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-deliver...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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NIHR Journals Library
2015-08-01
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| Series: | Health Technology Assessment |
| Subjects: | |
| Online Access: | https://doi.org/10.3310/hta19640 |
| _version_ | 1818478029524959232 |
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| author | Vasiliki Orgeta Phuong Leung Lauren Yates Sujin Kang Zoe Hoare Catherine Henderson Chris Whitaker Alistair Burns Martin Knapp Iracema Leroi Esme D Moniz-Cook Stephen Pearson Stephen Simpson Aimee Spector Steven Roberts Ian T Russell Hugo de Waal Robert T Woods Martin Orrell |
| author_facet | Vasiliki Orgeta Phuong Leung Lauren Yates Sujin Kang Zoe Hoare Catherine Henderson Chris Whitaker Alistair Burns Martin Knapp Iracema Leroi Esme D Moniz-Cook Stephen Pearson Stephen Simpson Aimee Spector Steven Roberts Ian T Russell Hugo de Waal Robert T Woods Martin Orrell |
| author_sort | Vasiliki Orgeta |
| collection | DOAJ |
| description | 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. Trial registration: Current Controlled Trials ISRCTN65945963. Funding: This project was funded by the National Institute of Health Research (NIHR) Health Technology Assessment (HTA) programme and will be published in full in Health Technology Assessment; Vol. 19, No. 64. See the NIHR Journals Library website for further information. |
| first_indexed | 2024-12-10T09:43:24Z |
| format | Article |
| id | doaj.art-bb2bab51e27541aab819ae8adb1a8c2e |
| institution | Directory Open Access Journal |
| issn | 1366-5278 2046-4924 |
| language | English |
| last_indexed | 2024-12-10T09:43:24Z |
| publishDate | 2015-08-01 |
| publisher | NIHR Journals Library |
| record_format | Article |
| series | Health Technology Assessment |
| spelling | doaj.art-bb2bab51e27541aab819ae8adb1a8c2e2022-12-22T01:53:56ZengNIHR Journals LibraryHealth Technology Assessment1366-52782046-49242015-08-01196410.3310/hta1964008/116/06Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trialVasiliki Orgeta0Phuong Leung1Lauren Yates2Sujin Kang3Zoe Hoare4Catherine Henderson5Chris Whitaker6Alistair Burns7Martin Knapp8Iracema Leroi9Esme D Moniz-Cook10Stephen Pearson11Stephen Simpson12Aimee Spector13Steven Roberts14Ian T Russell15Hugo de Waal16Robert T Woods17Martin Orrell18Division of Psychiatry, University College London, London, UKDivision of Psychiatry, University College London, London, UKDivision of Psychiatry, University College London, London, UKNorth Wales Organisation for Randomised Trials in Health, Institute of Medical and Social Care Research, Bangor, UKNorth Wales Organisation for Randomised Trials in Health, Institute of Medical and Social Care Research, Bangor, UKPersonal Social Services Research Unit, London School of Economics and Political Science, London, UKNorth Wales Organisation for Randomised Trials in Health, Institute of Medical and Social Care Research, Bangor, UKInstitute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UKPersonal Social Services Research Unit, London School of Economics and Political Science, London, UKInstitute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UKInstitute of Rehabilitation, University of Hull, Hull, UKDevon Partnership NHS Trust, Exeter, UKDorset Healthcare University NHS Foundation Trust, Dorset, UKResearch Department of Clinical, Educational and Health Psychology, University College London, London, UKLincolnshire Partnership NHS Foundation Trust, Lincoln, UKCollege of Medicine, Swansea University, Swansea, UKNorfolk and Suffolk NHS Foundation Trust, Norwich, UKDementia Services Development Centre Wales, Bangor University, Bangor, UKSchool of Medicine, Institute of Mental Health, Nottingham, UKBackground: 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. Trial registration: Current Controlled Trials ISRCTN65945963. Funding: This project was funded by the National Institute of Health Research (NIHR) Health Technology Assessment (HTA) programme and will be published in full in Health Technology Assessment; Vol. 19, No. 64. See the NIHR Journals Library website for further information.https://doi.org/10.3310/hta19640dementiaindividual cognitive stimulation therapyalzheimer’s diseaserandomised controlled trialquality of lifecarer-led intervention |
| spellingShingle | Vasiliki Orgeta Phuong Leung Lauren Yates Sujin Kang Zoe Hoare Catherine Henderson Chris Whitaker Alistair Burns Martin Knapp Iracema Leroi Esme D Moniz-Cook Stephen Pearson Stephen Simpson Aimee Spector Steven Roberts Ian T Russell Hugo de Waal Robert T Woods Martin Orrell Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial Health Technology Assessment dementia individual cognitive stimulation therapy alzheimer’s disease randomised controlled trial quality of life carer-led intervention |
| title | Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial |
| title_full | Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial |
| title_fullStr | Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial |
| title_full_unstemmed | Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial |
| title_short | Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial |
| title_sort | individual cognitive stimulation therapy for dementia a clinical effectiveness and cost effectiveness pragmatic multicentre randomised controlled trial |
| topic | dementia individual cognitive stimulation therapy alzheimer’s disease randomised controlled trial quality of life carer-led intervention |
| url | https://doi.org/10.3310/hta19640 |
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