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M Orrell - One of the best experts on this subject based on the ideXlab platform.
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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, 2017Co-Authors: M Orrell, Zoe Hoare, Martin Knapp, Christopher J Whitaker, Phuong Leung, Lauren Yates, Sujin Kang, Alistair Burns, Iracema Leroi, Esme MonizcookAbstract:Background: Cognitive Stimulation Therapy (CST) is a well-established group psychosocial intervention for people with dementia. There is evidence that homebased programmes of cognitive Stimulation delivered by family caregivers may benefit both the person and the caregiver. However, no previous studies have evaluated caregiver-delivered CST. This study aimed to evaluate the effectiveness of a home-based, caregiver-led individual Cognitive Stimulation Therapy (iCST) program in (i) improving cognition and quality of life (QoL) for the person with dementia and (ii) mental and physical health (wellbeing) for the caregiver. Methods and Findings: A single-blind, pragmatic randomized trial (RCT) at eight study sites across the UK. The intervention and blinded assessment of outcomes were conducted in participants’ homes. 356 people with mild to moderate dementia and their caregivers recruited from memory services, and community mental health teams. Participants were randomly assigned to iCST (75, 30 minute sessions) or treatment as usual (TAU) control over 25 weeks. iCST sessions consisted of themed activities designed to be mentally stimulating and enjoyable. Caregivers delivering iCST received training and support from an unblind researcher. Primary outcomes were cognition (Alzheimer’s Disease Assessment Scale cognitive [ADAS-Cog]) and self-reported quality of life (QoL) (Quality of Life Alzheimer’s Disease [QoL-AD]) for the person with dementia, and general health status (Short Form-12 [SF-12]) for the caregiver. Secondary outcomes included: quality of the caregiving relationship from the perspectives of the person and of the caregiver (Quality of the Carer Patient Relationships Scale), and health-related QoL (EQ5D) for the caregiver. Intention to treat (ITT) analyses were conducted. At the post-test (26 weeks), there were no differences between the iCST and TAU groups in the outcomes of cognition (MD = -0·55, 95% CI -2·00 to 0·90; p=0·45), and self-reported quality of life (QoL) (MD = -0·02, 95% CI -1·22 to 0·82; p= 0·97) for people with dementia, or caregivers’ general health status (MD=0·13, 95% CI -1·65 to 1·91; p=0·89). However, people with dementia receiving iCST rated the relationship with their caregiver more positively (MD = 1·77, 95% CI 0·26 to 3·28; p=0·02) and iCST improved QoL for caregivers (EQ-5D, MD = 0·06, 95% CI 0·02 to 0·10; p=0·01). Forty percent (72/180) of dyads allocated to iCST completed at least two sessions per week, with 22% (39/180) completing no sessions at all. Study limitations include low adherence to the intervention. Conclusions: There was no evidence that iCST has an effect on cognition or QoL for people with dementia. However, participating in iCST appeared to enhance the quality of the caregiving relationship and caregivers’ QoL.
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maintenance cognitive Stimulation Therapy for dementia single blind multicentre pragmatic randomised controlled trial
British Journal of Psychiatry, 2014Co-Authors: M Orrell, Elisa Aguirre, Aimee Spector, Amy Streater, Zoe Hoare, Robert T Woods, Martin Knapp, Helen Donovan, Juanita Hoe, Christopher J WhitakerAbstract:Background There is good evidence for the benefits of short-term cognitive Stimulation Therapy for dementia but little is known about possible long-term effects. Aims 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). Method 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][1]). Results 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). Conclusions Continuing CST improves quality of life; and improves cognition for those taking AChEIs. [1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN26286067
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Should we use individual cognitive Stimulation Therapy to improve cognitive function in people with dementia
