Cognitive Stimulation Therapy
What is Cognitive Stimulation Therapy?[edit | edit source]
Cognitive stimulation therapy or CST is a non-pharmacological, evidence-based, approach to treat the complex behavioral and psychological symptoms (BPSD) seen in patients with dementia. BPSD can range from mood changes, disruptive behaviors, hallucinations, aggression, agitation, sleep disturbance, motor changes, apathy, depression, and memory loss.
These behavioral and psychological symptoms are associated with adverse patient outcomes resulting in feelings of isolation and helplessness, increased risk of falls, injuries, and decreased quality of life. Apart from patient outcomes, BPSD is also associated with caregiver burnout and increased hospitalization rates, and admission to skilled facilities.
CST was developed in the UK by Dr. Spector and her team. It is recognized by The National Institute of Health and Clinical Excellence ( NICE, UK) as an evidence-based psychosocial intervention for the management of mild to moderate dementia which helps to improve patient confidence, cognition, social interaction, and quality of life.
CST relies on enhancing implicit memory in patients. 
How is Cognitive Stimulation Therapy administered?[edit | edit source]
CST is offered as a group-based therapy for patients with dementia with similar cognitive abilities. The main principle of CST is to offer activities that are fun, patient-centric, and mentally stimulating. The activities selected should be meaningful to the patient and help them to enhance memory, reasoning, and language. The group's size is anywhere from six to eight participants and requires two facilitators to run the program.
This program is offered for seven weeks duration for a total of 14 visits. Each week is themed and topics covered during these sessions range from childhood memories, current events to activities like baking, word search, etc. The sessions usually start with a warm-up song, group welcome, and utilize a reality orientation board with group information which helps to maintain continuity between the sessions. Participants are encouraged to provide their inputs on group activities and themes to make the sessions personable 
CST can be administered in a community setting and in long-term care homes. There was a study conducted to see the effectiveness of CST in an inpatient setting. The authors of this study provided a modified CST program for patients with dementia admitted in the hospital. This study found that CST was perceived to be enjoyable for both patients and their caregivers. The study also found improved nutritional status as the participants ate together, it also helped improve their ambulatory and transfer status as they were required to get of their rooms to attend the sessions and improved their social interactions. Since the stay in inpatient units are usually short the program was modified to reflect that.
What is the eligibility criteria for admission into the CST program?[edit | edit source]
Following are the criteria for admission in the CST:
- Physician confirmed diagnosis of dementia
- Available caregiver
- No physical limitations that would impact patient's participation
- Ability to communicate, socially engage for at least 45 minutes
- A score of 24 or less on the SLUMS ( Saint Louis university Mental Status Exam). 
What are the Benefits of CST?[edit | edit source]
- CST helps improve patients living with Dementia improve their language skills thus having a positive effect on their ability to communicate.
- CST is cost effective and easy to administer.
- A study conducted to see the effect of CST on patients with vascular dementia, treatment with CST demonstrated improvement in general cognition and short term memory
- Group based therapy helps in socialization thus helping with loneliness, despair, improving overall mood and thus improving quality of life.
- Combination of Acetylcholine treatment ( ACH) with CST has shown greater improvement in cognition than CST alone. 
Role of Physiotherapists in CST:[edit | edit source]
Although, there is a lack of direct evidence of the role PTs can play in CST, having the knowledge of nonpharmacological management of dementia can help PTs to suggest interventions to their patients. Physiotherapists can play an important role in exercise-based CST by designing appropriate exercise programs based on individual patient needs.
References[edit | edit source]
- YY Szeto J, JG Lewis S. Current treatment options for Alzheimer’s disease and Parkinson’s disease dementia. Current neuropharmacology. 2016 May 1;14(4):326-38.
- Abraha I, Rimland JM, Trotta FM, Dell'Aquila G, Cruz-Jentoft A, Petrovic M, Gudmundsson A, Soiza R, O'Mahony D, Guaita A, Cherubini A. Systematic review of systematic reviews of non-pharmacological interventions to treat behavioral disturbances in older patients with dementia. The SENATOR-OnTop series. BMJ Open. 2017 Mar 1;7(3):e012759.
- Ohno Y, Kunisawa N, Shimizu S. Antipsychotic treatment of behavioral and psychological symptoms of dementia (BPSD): management of extrapyramidal side effects. Frontiers in pharmacology. 2019 Sep 17;10:1045.
- Franchi B. Pharmacological management of behavioral and psychological symptoms of dementia. Journal of Pharmacy Practice and Research. 2016 Sep;46(3):277-85.
- Feast, A., Moniz-Cook, E., Stoner, C., Charlesworth, G. and Orrell, M., 2016. A systematic review of the relationship between behavioral and psychological symptoms (BPSD) and caregiver well-being. International psychogeriatrics, 28(11), pp.1761-1774.
- Richmond E. Running cognitive stimulation therapy (CST) groups as part of Core Community Mental Health Team (CMHT) work [Internet]. NICE. 2019 [cited 2021Nov26]. Available from: https://www.nice.org.uk/sharedlearning/running-cognitive-stimulation-therapy-cst-groups-as-part-of-core-community-mental-health-team-cmht-work
- Harrison BE, Son GR, Kim J, Whall AL. Preserved implicit memory in dementia: a potential model for care. American Journal of Alzheimer's Disease & Other Dementias®. 2007 Aug;22(4):286-93.
- McAulay J, Streater A. Delivery of Cognitive Stimulation Therapy for people with dementia in an inpatient setting (innovative practice). Dementia. 2020 Oct;19(7):2513-20.
- Stewart DB, Berg-Weger M, Tebb S, Sakamoto M, Roselle K, Downing L, Lundy J, Hayden D. Making a difference: A study of cognitive stimulation therapy for persons with dementia. Journal of gerontological social work. 2017 May 19;60(4):300-12.
- Gibbor L, Yates L, Volkmer A, Spector A. Cognitive stimulation therapy (CST) for dementia: a systematic review of qualitative research. Aging & mental health. 2021 May 27;25(6):980-90.
- Cognitive stimulation therapy (CST) and ICST [Internet]. SLU. [cited 2021Nov29]. Available from: https://www.slu.edu/medicine/internal-medicine/geriatric-medicine/aging-successfully/cognitive-stimulation-therapy.php
- Slums form - saint louis university : SLU [Internet]. [cited 2021Nov28]. Available from: https://www.slu.edu/medicine/internal-medicine/geriatric-medicine/aging-successfully/pdfs/slums_form.pdf
- Spector A, Orrell M, Woods B. Cognitive Stimulation Therapy (CST): effects on different areas of cognitive function for people with dementia. International journal of geriatric psychiatry. 2010 Dec;25(12):1253-8.
- Cost effectiveness [Internet]. Cognitive Stimulation Therapy. [cited 2021Nov29]. Available from: http://www.cstdementia.com/page/cost-effectiveness
- Piras F, Carbone E, Faggian S, Salvalaio E, Gardini S, Borella E. Efficacy of cognitive stimulation therapy for older adults with vascular dementia. Dementia & Neuropsychologia. 2017 Oct;11:434-41.
- Cohen-Mansfield J. The impact of group activities and their content on persons with dementia attending them. Alzheimer's research & therapy. 2018 Dec;10(1):1-8.
- Orrell M, Aguirre E, Spector A, Hoare Z, Woods RT, Streater A, Donovan H, Hoe J, Knapp M, Whitaker C, Russell I. Maintenance cognitive stimulation therapy for dementia: single-blind, multicentre, pragmatic randomised controlled trial. The British Journal of Psychiatry. 2014 Jun;204(6):454-61.