Cognitive Stimulation Therapy NICE or not?

ERoSH has been asked to raise awareness of an effective group therapy that is recommended by NICE for all people with mild-moderate dementia and which could be very useful in supporting residents with mild cognitive decline in sheltered housing.

The programme is Cognitive Stimulation Therapy (CST) that is evidence based (1), cost effective (2), and recommended by NICE (3) for all people with mild-moderate dementia and which helps meet objectives of the dementia strategy.

It is a proven, fun, support programme for people with mild-moderate dementia that increases self confidence, restores well-being and helps people live well for longer, that is now included in the NHS Choices, BUPA, Alzheimers Research Trust and Mental Health Foundation information on dementia.

Based on person-centred care principles, CST is a simple and effective group therapy for people in the early stages of the disease that reinforces the benefits of person-centred care and provides a meaningful group activity. The facilitator needs to have experience of working with groups, dementia awareness and access to supervision. The well designed programme is detailed in the guide, Making a Difference (see below) which offers a series of simple to follow, themed group activities to improve confidence, self-esteem and cognitive functioning. The hour long session is initially held in small (6-8 people) closed groups for a seven week, twice weekly period, and then weekly for a fixed period, or ideally ongoing, until the support is no longer suitable and more appropriate activities can be offered.

It is a great opportunity to support newly diagnosed people, and although it will not be suitable for all people with dementia, it is successful in providing social and mental stimulation and helping prevent people becoming depressed and isolated by normalising their situation. Appropriate CST courses could also be offered to new residents to help offset some of the cognitive decline that often accompanies the move into residential care and with the formation of friendship groups. Care homes could also offer courses, on a paid for basis, to people living in the community as an introduction to their local care home and possibly with an Alzheimers Society carer's information course alongside. CST sessions can be adapted to suit different abilities and interests. Groups could be run for people with early onset dementia, learning difficulties and in first language for people from BME groups.

References
(1) Spector A, Thorgrimsen L, Woods B, Royan L, Davies S, Butterworth M & Orrell M (2003). Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: Randomised Controlled Trial. British Journal of Psychiatry 183: 248-254.
(2) Knapp M, Thorgrimsen L, Patel A, Spector A, Hallam A, Woods B & Orrell M (2005). Cognitive Stimulation Therapy for people with dementia: Cost Effectiveness Analysis. British Journal of Psychiatry: 574 - 580.
(3) The current NICE guidelines on dementia from November 2006 state that: 'People with mild / moderate dementia of all types should be given the opportunity to participate in a structured group cognitive stimulation programme. This should be commissioned and provided by a range of health and social care workers with training and supervision. This should be delivered irrespective of any anti-dementia drug received by the person with dementia'.