BMJ (Clinical research ed.), 2012Co-Authors: M Orrell, Bob Woods, Aimee SpectorAbstract:Interest is growing in the potential for mental exercises and activities to maintain and improve cognitive function, especially for patients attending memory clinics. However, a recent six week study of online brain training1—using cognitive tasks designed to improve reasoning, memory, planning, visuospatial skills, and attention—found that although specific improvements occurred in each domain, these effects did not transfer to untrained tasks. Psychological therapies targeting cognitive function in dementia have been in widespread use for several decades. These approaches may involve personalised interventions, such as cognitive rehabilitation (which focuses on coping with deficits and enhancing remaining cognitive skills)2 or cognitive training (which aims to enhance cognitive skills such as memory and attention through practice). More generic approaches include reminiscence, reality orientation, and cognitive Stimulation Therapy (box).3 Reality orientation, which involved re-teaching information related to orientation to everyday life (such as date, location, and current events), has now been superseded by cognitive Stimulation, which uses more implicit methods, with activities including categorisation and word association. Group based cognitive Stimulation Therapy is now a well established, evidence based, and cost effective approach that can improve cognition and quality of life in people with dementia.3 4 #### Description of cognitive Stimulation Therapy
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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, 2011Co-Authors: Elisa Aguirre, Aimee Spector, Amy Streater, Karen Burnell, M OrrellAbstract:This study reports on the process of developing a maintenance programme manual following the Medical Research Council guidelines representing the ‘phase I’ or modelling. This study uses an inductive thematic analysis approach to examine user perceptions on the maintenance cognitive Stimulation Therapy (CST) programme. Three focus groups were carried out with people with dementia, three with staff, and three with family carers of people with dementia. In total 17 people with dementia, 13 staff and 18 family carers took part in separate focus groups. The main findings from the user focus clearly supports the recent draft NICE guidelines on dementia (NICE‐SCIE, 2006) that states that all people with mild/moderate dementia should be ‘given the opportunity to participate in a structured group of cognitive Stimulation programme’. People with dementia highly valued the opportunity to take part in a mental stimulating group programme and found it vital in keeping them healthy and active. Most family carers and st...
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the impact of cognitive Stimulation Therapy groups on people with dementia views from participants their carers and group facilitators
Aging & Mental Health, 2011Co-Authors: Aimee Spector, Charlotte Gardner, M OrrellAbstract:Objectives: Cognitive Stimulation Therapy (CST) can lead to significant improvements in cognitive function and quality of life for people with dementia. This study sought to investigate whether improvements found in clinical trials were also noted by people with dementia, their carers and group facilitators in everyday life. Method: Qualitative interviews and focus groups were conducted with people attending CST groups, their carers and the group facilitators. Data were recorded and transcribed, before being analysed using Framework Analysis. Results: Two main themes emerged, ‘Positive experiences of being in the group’ and ‘Changes experienced in everyday life’, along with seven sub-themes. The overall experience of attending CST was seen as being emotionally positive and most participants reported some cognitive benefits. Conclusions: The findings lend further support to previous quantitative findings, as well as providing information about the personal experience of CST.
Juanita Hoe - One of the best experts on this subject based on the ideXlab platform.
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maintenance cognitive Stimulation Therapy an economic evaluation within a randomized controlled trial
Journal of the American Medical Directors Association, 2015Co-Authors: Elisa Aguirre, Aimee Spector, Zoe Hoare, Ian Russell, Martin Knapp, Helen Donovan, Juanita Hoe, Francesco Damico, Amritpal Rehill, Amy StreaterAbstract:Abstract Background Cognitive Stimulation Therapy (CST) is effective and cost-effective for people with mild-to-moderate dementia when delivered biweekly over 7 weeks. Aims To examine whether longer-term (maintenance) CST is cost-effective when added to usual care. Methods Cost-effectiveness analysis within multicenter, single-blind, pragmatic randomized controlled trial; subgroup analysis for people taking acetylcholinesterase inhibitors (ACHEIs). A total of 236 participants with mild-to-moderate dementia received CST for 7 weeks. They were randomized to either weekly maintenance CST added to usual care or usual care alone for 24 weeks. Results Although outcome gains were modest over 6 months, maintenance CST appeared cost-effective when looking at self-rated quality of life as primary outcome, and cognition (MMSE) and proxy-rated quality-adjusted life years as secondary outcomes. CST in combination with ACHEIs offered cost-effectiveness gains when outcome was measured as cognition. Conclusions Continuation of CST is likely to be cost-effective for people with mild-to-moderate dementia.
