Maintenance cognitive stimulation therapy for dementia: Single-blind, multicentre, pragmatic randomised controlled trial

The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 03/2014; 204(6). DOI: 10.1192/bjp.bp.113.137414
Source: PubMed


There is good evidence for the benefits of short-term cognitive stimulation therapy for dementia but little is known about possible long-term effects.
To evaluate the effectiveness of maintenance cognitive stimulation therapy (CST) for people with dementia in a single-blind, pragmatic randomised controlled trial including a substudy with participants taking acetylcholinesterase inhibitors (AChEIs).
The participants were 236 people with dementia from 9 care homes and 9 community services. Prior to randomisation all participants received the 7-week, 14-session CST programme. The intervention group received the weekly maintenance CST group programme for 24 weeks. The control group received usual care. Primary outcomes were cognition and quality of life (clinical trial registration: ISRCTN26286067).
For the intervention group at the 6-month primary end-point there were significant benefits for self-rated quality of life (Quality of Life in Alzheimer's Disease (QoL-AD) P = 0.03). At 3 months there were improvements for proxy-rated quality of life (QoL-AD P = 0.01, Dementia Quality of Life scale (DEMQOL) P = 0.03) and activities of daily living (P = 0.04). The intervention subgroup taking AChEIs showed cognitive benefits (on the Mini-Mental State Examination) at 3 (P = 0.03) and 6 months (P = 0.03).
Continuing CST improves quality of life; and improves cognition for those taking AChEIs.

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Available from: Amy Streater, Apr 23, 2014
    • "The benefits of CR have been described in patients with traumatic brain injury (TBI) (Sohlberg et al., 2000), stroke (Cicerone et al., 2000, 2011; Poulin et al., 2012) or Alzheimer's disease (Spector et al., 2003; Sitzer et al., 2006; Orrell et al., 2014). The positive effects have been assessed using the levels of evidence adopted in pharmacological trials which are divided into class I (well-designed prospective randomized controlled trials), class Ia (almost-randomized trials), class II (prospective non-randomized controlled trials), and class III (clinical series) with the possibility to graduate the class II and III studies by adding positive or negative signs (e.g., class II++) (SPREAD, 2007; Cicerone et al., 2011). "
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    ABSTRACT: Aim of the study: To review the modalities of cognitive rehabilitation (CR), outcome endpoints, and the levels of evidence of efficacy of different interventions. Methods: A systematic research in Pubmed, Psychinfo, and SCOPUS was performed assessing the articles written in the entire period covered by these databases till December 2013. Articles in English, Spanish or French were evaluated. A manual research evaluated the references of all of the articles. The experimental studies were classified according to the level of evidence of efficacy, using a standardized Italian method (SPREAD, 2007), adopting the criteria reported by Cicerone et al. (2000, 2011). Results: Eighteen papers were classified into two reviews, four papers dealing with the principles and efficacy of CR in epilepsy, a methodological paper, a single-case report, a multiple-case report, and nine experimental papers. Most studies involved patients with temporal lobe epilepsy. Different types of CR were used to treat patients with epilepsy. A holistic rehabilitation approach was more useful than selective interventions to treat memory and attention disturbances. Conclusions: CR may be a useful tool to treat cognitive impairment in patients with epilepsy. However, the modalities of treatment and outcome endpoints are important concerns of clinical care and research. Controlled studies are needed to determine the efficacy of rehabilitation in well-defined groups of patients with epilepsy.
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    ABSTRACT: The Department of Health commissioned a team from the London School of Economics and Political Science and the London School of Hygiene and Tropical Medicine to consider progress in dementia care since 2009. We were asked to focus particularly on three areas: improvements in diagnosis and post-diagnostic support, changes in public attitudes, and developments in research. Two major policy documents provide the context: the National Dementia Strategy 2009, which is now finished, and the Prime Minister’s Challenge on Dementia 2012, which superseded it. Specifically, we were asked to examine the evidence available to address four policy questions: • What improvements have been made in dementia care and support, for people with dementia and their carers, since 2009? • What impact might these improvements have had on people with dementia and their carers, and (if evidence is available) on costs and cost-effectiveness? • What are the gaps and remaining obstacles to delivering against the commitments in the Prime Minister’s Challenge on Dementia? • What are the implications of all of the above, both for the priorities for action in the final year of the Prime Minister’s Challenge on Dementia and for the information needs to monitor future progress? Suggested Citation: Knapp M, Black N, Dixon J, Damant J, Rehill A, Tan S (2014) Independent Assessment of Improvements in Dementia Care and Support since 2009. London: Policy Innovation Research Unit and NIHR School for Social Care Research, LSE and LSHTM.
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