Benefits of cognitive stimulation for people with dementia

Overview: Cognitive stimulation is an intervention for people with dementia which offers a range of enjoyable activities providing general stimulation for thinking, concentration and memory usually in a social setting, such as a small group, aimed at general enhancement of cognitive and social functioning. Family caregivers can be trained to provide cognitive stimulation on a one-to-one basis.

In 2011, the World Alzheimer’s Report recommended that cognitive stimulation should be routinely offered to people with early stage dementia. However, in recent years, increased interest in its use in dementia has provoked concern about its effectiveness and potential negative effects on wellbeing.
See the NHS Evidence topic page on dementia for a general overview of the condition.
Current advice: NICE recommends that people with mild-to-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 staff with appropriate training and supervision, and offered irrespective of any drug prescribed for the treatment of cognitive symptoms of dementia.
The guidance also raised a need for more research into both the clinical and cost effectiveness of cognitive stimulation, both compared to and in combination with acetylcholinesterase inhibitors (donepezil, galantamine or rivastigmine).
NICE has a pathway on dementia, which brings together all related NICE guidance and associated products on the condition in a set of interactive topic-based diagrams.
New evidence: A Cochrane review evaluated the effectiveness and impact of cognitive stimulation interventions aimed at improving cognition for people with dementia, including any negative effects (Woods et al. 2012).
The review included 15 randomised controlled trials involving 718 people with mild-to-moderate dementia, mainly in the form of Alzheimer’s disease or vascular dementia. Participants were treated in small groups and involved in different activities, including discussion of past and present events and topics of interest, word games, puzzles, music and practical activities like baking or indoor gardening. All activities were designed to stimulate thinking and memory. Improvements following cognitive stimulation were compared with those seen without treatment and with ‘standard treatments’, which could include medicine, day care or visits from community mental health workers, or in some cases alternative activities such as watching TV and physical therapy.
Results showed that those who received cognitive stimulation interventions scored significantly higher in cognitive function tests. These benefits were still observed 1 to 3 months after treatment. In addition, positive effects on social interaction, communication and quality of life or wellbeing were observed in a smaller number of the trials, based on self-reported or carer-reported measures.
Where family members were trained to deliver cognitive stimulation on a one-to-one basis, no additional strain or burden on care givers was reported.
Commentary: “The caveat to the findings of this Cochrane review is that many of the studies were low quality and with small sample size. Study populations varied and the protocols and content of therapy quite diverse. Cognitive stimulation therapy is not an easily defined intervention. Disappointingly, there is no evidence for an effect on function, mood or difficult behaviour.
Old man doing a crossword“Important questions remain: Is there a need for maintenance sessions to sustain benefit beyond 3 months? What ‘dose’ of stimulation is needed? What is the active ingredient(s)? How much therapist training is needed and are the benefits clinically meaningful? Is it cost effective?
“Despite the limitations there is evidence here to support the principle of ‘use it or lose it’. That one study achieved this by using family carers as therapists, without detriment to them could help carers with the question ‘What can I do?’ and to deal with their frustration of feeling powerless.
“For professional carers there is a message to develop a culture of stimulation for people with dementia in their care and keep people’s brains active if we want to do the best for them. There is more to supporting people with dementia than just administering care.” – David Anderson, Consultant in Old Age Psychiatry with Merseycare NHS Trust and Honorary Senior Lecturer at the University of Liverpool.

This month in Eyes on Evidence

Data from the National Joint Registry for England and Wales indicates high failure rates for metal-on-metal hip replacements.
A Cochrane review shows cognitive stimulation therapies have beneficial effects on memory and thinking in people with dementia, as well as positive effects for wellbeing.
Developing more integrated support for people with mental and physical health problems could improve outcomes, by recognising the role of emotional and mental health problems in reducing people’s ability and motivation to manage their physical health.

Do renin-angiotensin system drugs reduce mortality in hypertension?

This systematic review provides good quality clinical evidence that  angiotensin-converting enzyme inhibitors reduce the risk of death in patients with hypertension. The benefits of angiotensin receptor blockers in reducing mortality are uncertain.
Angiotensin receptor blockers (ARBs) are no better than placebo or angiotensin-converting enzyme  inhibitors in reducing the risk of death, disability, or hospital admission for any reason. However, more patients stopped treatment early with ARBs than with placebo due to side effects.
An example from the Quality, Innovation, Productivity and Prevention collection on how the University Hospitals of Leicester NHS Trust has reduced delays, complications and costs around central venous access for patients.
Potential disinvestment opportunities highlighted this month are:
  • Biofeedback training for the management of faecal incontinence in children.
  • Non-pharmacological interventions for breathlessness.

Evidence Updates

This month NICE has published online via NHS Evidence an Evidence Update on constipation in children and young people.
How to get access, via NHS Athens on Apple and Android devices, to authoritative and practical information on the selection and clinical use of medicines from the British National Formulary.

What is a Cochrane Review?

In 2009, according to the Cochrane Library usage data that

“Every day someone, somewhere searches The Cochrane Library every second, reads an abstract every two seconds and downloads a full-text article every three seconds.”

If you’re a little unclear about Cochrane or systematic reviews and care enough about evidence based medicine to find out more, then go to Cochrane Reviews | The Cochrane Collaboration. Discover how they support healthcare staff to make the most informed decisions based on the latest evidence.

The Cochrane database of systematic reviews is included when searching NHS Evidence at www.evidence.nhs.uk

 

Cochrane Library – FREE Webex Training sessions

2 more dates to add to your diary if you would like to sign up for these FREE Introductory Cochrane Library online courses.  Follow this link to register:

 
3 Apr 2012  9:30    The Cochrane Library – An int…  
Gavin Stewart
  40 mins Register Register
17 Apr 2012  16:00    The Cochrane Library – An int…  
Gavin Stewart
  40 mins Register Register

Cochrane mini tutorials online

Online self-paced tutorials

Learn at your own pace and place!
These online tutorials are designed to provide a quick and informative overview and demonstration of The Cochrane Library. Part 1 provides an introduction to The Cochrane Library and Part 2 includes tips on advanced and MeSH searching, plus showing you how to save searches and set up email alerts.

Part 1. The Cochrane Library – an introduction         

Part 2. The Cochrane Library – Searching and MESH

The modules use sound and are free – brief details required when registering at the opening screen.

Here is a brochure about The Cochrane Library – click here

Cochrane Library web tutorials published

Two brand new Cochrane Library web tutorials have just been released.  To access these new tutorials, please follow the links below:

Part 1– The Cochrane Library – an introduction click here

Part 2– The Cochrane Library – searching & using MESH click here

To access the full suite of Wiley-Blackwell online tutorials including Essential Evidence Plus, Wiley Online Library and Evidence Based Medicine Guidelines, go to: wileyonlinelbrary.com/training

Additional support available on request from Library staff – call 01625 66 1362/1547 for an appointment.