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maintenance cognitive Stimulation Therapy for dementia single blind multicentre pragmatic randomised controlled trial
British Journal of Psychiatry, 2014Co-Authors: M Orrell, Elisa Aguirre, Aimee Spector, Amy Streater, Zoe Hoare, Robert T Woods, Martin Knapp, Helen Donovan, Juanita Hoe, Christopher J WhitakerAbstract:Background There is good evidence for the benefits of short-term cognitive Stimulation Therapy for dementia but little is known about possible long-term effects. Aims 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). Method 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][1]). Results 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). Conclusions Continuing CST improves quality of life; and improves cognition for those taking AChEIs. [1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN26286067
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cognitive Stimulation Therapy cst for people with dementia who benefits most
International Journal of Geriatric Psychiatry, 2013Co-Authors: Elisa Aguirre, Aimee Spector, Amy Streater, Zoe Hoare, Bob Woods, Juanita HoeAbstract:Background The efficacy of cognitive Stimulation Therapy (CST) has been demonstrated, but little is known about the characteristics of people with dementia, which may predict a more positive response to CST. This study sought to investigate which factors may predict response to CST. Methods Two hundred and seventy-two participants with dementia took part in a 7-week CST intervention. Assessments were carried out pre-treatment and post-treatment. The results were compared with those of a previous comparable CST randomised control trial. A comparison of mean scores pre-CST and post-CST groups was undertaken, and contributing factors that predicted change in outcomes were examined. Results CST improved cognition and quality of life, and the results showed that the benefits of CST were independent of whether people were taking acetylcholinesteraseinhibitor (AChEI) medication. Increasing age was associated with cognitive benefits, as was female gender. Care home residents improved more than community residents on quality of life, but the community sample seemed to benefit more in relation to behaviour problems. Conclusions These results demonstrate that CST improves cognition and quality of life for people with dementia including those already on AChEIs. Older age and being female were associated with increased cognitive benefits from the intervention. Consideration should be given to aspects of CST, which may enhance the benefits for people with dementia who are male and those younger than 80 years. Copyright © 2012 John Wiley & Sons, Ltd.
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maintenance cognitive Stimulation Therapy cst for dementia a single blind multi centre randomized controlled trial of maintenance cst vs cst for dementia
Trials, 2010Co-Authors: Elisa Aguirre, Aimee Spector, Ian Russell, Robert T Woods, Martin Knapp, Juanita Hoe, M OrrellAbstract:Background: Psychological 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/Design: This multi-centre, pragmatic randomised controlled trial (RCT) to assess the effectiveness and costeffectiveness 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. Discussion: A 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 longerterm 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.
Aimee Spector - One of the best experts on this subject based on the ideXlab platform.
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a feasibility randomised control trial of individual cognitive Stimulation Therapy for dementia impact on cognition quality of life and positive psychology
Aging & Mental Health, 2021Co-Authors: Luke Gibbor, Lauren Yates, Lycia Forde, Stavros Orfanos, Christina Komodromos, Harriet Page, Kate Harvey, Aimee SpectorAbstract:Objectives: This study aimed to evaluate the feasibility of a 14-session programme of individual Cognitive Stimulation Therapy (iCST) for people with dementia (PWD). It addressed potential limitati...
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Changes in Default Mode Network Connectivity in Resting-State fMRI in People with Mild Dementia Receiving Cognitive Stimulation Therapy
'MDPI AG', 2021Co-Authors: Tianyin Liu, Aimee Spector, Daniel C. Mograbi, Gary Cheung, Gloria H. Y. WongAbstract:Group cognitive Stimulation Therapy (CST) is a 7-week activity-based non-pharmacological intervention for people with mild to moderate dementia. Despite consistent evidence of clinical efficacy, the cognitive and brain mechanisms of CST remain unclear. Theoretically, group CST as a person-centred approach may work through promoting social interaction and personhood, executive function, and language use, especially in people with higher brain/cognitive reserve. To explore these putative mechanisms, structural MRI and resting-state functional MRI data were collected from 16 people with mild dementia before and after receiving CST, and in 13 dementia