CST involves a set of tasks designed to reflect cognitive functions such as attention, memory, language, and problem solving combined with some RO sessions as described above. CST usually takes place in small group or individual settings. CS reflects a general view that lack of cognitive activity hastens cognitive decline therefore if an individuals cognitive activity is increased cognitive decline is prolonged. Therefore, the primary postulation of CST is that practice with specific cognitive functions may improve or at least maintain functioning in a given domain and that any effects of practice will generalise and induce general improvements in cognitive/social functioning. CST roots itself on a set of 18 key values, these were developed by the originators based on their experiences working with service users with dementia and the components they thought made for a successful group intervention. Principles include as followed:
Mental stimulation, New ideas and thoughts, using orientation sensitively and implicitly, using reminiscence as an aid to the here and now, providing triggers for recall, continuity and consistently between sessions, implicit learning, stimulating language, person centered,respect, involvement, inclusion, choice, fun, maximising potential and building relationship.As previously mentioned some of the most common symptoms of dementia include deficits in remembering events, mood disorders and impaired communication therefore this not only affects ones’ cognitive ability but overall quality of life. Therefore, one of the main functions of CST and RO is to address not only the loss of cognition but also the negative impact the disease may have on one’s attitude and sense of self. Dementia is a deliberating disease that robs an individual of many things for one; their independence, CST allows an individual choice and socialisation focusing on the acknowledgement of the individual’s personhood regardless of disease prognosis. Allowing the individual, the prospect to have a contribution into the choice of activity they participate has been associated with a reduction in behavioural issues and a decrease in pharmacological treatment in their daily care (Spector et al, 2003).
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Recent reviews document the success on the non-pharmacological intervention which conclude its significantly effective in improving a number of domains i.e. Cognition, Communication, Social Interaction, Well-being and Quality of life (Qol) (Woods, 2012).
In a study to test the hypothesis that ‘’cognitive stimulation therapy (CST) for older people with dementia would benefit cognition and quality of life’’, 115 people took part in 14 cognitive stimulation sessions that ran twice a week for 45 minutes over 7 weeks. Topics included using money, word activities, the present day and famous faces as well as including a reality orientation board.
Findings suggest an improvement in both cognition and quality of life (Spector et al, 2003). However, differences in the control conditions between centres meant that the control group was not homogeneous, Furthermore, the long-term effects of CST were not accounted for, therefore, this study could be criticised for its limitations. Nevertheless, other studies have tended to conclude a positive outcome on cognition (Woods 1995, Spector 2001, Baldelli 1993, Requena 2005). Research has also studied the effectiveness that maintenance CST has on dementia and has concluded that cognitive benefits can be maintained up to 6 months after the initial 2 weekly session programme, again supporting the assumption that CST significantly benefits people with dementia. Drawing from a strong theoretical base, Spector and colleagues (2003)evaluated CST in a pilot study and subsequent single-blind, multi-centre randomized control trial (n= 115). The authors noted significant improvement in cognition and quality of life in individuals with dementia (Spector et al., 2003). Spector and colleagues continued to validate the effectiveness of CST and its related program,Maintenance CST (Knapp, Thorgrimsen, Patel, Spector. Hallam, Woods, & Orrell,2005; Leach,2004; Orrell, Spector, Thorgrimsen, & Woods,2005; Spector et al.,2010,2003;Woods,Thorgrimsen,Spector,Royan & Orrell, 2006).
Cognitive problems have been the main focus of interest in treatment and research for people with dementia. It is becoming increasingly recognised, however, that a number of common non-cognitive symptoms also provide problems not only for the person with dementia and the carers, but also in relation to clinical management. The most obvious are agitation, aggression, mood disorders and psychosis, but other important symptoms include sexual disinhibition, eating problems and abnormal vocalisations.
To explain more on the CST process, there are five stimulation activities done in a cognitive stimulation therapy session. To start with, there is the art therapy which is usually non-verbal. It uses images to allow for dementia patients to express themselves. The forms of images include paintings, scups, and curvatures. According to Cognitive Stimulation Therapy (2017), this form of therapy provides a way for the patients to connect to their inner being and speak their mind. The arts allow them to focus enabling them to have a memory of their past or lost parts of their lives.
Second form of activity is the aromatherapy. This form of therapy is meant to ensure patients interact with each other and their social environment. Aromatherapy includes activities such as massage, baths, and spa activities. These activities evoke memories which might be associated with them. Music therapy is the third form of activity. This medium is usually flexible since music has a positive effect on the patients. Music therapy is a good form of stress reliever and reduces anxiety. Social life is also promoted by music and communication is also enhanced. It is also a good form of triggering memories depending on the genres of music.
