Thursday, 28 March, 2024
HomePsychiatryEffects of at-home iCST on dementia patients and caregivers

Effects of at-home iCST on dementia patients and caregivers

Individual Cognitive Stimulation Therapy (iCST), an intervention carried out at home by family caregivers, has little impact on the cognition of patients with dementia, a UK study has found – but it boosts the quality of the relationship between the patient and caregiver.

The study, a randomised, controlled trial, is led by Martin Orrell of the University of Nottingham and colleagues.

Cognitive Stimulation Therapy (CST), which involves activities designed to improve cognition and memory in people with dementia, is often used in group settings, at day centers or residential care facilities, but evidence is lacking on CST delivered individually in the home-care setting.

In the new study, 356 people with mild to moderate dementia and their family caregivers were randomly assigned either to three 30 minute sessions of iCST per week, or to treatment as usual, for 25 weeks. Caregivers were given training on how to carry out individual CST sessions at home. Follow-up tests and surveys were completed at 26 weeks.

At the conclusion of the study period, patients who had been assigned to the iCST groups had no differences in cognition or self-reported quality of life compared to those in the control group. However, quality of life for caregivers was higher, and patients rated the relationship with their caregiver higher, in the iCST groups.

The study was limited by low adherence to the intervention – only 40% of people in the iCST groups completed two sessions of the intervention per week, as assigned, and 22% completed no sessions at all.

“From a clinical perspective, improved quality of life for the caregiver, and an improved relationship for the person with dementia by means of a low cost, non-drug intervention are very worthwhile outcomes,” the authors say. “The longer-term associated effect of reducing depression for caregivers who did more sessions may mean that caregivers remain better mentally, and perhaps physically, for longer.”

Abstract
Background: Cognitive stimulation therapy (CST) is a well-established group psychosocial intervention for people with dementia. There is evidence that home-based 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 (well-being) for the caregiver.
Methods and findings: A single-blind, pragmatic randomised controlled trial (RCT) was conducted at eight study sites across the United Kingdom. The intervention and blinded assessment of outcomes were conducted in participants’ homes. Three hundred fifty-six people with mild to moderate dementia and their caregivers were recruited from memory services and community mental health teams (CMHTs).
Participants were randomly assigned to iCST (75, 30-min sessions) or treatment as usual (TAU) control over 25 wk. 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 QoL (Quality of Life Alzheimer’s Disease [QoL-AD]) for the person with dementia and general health status (Short Form-12 health survey [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 Relationship Scale) and health-related QoL (European Quality of Life–5 Dimensions [EQ-5D]) for the caregiver.
Intention to treat (ITT) analyses were conducted. At the post-test (26 wk), there were no differences between the iCST and TAU groups in the outcomes of cognition (mean difference [MD] = −0.55, 95% CI −2.00–0.90; p = 0.45) and self-reported QoL (MD = −0.02, 95% CI −1.22–0.82; p = 0.97) for people with dementia, or caregivers’ general health status (MD = 0.13, 95% CI −1.65–1.91; p = 0.89). However, people with dementia receiving iCST rated the relationship with their caregiver more positively (MD = 1.77, 95% CI 0.26–3.28; p = 0.02), and iCST improved QoL for caregivers (EQ-5D, MD = 0.06, 95% CI 0.02–0.10; 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.

Authors
Martin Orrell, Lauren Yates, Phuong Leung, Sujin Kang, Zoe Hoare, Chris Whitaker, Alistair Burns, Martin Knapp, Iracema Leroi, Esme Moniz-Cook, Stephen Pearson, Stephen Simpson, Aimee Spector, Steven Roberts, Ian Russell, Hugo de Waal, Robert T Woods, Vasiliki Orgeta

[link url="https://www.plos.org/"]PLOS material[/link]
[link url="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002269"]PLOS Medicine abstract[/link]

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