Structured and manualized Cognitive stimulation therapy (CST) is a particularly promising psychosocial intervention recommended for people with mild-to-moderate dementia. It has robust evidence on improving patient cognitive function, especially global cognition. It has been adapted to multiple cultures and societies (the UK, Spain, Italy, Japan, and so on). However, there are only four CST studies targeted on mild to moderate dementia. Moreover, these studies have some limitations: non-structured intervention programs, carried out only by medical care personnel, participants only from hospital or military senior homes, and intervention sessions conducted individually. There are only two studies for MCI individuals. it is controversial whether CST can improve cognitive function of MCI. The causes might be that the difficulty level of the cognitive stimulation therapy program for dementia is relatively low and do not suitable for MCI. In addition, there is a lack of research on the effect of cognitive stimulation therapy for individuals with different pathological progressions (Mild Cognitive Impairment, mild dementia, and moderate dementia).
Therefore, the present study developed a difficulty-based cognitive stimulation therapy program for individuals with different severity of cognitive impairment adhering to Spector's traditional cognitive stimulation therapy framework and manual, based on the characteristics of Chinese cultures and societies. We investigated the impacts of the difficulty-based cognitive stimulation therapy on cognitive function especially global cognition for individuals with different severity cognitive impairment by conducting an eight-week difficulty-based CST intervention program (Study 1).
Previous studies and our study 1 suggested that the effect of CST on Behavioral and psychological symptoms (BPS) was not significant. Multi-Sensory Stimulation Therapy (MSST) is designed for individuals with moderate and severe dementia. There is various evidence that MSST may be effective at managing BPS. So, we developed difficulty-based Multi-Sensory CST by incorporating the five senses element in our intervention program. We explored the further strengthened impacts of the difficulty-based multi-sensory cognitive stimulation therapy on global cognition and the broadened impact on BPS for individuals with different severity cognitive impairment (Study 2).
Intention to treat (ITT) analyses were conducted. Study 1 data analysis revealed that there were significant differences between the difficulty-based CST and TAU groups in the outcome of global cognition and delayed memory. The results of Study 2 suggested the beneficial effects of difficulty-based Multi-Sensory CST on global cognition and depression. More importantly, there was a larger effect size on the improvement of global cognition in the difficulty-based Multi-Sensory CST group than in the TAU group.
The results suggest that difficulty-based CST benefits the maintaining and promoting of global cognition, and the beneficial effect on global cognition can be strengthened and the beneficial effect can be broadened to depression by difficulty-based Multi-Sensory CST.
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