Maintenance Cognitive Stimulation Therapy (CST) for dementia: A single-blind, multi-centre, randomized controlled trial of Maintenance CST vs. CST for dementia

  1. Aguirre, Elisa 1
  2. Spector, Aimee 1
  3. Hoe, Juanita 1
  4. Russell, Ian T 2
  5. Knapp, Martin 13
  6. Woods, Robert T 2
  7. Orrell, Martin
  1. 1 University College London
    info

    University College London

    Londres, Reino Unido

    ROR https://ror.org/02jx3x895

  2. 2 Bangor University
    info

    Bangor University

    Bangor, Reino Unido

    ROR https://ror.org/006jb1a24

  3. 3 Centre for Economics of Mental Health, Institute of Psychiatry, London, UK
Mostrar afiliaciones +
Revista:
Trials

ISSN: 1745-6215

Año de publicación: 2010

Volumen: 11

Número: 1

Tipo: Artículo

DOI: 10.1186/1745-6215-11-46 GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: Trials

Resumen

BackgroundPsychological treatments for dementia are widely used in the UK and internationally, but only rarely have they been standardised, adequately evaluated or systematically implemented. There is increasing recognition that psychosocial interventions may have similar levels of effectiveness to medication, and both can be used in combination. Cognitive Stimulation Therapy (CST) is a 7-week cognitive-based approach for dementia that has been shown to be beneficial for cognition and quality of life and is cost-effective, but there is less conclusive evidence for the effects of CST over an extended period.Methods/DesignThis multi-centre, pragmatic randomised controlled trial (RCT) to assess the effectiveness and cost-effectiveness of Maintenance CST groups for dementia compares a intervention group who receive CST for 7 weeks followed by the Maintenance CST programme once a week for 24 weeks with the control group who receive CST for 7 weeks, followed by treatment as usual for 24 weeks.The primary outcome measures are quality of life of people with dementia assessed by the QoL-AD and cognition assessed by the ADAS-Cog. Secondary outcomes include the person with dementia's mood, behaviour, activities of daily living, ability to communicate and costs; as well as caregiver health-related quality of life. Using a 5% significance level, comparison of 230 participants will yield 80% power to detect a standardised difference of 0.39 on the ADAS-Cog between the groups. The trial includes a cost-effectiveness analysis from a public sector perspective.DiscussionA pilot study of longer-term Maintenance CST, offering 16 weekly sessions of maintenance following the initial CST programme, previously found a significant improvement in cognitive function (MMSE) for those on the intervention group. The study identified the need for a large-scale, multi-centre RCT to define the potential longer-term benefits of continuing the therapy. This study aims to provide definitive evidence of the potential efficacy of maintenance CST and establish how far the long-term benefits can be compared with antidementia drugs such as cholinesterase inhibitors.

€ Ver financiación

Información de financiación

Maintenance Cognitive Stimulation Programme (ISRCTN26286067) is part of the Support at Home - Interventions to Enhance Life in Dementia (SHIELD) project (Application No RP-PG-0606-1083) which is funded by the NIHR Programme Grants for Applied research funding scheme. The grant holders are Professors Orrell (UCL), Woods (Bangor), Challis (Manchester), Moniz-Cook (Hull), Russell (Swansea), Knapp (LSE) and Dr Charlesworth (UCL).