Pet therapy or animal-assisted therapy is also used to treat dementia patients. This type of therapy is yet to be used in most clinical facilities. The facilities use pets since they are friendly with the aged. This stimulates the production of neurochemicals and reduces blood pressure levels. These activities can be conducted in any environment that the patient and family are comfortable with such as home, day care centres for the old, or clinics. Only trained individuals can conduct this form of exercise since they have the knowledge and expertise on memory impairment issue. Evaluation was done on the effects of CST and people’s perception on CST.
CST is seen to improve the lives of dementia patients. A qualitative study will test the hypothesis whether CST benefits service users experiencing memory impairments. To start with, therapy done to determine the memory conditions of the patient is done. This is the cognition part of the programme. The tested issues are response to commands, recognizing objects around the patient, speech, and following instructions. This is aimed at evaluating the level of the impairment and determine the level of therapy to provide. With knowledge of the health of the patient before suffering from dementia is also examined. This is meant to determine the behaviour of the person with dementia before the impairment and also the stress levels he can accommodate.
According to the data collected, 80% of the patients were positive with the results of CST. They noted improvements in their memory. This result is in agreement with the study done by Hall et al. (2013) which noted that people who had been given the non-pharmacological form of treatment had made some improvements in their memory. Their responses to commands and instructions had also improved immensely. Therefore, CST benefits the participants with their cognitive abilities since they improve in a significant way. Since dementia affects the aged, there are predicted results of the therapy programme. It has also been noted that women regained their cognition faster than men even under equal number of treatment sessions. The chances of a success rate of CST is evident on people who are older than the younger ones in age.
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The quality of life was also affected by CST. Independent researchers have had different conclusions on this part of the study. People diagnosed with dementia had improved their functioning which in turn improved their quality of life. The impact of CST on quality of life of a dementia person. The quality of life involves the chances of disturbing behaviour and rapid change in mood (Woods, Aguirre, Spector, & Orrell, 2012). Most of the patients admitted that CST made a significance effect on their lives since it was observed that the behaviours were calm and the quality of life rate was positive. Therapy had an impact on the person with an impaired memory. The positive change in quality of life is directly related to the cognition therapy conducted. Just like with cognition recovery, the female gender improved faster in their quality of life than the male species (Aguirre, Hoare, Streater, Spector, Woods, Hoe, Orrell, 2013). Those who were given therapy at their residential home also recovered faster than those who went to medical clinics to receive therapy. However, this is yet to be deeply investigated.
In addition to improvements in the patient’s cognitive abilities, CST had a great impact on their language and information. Many people with impaired memory need to be reminded over and over on vital information. With CST, one of the activities done is learning and creativity. Emphasis on creative thinking and a chance to raise creative ideas helps the memory impaired person to think more critically. The ability to rehearse information and instructions is also improved. Since CST was conducted in groups, verbal communication was encouraged (Hall, Orrell, Stott, & Spector, 2013). This is because the people suffering from dementia could comfortably discuss any topic and have a conversation about their environment.
The study also revealed that CST improved the nature of communication between the person with dementia and the caregivers. They managed to have meaningful conversations and express themselves more clearly. The social life of person with dementia also improved significantly. This is because they could communicate well with those around them without any hitches. Chances of forgetting information were also minimal since they are taught some rehearsal mechanisms through the different forms of therapy activities. Language improvement acts as a mediator between the person with dementia and social world (Wimo, Jönsson, Bond, Prince, Winblad, & International, 2013). Social integration becomes easier than before. People with dementia also get a chance to regain control of their life since they can do some activities by themselves.
CST benefited the users by reducing chances of depression. Dementia poses as a risk of depression occurrences. Depression causes the dementia patients to lose focus on themselves and engage in uncalled behaviour. The mood swings also come with depression (Mioshi, Foxe, Leslie, Savage, Hsieh, Miller, & Piquet, 2013). Therefore, with CST treatment majority of those who participated were happier and jovial which is a good way to avoid stress. Involvement in activities such as games and quizzes kept their minds engaged enabling them to focus on the important activities. Integration to social life also improves on their insight about life and progress is noted in behaviour.
