A preliminary study of the effects of early intervention with people with dementia and their families in a memory clinic

Moniz-Cook, Esmé; Agar, Sharon; Gibson, Gillian; Thein, Win; Wang, M.

doi:10.1080/13607869856687

Cited by 91 publications

(91 citation statements)

References 44 publications

(20 reference statements)

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“…In terms of cognition and quality of life, our findings do not provide support for the use of home-based cognitive stimulation programmes for people with dementia, which is contrary to previous work on home-based memory rehabilitation 10 and RO for people with dementia. 12 It is unclear which factors could account for the differential efficacy.…”

Section: Secondary Outcomescontrasting

confidence: 56%

“…Carers' and professionals' feedback was sought in relation to the adaptation of group CST approaches 6,19 and the key characteristics of previous individual cognitive-based interventions involving carers. 10,12 These consultations concluded that a carer-led manual should adapt similar layouts to those used in previous literature (i.e. group CST) but overall length should be reduced, academic terms should be simplified and simple instructions should be incorporated.…”

Section: Development Study 1: Service Users' Views About the Intervenmentioning

confidence: 99%

“…The justification of evaluating individual carer-led programmes stems from promising findings from studies that have applied home-based cognitive interventions. A carer-led, home-based programme of active training in memory management including cognitive stimulation, orientation and family carer counselling 10 reported long-term benefits for cognition for people with dementia, reduced care home admissions and improved carer well-being. Home-based cognitive stimulation has also been associated with improvements in problem solving and memory, and a reduction in carers' depressive symptoms, 11 whereas the first RCT evaluating a home-based RO/cognitive stimulation intervention demonstrated improvements in cognition for the person with dementia.…”

Section: Introductionmentioning

confidence: 99%

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Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial

Orgeta

Leung

Yates

et al. 2015

Health Technol Assess

153

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BackgroundGroup 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.ObjectivesTo 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).DesignA multicentre, single-blind, randomised controlled trial assessing clinical effectiveness and cost-effectiveness. Assessments were at baseline, 13 weeks and 26 weeks (primary end point).SettingParticipants were recruited through Memory Clinics and Community Mental Health Teams for older people.ParticipantsA total of 356 caregiving dyads were recruited and 273 completed the trial.InterventioniCST 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 measuresPrimary 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.ResultsThere 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.ConclusionsiCST 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 registrationCurrent Controlled Trials ISRCTN65945963.FundingThis project was funded by the National Institute of Health Research (NIHR) Health Technology Assessment (HTA) programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 64. See the NIHR Journals Library website for further information.

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Section: Secondary Outcomescontrasting

confidence: 56%

Section: Development Study 1: Service Users' Views About the Intervenmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial

Orgeta

Leung

Yates

et al. 2015

Health Technol Assess

153

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“…It is plausible that this difference may influence how carers report emerging behaviours, for example by considering a longer time period. Importantly, patient management that emphasises preserved abilities has been shown to benefit both patients and carers [36]. Thus, an awareness of these behaviour changes in PPA patients, and tailoring of daily activities to complement a patient's strengths, will be important steps towards optimising the management of PPA patients, for whom curative or disease-modifying treatments currently remain unavailable.…”

Section: Discussionmentioning

confidence: 99%

Characterisation of “Positive” Behaviours in Primary Progressive Aphasias

Midorikawa¹,

Kumfor²,

Leyton³

et al. 2017

Dement Geriatr Cogn Disord

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Background/Aims: Although some patients with primary progressive aphasia (PPA) exhibit novel or improved skills after the onset of dementia, these changes have yet to be quantified. Therefore, this study systematically explored and identified the emergence of positive behaviours after dementia onset. Methods: This study included 48 carers of patients with PPA: 12 nonfluent/agrammatic PPA (nfvPPA), 22 semantic variant PPA (svPPA), and 14 logopenic variant PPA (lvPPA). The presence and frequency of positive behaviour changes after dementia onset were established using the Hypersensory and Social/Emotional Scale (HSS). Results: Scores on Sensitivity to Details, Visuospatial Activities, and Music Activities differed significantly among the groups. More specifically, svPPA was associated with increased visuospatial activity, but only in the mild stage of the disease; nfvPPA was associated with increased visuospatial activity and decreased music activity, while lvPPA exhibited the reverse profile. Conclusions: The results demonstrate that subsets of PPA patients show novel or increased positive behaviours following dementia onset, and differences among subtypes may be helpful for improving diagnostic accuracy. Additionally, harnessing these skills may improve the quality of life of both patients and carers.

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“…In the long term, it can reduce total costs by lowering medical expenses, which are associated with the impairment and comorbidities, and delaying the time to nursing home admission. Further, early detection may facilitate more timely access to social support, allow planning for future care, and help the individuals and their families to cope with the potential progression to dementia (Moniz-Cook, Agar, Gibson, Win, & Wang, 1998;Woods et al, 2003).…”

Section: How Does Aging Affect Cognitive Abilities?mentioning

confidence: 99%

Using Cognitive Screening Tests in Audiology

et al. 2016

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Purpose: The population of the United States is aging. Those older adults are living longer than ever and have an increased desire for social participation. As a result, audiologists are likely to see an increased demand for service by older clients whose communication difficulty is caused by a combination of hearing loss and cognitive impairment. For these individuals, early detection of mild cognitive impairment is critical for providing timely medical intervention and social support. Method: This tutorial provides information about cognition of older adults, mild cognitive impairment, and cognitive screening tests, with the purpose of assisting audiologists in identifying and appropriately referring potential cases of cognitive impairment.Results: Topics addressed also include how to administer cognitive screening tests on individuals with hearing loss, how to use test results in audiology practice, and the potential of using cognitive screening tests for evaluating the benefit of clinical interventions. Conclusions: As health care professionals who serve the aging population, audiologists are likely to encounter cases of undiagnosed cognitive impairment. In order to provide timely referral for medical assistance as well as an optimized individual outcome of audiologic interventions, audiologists should be trained to recognize an abnormality in older clients' cognitive status.

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A preliminary study of the effects of early intervention with people with dementia and their families in a memory clinic

Cited by 91 publications

References 44 publications

Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial

Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial

Characterisation of “Positive” Behaviours in Primary Progressive Aphasias

Using Cognitive Screening Tests in Audiology

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