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Cognitive Stimulation Therapy

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Cognitive stimulation therapy (CST) is a short-term, evidence-based, group or individual intervention program for people with mild to moderate dementia or Alzheimer’s disease. The goal of CST is to guide people with dementia through a series of themed activities designed to promote continued learning so that they can stay mentally stimulated and socially engaged. Activities may include puzzles or games, playing instruments, or engaging in conversation with other group members and/or program facilitators.

Because social engagement is a key component of CST, the intervention is most often administered in a group setting. When CST is provided one-on-one with an individual, rather than within a group, it may be referred to as iCST. While group CST is generally thought to be most effective, the individual approach can also serve to enhance the relationship between the individual and the facilitator and may also lead to psychological and cognitive improvement.

CST is a relatively new modality and it is considered effective and evidence-based; in the UK, where it was developed, it is currently the only non-drug treatment recommended by the National Institute for Health and Care Excellence (NICE) for mild to moderate dementia. Some evidence suggests that CST may be as effective as some dementia medications at improving patients’ memory, language processing, and visuospatial abilities; it may also be administered alongside medication.

How It's Used

CST is administered to small groups or to individuals in adult memory care facilities, hospitals, or other treatment centers. Individual caregivers can also practice iCST interventions at home on adults with mild to moderate dementia. CST is more widely used in the United Kingdom, where the program originated, though it can also be accessed in some locations in the U.S. and around the world. However, because it was developed primarily for a Western, English-speaking population, further research is likely needed to determine whether the program is equally effective across cultures.

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What to Expect

CST groups tend to be small, typically comprising fewer than 10 people. Generally, the atmosphere is intended to be friendly and club-like. The therapy group often takes on a special name for itself and may choose a song to sing at the beginning of each session to promote consistency and collegiality. On display will be a “reality orientation board,” which contains information about the group as well as the date, place, and time.

Groups often start sessions with a recurring warm-up activity, which may be something as simple as recalling the current day and date. From there, each session follows a general theme; potential themes include childhood, food, or current events. The therapist or facilitator will initiate conversations to help group members connect ideas and bring memories from their past into the current moment. For instance, group members may be encouraged to compare how things were in their childhood or early adulthood to how they are now.

Group members will also engage in stimulating mental activities, tailored to the group’s interests and needs. Potential activities include reading and discussing a current news article, remembering the names of actors and actresses from another era, baking a simple recipe together, throwing a ball or engaging in other low-impact exercises, or singing a song. Ultimately, each group directs itself with respect to topics discussed and preferred activities. Some groups may incorporate members’ faith or spirituality into their sessions, if relevant.

Most groups aim to offer a range of multi-sensory experiences to keep participants active and engaged. Regardless of the specific agenda, CST should be fun and enjoyable for participants, at least most of the time, and the social connection is often just as important as the activities themselves.

How It Works

Dementia is notoriously challenging to treat because current drugs are often not as effective as patients or their caregivers hope for, and symptoms can quickly become frustrating for both patients and caregivers to manage. Alternative therapies that emphasize psychological well-being can thus be especially valuable and may improve both patients' and caregivers' quality of life.

The original CST program was developed by British researchers and psychologists Amy Spector, Martin Orell, and Bob Woods in the late 1990s and early 2000s, and began with Spector’s Ph.D. thesis researching effective, non-pharmacological therapies for people with mild and moderate dementia. The group found that CST interventions could be as effective as medications commonly used to treat the cognitive symptoms of dementia like memory loss and difficulty learning new information. It has since been shown that CST enhances cognition in eligible patients, whether or not the person is simultaneously taking medication.

CST sessions are generally offered twice a week for at least seven weeks. Studies have shown that during an initial course of therapy, weekly sessions are not as effective as twice-weekly. This type of intervention has been shown to significantly improve quality of life, social interaction, communication, and cognitive abilities in people with dementia; in some cases, it may help minimize aggressive or challenging behavior. After the program is complete, maintenance sessions may be administered periodically or on a weekly basis. While further research is needed to better understand CST's long-term effects, some evidence suggests that once-weekly maintenance CST (sometimes referred to as MCST) can continue to improve symptoms and enhance participants' quality of life.

Caregivers who learn CST interventions can also benefit from improved communication and interactions with their loved ones. At least one study found, however, that while home-based iCST interventions helped improve the relationship between family caregivers and patients, there was not the same evidence of improved cognition or quality of life for the iCST patient as with group work. Because of this, group programs may be preferable for those who are able to access them; however, iCST can still be beneficial in some cases.

What to Look for in a Cognitive Stimulation Therapist

Some nursing homes and other eldercare facilities offer CST programs. Those who administer CST include social workers, psychologists, occupational therapists, nurses, and other care workers. Those wishing to practice iCST at home should first seek out a training program in their area or online.

Those looking for professional individual care or to join a group should look for a licensed, qualified professional who has CST training and experience working with people with dementia and their families; if needed, hospitals or primary care providers may be able to offer a referral to a nearby CST program.

Orrell M, Yates L, Leung P, et al. The impact of individual Cognitive Stimulation Therapy (iCST) on cognition, quality of life, caregiver health and family relationships in dementia: A randomised controlled trial. PLOS Medicine. March 28, 2017. 
Orrell, M., Aguirre, E., Spector, A., Hoare, Z., Woods, R. T., Streater, A., Donovan, H., Hoe, J., Knapp, M., Whitaker, C., & Russell, I. (2014). Maintenance cognitive stimulation therapy for dementia: single-blind, multicentre, pragmatic randomised controlled trial. The British journal of psychiatry : the journal of mental science204(6), 454–461.
Cove J, Jacobi N, Donovan H, et al. Effectiveness of weekly cognitive stimulation therapy for people with dementia and the additional impact of enhancing cognitive stimulation therapy with a carer training program. Clinical Interventions in Aging. 2014;9:2143-2150
Aguirre E, Spector A, Orrell M. Guidelines for adapting cognitive stimulation therapy to other cultures. Clinical Interventions in Aging. June 26, 2014;9:1003-1007.
Aguirre E, Woods RT, Spector A, Orrell M. Cognitive stimulation for dementia: A systematic review of the evidence of effectiveness from randomized controlled trials. Aging Research Reviews. January 2013;12(1):253-262.
International Cognitive Stimulation Therapy Centre website.
Saint Louis University School of Medicine website. Cognitive Stimulation Therapy (CST) and iCST. 
Last updated: 08/26/2022