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Cognitive Stimulation Therapy (CST): effects on different areas of cognitive function for people with dementia
- Authors:
- SPECTOR Aimee, ORRELL Martin, WOODS Bob
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(12), December 2010, pp.1253-1258.
- Publisher:
- Wiley
The aim of this paper was to investigate the effects of Cognitive Stimulation Therapy (CST) on specific areas of cognition for people with dementia. The study used data from a recent randomised controlled trial involving a 14 session group treatment programme using CST with 201 participants from day centres and residential homes in the Greater London area, and analysed subsections of the Alzheimer's disease assessment scale-Cognition (ADAS-Cog) from those results. The key finding from the study was that the cognitive skill which showed most improvement following CST was language. The authors conclude that CST appears to have particular effects in promoting language function, which is likely to lead to generalised benefits.
Evaluating two group programmes of cognitive training in mild-to-moderate AD: is there any difference between a ‘global’ stimulation and a ‘cognitive-specific’ one?
- Author:
- FARINAMD E.
- Journal article citation:
- Aging and Mental Health, 10(3), May 2006, pp.211-218.
- Publisher:
- Taylor and Francis
This study evaluated the efficacy of two different group procedures of non-pharmacological treatment in mild-to-moderate Alzheimer's disease (AD). Thirty-two patients entered the study and were divided in groups of four subjects. We compared recreational activities (‘global’ stimulation) with a combination of procedural memory training on activities of daily living and neuropsychological rehabilitation of ‘residual’ functions (‘cognitive-specific’). All patients and caregivers were ensured psychological support. Both group treatments were delivered for six weeks. Multidimensional efficacy assessment of functional, behavioural and neuropsychological aspects was performed. Patients receiving ‘global’ stimulation showed a substantial reduction in behavioural disturbances; Revised Memory Behaviour Problems Checklist, and better performance in the Functional Living Skills Assessment (FLSA), a standardized direct measure of performance in everyday life and Verbal Fluency for Letters. Patients receiving ‘cognitive-specific’ treatment improved only on the scale evaluating functional competence in daily living (Nurses’ Observation Scale for Geriatric Patients [NOSGER] p=0.018). At follow-up (six months later), compared with baseline, patients following the ‘global’ stimulation treatment showed an improvement at caregiver distress on NPI. No other significant difference was detected. Our results support the contention that a ‘global’ treatment can lead to a significant improvement in AD patients, both for behavioural and functional aspects. The ‘cognitive-specific’ treatment we used in this research did not show better efficacy.
Improved quality of life and cognitive stimulation therapy in dementia
- Authors:
- WOODS B., et al
- Journal article citation:
- Aging and Mental Health, 10(3), May 2006, pp.219-226.
- Publisher:
- Taylor and Francis
Quality of life (QoL) is now seen as a key outcome in many aspects of dementia care. In a recent randomized controlled trial of Cognitive Stimulation Therapy (CST) groups, significant improvements in self-reported QoL were identified as well as changes in cognitive function. This further analysis of results from the trial examines whether the changes in these two domains occurred independently, perhaps for different reasons, or whether the effect of treatment on QoL was mediated by the changes in cognition. In all, 201 people with dementia living in residential homes or attending day centres were assessed using the Quality of Life-Alzheimer's Disease (QOL-AD) scale and a range of measures of cognition, dementia level, mood, dependency and communication. Participants were randomized to receive an intervention programme of CST or to receive treatment as usual. The QoL-AD and other measures were repeated eight weeks later. At baseline, higher QoL in dementia was significantly correlated with lower levels of dependency and depression, but not with cognitive function or dementia severity. Improvement in quality of life was associated with being female, low quality of life at baseline, reduced depression and increased cognitive function. Changes in cognitive function mediated the effects of treatment in improving QoL. These results suggest that whilst QoL in dementia appears to be independent of level of cognitive function, interventions aimed at improving cognitive function can, nonetheless, have a direct effect on QoL.
Supporting everyday activities for people with early stage AD: the benefits of cognitive rehabilitation
- Author:
- CLARE Linda
- Journal article citation:
- Journal of Dementia Care, 18(5), September 2010, pp.37-38.
