Cognitive Stimulation Therapy

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. When CST is provided one-on-one with an individual, rather than a group, it may be referred to as iCST. The goal of CST is to stimulate people with dementia through a series of themed activities designed to help them continue to learn and stay socially engaged. The individual approach also serves to enhance the relationship between the individual and the facilitator.

How It's Used

CST is administered to small groups or individuals in adult daycare facilities, hospitals or other treatment centers, and caregivers can also practice iCST interventions at home. While CST is increasingly popular in the United Kingdom, where the program originated, throughout the U.S., and around the world, researchers are finding a need to develop clear guidelines for modifying standard interventions so they are effective in different cultures.

What to Expect

The therapy group often takes on a special name for itself, and chooses a song to sing at the beginning of each session so that the atmosphere is friendly and club-like. An opening exercise may be something as seemingly simple as recalling the current day and date. The therapist or facilitator may then try to initiate a conversation, perhaps about family holidays and vacations, and 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 things are now. Stimulating mental activities could also include reading and discussing a current news article or remembering the names of actors and actresses from another era that may be familiar to others in the group. Ultimately, each group directs itself with respect to topics discussed and preferred activities.

How It Works

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 learning. 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 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 and, in some cases, also improve challenging behavior. Caregivers who learn CST interventions can also benefit from improved communication and interactions with these individuals. 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. There is some evidence of continued effectiveness and enhanced quality of life for participants in follow-up maintenance programs.

What to Look for in a Cognitive Stimulation Therapist

Those who administer CST include social workers, psychologists, occupational therapists, nurses, and other care workers. Look for a licensed, qualified professional who has CST training and experience working with people with dementia and their families.

References

  • 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
  • International Cognitive Stimulation Therapy Centre website. Accessed September 5, 2017.
  • 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.
  • 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.
  • 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. 
  • Saint Louis University School of Medicine website. Cognitive Stimulation Therapy (CST) and iCST. Accessed September 5, 2017.