extra” (Spector et al 2003, p 249).

A Mini-Mental State Examination (MMSE) was completed with each participant prior to the commencement of the groups and again at the end of the 14 weeks of CST sessions (Spector et al 2003). In addition, a number of secondary assessments were also completed, the results of which were used as further measures to assess the success of the groups (Spector et al 2003). The secondary assessment measures used were: Alzheimer’s Disease Assessment Scale – Cognition (ADAS-Cog) (Rosen et al 1984); The Quality of Life - Alzheimer’s Disease Scale (Logsdon et al 1999); The Holden Communication Scale (Holden and Woods 1995); The Clifton Assessment Procedures for the Elderly – Behaviour Rating Scale (Pattie and Gilleard 1979); The Clinical Dementia Rating Scale (Hughes et al 1982), The Cornell Scale for Depression in Dementia (Alexopoulos et al 1982) and Rating Anxiety in Dementia (Shankar et al 1999).

The results of the study indicated that participation in the 14 week programme of CST groups positively impacted group participants’ cognition, with higher scores being noted in the follow-up MMSE and ADAS-Cog assessments in comparison to the control group scores (Spector et al 2003). Furthermore, the treatment group scored higher in the Quality of Life Assessment, and marginally higher in the Holden Communication Scale. However, there was no difference in scores between the control and treatment groups’ Clifton Assessment Procedures for the Elderly – Behaviour Rating Scale, which assesses behaviour and functional ability; Rating Anxiety in Dementia and the Cornell Scale for Depression in Dementia (Spector et al 2003).

Overall, the results of Spector et al’s (2003) research positively support the use and benefits of CST as an intervention for people with dementia: there are encouraging results around the effectiveness of CST participation on cognition and quality of life. The authors argue that, when delivered correctly and appropriately, CST could be used in place of some drug-based interventions for people with mild to moderate dementia (Spector et al 2003). Streater et al (2016) completed an observational piece of research over one year with 89 people with dementia living in care homes and in the community. The aim of Streater et al’s (2016) study is similar to that of Spector et al’s (2003) research in that it seeks to identify any connection between participation in a CST group and cognition and quality of life for people with dementia (Streater et al 2016). Streater et al’s (2016) work also mirrors Spector et al’s (2003) study in that the MMSE and QOL – AD assessments were used as standardized outcome measures. Streater et al (2016) found that participation in a 14 week programme of a twice weekly CST group positively impacted group members’ cognition, with MMSE scores increasing following attendance in either 7 or 14 weeks of CST. Unlike Spector et al’s (2016) study, Streater et al (2016) did not report any marked improvement in participants’ QOL-AD scores.

There are elements of Streater et al’s (2016) research that should be noted as points that could potentially reduce the validity of their findings, for example: there was no control group, meaning that there were no comparative results obtained to analyse the difference between those who took part in CST and those who didn’t. Furthermore, the CST groups were not delivered or developed by the researchers and rather by members of staff within the included day centre, care home, day hospitals and memory clinics (Streater et al 2016). This creates a potential issue in that there is no guarantee that the groups were delivered in a uniform manner, meaning that participants may have taken part in different styles of group which may have an impact on their follow-up assessment scores (Streater et al 2016). Based on the findings of both Spector et al’s (2003) and Streater et al’s (2016) research, it can be concluded that there is strong evidence supporting the argument that CST has a positive impact on the cognition of people with dementia and also has the potential to improve overall quality of life.