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Cognitive stimulation therapy improved cognition and quality of life in dementia
  1. Calvin H Hirsch, MD
  1. University of California at Davis
 Sacramento, California, USA

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 Q In people with dementia, does cognitive stimulation therapy (CST) improve cognition and quality of life?

    Clinical impact ratings Mental health ★★★★★★☆ Geriatrics ★★★★★☆☆


    Embedded ImageDesign:

    randomised controlled trial.*

    Embedded ImageAllocation:


    Embedded ImageBlinding:

    blinded (outcome assessors).

    Embedded ImageFollow up period:

    7 weeks.

    Embedded ImageSetting:

    23 day centres and residential homes (with ⩾15 people in each) in the UK.

    Embedded ImagePatients:

    201 people (mean age 85 y, 79% women) who met DSM-IV criteria for dementia, scored 10–24 on the Mini-Mental State Examination, were able to communicate, had sufficient vision and hearing to participate and use material in a group, and did not have major physical illness or disability.

    Embedded ImageInterventions:

    CST (n = 115): fourteen 45 minute sessions twice a week for 7 weeks. The programme used the concepts of reality orientation and cognitive stimulation and included the topics of money, word games, the present day, and famous faces. Usual activities (n = 86): in most settings, this consisted of doing nothing.

    Embedded ImageOutcomes:

    cognition, quality of life, communication, behaviour, global functioning, depression, and anxiety.

    Embedded ImagePatient follow up:



    Analysis was by intention to treat. Cognition and quality of life were improved in the CST group but deteriorated in the usual activities group (table). The groups did not differ for any other outcome.

    Cognitive stimulation (CST) v usual activities in dementia*


    In people with dementia, cognitive stimulation therapy improved cognition and quality of life.

    A modified version of this abstract appears in Evidence-Based Nursing.


    The finding that leisure time intellectual activity can significantly reduce the risk of dementia in people over the age of 75 years1 lends credence to the possibility that CST might be effective in people with established dementia. The study by Spector et al provides evidence that CST in the form of reality orientation can significantly increase performance on selected neuropsychological tests. Even a small, 4 point decline in the Alzheimer’s Disease Assessment Scale–Cognition among patients with mild to moderate Alzheimer’s disease has been associated with a 35% increase in the odds of becoming dependent.2 Activity-of-daily-living dependency from cognitive impairment is a major determinant of the time required to care for nursing home residents.3

    Spector et al do not report the characteristics of patients who benefited from CST or the domains of cognitive function that were most likely to improve. It is unclear how much of the observed improvement occurred in orientation, which makes up 10 of 30 points on the MMSE and 8 of 70 points on the ADAS-Cog. Notably, staff ratings of personal care and behaviour—clinically relevant correlates of cognition—deteriorated similarly in the 2 groups.

    Social and cultural factors, as well as systems of healthcare financing, will probably determine how well CST can be disseminated. Senior day care centres represent an ideal setting for CST, but their use varies substantially among ethnic groups in the US.4

    Further studies of the costs and benefits of CST are needed before its widespread adoption can be recommended.


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    • * See glossary.

    • For correspondence: Dr M Orrell, University College London, London, UK.

    • Sources of funding: NHS London Regional Office Research and Development Programme and Barking, Havering and Brentwood Community NHS Trusts.

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