- Publisher:
- Hawker
People with early-stage Alzheimer’s Disease may benefit from extra support with engaging in everyday activities. This article describes a cognitive rehabilitation intervention for people with early-stage Alzheimer’s Disease. The approach is called cognitive rehabilitation because it addresses difficulties resulting from impairments in memory and other cognitive functions. Individual goals are identified in discussion with a therapist. These are areas where the person with Alzheimer’s Disease would like to manage things better, or develop new skills or ways of coping. Once the goals are selected the therapist works together with the person to devise a plan for addressing the goal. This may involve compensatory or restorative approaches. This article briefly describes a randomised controlled trial comparing this approach with relaxation therapy and with no treatment. A total of 69 participants were randomly assigned to one of the three conditions and set goals, but only those allocated to the cognitive rehabilitation group actively worked with the therapist to achieve the goals. The results showed that the participants in the cognitive rehabilitation group improved performance in relation to their goals, while the other groups did not change. The article concludes that the extra support offered by the cognitive rehabilitation approach can help people stay engaged in everyday activities and manage their memory difficulties more effectively.
Cognitive training in Alzheimer’s disease: a meta-analysis of the literature
- Authors:
- SITZER D.I., TWAMLEY E.W., JESTE C.V.
- Journal article citation:
- Acta Psychiatrica Scandinavica, 114(2), August 2006, pp.75-90.
- Publisher:
- Blackwell Publishing
Effect sizes (Cohen’s d) were calculated for 19 controlled studies, and an overall effect size of 0.47 was observed for all cognitive training (CT) strategies across all measured outcomes. Mean effect sizes were higher for restorative strategies (designed to return functioning in specific domains to pre-disease levels) than for compensatory strategies (to teach new ways of performing tasks by ‘working round’ the cognitive deficit). Primarily medium effect sizes were observed for learning, memory, executive functioning, activities of daily living, general cognitive problems and self-rated general functioning. Several limitations of the published literature are discussed, including small sample sizes and the fact that most studies combine multiple treatment strategies, making it difficult to evaluate the efficacy of individual components.
Giving up driving in Alzheimer's Disease - an integrative therapeutic approach
- Authors:
- BAHRO Marcel, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 10(10), October 1995, pp.871-874.
- Publisher:
- Wiley
For patients with Alzheimers Disease (AD), a recommendation to stop operating a motor vehicle can be a serious event complicated by a loss of self-esteem and personal dignity. Patients are often reluctant to give up an activity so essential, both practically and symbolically, to independent living. Describes a patient with moderately progressed AD who lacked insight of his need to cease driving. Through an integrative treatment approach, combining behavioural and psychodynamic modalities, he was helped to formulate effective ways of coping with his loss of access to independent transportation. Argues for a psychotherapeutic strategy that combines behavioural and managerial measures with dynamic patient interaction, thereby developing the patient's insight of the need to give up driving while fostering his sense of autonomy.
Non-drug treatments for symptoms in dementia: an overview of systematic reviews of non-pharmacological interventions in the management of neuropsychiatric symptoms and challenging behaviours in patients with dementia
- Authors:
- DICKSON Kelly, et al
- Publisher:
- Policy Innovation Research Unit
- Publication year:
- 2012
- Pagination:
- iii, 52
- Place of publication:
- London
Despite current clinical guidance which recommends the use of non-pharmacological approaches – that is, treatments or therapies other than medication – to improve behavioural and psychological symptoms in patients with dementia, the widespread use of antipsychotics for these patients continues. In order to fill the gap in evidence and on behalf of the Department of Health, PIRU examined thirty recent systematic reviews on the effectiveness of non-pharmacological treatments or therapies for managing neuropsychiatric and challenging behaviours in patients with dementia In all, 19 non-pharmacological treatments were identified in the systematic reviews. Of these, the most consistent evidence for effectively managing behavioural and psychological symptoms was found for behaviour management techniques delivered by professional staff, and for staff and caregiver training and support. There was promising evidence for four other alternative treatments – physical activity/exercise; massage/touch therapies; multi-sensory stimulation and music therapy – although the evidence for these was not as robust, either because the primary studies were not as rigorous, the results were more mixed or the evidence available was limited. Only one treatment appeared to be ineffective – validation therapy. For the vast majority of treatments, however, the evidence was inconclusive, either because it was inconsistent across primary studies, or these studies were of poor quality, or the evidence was almost totally lacking. This general lack of high quality evidence meant that the systematic reviews included in this overview refrained from making policy and practice recommendations. It also leads to the conclusion that more and better research is needed on these alternative interventions in order to inform future policy and practice. (Edited publisher abstract)
Brief cognitive screening instruments: an update
- Authors:
- ISMAIL Zahinoor, RAJJI Tarek K., SHULMAN Kenneth I.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(2), February 2010, pp.111-120.
