Benefit of Cognitive Stimulation Therapy in a Patient with Vascular Dementia: A Case Report

BACKGROUND: Cognitive stimulation therapy (CST) is a restoration therapy based on cognitive improvement of patients, by giving patients a variety of stimulation. This therapy is highly recommended for people with mild dementia from mild to moderate in either Alzheimer dementia or vascular dementia. Vascular dementia is a collection of symptoms of decreased cognitive abilities associated with the incidence of stroke. CASE REPORT: Reported a 76-year-old man, who had a bleeding stroke, in admission the patient were often angry, sleepless, and aphasic. After returning home the patient experienced impairment in memory, language, executive ability, mild to moderate degree of visuospatial and incapable to manage his daily activities, therefore in routine evaluation of the 3rd month, patient was diagnosed as Vascular cognitive impairment. On regular home visits until the 6th month after the stroke, it was reported that in the first 6 months had been received CST. However, in the 7th–9th month of CST because at the time of the coronavirus disease-19 pandemic, human interaction was severely restricted, so patient monitoring was carried out using Ina AD-8 through phone. An evaluation of the cognitive function by measuring the cognitive function of the patient was using the Indonesian version of Montreal Cognitive Assessment (MoCA-Ina), as well as using activity daily living and instrumental daily living activities to measure the patient’s independence function. After 6 months of CST, there were cognitive improvements and were seen in MoCA – Ina, Ina AD-8 followed by improved patient independence. CONCLUSION: Cognitive stimulation is the best intervention option in the treatment of mild to moderate vascular dementia. This case is one good example that shows the success of CST that has been observed for 9 months, not only on the cognitive component but also in terms of the ability to perform daily activities

SenseCam intervention based on cognitive ctimulation therapy framework for early-stage dementia.

Estimates suggest that Ireland will have 50,000 people with dementia by 2016 and over 100,000 by 2036. Combined with European total costs estimated in 2005 at €130 billion. In the absence of a cure for dementia there is a real need to develop pervasive, user-centered technologies to enhance the well-being and quality of life of people with dementia. This study explores the use of Microsoft SenseCam images within the principles of Cognitive Stimulation Therapy (CST) to engage people with early stage dementia in meaningful discussion. The SenseCam intervention, like the CST approach, is aimed at general enhancement of quality of life and global cognitive and social functioning

Individual cognitive stimulation therapy for dementia : a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial

Background Group cognitive stimulation therapy programmes can benefit cognition and quality of life for people with dementia. Evidence for home-based, carer-led cognitive stimulation interventions is limited. Objectives To evaluate the clinical effectiveness and cost-effectiveness of carer-delivered individual cognitive stimulation therapy (iCST) for people with dementia and their family carers, compared with treatment as usual (TAU). Design A multicentre, single-blind, randomised controlled trial assessing clinical effectiveness and cost-effectiveness. Assessments were at baseline, 13 weeks and 26 weeks (primary end point). Setting Participants were recruited through Memory Clinics and Community Mental Health Teams for older people. Participants A total of 356 caregiving dyads were recruited and 273 completed the trial. Intervention iCST consisted of structured cognitive stimulation sessions for people with dementia, completed up to three times weekly over 25 weeks. Family carers were supported to deliver the sessions at home. Main outcome measures Primary outcomes for the person with dementia were cognition and quality of life. Secondary outcomes included behavioural and psychological symptoms, activities of daily living, depressive symptoms and relationship quality. The primary outcome for the family carers was mental/physical health (Short Form questionnaire-12 items). Health-related quality of life (European Quality of Life-5 Dimensions), mood symptoms, resilience and relationship quality comprised the secondary outcomes. Costs were estimated from health and social care and societal perspectives. Results There were no differences in any of the primary outcomes for people with dementia between intervention and TAU [cognition: mean difference –0.55, 95% confidence interval (CI) –2.00 to 0.90; p-value = 0.45; self-reported quality of life: mean difference –0.02, 95% CI –1.22 to 0.82; p-value = 0.97 at the 6-month follow-up]. iCST did not improve mental/physical health for carers. People with dementia in the iCST group experienced better relationship quality with their carer, but there was no evidence that iCST improved their activities of daily living, depression or behavioural and psychological symptoms. iCST seemed to improve health-related quality of life for carers but did not benefit carers’ resilience or their relationship quality with their relative. Carers conducting more sessions had fewer depressive symptoms. Qualitative data suggested that people with dementia and their carers experienced better communication owing to iCST. Adjusted mean costs were not significantly different between the groups. From the societal perspective, both health gains and cost savings were observed. Conclusions iCST did not improve cognition or quality of life for people with dementia, or carers’ physical and mental health. Costs of the intervention were offset by some reductions in social care and other services. Although there was some evidence of improvement in terms of the caregiving relationship and carers’ health-related quality of life, iCST does not appear to deliver clinical benefits for cognition and quality of life for people with dementia. Most people received fewer than the recommended number of iCST sessions. Further research is needed to ascertain the clinical effectiveness of carer-led cognitive stimulation interventions for people with dementia

Computer Interactive Reminiscence and Conversation Aid groups – delivering cognitive stimulation with technology

