Background: Increasing evidence demonstrates the efficacy of cognitive stimulation (CS) in individuals with dementia. However, conducting studies in nursing homes engenders specific challenges that have limited the data gathered on this topic so far.
Objective: The aim of this randomized controlled trial was to investigate the effects of CS on cognition, quality of life (QoL), behavioral symptoms, and activities of daily life in persons with dementia living in nursing homes. We further aimed to identify predictors of the intervention’s benefits.
Methods: Seventy-one persons with mild to moderate dementia were randomly allocated to the experimental group (EG; n = 36) that visited a CS program twice weekly for eight weeks or to the control group (CG; n = 35) that was receiving usual care. Neuropsychological tests were conducted before and after the intervention period and at six-week follow-up.
Results: There were no significant interaction effects Time×Group for the outcome measures. However, regression analysis revealed that a low cognitive baseline level predicted cognitive improvements. Furthermore, a low baseline level of QoL predicted a QoL benefit. For both findings, depression was a significant moderator, meaning that persons with fewer depressive symptoms had a higher probability of showing improvements.
Conclusion: This study provides data on profiles of patients who are most likely to profit from CS intervention in nursing-home settings and demonstrates that treatment of depression is of the utmost relevance for a positive outcome of CS. Living conditions will have to be considered more thoroughly in future research.
AlvesJ, Alves-CostaF, MagalhaesR, GoncalvesÓF, SampaioA (2014) Cognitive stimulation for portuguese older adults with cognitive impairment: A randomized controlled trial of efficacy, comparative duration, feasibility, and experiential relevance. Am J Alzheimers Dis Other Demen29, 503–512.
2.
WoodsB, AguirreE, SpectorAE, OrrellM (2012) Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev2, CD005562.
3.
NICE-SCIE (2007) A NICE–SCIE NCIE-SCIE. Guideline on supporting people with dementia and their carers in health and social care. National Clinical Practice Guideline Number 42, London.
4.
LivingstonG, KellyL, Lewis-HolmesE, BaioG, MorrisS, PatelN, OmarRZ, KatonaC, CooperC (2014) A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia. Health Technol Assess18, 1–226.
5.
GraesselE, StemmerR, EichenseerB, PickelS, DonathC, KornhuberJ, LuttenbergerK (2011) Non-pharmacological, multicomponent group therapy in patients with degenerative dementia: A 12-month randomized, controlled trial. BMC Med9, 129.
6.
LuttenbergerK, DonathC, UterW, GraesselE (2012) Effects of multimodal nondrug therapy on dementia symptoms and need for care in nursing home residents with degenerative dementia: A randomized-controlled study with 6-month follow-up. J Am Geriatr Soc60, 830–840.
7.
ClareL, WoodsRT (2004) Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer’s disease: A review. Neuropsychol Rehabil14, 385–401.
Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) (2009) Nichtmedikamentöse Behandlung der Alzheimer Demenz1 Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Köln.
10.
SubramaniamP, WoodsB (2012) The impact of individual reminiscence therapy for people with dementia: Systematic review. Expert Rev Neurother12, 545–555.
11.
AguirreE, WoodsRT, SpectorA, OrrellM (2013) Cognitive stimulation for dementia: A systematic review of the evidence of effectiveness from randomised controlled trials. Ageing Res Rev12, 253–262.
12.
AlvesJ, MagalhaesR, ThomasRE, GoncalvesOF, PetrosyanA, SampaioA (2013) Is there evidence for cognitive intervention in Alzheimer disease? A systematic review of efficacy, feasibility, and cost-effectiveness. Alzheimer Dis Assoc Disord27, 195–203.
13.
KurzAF, LeuchtS, LautenschlagerNT (2011) The clinical significance of cognition-focused interventions for cognitively impaired older adults: A systematic review of randomized controlled trials. Int Psychogeriatr23, 1364–1375.
14.
HuntleyJD, GouldRL, LiuK, SmithM, RJH (2015) Do cognitive interventions improve general cognition in dementia? A meta-analysis and meta-regression. BMJ Open5, e005247.
15.
SitzerDI, TwamleyEW, JesteDV (2006) Cognitive training in Alzheimer’s disease: A meta-analysis of the literature. Acta Psychiatr Scand114, 75–90.
16.
OrrellM, YatesLA, BurnsA, RussellI, WoodsRT, HoareZ, Moniz-CookE, HendersonC, KnappM, SpectorA, OrgetaV (2012) Individual Cognitive Stimulation Therapy for dementia (iCST): Study protocol for a randomized controlled trial. Trials13, 172.
17.
