The benefits of cognitive stimulation therapy for dementia patients

Cognitive stimulation therapy is gaining a positive reputation among some professionals but news of its benefits is slow to travel, writes Jackie Cosh

Until recently, Margaret Smith would regularly see images, often at night, but also during the day. A symptom of her dementia, she would become depressed about them and her condition.

But she is now benefiting from twice weekly cognitive stimulation therapy (CST) sessions at Broad Street health centre in Dagenham, east London.

“I am better than I was,” says Smith. “I don’t really see the images very often any more. I was getting depressed at home, so was pleased to have the chance to come here and talk to the girls and have a laugh.”

Devised by Dr Aimee Spector and a team of researchers at University College London, CST involves a series of themed, group activity sessions to help people strengthen their cognitive capacity.

A controlled trial of 201 people in 23 centres found that their cognition and quality of life improved and that CST performed as well as several dementia drugs. A further analysis conducted with the London School of Economics found the treatment could be more cost-effective than some dementia drugs, while a pilot study in 2005 suggested that benefits in cognition from CST could be maintained for a period after the sessions ended.

Lindsay Royan, consultant clinical psychologist at North East London NHS Foundation Trust, helped with the research and design of the original study. Today she takes CST sessions at the Broad Street centre.

“Drugs are important,” she says. “They help people feel they may want to engage, but on their own they don’t provide opportunities to feel, to learn, to contribute and to participate.”

Proof that CST works comes in the feedback. “People tell us afterwards that it was good and that they learned something, that it stimulated their mind,” Royan says. “Every week there is a learning process and we try to make the groups sociable, so that they don’t feel that they are in a classroom or are being patronised.”

Topics are chosen to stimulate the brain, but the social aspect is also important. “There is a really nice group dynamic,” says Royan. “They are tolerant of each other’s cognitive difficulties. They help each other, whether it be out of a chair or if someone can’t hear something. The group cohesion is apparent, which you don’t get from all therapy groups.”

But despite the evidence in its favour, a National Audit Office census in 2006 found that it was used regularly by only 36% of community mental health teams for older people for early stage dementia, by 33% for mid-stage and by 20% for late stage.

In the same year, the National Institute for Health and Clinical Excellence recommended that all people with mild to moderate dementia should be “given the opportunity to participate in a structured group cognitive stimulation programme”, irrespective of whether they received drugs.

However, Royan points out that her trust is one of few to offer CST.

“In most settings staff are not highly qualified or have much training, so when we were designing CST we had to take this into account,” she says. “The downside is that staff will then say that CST is something we do anyway. We say it is about doing it in a more systematic way. We focus on specific genitive functions and tailor activities accordingly.”

Some people can’t believe that something so simple can work. “If it is too accessible people think it won’t work and that it is too easy. People find it hard to invest belief in it,” Royan says. “They know that dementia is devastating and wonder how a couple of hours of fun a week can make a difference. Other people perceive it as a lot of work. They see lots of resources, and lots of staff needed. They lack smaller rooms to hold the sessions.”

Steve Shrubb, the director of the NHS Confederation’s Mental Health Network, thinks it is a matter of time before CST take-up improves.

“The health service has a history of having a long lag period before taking up new therapies,” he says. “There are a number of reasons for this. Sometimes it is about communication. Clinical staff on the front line are not always aware of what is new. Sometimes there is no reason. Generally it takes a long time.

“We have brought it to the attention of members by highlighting it in our newsletter and providing links to more information, so we are doing our bit.”

HOW COGNITIVE STIMULATION THERAPY WORKS

Cognitive stimulation therapy programmes should be delivered to groups of five to eight, with sessions run by a facilitator who can be any health or social care practitioner with the relevant training.

Programmes consist of 14 sessions of 45 minutes taking place twice a week.

Participants take part in various tasks and activities relating to: physical games; sound; childhood; food; current affairs; faces/scenes; word association; being creative; categorising objects; orientation; using money; number games; word games; and team quizzes.

This article is published in the 29 April 2010 edition of Community Care under the headline “Making the mind willing” 

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