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Cognitive Stimulation Therapy (CST) is currently recommended by the National Institute for Clinical Excellence (NICE) for all people with mild-moderate dementia.
It is simple to deliver and effective but not often offered. 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. It should be delivered irrespective of any anti-dementia drug received by the person with dementia".
Who is it for?
'Cognitive stimulation is the only non-pharmacological intervention to be recommended for cognitive symptoms and maintenance of function. As NICE only recommend drugs for people in the moderate stages of Alzheimer's disease, Cognitive Stimulation is the treatment of choice for people in earlier stages of dementia (with a Mini-Mental State Score above 20). This points to the importance of CST being offered routinely in services' www.cstdementia.com.
CST can be adapted to run in community with a carers’ course alongside or in the care home setting, for people with early onset dementia or in first language for black and other ethnic minority groups, it can be offered as a short intervention or on a weekly basis as a useful ongoing support providing respite and access to carer's support for the carers of people living in the community.
What is CST?
It is a proven programme of themed, group activities and discussions that aim to actively stimulate and engage people with mild-moderate dementia and help them function at their maximum capability. Based on Person-Centred Care with each member respected as a unique individual, where possible assigned roles within the group reflecting their interests and capabilities, the therapy is designed to create an enjoyable and relaxed environment where people learn implicitly whilst strengthening their existing skills.
How does CST work?
Simple to deliver, the programme of detailed sessions is available in the guidebook, “Making a Difference”. The maintenance guide of a further 16 sessions is currently in research at UCL. Each session is sufficiently flexible to be adapted to the group’s capabilities and interests. A typical session like ‘Sounds’ starts with the members being individually welcomed and attention drawn to the group’s name. Each session starts with a recap of the previous session and is followed by a short reality orientation discussion covering the date, month, year, season, weather, time and some current news. A warm up game of softball is played with members stating their name or the name of the person they are throwing to, or as this session is ‘Sounds’, the name of a favourite song, instrument or type of music. For the main activity, percussion instruments are given to each person to be played along in accompaniment to some familiar music on CD. Members are invited to name the song or singer and, if necessary, are supported with a limited choice on the whiteboard. This is followed by some sounds, from a sound effect CD, that are matched with a selection of pictures. These provide a tangible focus and the combination of auditory and visual stimulation simplifies the task.
The sequence is repeated, with different themes, for each session, which all close with everyone being individually thanked for attending and their contributions, the discussions and ideas are summarised and feedback is encouraged. The group’s theme song, chosen along with the group name at the outset of the course, is sung at the opening and closing of the session. The group is reminded of the next start time and the theme is outlined briefly for the next session.
Who should commission CST?
CST is recommended by NICE and is a clinically proven therapy so PCT's could commission and Memory Clinics will need to offer services. Dementia UK, the 2007 Alzheimers Society report showed that a £1,291 pp pa increase in statutory costs when someone living in the community moves from mild to moderate dementia is borne by Social Services who again bear a £1,209 increase pp pa on the move to a severe level of dementia, so it would seem to make economic sense for the Local Authority to commission the service which from the Sussex pilot shows a promising impact on people with dementia and on their carer, helping to support people to live well for longer. Further, when CST is offered on a weekly basis - ongoing support and signposting is also provided and as the needs of the person with dementia change, the move to a higher level of care can be planned, thus helping to avoid expensive crisis care. The Sussex pilot showed that participants are prepared to pay a contribution to the costs of this service.
Who should deliver CST?
The UCL devised programme is very simple to deliver. The facilitator could come from a wide variety of backgrounds from psychiatry to volunteer past carers, occupational therapists, CPNs, Activity co-ordinators in care homes, psychologists - experience of working with groups and people with dementia is the most important criterion. On-site training is available through www.cstdementia.com, open training with sessions in London and planned for Manchester www.fordementia.org.uk. The guide book, "Making a Difference" is available from www.careinfo.org/books/. Voluntary sector organisations could be commissioned to deliver cost effective services, utlising volunteers to run carers courses and support the CST delivery.
Comments from people with dementia attending the Sussex CST group:
‘We just enjoyed ourselves there’s an awful lot of laughing’
‘You feel like a little family’
‘It helped all of us know we were in the same boat’
‘Over the time I noticed everyone becoming more relaxed and not having to be worried if you said the wrong thing’
Comments from carers of persons with dementia attending the CST group:
‘She’s started to remember things better since coming to the group’
‘It’s been wonderful to find an activity that matches both of our needs so well’
‘He has enjoyed being with other people he could relate to’
‘When you’ve seen them going down, to see them coming back up again is fantastic’
What Next?
This is a simple, proven, cost-effective therapy for people with dementia that is ready to roll out today. CST can be effectively combined with the carer’s peer support group to offer a useful intervention in the earlier stages of dementia, the cost varies but to train and equip a facilitator and publicise a course, costs about £1,750. I am working, voluntarily, to raise awareness and help more groups set up – if you would like any further information, visit www.cstdementia.com or please get in touch.
Joanne Knowles
Tel. 07711 698 279
BGS Newsletter, July 2009
Issue 22 ISSN 1748-6343 22 |