- Publisher:
- Wiley
This article reviews the recent literature on cognitive screening with a focus on brief screening methods in primary care as well as geriatric services. Using the Medline search engine with the keyword search terms cognitive screening, cognitive assessment, and dementia screening limiting articles to those published in English since 1998, 679 abstracts were retrieved. Articles focusing on attitudes toward cognitive screening, current screening practices, promising new instruments and more recent updates contributing significant information on established instruments were incorporated into this review. Instruments recommended from previous reviews of cognitive screening and those identified in surveys as most frequently used in primary care and geriatric settings were emphasised in this review. The authors conclude that dementia remains under-diagnosed in the elderly population. Despite limitations, the Mini Mental State Exam remains the most frequently used cognitive screening instrument, where it’s best value in the community and primary care appears to be for the purpose of ruling out a diagnosis of dementia. Instruments such as the Mini-Cog, Memory Impairment Screen, and the General Practitioner Assessment of Cognition have consistently been recognised for utility in primary care. The ‘clock drawing test’ and newer instruments such as the Montreal Cognitive Assessment and the Rowland Universal Dementia Assessment Scale are gaining credibility due to improvements in sensitivity, addressing frontal/executive functioning, and decreasing susceptibility to cultural and educational biases.
Early-stage cognitive impairment: a social work practice and research agenda
- Authors:
- ADAMS Kathryn Betts, McCLENDON McKee J.
- Journal article citation:
- Families in Society, 87(4), October 2006, pp.590-600.
- Publisher:
- The Alliance for Children and Families
With the current emphasis on early diagnosis of mild cognitive impairment or dementia such as Alzheimer’s disease, it is increasingly common to receive the diagnosis of impairment before functioning is seriously compromised. People in the early stages of cognitive loss experience distress related to their current and future functioning and yet are capable of participating in psychosocial treatment or support. This article presents a review of the literature describing the experience, characteristics and psychosocial service needs of individuals with mild cognitive impairment or early-stage Alzheimer's disease and related disorders. It then reviews reports on psychosocial interventions with this population from the clinical and research literature. Psychosocial interventions are often aimed at alleviating the stress, depression, and anxiety while promoting a positive outlook. Finally, the authors discuss implications for future directions in establishing a cadre of evidence-based social work services for this group.
Development and implementation of nonpharmacologic protocols for the management of patients with Alzheimer's disease and their families in a multiracial primary care setting.
- Authors:
- AUSTROM Mary Guerriero, et al
- Journal article citation:
- Gerontologist, 44(4), August 2004, pp.548-553.
- Publisher:
- Oxford University Press
Most patients and families with dementia are cared for in primary care clinics. These clinics are seldom designed to provide the necessary comprehensive care. The purpose of this article is to describe nonpharmacologic protocols for the management of patients with Alzheimer's disease and their families that are administered as part of a multifaceted care-management intervention program in a multiracial primary care clinic. The nonpharmacologic component for the integrated program of collaborative care was developed based on a literature review and previous clinical experience. The care is coordinated by a geriatric nurse practitioner who meets with patients, families, and the primary care physicians. The nonpharmacologic protocols included general educational guidelines about Alzheimer's disease. Specific protocols to treat the common behavioral disturbances associated with Alzheimer's disease also were developed. A major component of the intervention is a monthly psychoeducational support group for caregivers. The intervention has been well accepted by patients, families, and physicians. Approximately one-half of the treatment group has participated in the support group regularly. The integration of behavioural interventions and team care within the primary care environment has been successful.