Cognitive Stimulation Therapy in Outpatient Settings for Persons with Dementia

Cognitive Stimulation Therapy (CST) is a non-pharmacologic evidence-based intervention for persons living with mild to moderate dementia. This clinical intervention therapy follows a structured protocol designed to connect people with memory loss to others by providing opportunities for social engagement and group discussion of current events and a different themed activity each session. This presentation will include findings from a multi-site study of the group intervention conducted in an urban and two rural out-patient settings with community-dwelling older adults. Pre- and post-assessments captured data on cognitive function, depression, quality-of-life, and mobility. While CST is offered in over 30 countries, this is the first large-scale CST study conducted in the U.S. Implications for future practice and research will be presented.

Differences in care between younger and older patients in the 2019 English national memory service audit

Aims and method This paper analyses how practice varied between patients aged <65 and ≥65 years in the 2019 UK national memory service audit. Results Data on 3959 patients were analysed. Those aged <65 (7% of the sample) were less likely than those aged ≥65 to be diagnosed with dementia (23 v. 67%) and more likely to receive a functional, psychiatric or no diagnosis. Younger patients were more likely to have magnetic resonance imaging; use of dementia biomarkers was low in both groups. Frontotemporal dementia and functional cognitive disorder were diagnosed infrequently. Use of dementia navigators/advisors and carer psychoeducation was similar between groups; younger patients were less likely to be offered but more likely to accept cognitive stimulation therapy. Clinical implications Memory services seeing younger people need expertise in functional cognitive disorder, alongside clinical skills and technologies to diagnose rarer forms of dementia. Further work is needed to understand why cognitive stimulation therapy is less frequently offered to younger people.

Changes in Default Mode Network Connectivity in Resting-State fMRI in People with Mild Dementia Receiving Cognitive Stimulation Therapy

Group cognitive stimulation therapy (CST) is a 7-week activity-based non-pharmacological intervention for people with mild to moderate dementia. Despite consistent evidence of clinical efficacy, the cognitive and brain mechanisms of CST remain unclear. Theoretically, group CST as a person-centred approach may work through promoting social interaction and personhood, executive function, and language use, especially in people with higher brain/cognitive reserve. To explore these putative mechanisms, structural MRI and resting-state functional MRI data were collected from 16 people with mild dementia before and after receiving CST, and in 13 dementia controls who received treatment as usual (TAU). Voxel-based morphometry (VBM) and resting-state functional connectivity (rs-FC) analyses were performed. Compared with TAU, the CST group maintained the total brain volume/total intracranial volume (TBV/TICV) ratio. Increased rs-FC in the default mode network (DMN) in the posterior cingulate cortex and bilateral parietal cortices nodes was observed in the CST over TAU groups between pre- and post-intervention timepoints. We provided preliminary evidence that CST maintains/enhances brain reserve both structurally and functionally. Considering the role of DMN in episodic memory retrieval and mental self-representation, preservation of personhood may be an important mechanism of CST for further investigation.

A multicomponent psychosocial intervention among people with early-stage dementia involving physical exercise, cognitive stimulation therapy, psychoeducation and counselling: Results from a mixed-methods study

Background There is increasing awareness of the benefits of both physical and psychosocial interventions to empower and benefit people with dementia and their caregivers. However, the potential additional benefits of combining physical and psychosocial interventions have only been sparsely explored. The aim of this pilot study was to investigate the acceptability and potential impact of a multicomponent intervention comprising physical exercise, cognitive stimulation therapy (CST), psychoeducation and counselling for people with early-stage dementia. Design A 15-week multicomponent group-based intervention was offered to people with early-stage dementia in Denmark ( N = 44). A mixed-methods design combining interviews, observations, tests of cognitive and physical functioning and an interviewer-assisted questionnaire on quality of life was applied to (1) investigate acceptability of the intervention, including whether people with dementia and their caregivers found the intervention meaningful and (2) to explore and assess changes in participants’ physical and cognitive functioning and quality of life. The study was conducted between June 2018 and August 2019. Results The pilot study demonstrated that the multicomponent intervention was acceptable for people with early-stage dementia and their caregivers. Test results did not show significant changes in measures of participants’ physical and cognitive functioning or quality of life. However, qualitative data revealed that participants perceived the intervention as meaningful and found that it had a positive influence on their physical and social well-being. In addition, interaction and support from peers and staff members was considered important and rewarding. Conclusion This multicomponent intervention constitutes a meaningful and beneficial activity for people with early-stage dementia and their caregivers. It provides an opportunity to engage in social interactions with peers and experience professional support. The study also underlines the importance of providing prolonged and sustainable interventions for people with dementia to maintain personal and social benefits.