Financiadores

Referencias bibliográficas

  • Livingston G, Johnston K, Katona C, Paton J, Lyketsos CG: Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia. American Journal of Psychiatry. 2005, 162: 1996-2021. 10.1176/appi.ajp.162.11.1996.
  • Woods RT: Non-pharmacological techniques. Evidence-based dementia practice. Edited by: Qizilbash N. 2002, Oxford: Blackwell, 428-446.
  • Brodaty H, Green A, Koschera A: Meta-analysis of psychosocial interventions for caregivers of people with dementia. JAGS. 2003, 51: 657-664. 10.1034/j.1600-0579.2003.00210.x.
  • Clare L, Moniz-Cook E, Orrell M, Spector A, Woods B: Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia. In The Cochrane Library. 2004, Chichester: Wiley
  • Spector A, Orrell M, Davies S, Woods B: Reality orientation for dementia: a review of the evidence of effectiveness (Cochrane Review). In The Cochrane Library. 1998, Oxford: Update Software
  • Spector A, Thorgrimsen L, Woods B, Royan L, Davies S, Butterworth M, Orrell M: A randomised controlled trial investigating the effectiveness of an evidence-based cognitive stimulation therapy programme for people with dementia. British Journal of Psychiatry. 2003, 183: 248-254. 10.1192/bjp.183.3.248.
  • Knapp M, Thorgrimsen L, Patel A, Spector A, Hallam A, Woods B, Orrell M: Cognitive stimulation therapy for people with dementia: cost-effectiveness analysis. British Journal of Psychiatry. 2006, 188: 574-580. 10.1192/bjp.bp.105.010561.
  • National Institute for Health and Clinical Excellence and the Social Care Institute for Excellence (NICE-SCIE): Dementia: supporting people with dementia and their carers in health and social care. Clinical Guideline 42. 2006, London: NICE-SCIE
  • Orrell M, Spector A, Thorgrimsen L, Woods B: A pilot study examining the effectiveness of maintenance Cognitive Stimulation Therapy (MCST) for people with dementia. International Journal of Geriatric Psychiatry. 2005, 20: 446-451. 10.1002/gps.1304.
  • Olazaran J, Muniz R, Reisberg B, Peña-Casanova J, del Ser T, Cruz-Jentoft AJ, Serrano P, Navarro E, García de la Rocha ML, Frank A, Galiano M, Fernández-Bullido Y, Serra JA, González-Salvador MT, Sevilla C: Benefits of cognitive-motor intervention in MCI and mild to moderate Alzheimer's disease. Neurology. 2004, 63: 2348-2353.
  • Onder G, Zanetti O, Giacobini E, Frisoni GB, Bartorelli L, Carbone G, Lambertucci P, Silveri MC, Bernabei R: Reality orientation therapy combined with cholinesterase inhibitors in Alzheimer's disease: randomised controlled trial. British Journal of Psychiatry. 2005, 187: 450-455. 10.1192/bjp.187.5.450.
  • Gerber GJ, Prince PN, Snider HG, Atchison K, Dubois L, Kilgour JA: Group activity and cognitive improvement among patients with Alzheimer's disease. Hospital and Community Psychiatry. 1991, 42 (8): 843-845.
  • Wallis GG, Baldwin M, Higginbotham P: Reality orientation therapy-a controlled trial. British Journal of Medical Psychology. 1983, 56 (3): 271-277.
  • Zanetti O, Frisoni GB, De Leo D, Buono MD, Bianchetti A, Trabucci M: Reality Orientation Therapy in Alzheimer's disease: Useful or not? A controlled study. Alzheimer's disease and Associated Disorders. 1995, 9: 132-138.
  • Metitieri T, Zanetti O, Geroldi C, Frisoni GB, De Leo D, Dello Buono M, Bianchetti A, Trabucchi M: Reality Orientation Therapy to delay outcomes of progression in patients with dementia: A retrospective study. Clinical Rehabilitation. 2001, 15: 471-478. 10.1191/026921501680425199.
  • Folstein MF, Folstein SE, McHugh PR: 'Mini Mental State': a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research. 1975, 12: 189-198. 10.1016/0022-3956(75)90026-6.
  • Ferrario E, Cappa G, Molaschi M, Rocco M, Fabris F: Reality orientation therapy in institutionalized elderly patients: Preliminary results. Archives of Gerontology and Geriatrics. 1991, 12 (2): 139-42.
  • Woods RT: Reality Orientation and Staff attention: A Controlled Study. British Journal of Psychiatry. 1979, 134: 502-7. 10.1192/bjp.134.5.502.
  • Woods B, Spector A, Prendergast L, Orrell M: Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev. 2005, 4: CD005562-
  • Baines S, Saxby P, Ehlert K: Reality orientation and reminiscence therapy A controlled cross-over study of elderly confused people. British Journal of Psychiatry. 1987, 151: 222-31. 10.1192/bjp.151.2.222.
