Cognitive skills are the skills the brain uses to think, learn, remember, problem solve and communicate. There are a number of approaches (we call them interventions) to help people with dementia improve their memory and thinking skills and to cope with memory loss, one of these is Cognitive Stimulation Therapy (CST). CST has been developed by reviewing the best available research on approaches to improve cognitive skills for people with dementia. There is a training manual and DVD with information on how the therapy sessions should be carried out.
Key points:
Cognitive Stimulation Therapy involves 14 sessions of structured 45 minute group therapy sessions. The sessions run over 7 weeks and each one covers a different topic. To make sure that there is continuity between the sessions they include some activities which are the same such as the warm-up activity, a song and a ‘reality orientation board’ 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:
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 (3) has been developed with guidance on how to plan and run the sessions and different ways to check progress. This has been translated and adapted for other countries. (4)
There is a longer version of CST called ‘maintenance CST’ (MCST) and this is covered in a separate summary
Many people with dementia want to find ways improve their memory and thinking skills and cope with memory loss. While there are some drugs that help people in some stages of Alzheimer’s disease, they are not suitable for everybody and only have a limited effect.
CST is important because, as well as stimulating the mind, the group sessions offer an opportunity to share experiences and talk with other people with dementia in a relaxed and supportive environment. Being part of the group helps to their build self esteem so they feel better about themselves and more confident to join in conversations and activities.
Improved cognitive skills and quality of life
CST has been found to significantly benefit the memory and thinking skills of most people with mild to moderate dementia. (2,5) People with dementia who took part in the therapy programme said that there was an improvement in the quality of their daily life. (13) Some carers and relatives said that there was an improvement in language and the willingness of people with dementia to join in conversations. (12)
These findings are based on two studies, in the first one, a randomised controlled trial (RCT) (2) the people taking part were put into two groups by a computer. The first group took part in CST in addition to being given their normal care. The second group were given their normal care. In this trial most of the people with dementia were living in care homes. Its findings were confirmed by a second study (5) where half of the people were living in their own home and half in care homes. The first trial (2) found that CST worked as well as drugs commonly prescribed for mild to moderate Alzheimer’ s disease (usually donepezil) and the second study (5) that CST had benefits for people in addition to the benefits from taking the medication.
Smaller pilot studies of adapted versions of CST in Chile and Japan have also reported benefits in memory and thinking skills and quality of life. (6, 7).
These findings are supported in the Cochrane review on cognitive stimulation that was carried out in 2012. (1)
Research has shown that CST offers value for money (we call this cost effective). It is not an expensive programme and it has significant benefits to the thinking and memory skills of the people who take part in it.
A study, based on the first trial, looked into whether CST is cost-effective. (8) The health and social care costs of those taking part in CST were slightly higher than the costs of the group having their normal care. The additional cost was £20 per person over 8 weeks, which included the costs of CST itself.
Researchers compared this cost to the improvement CST made to the thinking, memory and quality of life of people with dementia. To measure the benefit they used questionnaires commonly used to assess the progression of dementia. The cost of achieving a one point improvement in thinking and memory, using a thirty point scale called the mini-mental state examination (MMSE), was £90. The cost of achieving one point improvement in quality of life (using a thirteen point scale called Qol-AD) was £27. The researchers concluded that CST is cost effective.
The cost of CST for the NHS (at 2016 prices)
In the trial CST cost, on average, £241.90 per person over 8 weeks (£30.49 a week). In the trial CST was delivered by researchers, whereas in practice it is usually delivered by trained care staff, which would reduce the cost. However it is not known if this would make any difference to the benefits of CST.
People with dementia, family carers and staff facilitating the CST groups were asked for their views on the CST programme(12):
What they liked
People with dementia who took part in the group sessions thought:
‘First thing it was fun, because nobody, well it was serious but it was enjoyable, yes it was enjoyable . . . There was an awful lot of laughing’. (p.947)
‘It’s made me a bit more confident, you know at the beginning I was a bit hesitant to say much, well you just think well if I’ve got something to say then I’ll say’. (p.947)
‘Yes you get other people’s point of view. If you are by yourself at home all the time you haven’t got anyone to discuss anything with. Well its better than stagnating at home saying nothing to anyone all day isn’t it’. (p.947)
Difference it made
People with dementia said that they were concentrating more and noticed an improvement in their memory. They also felt that the action of talking in the group helped them to remember.
‘It always makes a change when you have to concentrate on something it’s more helpful for your memory . . . . I think it makes you concentrate more in everything you’re doing really’. (p.947)
A third of carers said that their relatives were showing improvements in memory and that they were more willing to join in conversations outside of the group.
Staff running the groups said that there was an improvement in the memories of people taking part on the structure of the group and the activities of previous sessions.
England
The NICE-SCIE guidelines published in 2006 (9) recommend that people with mild to moderate dementia should have the opportunity to take part in a group CST programme.
CST is now offered in some areas of England through the NHS, often in memory clinics. (10) Your GP will be able to provide you with more information on memory clinics in your area.
Some care homes also provide CST and in a recent study networking and offering support to care homes was found to be effective in increasing the number interested in the programme. (11)
The team who developed CST have a website with:
International
The international CST centre has information on adapted versions of CST in over 24 countries along with dates of training events and conferences.
http://www.ucl.ac.uk/international-cognitive-stimulation-therapy
Resources:
Reviews, reports and guidance:
Cochrane Review (2012): Can cognitive stimulation benefit people with dementia?
Cognitive Stimulation Therapy (CST) website
Organisations:
Find out more about organisations that have information or offer support to people with dementia and their families.
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3. Spector A, Thorgrimsen L, Woods RT, Orrell M. Making a Difference: An Evidence-Based Group Programme to Offer Cognitive Stimulation Therapy (CST) to People With Dementia. London: Hawker Publications; 2006.
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10. Hodge S and Hailey E (2015) Memory Services National Accreditation Programme Third Annual Report 2013-2014.
11. Streater A and Orrell M (2015) CST in care homes: results of evaluation. Journal of Dementia Care 23(6): 12-14
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Authors: Adelina Comas-Herrera, Martin Knapp
Edited by: Helen Hayes with support from members of the MODEM User and Carer Reference Group
Summary First Published: Thursday, April 7th, 2016
Summary Last Updated: Monday, July 25th, 2016The support of the Economic and Social Research Council (ESRC) and National Institute for Health Research (NIHR) is gratefully acknowledged. The views expressed in this publication are those of the author(s) and not necessarily those of the ESRC, NIHR or Department of Health.