May 21, 2017
Dementia is a general term for a decline in memory, communication, and reasoning skills which are severe enough to interfere with a person’s ability to perform daily activities. A recent study out of the UK found that although at-home caregiver-delivered cognitive stimulation therapy did not improve either cognition or quality of life for people with dementia, the quality of the relationship between the patient and their caregiver improved.
Dementia is caused by damage to brain cells which can cause changes in memory, the ability to think, and even personality, depending on which regions of the brain are affected. While most changes in the brain that cause dementia are permanent and tend to worsen over time, there are strategies to address symptomatic thinking and memory problems.
Cognitive stimulation therapy (CST) is an evidence-based intervention designed to improve cognition, memory, and the overall quality of life in individuals with mild to moderate dementia. Most often, CST is implemented with groups of patients in day centers and residential programs. Individual cognitive stimulation therapy (iCST) is a version of CST which has been modified for home-based delivery by a caregiver. In addition to being a low cost, non-drug intervention for dementia, iCST programs delivered in the home setting improve accessibility to CST programs, especially in situations where there is a problem with mobility, a reluctance to participate in a group setting, or a lack of available local CST groups.
In a 2017 study published in PLoS Medicine, researchers from the United Kingdom sought to explore the outcomes of a caregiver-delivered CST in people with dementia. From April of 2012 to July of 2013, 356 people with mild to moderate dementia and their family caregivers were recruited to participate in this study. The participants were randomly assigned to either an iCST intervention group or a treatment as usual control group.
Caregivers in the iCST group were given a manual containing guidance on the sessions, ideas for activities, an activity workbook, and a toolkit with items such as playing cards and maps. After receiving 60-90 minutes of standardized training from researchers on how to use the iCST manual, caregivers were observed delivering their first session and were given feedback and assistance. They were asked to provide three 30 minute iCST sessions each week throughout the 25 weeks of the study. Caregivers also received up to 10 hours of additional researcher support over the course of the 25-week intervention. Participants in the treatment as usual group had access to a similar range of mentally stimulating activities but did not receive any caregiver-delivered iCST sessions. Evaluation measures were taken at baseline and at 13 and 26 weeks.
Individuals with dementia and their caregivers found the program activities stimulating and enjoyable. For those in the iCST group, self-reported quality of life for caregivers was higher and patients rated the relationship with their caregivers higher. However, no significant differences in cognition or self-reported quality of life for people with dementia were found between the iCST and the control group.
This finding may be attributed to the low intervention adherence rates. Only 40% of participants in the iCST group completed at least 2 sessions per week, and 22% failed to complete any sessions at all.
This was a major limitation of this study. Future research approaches should provide additional support for individuals delivering the intervention. Increased support from CST professionals, peer support, strategies to improve caregivers confidence in iCST session delivery, or training two caregivers to deliver the intervention to reduce role strain may improve intervention adherence.
Written By: Debra A. Kellen, PhD
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