  • Requena C, Maestu F, Campo P, Fernandez A, Ortiz T: Effects of cholinergic drugs and cognitive training on dementia: 2-year follow-up. Dementia and Geriatric Cognitive Disorders. 2006, 22 (4): 339-345. 10.1159/000095600.
  • Aguirre E, Spector A, Streater A, Burnell K, Orrell M: Service users' involvement in the development of a maintenance Cognitive Stimulation Therapy (CST) programme: A comparison of the views of people with dementia, staff and family carers. Dementia Journal.
  • Gadner C: The impact of Cognitive Stimulation Therapy groups on people with dementia: views from participants, their carers and group facilitators. D Clin Psy Thesis. 2009, University College London
  • Office of Public Sector Information (OPSI): Mental Capacity Act. 2005, http://www.opsi.gov.uk/acts/acts2005/ukpga_20050009_en_1
  • Rosen WG, Mohs RC, Davis KL: A new rating scale for Alzheimer's disease. American Journal of Psychiatry. 1984, 141: 1356-64.
  • Logsdon RG, Gibbons LE, McCurry SM, Teri L: Assessing quality of life in older adults with cognitive impairment. Psychosomatic Medicine. 2002, 64: 510-519.
  • Moniz-Cook E, Vernooij-Dassen M, Woods R, Verhey F, Chattat R, de Vugt M, Mountain G, O'Connell M, Harrison J, Vasse E, Dröes RM, Orrell M: A European consensus on outcome measures for psychosocial intervention research in dementia care. Aging & Mental Health. 2008, 12 (1): 14-25.
  • Holden UP, Woods RT: Positive Approaches to Dementia Care. 1995, Edinburgh: Churchill Livingstone, 3
  • Alexopoulos GS, Abrams RC, Young RC, Shamoian CA: Cornell Scale for Depression in Dementia. Biological Psychiatry. 1988, 23: 271-284. 10.1016/0006-3223(88)90038-8.
  • Shankar KK, Walker M, Frost D, Orrell MW: The development of a valid and reliable scale for rating anxiety in dementia (RAID). Aging & Mental Health. 1999, 3 (1): 39-49.
  • Cummings L, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J: The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology. 1994, 44: 2308-2314.
  • Galasko D, Bennet D, Sano M, Ernesto C, Thomas R, Grundman M, Ferris S: An inventory to assess activities of daily living for clinical trials in Alzheimer's disease. The Alzheimer Disease Cooperative Study. Alzheimer Disease & Associated Disorders. 1997, 11: S33-39.
  • Ware JE, Kosinki M, Keller S: A 12 tem short form health survey. Construction of scales and preliminary tests of reliability and validity. Medical Care. 1996, 34: 220-223. 10.1097/00005650-199603000-00003.
  • Beecham J, Knapp M: Costing psychiatric interventions. Measuring mental health needs. Edited by: Thornicroft G, Brewin C, Wing J. 1992, London: Gaskell, 163-183.
  • EuroQoL Group: EuroQoL: A new facility for the measurement of health related quality of life. Health Policy. 1990, 16: 199-208. 10.1016/0168-8510(90)90421-9.
  • Smith SC, Lamping DL, Banerjee S, Harwood A, Foley B, Smith P, Cook JC, Murray J, Prince M, Levin E, Mann A, Knapp M: 'Measurement of health-related quality of life for people with dementia: development of a new instrument (DEMQOL) and an evaluation of current methodology'. Health Technology Assessment. 2005, 9 (10): 1-112.
  • Vickers AJ, Altman DG: Analysing controlled trials with baseline and follow up measurements. British Medical Journal. 2001, 323: 1123-1124. 10.1136/bmj.323.7321.1123.
  • National Audit Office: Improving Services and support for people with dementia. Report by the comptroller and auditor general. 2008, The Stationery office, London, UK
  • Matsuda O: Cognitive stimulation therapy for Alzheimer's disease: the effect of cognitive stimulation therapy on the progression of mild Alzheimer's disease in patients treated with donepezil. International Psychogeriatrics. 2007, 19 (2): 241-52. 10.1017/S1041610206004194.
  • Chapman SB, Weiner MF, Rackley A, Hynan LS, Zientz J: Effects of cognitive-communication stimulation for Alzheimer's disease patients treated with donepezil. Journal of Speech, Language, and Hearing Research. 2004, 47 (5): 1149-63. 10.1044/1092-4388(2004/085).
  • National Audit Office: Improving Services and support for people with dementia. Report by the comptroller and auditor general. 2007, The Stationery office, London, UK