Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia

TLDR

A recent Cochrane review highlighted the need for large, well‑designed, multi‑centre trials of reality orientation therapy in dementia. The study aimed to test whether cognitive stimulation therapy improves cognition and quality of life in older adults with dementia. A single‑blind, multi‑centre RCT enrolled 201 participants, comparing CST to control with intention‑to‑treat ANCOVA on cognitive function and quality‑of‑life outcomes. CST produced significant gains in MMSE, ADAS‑Cog, and QoL versus control (P = 0.044, 0.014, 0.028), with a number‑needed‑to‑treat of six, and its benefits were comparable to pharmacological trials.

Abstract

Background A recent Cochrane review of reality orientation therapy identified the need for large, well-designed, multi-centre trials. Aims To test the hypothesis that cognitive stimulation therapy (CST) for older people with dementia would benefit cognition and quality of life. Method A single-blind, multi-centre, randomised controlled trial recruited 201 older people with dementia. The main outcome measures were change in cognitive function and quality of life. An intention-to-treat analysis used analysis of covariance to control for potential variability in baseline measures. Results One hundred and fifteen people were randomised within centres to the intervention group and 86 to the control group. At follow-up the intervention group had significantly improved relative to the control group on the Mini-Mental State Examination ( P =0.044), the Alzheimer's Disease Assessment Scale – Cognition (ADAS–Cog) ( P =0.014) and Quality of Life – Alzheimer's Disease scales ( P =0.028). Using criteria of 4 points or more improvement on the ADAS–Cog the number needed to treat was 6 for the intervention group. Conclusion The results compare favourably with trials of drugs for dementia. CST groups may have worthwhile benefits for many people with dementia.