It is also evident that the wellbeing of people with dementia improved even as cognition and quality of life improved. This is in line with costs of treatment. Once CST is successfully done, the patient can do away with the medication and channel the finances on other affairs. Since the aim of the therapy is to be easily accessed by all people irrespective of economic background, the costs are effective (Wimo et al., 2013). As a result, the treatment was affordable to the public. The results from CST and medication treatment vary in that therapy proves to be the better treatment. The length of the CST treatment was not long compared to drugs. Hence, the patient were assumed to save more on costs through therapy and gain more through the activities done.
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Cognition Stimulation therapy had an indirect impact on the family of the participants, caregivers, and trainers. No much benefit is reaped by the caregivers since CST is not done on them (Raghuraman, Lakshminarayanan, Vaitheswaran, & Rangaswamy, 2017). However, from the study it should be noted that an improvement in the life of the participants had a positive impact on their family and relatives. The participants had reduced cases of depression which in turn improved because they lacked stress. The care-givers also noted the positive results made them be positive about themselves. This is to mean that the intervention works indirectly for their psychological health (Schulz, & Sherwood, 2008). The quality of life of the caregivers is not affected by the CST since there are other things in their surrounding that can cause stress.
Further, the benefits of CST on the users was noted after the group activities were done. The participants had a good time and enjoyed the games and enjoyed the activities more especially music therapy. Some of the family members are trained on administering individual CST at home. This means that the caregivers gained knowledge and skills which would be important life skills in handling other cases of dementia. Moreover, CST was an advantage to the caregivers indirectly when their family member who has dementia improved socially. This means that they did not have to attend to their every physical need and feelings of security are expressed (Huntley, Gould, Liu, Smith, Howard, 2015). This relived them of some activities and could, hence, engage in other productive activities like going to work.
In summary, the above discussion explains the practice of Cognition Stimulation therapy and the benefits to its users. Cases of dementia, if they go unnoticed and ignored can have severe consequences on the patients and their families. From the data collected from the 115 participants, it can be concluded that therapy helped them by improve their quality of life, depression, and cognition. The perception of CST on people also changed since the effect was evident on the participants. This form of intervention should be encouraged around the globe by experienced health professionals as a mode of treatment besides the pharmacological type of treatment. Many people especially in developing and under-developed countries are not aware of this form of treatment. Therefore, an outreach campaign should be done to ensure awareness is improved. Furthermore, research should be done on which method is more effective between the medication mode of treatment versus therapy, and the thoughts of the users after undergoing CST.
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- Aguirre, E., Hoare, Z., Streater, A., Spector, A., Woods, B., Hoe, J., & Orrell, M. (2013). Cognitive stimulation therapy (CST) for people with dementia—who benefits most?. International journal of geriatric psychiatry, 28(3), 284-290
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- Huntley, J. D., Gould, R. L., Liu, K., Smith, M., & Howard, R. J. (2015). Do cognitive interventions improve general cognition in dementia? A meta-analysis and meta regression. BMJ open, 5 (4), e005247.
- Hall, L., Orrell, M., Stott, J & A. Spector, J. (2013). “Cognitive stimulation therapy (CST): neuropsychological mechanisms of change,” International Psychogeriatric, vol. 25, no. 3, pp. 479–489.
- Mioshi, E., Foxe, D., Leslie, F., Savage, S., Hsieh, S., Miller, L., & Piquet, O. (2013). The impact of dementia severity on caregiver burden in frontotemporal dementia and Alzheimer disease. Alzheimer Disease & Associated Disorders, vol. 27, no. 1, pp. 68-73
- Raghuraman, S., Lakshminarayanan, M., Vaitheswaran, S., & Rangaswamy, T. (2017). Cognitive Stimulation Therapy for Dementia: Pilot Studies of Acceptability and Feasibility of Cultural Adaptation for India. The American Journal of Geriatric Psychiatry.
- Schulz, R., & Sherwood, P. R. (2008). Physical and mental health effects of family caregiving. Journal of Social Work Education, 44(sup3), 105-113
- Spector, A., Martin, O. and Bob, W. (2010). “Cognitive Stimulation Therapy (CST): effects on different areas of cognitive function for people with dementia.” International journal of geriatric psychiatry, vol. 25, no. 12, pp. 1253-1258
- Wimo, A., Jönsson, L., Bond, J., Prince, M., Winblad, B., & International, A. D. (2013). The worldwide economic impact of dementia 2010. Alzheimer’s & Dementia, 9(1), 1-11.
- Woods, B., Aguirre, E., Spector, A. E., & Orrell, M. (2012). Cognitive stimulation to improve cognitive functioning in people with dementia. The Cochrane Library.