YamanakaK, KawanoY, NoguchiD, NakaakiS, WatanabeN, AmanoT, SpectorA (2013) Effects of cognitive stimulation therapy Japanese version (CST-J) for people with dementia: A single-blind, controlled clinical trial. Aging Ment Health17, 579–586.
18.
CoenRF, FlynnB, RigneyE, O’ConnorE, FitzgeraldL, MurrayC, DunleavyC, McDonaldM, DelaneyD, MerrimanN, EdgeworthJ (2011) Efficacy of a cognitive stimulation therapy programme for people with dementia. Ir J Psych Med28, 145–147.
19.
OrgetaV, LeungP, YatesL, KangS, HoareZ, HendersonC, WhitakerC, BurnsA, KnappM, LeroiI, Moniz-CookED, PearsonS, SimpsonS, SpectorA, RobertsS, RussellIT, de WaalH, WoodsRT, OrrellM (2015) Individual cognitive stimulation therapy for dementia: A clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial. Health Technol Assess19, 1–108.
20.
OnorML, TrevisiolM, NegroC, SignoriniA, SainaM, AgugliaE (2007) Impact of a multimodal rehabilitative intervention on demented patients and their caregivers. Am J Alzheimers Dis Other Demen22, 261–272.
21.
AguirreE, HoareZ, StreaterA, SpectorA, WoodsB, HoeJ, OrrellM (2013) Cognitive stimulation therapy (CST) for people with dementia - who benefits most?Int J Geriatr Psychiatry28, 284–290.
22.
KnappM, ThorgrimsenL, PatelA, SpectorA, HallamA, WoodsB, OrrellM (2006) Cognitive stimulation therapy for people with dementia: Cost-effectiveness analysis. Br J Psychiatry188, 574–580.
23.
WoodsB, ThorgrimsenL, SpectorA, RoyanL, OrrellM (2006) Improved quality of life and cognitive stimulation therapy in dementia. Aging Ment Health10, 219–226.
24.
SpectorA, ThorgrimsenL, WoodsB, RoyanL, DaviesS, ButterworthM, OrrellM (2003) Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: Randomised controlled trial. Br J Psychiatry183, 248–254.
25.
HuangHC, ChenYT, ChenPY, Huey-Lan HuS, LiuF, KuoYL, ChiuHY (2015) Reminiscence therapy improves cognitive functions and reduces depressive symptoms in elderly people with dementia: A meta-analysis of randomized controlled trials. J Am Med Dir Assoc16, 1087–1094.
26.
MentesJC, Tripp-ReimerT (2002) Barriers and facilitators in nursing home intervention research. West J Nurs Res24, 918–936.
27.
MaasML, KelleyLS, ParkM, SpechtJP (2002) Issues in conducting research in nursing homes. West J Nurs Res24, 373–389.
28.
SnowdenM, SatoK, Roy-ByrneP (2003) Assessment and treatment of nursing home residents with depression or behavioral symptoms associated with dementia: A review of the literature. J Am Geriatr Soc51, 1305–1317.
29.
Brüne-CohrsU, JuckelG, SchröderSG (2007) Qualität der Demenzdiagnostik im Seniorenheim. Z Arztl Fortbild Qualitatssich12, 611–615.
30.
MurfieldJ, CookeM, MoyleW, ShumD, HarrisonS (2011) Conducting randomized controlled trials with older people with dementia in long-term care: Challenges and lessons learnt. Int J Nurs Pract17, 52–59.
31.
YamagamiT, TakayamaY, MakiY, YamaguchiH (2012) A randomized controlled trial of brain-activating rehabilitation for elderly participants with dementia in residential care homes. Dement Geriatr Cogn Dis Extra2, 372–380.
32.
BoutronI, MoherD, AltmanD, SchulzK, RavaudP (2008) Extending the CONSORT Statement to randomized trials of nonpharmacologic treatment: Explanation and elaboration. Ann Intern Med148, 295–309.
33.
MoherD, HopewellS, SchulzKF, MontoriV, GøtzschePC, DevereauxPJ, ElbourneD, EggerM, AltmanDG (2010) CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomised trials. Int J Surg10, 28–55.
34.
SchulzKF, AltmanD, MoherD (2010) CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomised trials. Int J Surg9, 672–677.
35.
SpectorA, OrrellM, WoodsB (2010) Cognitive Stimulation Therapy (CST): Effects on different areas of cognitive function for people with dementia. Int J Geriatr Psychiatry25, 1253–1258.
36.
HaslamC, HaslamSA, JettenJ, BevinsA, RavenscroftS, TonksJ (2010) The social treatment: The benefits of group interventions in residential care settings. Psychol Aging25, 157–167.
37.
