The Evidence-Base

Group CST was designed through systematically reviewing the literature on the main non-pharmacological therapies for dementia (23). The most effective elements of the different therapies were combined to create the CST programme, which was modified following a pilot study (4). CST was then evaluated as a multi-centre randomised controlled trial (RCT) in 23 centres (residential homes and day centres) (1).

The 201 participants with a diagnosis of dementia were randomly allocated to either CST groups or a 'treatment as usual' control condition. The results of the trial showed that CST led to significant benefits in people's cognitive functioning, as measured by the Mini-Mental State Examination (MMSE) and the ADAS-COG. These tests primarily investigate memory and orientation, but also language and visuospatial abilities. Because these outcome measures are used in the dementia drug trials, direct comparisons could be made. Further research showed that CST made a significant impact on language skills including naming, word-finding and comprehension (13).

Analysis suggested that for larger improvements in cognition, CST is equally effective as several dementia drugs. Further, CST led to significant improvements in quality of life, as rated by the participants themselves using the QoL-AD. There were no reported side-effects of CST.

Further research has involved interviewing people with dementia, carers and staff about their experiences of CST sessions (14). Key themes emerging included positive experiences of being in the groups, due to a supportive and non-threatening environment; and improvements in mood, confidence and concentration. Quotes from people with dementia participating included:

“I noticed people becoming more fluent and you could see people trying to express themselves more”.

“We just enjoyed ourselves; there’s an awful lot of laughter”.

“It helped all of us know we were in the same boat”.

 

Quotes from family carers included:

“There is no argument that my wife is brighter”.

“She’s started remembering things since coming to the group”.

“The value of the group has been to make him more animated and motivated”.

A more recent trial (15) has looked at longer-term, or 'Maintenance CST', consisting of 26, weekly sessions following the CST programme. It found that ongoing CST led to continuous benefits in quality of life over a six month period. Cognitive benefits continued too, although the difference between the treatment and control conditions was no longer statistically signifcant - an inevitable consequence of the decline found in dementia. The trial, which included 237 participants, also found that those who improved the most were receiving both maintenance CST and anti-dementia medication, suggesting that people should have the option of both wherever possible.

A trial on ‘Individualised CST’ (iCST) has evaluated the effectiveness of CST delivered on a one-to-one basis by family carers [18]. 356 people with dementia were randomly allocated to receive either (up to) 75 sessions of iCST or treatment as usual. Changes in cognitive function and quality of life for the people with dementia were not significant, as they had been following group CST. However, the people with dementia reported an improvement in their relationship with their carer after taking part in iCST sessions. Additional benefits also emerged as carers reported an improvement in their own quality of life. Both people with dementia and family carers valued mental stimulation and people with dementia also valued activities that were meaningful and helped them keep in touch with the world around them.