controls who received treatment as usual (TAU). Voxel-based morphometry (VBM) and resting-state functional connectivity (rs-FC) analyses were performed. Compared with TAU, the CST group maintained the total brain volume/total intracranial volume (TBV/TICV) ratio. Increased rs-FC in the default mode network (DMN) in the posterior cingulate cortex and bilateral parietal cortices nodes was observed in the CST over TAU groups between pre- and post-intervention timepoints. We provided preliminary evidence that CST maintains/enhances brain reserve both structurally and functionally. Considering the role of DMN in episodic memory retrieval and mental self-representation, preservation of personhood may be an important mechanism of CST for further investigation
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a feasibility randomised control trial of individual cognitive Stimulation Therapy for dementia impact on cognition quality of life and positive psychology
Aging & Mental Health, 2020Co-Authors: Luke Gibbor, Lauren Yates, Lycia Forde, Stavros Orfanos, Christina Komodromos, Harriet Page, Kate Harvey, Aimee SpectorAbstract:Objectives: This study aimed to evaluate the feasibility of a 14-session programme of individual Cognitive Stimulation Therapy (iCST) for people with dementia (PWD). It addressed potential limitations in previous literature of iCST and evaluated possible impact on cognition, quality of life (QoL) and positive psychology.Method: The 14-session iCST programme was developed using existing manuals for group and individual CST and consultation with experts in the field. Thirty-three PWD were recruited from care homes and randomly assigned to iCST (14, 45-min sessions) or treatment as usual (TAU) over seven weeks. Outcomes measures were assessed at baseline and follow-up after the intervention.Results: The intervention appeared feasible with high attendance to sessions, minimal levels of attrition, and ease of recruitment. Analysis of covariance indicated significant improvements in cognition (Alzheimer's Disease Assessment Scale-Cognitive subscale) for PWD receiving iCST compared to TAU. There were no significant differences between groups on follow-up scores on the standardised Mini Mental State Examination, measures of positive psychology or self- and proxy- reported QoL.Conclusion: A 14-session programme of iCST delivered by professionals was feasible and acceptable to PWD and may provide benefits to cognition. A larger randomised control trial would be necessary to fully evaluate intervention impact on cognition, as well as QoL and positive psychology.
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maintenance cognitive Stimulation Therapy an economic evaluation within a randomized controlled trial
Journal of the American Medical Directors Association, 2015Co-Authors: Elisa Aguirre, Aimee Spector, Zoe Hoare, Ian Russell, Martin Knapp, Helen Donovan, Juanita Hoe, Francesco Damico, Amritpal Rehill, Amy StreaterAbstract:Abstract Background Cognitive Stimulation Therapy (CST) is effective and cost-effective for people with mild-to-moderate dementia when delivered biweekly over 7 weeks. Aims To examine whether longer-term (maintenance) CST is cost-effective when added to usual care. Methods Cost-effectiveness analysis within multicenter, single-blind, pragmatic randomized controlled trial; subgroup analysis for people taking acetylcholinesterase inhibitors (ACHEIs). A total of 236 participants with mild-to-moderate dementia received CST for 7 weeks. They were randomized to either weekly maintenance CST added to usual care or usual care alone for 24 weeks. Results Although outcome gains were modest over 6 months, maintenance CST appeared cost-effective when looking at self-rated quality of life as primary outcome, and cognition (MMSE) and proxy-rated quality-adjusted life years as secondary outcomes. CST in combination with ACHEIs offered cost-effectiveness gains when outcome was measured as cognition. Conclusions Continuation of CST is likely to be cost-effective for people with mild-to-moderate dementia.
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maintenance cognitive Stimulation Therapy for dementia single blind multicentre pragmatic randomised controlled trial
British Journal of Psychiatry, 2014Co-Authors: M Orrell, Elisa Aguirre, Aimee Spector, Amy Streater, Zoe Hoare, Robert T Woods, Martin Knapp, Helen Donovan, Juanita Hoe, Christopher J WhitakerAbstract:Background There is good evidence for the benefits of short-term cognitive Stimulation Therapy for dementia but little is known about possible long-term effects. Aims 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). Method 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][1]). Results 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). Conclusions Continuing CST improves quality of life; and improves cognition for those taking AChEIs. [1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN26286067
Bob Woods - One of the best experts on this subject based on the ideXlab platform.