LaiCK, ChiI, Kayser-JonesJ (2004) A randomized controlled trial of a specific reminiscence approach to promote the well-being of nursing home residents with dementia. Int Psychogeriatr16, 33–49.
38.
BinettiG, MorettiDV, ScalviniC, di GiovanniG, VerzelettiC, MazziniF, ValentS, GhidoniR, BenussiL (2013) Predictors of comprehensive stimulation program efficacy in patients with cognitive impairment. Clinical practice recommendations. Int J Geriatr Psychiatry, 28, 26–33.
39.
WhitlockLA, McLaughlinAC (2012) Individual differences in response to cognitive training: Using a multi-modal, attentionally demanding game-based intervention for older adults. Comput Human Behav28, 1091–1096.
40.
GrossAL, RebokGW, UnverzagtFW, WillisSL, BrandtJ (2011) Cognitive predictors of everyday functioning in older adults: Results from the ACTIVE cognitive intervention trial. J Gerontol B Psychol Sci Soc Sci66, 557–566.
41.
RaheJ, BeckerJ, FinkGR, KesslerJ, KukoljaJ, RahnA, RosenJB, SzabadosF, WirthB, KalbeE (2015) Cognitive training with and without additional physical activity in healthy older adults: Cognitive effects, neurobiological mechanisms, and prediction of training success. Front Aging Neurosci13, 187.
42.
DillingH, MombourW, SchmidtMH (2015) Internationale Klassifikation psychischer Störungen: ICD-10 Kapitel V (F) - Klinisch-diagnostische Leitlinien, Hans Huber, Bern.
43.
FolsteinMF, FolsteinSE, McHughPR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res12, 189–198.
44.
BruerRA, SpitznagelE, CloningerCR (2007) The temporal limits of cognitive change from music therapy in elderly persons with dementia or dementia-like cognitive impairment: A randomized controlled trial. J Music Ther44, 308–328.
45.
BallerG, KalbeE, KaesbergS, KesslerJ (2009) NEUROvitalis. Ein Neuropsychologisches Gruppenprogramm zur Förderung der Geistigen Leistungsfähigkeit, ProLog, Köln.
46.
PetrelliA, KaesbergS, BarbeMT, TimmermannL, FinkGR, KesslerJ, KalbeE (2014) Effects of cognitive training in Parkinson’s disease: A randomized controlled trial. Parkinsonism Relat Disord20, 1196–1202.
47.
RaheJ, PetrelliA, KaesbergS, FinkGR, KesslerJ, KalbeE (2015) Effects of cognitive training with additional physical activity compared to pure cognitive training in healthy older adults. Clin Interv Aging10, 297–310.
48.
LieskJ, HartoghT, KalbeE (2015) Kognitive Stimulation und Musikintervention bei stationär versorgten Menschen mit Demenz. Eine Pilotstudie, Probleme und Perspektiven. Z Gerontol Geriatr48, 275–281.
49.
WerheidK, Thöne-OttoA (2006) Kognitives Training bei Alzheimer-Demenz. Aktuelle Entwicklungen, Chancen und Grenzen gerontologischer Gedächtnisrehabilitation. Nervenarzt77, 549–557.
50.
PuckM (2010) Stundenaufbau In Gedächtnistraining: Theoretische und praktische Grundlagen, Schloffer H, Prang E, Frick-Salzmann A, eds, Springer, Heidelberg.
51.
JacobsonE (1990) Entspannung als Therapie. Progressive Relaxation in Theorie und Praxis, Klett-Cotta, Stuttgart.
Moniz-CookE, Vernooij-DassenM, WoodsR, VerheyF, ChattatR, De VugtM, MountainG, O’ConnellM, HarrisonJ, VasseE, DröesRM, OrrellM (2008) A European consensus on outcome measures for psychosocial intervention research in dementia care. Aging Ment Health12, 14–29.
54.
RosenWG, MohsRC, DavisKL (1984) A new rating scale for Alzheimer’s disease. Am J Psychiatry141, 1356–1364.
55.
LogsdonRG, GibbonsLE, McCurrySM, TeriL (1999) Quality of life in Alzheimer’s disease: Patient and caregiver reports. J Ment Health Aging5, 21–32.
56.
HobartJ, CanoS, PosnerH, SelnesO, SternY, ThomasR, ZajicekJ (2013) Putting the Alzheimer’s cognitive test to the test I: Traditional psychometric methods. Alzheimers Dement9, 4–9.
57.
CummingsJL (1997) The Neuropsychiatric Inventory: Assessing psychopathology in dementia patients. Neurology48, 10–16.
