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Effects of at-home cognitive stimulation therapy on dementia patients and caregivers

PLOS

Individual Cognitive Stimulation Therapy (iCST), an intervention carried out at home by family caregivers, has little impact on the cognition of patients with dementia, a new study has found, but boosts the quality of the relationship between the patient and caregiver. The new study, a randomized, controlled trial by Martin Orrell of the University of Nottingham, UK, and colleagues, is published in PLOS Medicine.

Cognitive Stimulation Therapy (CST), which involves activities designed to improve cognition and memory in people with dementia, is often used in group settings, at day centers or residential care facilities, but evidence is lacking on CST delivered individually in the home-care setting. In the new study, 356 people with mild to moderate dementia and their family caregivers were randomly assigned either to three 30 minute sessions of iCST per week, or to treatment as usual, for 25 weeks. Caregivers were given training on how to carry out individual CST sessions at home. Follow-up tests and surveys were completed at 26 weeks.

At the conclusion of the study period, patients who had been assigned to the iCST groups had no differences in cognition or self-reported quality of life compared to those in the control group. However, quality of life for caregivers was higher, and patients rated the relationship with their caregiver higher, in the iCST groups. The study was limited by low adherence to the intervention--only 40 percent of people in the iCST groups completed two sessions of the intervention per week, as assigned, and 22 percent completed no sessions at all.

"From a clinical perspective, improved quality of life for the caregiver, and an improved relationship for the person with dementia by means of a low cost, non-drug intervention are very worthwhile outcomes," the authors say. "The longer-term associated effect of reducing depression for caregivers who did more sessions may mean that caregivers remain better mentally, and perhaps physically, for longer."

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This research article appears in the PLOS Medicine Special Issue on Dementia, publishing each week throughout March.

Research Article

Funding:

This article presents independent research funded by the National Institute for Health Research (NIHR) under the Health Technologies Assessment (HTA) Programme (UK), grant number 08/116/06. The funders reviewed the grant proposal and provided feedback prior to awarding the grant. The grant holders are authors MO (University of Nottingham), AB (Manchester), IR (Swansea), RTW (Bangor), EMC (Hull), MK (LSE), and AS (UCL).

Competing Interests:

I have read the journal's policy and the authors of this manuscript have the following competing interests: LY, MO, PL, AS, RTW, and VO have a patent iCST Manual. MO reports grants from UCL during the conduct of the study and grants from UCL outside the submitted work. MO, AS, and RTW have a patent Making a Difference manuals 1 and 2. RTW reports royalties for the sales of the Making a Difference manuals (1,2, and 3) on behalf of DSDC Wales, Bangor University (Hawker Publications & Freiberg Press, US). AS reports personal fees from NHS trusts, outside the submitted work. AB reports personal fees from International Journal of Geriatric Psychiatry, personal fees from NHS England, personal fees from various lectures and talks, personal fees from occasional court reports, other from Kings College London, and other from DVLA, outside the submitted work. IR reports grants from UCL, both for the submitted work and outside the submitted work

Citation:

Orrell M, Yates L, Leung P, Kang S, Hoare Z, Whitaker C, et al. (2017) The impact of individual Cognitive Stimulation Therapy (iCST) on cognition, quality of life, caregiver health, and family relationships in dementia: A randomised controlled trial. PLoS Med 14(3): e1002269. doi:10.1371/journal.pmed.1002269

Author Affiliations:

Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
Division of Psychiatry, University College London (UCL), London, United Kingdom
North Wales Organisation for Randomised Trials in Health (& Social Care), University of Bangor, Bangor, United Kingdom
Whitaker Research Ltd., Bangor, United Kingdom
Institute of Brain, Behaviour and Mental Health, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
Personal Social Services Research Unit, London School of Economics and Political Science, London, United Kingdom
Faculty of Health and Social Care, University of Hull, Hull, United Kingdom
Devon Partnership NHS Trust, Devon, United Kingdom
Dorset Healthcare University NHS Foundation Trust, Dorset, United Kingdom
Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
Lincolnshire Partnership NHS Foundation Trust, Witham Court, Lincoln, United Kingdom
College of Medicine, Swansea University, Swansea, United Kingdom
Norfolk & Suffolk NHS Foundation Trust, Norwich, United Kingdom
South London and Maudsley NHS Foundation Trust, London, United Kingdom
Dementia Services Development Centre Wales, Bangor University, Bangor, United Kingdom

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