Limited Benefits of Individual Cognitive Stimulation Therapy in Dementia

By Will Boggs MD

NEW YORK (Reuters Health) - In a study of people with dementia and their caregivers, individual cognitive stimulation therapy (iCST) enhanced the quality of the caregiving relationship and caregivers' quality of life but appeared to have no effect on patients’ cognition or quality of life, researchers from UK report.

"I was very pleased to see that the person with dementia said the relationship with their family carer had improved,” Dr. Martin Orrell from University of Nottingham, UK told Reuters Health by email. “In the past, family carers have expressed frustration about not knowing what activities they can still enjoy together. After iCST sessions, some relatives wrote to us telling us how it had made the time together much more rewarding and enjoyable.”

iCST is an adapted version of CST delivered at home by a family carer or friend for 30 minutes, ideally two or three times a week. The 30-minute sessions of structured cognitive stimulation employ themed activities (word games, current affairs, being creative, and the like).

Carers received a manual containing guidance on sessions, key principles of iCST, and ideas for activities; an activity workbook with paper resources for activities; and a toolkit of additional items such as playing cards, dominoes, sound activity compact discs, and maps.

Dr. Orrell and colleagues compared iCST versus treatment as usual in 356 pairs of individuals with dementia and their caregivers.

Pairs assigned to iCST engaged in up to three sessions per week over 25 weeks.

Attrition rates were as high as 26% and did not differ between the iCST and treatment as usual groups, according to the report, which appeared online March 28 in a special issue of PLoS Medicine devoted to dementia.

iCST and treatment as usual groups did not differ significantly on the primary outcomes of cognition and quality of life for the person with dementia.

There was, however, a significant improvement in the quality of the carer-patient relationship with iCST, albeit with a small-medium effect size of 0.32.

For caregivers, iCST was associated with improvements in quality of life, with a small effect size of 0.25.

Only 40% of dyads allocated to iCST completed at least two sessions per week, and 22% completed no sessions at all.

Higher numbers of sessions completed were associated with significant improvements in the quality of the caregiving relationship from the person with dementia's viewpoint and with reduced depression scores for caregivers.

“Enhancing the caregiving relationship through iCST may reduce the risk of presentation to services and deterioration of the person's functioning, which has been associated with conflict in the caregiving relationship,” the researchers conclude. “In turn, risk of institutionalization may be reduced or delayed, which is important from a societal and cost perspective, as the cost of residential care is high. This indicates that iCST may be introduced as a useful component of individually tailored home care packages, which may also help maintain people with dementia in their home situation for longer.”

“The manual provides guidance for family carers about how to run iCST sessions, and the DVD shows some of the actual people with dementia and their carers who had done the program,” Dr. Orrell explained. “Together, the manual and the DVD provide what a family carer needs to be able to start and run the sessions. This should make it more accessible and easy to use.”

SOURCE: bit.ly/2ns0CQw

PLoS Med 2017.

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