None listed
Conditions
Brief summary
Cognitive stimulation is defined as “engagement in a range of activities and discussions (usually in a group) aimed at general enhancement of cognitive and social functioning”. Cognitive stimulation therapy (CST) is a structured and manualised group treatment specifically developed for people with mild to moderate dementia. It involves 14 or more sessions of themed activities. They were designed to run twice a week over a seven-week period. Sessions are aimed to actively stimulate and engage people with dementia, while providing an optimal learning environment and the social benefits of a group. The effects of CST appear to be of a comparable size to those reported with the currently available anti-dementia drugs. A cost effectiveness study found that CST for people with dementia may be more cost-effective than usual treatment. CST was developed in the UK and recommended in the NICE dementia guidelines. It has been adopted in 24 countries including New Zealand. A recent Cochrane review concludes that cognitive stimulation programmes can benefit cognition in people with mild to moderate dementia over and above any medication effects, while the improvements in self-reported quality of life and well-being were promising. Individual CST (iCST) is a novel home-based approach to deliver CST. There is only one previous study on iCST which was delivered by family carers. The study did not find any significant difference in the primary outcomes (cognition and quality of life for people with dementia, and quality of life for their carer). However, it found people with dementia had better quality of relationship with their carer who delivered the programme and carer had better health-related quality of life and less depression. The researchers suggested future research should investigate the efficacy of iCST when it is delivered by healthcare professionals. The primary purpose of the study is to compare the efficacy of iCST delivered by health professionals and trained volunteers with treatment as usual (TAU). The null hypothesis is that when compared to treatment as usual, iCST (delivered by health professionals or trained volunteers) has no positive benefit on cognition or quality of life for people with mild to moderate dementia.
Interventions
30 Participants will be randomised into one of the 3 arms: (i) individual Cognitive Stimulation Therapy (iCST) delivered by health professionals employed by Alzheimers Auckland; (ii) iCST delivered by Alzheimers Auckland volunteers trained by the research team; and (iii) Treatment as usual.
iCST will be delivered at home two 45-minute sessions per week for 12 weeks.
The iCST programme (delivered by health professionals or volunteers): The iCST facilitator has completed the one day master clas
30 Participants will be randomised into one of the 3 arms: (i) individual Cognitive Stimulation Therapy (iCST) delivered by health professionals employed by Alzheimers Auckland; (ii) iCST delivered by Alzheimers Auckland volunteers trained by the research team; and (iii) Treatment as usual. iCST will be delivered at home two 45-minute sessions per week for 12 weeks. The iCST programme (delivered by health professionals or volunteers): The iCST facilitator has completed the one day master class iCST training delivered by members of the research team. The iCST programme is: 15 minutes warming up (discuss the day, date, weather and season; discuss recent or current events in the news; listen to a piece of music or sing along to a favourite song; engage in gentle movement/stretches; breathing exercise) 20 minutes of the iCST activity 10 minutes warming down (refreshment; discuss topic of next session) TOTAL 45 minutes The key principles of iCST are 1. Mental stimulation 2. Developing new idea, thoughts and associations 3. Using orientation in a sensitive manner 4. Focusing on opinions, rather than facts 5. Using reminiscence as an aid to the here and now 6. Providing triggers to support memory 7. Stimulate language and communication 8. Stimulate every day planning ability 9. Using a “person-centred” approach 10. Offering a choice of activities 11. Enjoyment and fun 12. Maximising potential 13. Strengthening the relationship by spending quality time together NB 1: The participant's carer is NOT involved in intervention sessions. NB 2: The intervention (i.e. the iCST activities) follow the 37 topics of iCST sessions described in the manual of Individual Cognitive Stimulation Therapy (Making a difference 3. Hawker Publications) NB 3: The intervention adherence or fidelity will not be assessed. All iCST facilitators have attended a 1-day training workshop on how to deliver iCST and will strictly follow the manual. NB 4: The intervention is NOT a physical activity intervention. It is cognitive stimulation.
Sponsors
University of Auckland
Study design
Allocation
Randomised controlled trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1) mild to moderate dementia (Montreal Cognitive Examination score of 15 or more) 2) the person can have a ‘meaningful’ conversation; 3) the person can hear well enough to participate in a 1-to-1 discussion. 4) the person’s vision is good enough to see most pictures. 5) the person is likely to remain in a session for 45 minutes NB: Carers do not participate in the intervention. However, the next of kin will provide consent given the person with dementia may have diminished capacity to provide informed consent; the person with dementia will provide assent to participate.
Exclusion criteria
a recent acute medical illness such as stroke or heart attack within the past 6 weeks will not be eligible
Outcome results
None listed