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cognitive Stimulation Therapy cst for people with dementia who benefits most
International Journal of Geriatric Psychiatry, 2013Co-Authors: Elisa Aguirre, Aimee Spector, Amy Streater, Zoe Hoare, Bob Woods, Juanita HoeAbstract:Background The efficacy of cognitive Stimulation Therapy (CST) has been demonstrated, but little is known about the characteristics of people with dementia, which may predict a more positive response to CST. This study sought to investigate which factors may predict response to CST. Methods Two hundred and seventy-two participants with dementia took part in a 7-week CST intervention. Assessments were carried out pre-treatment and post-treatment. The results were compared with those of a previous comparable CST randomised control trial. A comparison of mean scores pre-CST and post-CST groups was undertaken, and contributing factors that predicted change in outcomes were examined. Results CST improved cognition and quality of life, and the results showed that the benefits of CST were independent of whether people were taking acetylcholinesteraseinhibitor (AChEI) medication. Increasing age was associated with cognitive benefits, as was female gender. Care home residents improved more than community residents on quality of life, but the community sample seemed to benefit more in relation to behaviour problems. Conclusions These results demonstrate that CST improves cognition and quality of life for people with dementia including those already on AChEIs. Older age and being female were associated with increased cognitive benefits from the intervention. Consideration should be given to aspects of CST, which may enhance the benefits for people with dementia who are male and those younger than 80 years. Copyright © 2012 John Wiley & Sons, Ltd.
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Should we use individual cognitive Stimulation Therapy to improve cognitive function in people with dementia
BMJ (Clinical research ed.), 2012Co-Authors: M Orrell, Bob Woods, Aimee SpectorAbstract:Interest is growing in the potential for mental exercises and activities to maintain and improve cognitive function, especially for patients attending memory clinics. However, a recent six week study of online brain training1—using cognitive tasks designed to improve reasoning, memory, planning, visuospatial skills, and attention—found that although specific improvements occurred in each domain, these effects did not transfer to untrained tasks. Psychological therapies targeting cognitive function in dementia have been in widespread use for several decades. These approaches may involve personalised interventions, such as cognitive rehabilitation (which focuses on coping with deficits and enhancing remaining cognitive skills)2 or cognitive training (which aims to enhance cognitive skills such as memory and attention through practice). More generic approaches include reminiscence, reality orientation, and cognitive Stimulation Therapy (box).3 Reality orientation, which involved re-teaching information related to orientation to everyday life (such as date, location, and current events), has now been superseded by cognitive Stimulation, which uses more implicit methods, with activities including categorisation and word association. Group based cognitive Stimulation Therapy is now a well established, evidence based, and cost effective approach that can improve cognition and quality of life in people with dementia.3 4 #### Description of cognitive Stimulation Therapy
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Cognitive Stimulation Therapy (CST): effects on different areas of cognitive function for people with dementia.
International journal of geriatric psychiatry, 2010Co-Authors: Aimee Spector, M Orrell, Bob WoodsAbstract:Background There is good evidence indicating that group Cognitive Stimulation Therapy (CST) leads to generalised cognitive benefits for people with dementia. However, little is known about whether some aspects of cognition might change more than others and why. Methods Cognitive Stimulation Therapy, a 14-session group treatment, has been evaluated in a multi-centre, single-blind, randomised controlled trial. This study looks at the subscales of the ADAS-Cog (memory and new learning, praxis and language) and compares the outcome of CST with a treatment as usual control group. Results There was a significant difference between treatment and control groups in total ADAS-Cog score (p = 0.01) and in the language subscale (p = 0.01). There were no significant changes in memory and orientation or praxis. Conclusions CST appears to have particular effects in promoting language function, which is likely to lead to generalised benefits. This may be through generating opinions and creating new semantic links through categorisation. Future research might use more sensitive psychometric tests to assess these effects in more depth. Copyright © 2010 John Wiley & Sons, Ltd.
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Improved quality of life and cognitive Stimulation Therapy in dementia.
Aging & mental health, 2006Co-Authors: M Orrell, Aimee Spector, Bob Woods, L Thorgrimsen, Lindsay RoyanAbstract:Quality of life (QoL) is now seen as a key outcome in many aspects of dementia care. In a recent randomized controlled trial of Cognitive Stimulation Therapy (CST) groups, significant improvements in self-reported QoL were identified as well as changes in cognitive function. This further analysis of results from the trial examines whether the changes in these two domains occurred independently, perhaps for different reasons, or whether the effect of treatment on QoL was mediated by the changes in cognition. In all, 201 people with dementia living in residential homes or attending day centres were assessed using the Quality of Life-Alzheimer's Disease (QOL-AD) scale and a range of measures of cognition, dementia level, mood, dependency and communication. Participants were randomized to receive an intervention programme of CST or to receive treatment as usual. The QoL-AD and other measures were repeated eight weeks later. At baseline, higher QoL in dementia was significantly correlated with lower levels of ...
