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Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia

Randomised controlled trial

Department of Psychiatry and Behavioural Sciences, University College London

BOB WOODS, MSc

Dementia Services Development Centre, University of Wales, Bangor

LINDSAY ROYAN, BA

Department of Clinical Psychology, Petersfield Centre, Harold Hill, London

STEVE DAVIES, MSc

Department of Psychology, Derwent Unit, Princess Alexandra Hospital, Harlow, Essex

MARGARET BUTTERWORTH (deceased), BA and MARTIN ORRELL, PhD

Department of Psychiatry and Behavioural Sciences, University College London, UK

Correspondence: Dr Martin Orrell, Department of Psychiatry and Behavioural Sciences, UCL, Wolfson Building, 48 Riding House Street, London W1N 8AA, UK. Tel: 020 7679 9452; fax: 020 7679 9426; e-mail: m.orrell{at}ucl.ac.uk

Declaration of interest None. Funding detailed in Acknowledgements.

Background A recent Cochrane review of reality orientation therapy identified the need for large, well-designed, multi-centre trials.

Aims To testthe hypothesis that cognitive stimulation therapy (CST) for older people with dementia would benefit cognition and quality of life.

Method A single-blind, multi-centre, randomised controlled trial recruited 201 older people with dementia. The main outcome measures were change in cognitive function and quality of life. An intention-to-treat analysis used analysis of covariance to control for potential variabilityin baseline measures.

Results One hundred and fifteen people were randomised within centres to the intervention group and 86 to the control group. At follow-up the intervention group had significantly improved relative to the control group on the Mini-Mental State Examination (P=0.044), the Alzheimer’s Disease Assessment Scale – Cognition (ADAS–Cog) (P=0.014) and Quality of Life – Alzheimer’s Disease scales (P=0.028). Using criteria of 4 points or more improvement on the ADAS–Cog the number needed to treat was 6 for the intervention group.

Conclusion The results compare favourably with trials of drugs for dementia. CST groups may have worthwhile benefits for many people with dementia.

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