WoodS, CummingsJL, HsuM-A, BarclayT, WheatleyMV, YaremaKT, SchnelleJF (2000) The use of the Neuropsychiatric Inventory in nursing home residents, characterization and measurement. Am J Geriatr Psychiatry8, 75–83.
60.
GalaskoD, BennettD, SanoM, EmestoC, ThomasR, GrundmanM, FerrisS, the Alzheimer’s Disease Cooperative, Study (1997) An inventory to assess activities of daily living for clinical trials in Alzheimer’s disease. Alzheimer Dis Assoc Disord11, 33–39.
61.
KleistP (2009) Das Intention-to-Treat-Prinzip. Schweiz Med Forum9, 450–453.
62.
DawsonJF, RichterAW (2006) Probing three-way Interactions in moderated multiple regression: Development and application of a slope difference test. J Applied Psychol91, 917–926.
63.
FaulF, ErdfelderE, LangA-G, BuchnerA (2007) G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods39, 175–191.
64.
LogsdonRG, GibbonsLE, McCurrySM, TeriL (2002) Assessing quality of life in older adults with cognitive impairment. Psychosom Med64, 510–519.
65.
BrooksS, GelmanA, JonesG, MengX-L (2011) Handbook of Markov Chain Monte Carlo, Chapman & Hall/CRC.
BühnerM, ZieglerM (2009) Statistik für Psychologen und Sozialwissenschaftler, Pearson Studium, München.
68.
JacobsonNS, TruaxP (1991) Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol59, 12–19.
69.
SpectorA,
OrrellM,
HallL (2012) Systematic Review of Neuropsychological Outcomes in Dementia from Cognition-Based Psychological Interventions. Dementia and Geriatric Cognitive Disorders34, 244–255.
70.
RobertP, FerrisS, GauthierS, IhlR, WinbladB, TennigkeitF (2010) Review of Alzheimer’s disease scales: Is there a need for a new multi-domain scale for therapy evaluation in medical practice?Alzheimers Res Ther2, 24.
71.
Cahn-WeinerDA, MalloyPF, RebokGW, OttBR (2003) Results of a randomized placebo-controlled study of memory training for mildly impaired Alzheimer’s disease patients. Appl Neuropsychol10, 215–223.
72.
OrrellM, SpectorA, ThorgrimsenL, WoodsB (2005) A pilot study examining the effectiveness of maintenance Cognitive Stimulation Therapy (MCST) for people with dementia. Int J Geriatr Psychiatry20, 446–451.
73.
SandbergP, RonnlundM, Derwinger-HallbergA, Stigsdotter NeelyA (2015) Memory plasticity in older adults: Cognitive predictors of training response and maintenance following learning of number-consonant mnemonic. Neuropsychol Rehabil4, 1–19.
74.
FairchildJK, FriedmanL, RosenAC, YesavageJA (2013) Which older adults maintain benefit from cognitive training? Use of signal detection methods to identify long-term treatment gains. Int Psychogeriatr25, 607–616.
75.
KennedyRE, CutterGR, WangG, SchneiderLS (2015) Using baseline cognitive severity for enriching Alzheimer’s disease clinical trials: How does Mini-Mental State Examination predict rate of change?Alzheimers Dement (N Y)1, 46–52.
76.
KalbeE, KaesbergS, KesslerJ (2010) Neuropsychologische Therapie bei Demenzpatienten: Was ist sinnvoll?Fortschr Neurol Psychiatr78, 519–531.
77.
SmithB (2013) Depression and motivation. Phenom Cogn Sci12, 615–635.
de OliveiraAM, RadanovicM, de MelloPC, BuchainPC, VizzottoAD, CelestinoDL, StellaF, PiersolCV, ForlenzaOV (2015) Nonpharmacological interventions to reduce behavioral and psychological symptoms of dementia: A systematic review. Biomed Res Int218980, 29.
80.
Bundesministerium für Familie, Senioren, Frauen und Jugend (BMFSFJ) (2005) Gender-Datenreport. 1. Datenreport zur Gleichstellung von Frauen und Männern in der Bundesrepublik Deutschland, BMFSFJ, München.
81.
ZhuangJP, FangR, FengX, XuXH, LiuLH, BaiQK, TangHD, ZhaoZG, ChenSD (2013) The impact of human-computer interaction-based comprehensive training on the cognitive functions of cognitive impairment elderly individuals in a nursing home. J Alzheimers Dis36, 245–251.
82.
SterneJAC, WhiteIR, CarlinJB, SprattM, RoystonP, KenwardMG, WoodAM, CarpenterJR (2009) Multiple imputation for missing data in epidemiological and clinical research: Potential and pitfalls. BMJ338, b2393.