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a pilot study examining the effectiveness of maintenance cognitive Stimulation Therapy mcst for people with dementia
International Journal of Geriatric Psychiatry, 2005Co-Authors: M Orrell, Aimee Spector, L Thorgrimsen, Bob WoodsAbstract:SUMMARY Background A recent randomised controlled trial on Cognitive Stimulation Therapy (CST) identified the need to evaluate its more long-term benefits for people with dementia. This study evaluates the effectiveness of a weekly maintenance CST programme for people with dementia in residential care. Method Thirty-five people with dementia were included, following on from a seven-week twice-weekly study of CST. The maintenance CST sessions ran in two residential homes using a once a week programme of CST over an additional 16 weeks. Two control homes did not receive the maintenance intervention. Results Using repeated measures ANOVAS, there was a continuous, significant improvement in cognitive function (MMSE) for those receiving MCST (CST þ maintenance CST sessions) as compared to CST alone or no treatment (p ¼ 0.012). There were no effects on quality of life, behaviour or communication following maintenance sessions. The initial cognitive improvements following CST were only sustained at follow-up when followed by the programme of maintenance CST sessions. Conclusions The cognitive benefits of CST can be maintained by weekly sessions for around 6 months. A large-scale, multi-centre maintenance CST trial is required to clarify potential longer-term benefits of maintenance CST for dementia. Copyright # 2005 John Wiley & Sons, Ltd.
John A Coller - One of the best experts on this subject based on the ideXlab platform.
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long term durability of sacral nerve Stimulation Therapy for chronic fecal incontinence
Diseases of The Colon & Rectum, 2013Co-Authors: Tracy Hull, Chad Giese, Steven D Wexner, Anders F Mellgren, Ghislain Devroede, Robert D Madoff, Katherine Stromberg, John A CollerAbstract:BACKGROUND: Limited data have been published regarding the long-term results of sacral nerve Stimulation, or sacral neuromodulation, for severe fecal incontinence. OBJECTIVES: The aim was to assess the outcome of sacral nerve Stimulation with the use of precise tools and data collection, focusing on the long-term durability of the Therapy. Five-year data were analyzed. DESIGN: Patients entered in a multicenter, prospective study for fecal incontinence were followed at 3, 6, and 12 months and annually after device implantation. PATIENTS: Patients with chronic fecal incontinence in whom conservative treatments had failed or who were not candidates for more conservative treatments were selected. INTERVENTIONS: Patients with ≥ 50% improvement over baseline in fecal incontinence episodes per week during a 14-day test Stimulation period received sacral nerve Stimulation Therapy. MAIN OUTCOME MEASURES: Patients were assessed with a 14-day bowel diary and Fecal Incontinence Quality of Life and Fecal Incontinence Severity Index questionnaires. Therapeutic success was defined as ≥ 50% improvement over baseline in fecal incontinence episodes per week. All adverse events were collected. RESULTS: A total of 120 patients (110 women; mean age, 60.5 years) underwent implantation. Seventy-six of these patients (63%) were followed a minimum of 5 years (maximum, longer than 8 years) and are the basis for this report. Fecal incontinence episodes per week decreased from a mean of 9.1 at baseline to 1.7 at 5 years, with 89% (n = 64/72) having ≥ 50% improvement (p < 0.0001) and 36% (n = 26/72) having complete continence. Fecal Incontinence Quality of Life scores also significantly improved for all 4 scales between baseline and 5 years (n = 70; p < 0.0001). Twenty-seven of the 76 (35.5%) patients required a device revision, replacement, or explant. CONCLUSIONS: The therapeutic effect and improved quality of life for fecal incontinence is maintained 5 years after sacral nerve Stimulation implantation and beyond. Device revision, replacement, or explant rate was acceptable, but future efforts should be aimed at improvement.
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long term durability of sacral nerve Stimulation Therapy for chronic fecal incontinence
Diseases of The Colon & Rectum, 2013Co-Authors: Tracy L Hull, Chad Giese, Steven D Wexner, Ghislain Devroede, Robert D Madoff, Katherine Stromberg, Anders Mellgren, John A CollerAbstract:BACKGROUND:Limited data have been published regarding the long-term results of sacral nerve Stimulation, or sacral neuromodulation, for severe fecal incontinence.OBJECTIVES:The aim was to assess the outcome of sacral nerve Stimulation with the use of precise tools and data collection, focusing on th