INTRODUCTION: Group-based cognitive stimulation is the only nonpharmacological intervention recommended by the UK National Institute for Clinical and Health Excellence (NICE) for people with dementia. The potential of technology to extend the availability of group-based cognitive stimulation has not been tested. METHOD: One hundred and sixty-one people with dementia participated in an 8-session group activity using Computer Interactive Reminiscence and Conversation Aid (CIRCA). Cognition, quality of life and general health were assessed pre-, post- and three-months later. RESULTS: There was a significant improvement in cognition and quality of life at the end of the CIRCA group intervention, which was further improved at three-month follow-up. CONCLUSION: CIRCA group sessions improved cognition and quality of life similar to group-base cognitive stimulation approved by NICE. These benefits were maintained at three-month follow-up. The data confirm the potential of CIRCA, which can be populated with different cultural and language contents for different user groups

Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia

Objective: The authors systematically reviewed the literature on psychological approaches to treating the neuropsychiatric symptoms of dementia.Method: Reports of studies that examined effects of any therapy derived from a psychological approach that satisfied prespecified criteria were reviewed. Data were extracted, the quality of each study was rated, and an overall rating was given to each study by using the Oxford Centre for Evidence-Based Medicine criteria.Results: A total of 1,632 studies were identified, and 162 satisfied the inclusion criteria for the review. Specific types of psychoeducation for caregivers about managing neuropsychiatric symptoms were effective treatments whose benefits lasted for months, but other caregiver interventions were not. Behavioral management techniques that are centered on individual patients' behavior or on caregiver behavior had similar benefits, as did cognitive stimulation. Music therapy and Snoezelen, and possibly sensory stimulation, were useful during the treatment session but had no longer-term effects; interventions that changed the visual environment looked promising, but more research is needed.Conclusions: Only behavior management therapies, specific types of caregiver and residential care staff education, and possibly cognitive stimulation appear to have lasting effectiveness for the management of dementia-associated neuropsychiatric symptoms. Lack of evidence regarding other therapies is not evidence of lack of efficacy. Conclusions are limited because of the paucity of high-quality research ( only nine level-1 studies were identified). More high-quality investigation is needed

Raising the standard of applied dementia care research : addressing the implementation error

Editoria

Systematic Multi-Domain Alzheimer's Risk Reduction Trial (SMARRT): Study Protocol.

This article describes the protocol for the Systematic Multi-domain Alzheimer's Risk Reduction Trial (SMARRT), a single-blind randomized pilot trial to test a personalized, pragmatic, multi-domain Alzheimer's disease (AD) risk reduction intervention in a US integrated healthcare delivery system. Study participants will be 200 higher-risk older adults (age 70-89 years with subjective cognitive complaints, low normal performance on cognitive screen, and ≥ two modifiable risk factors targeted by our intervention) who will be recruited from selected primary care clinics of Kaiser Permanente Washington, oversampling people with non-white race or Hispanic ethnicity. Study participants will be randomly assigned to a two-year Alzheimer's risk reduction intervention (SMARRT) or a Health Education (HE) control. Randomization will be stratified by clinic, race/ethnicity (non-Hispanic white versus non-white or Hispanic), and age (70-79, 80-89). Participants randomized to the SMARRT group will work with a behavioral coach and nurse to develop a personalized plan related to their risk factors (poorly controlled hypertension, diabetes with evidence of hyper or hypoglycemia, depressive symptoms, poor sleep quality, contraindicated medications, physical inactivity, low cognitive stimulation, social isolation, poor diet, smoking). Participants in the HE control group will be mailed general health education information about these risk factors for AD. The primary outcome is two-year cognitive change on a cognitive test composite score. Secondary outcomes include: 1) improvement in targeted risk factors, 2) individual cognitive domain composite scores, 3) physical performance, 4) functional ability, 5) quality of life, and 6) incidence of mild cognitive impairment, AD, and dementia. Primary and secondary outcomes will be assessed in both groups at baseline and 6, 12, 18, and 24 months

Emotional robots: principles and practice with PARO in Denmark, Germany and the UK

As societies age there will be a significant increase of those over 80 and a predicted increase in people with dementia. We know that loneliness increases with old age, and those living with dementia are at risk of social isolation. Also opportunities for sensory stimulation and engagement in pleasurable activities are reduced in old age. The question is what technologies can be used to extend the range of available interventions that can enhance well-being. Emotional robots have been developed for activity and therapeutic purposes. This article explores experiences of the emotional robot PARO in Denmark, Germany and UK, and provides principles of this robot as an activity or activity with a therapeutic purpose

Effects of dance therapy on balance, gait and neuro-psychological performances in patients with Parkinson's disease and postural instability

Postural Instability (PI) is a core feature of Parkinson’s Disease (PD) and a major cause of falls and disabilities. Impairment of executive functions has been called as an aggravating factor on motor performances. Dance therapy has been shown effective for improving gait and has been suggested as an alternative rehabilitative method. To evaluate gait performance, spatial-temporal (S-T) gait parameters and cognitive performances in a cohort of patients with PD and PI modifications in balance after a cycle of dance therapy