Cognitive stimulation therapy for people with dementia in Brazil (CST‐Brasil): Results from a single blind randomized controlled trial

Abstract

ObjectiveThe prevalence of dementia has been increasing particularly in developing countries but care provision is still limited in these regions. Psychosocial interventions are recognized as useful tools to improve cognitive and behavioral difficulties, as well as quality of life of people with dementia (PwD) and their caregivers. Cognitive stimulation therapy (CST) is an evidence‐based psychosocial intervention, recommended and implemented in many countries. In Brazil, there is no validated psychosocial intervention for dementia care. The present study aims to explore feasibility and obtain preliminary data on the efficacy of CST‐Brasil in a sample of 47 people with mild to moderate dementia attending an outpatient unit.MethodsA single‐blind design was used, with participants being randomly allocated to either 14 sessions of CST + treatment as usual (TAU; n = 23) or TAU (n = 24) during 7 weeks. Changes in cognition, quality of life, depressive symptoms, caregiver burden and functionality were measured.ResultsPwD receiving CST and their family caregivers expressed good acceptance of the intervention, with low attrition and high attendance. Participants receiving CST exhibited significant improvements in mood and in activities of daily living compared to TAU. There were no significant effects in cognition, quality of life and caregiver burden.ConclusionsCST‐Brasil proved to be a feasible and useful intervention to improve mood in PwD, with high acceptance between study participators. CST‐Brasil is a promising psychosocial intervention for dementia and should be explored in other clinical settings to allow generalization to a wider Brazilian context.

The Role of Individual Characteristics in Predicting Short- and Long-Term Cognitive and Psychological Benefits of Cognitive Stimulation Therapy for Mild-to-Moderate Dementia

“…This is because some cognitive dysfunctions exacerbate an individual’s susceptibility to recurrent depression, while low mood drives deficits in cognitive functioning ( Wiels et al, 2021 ). Our results are inconsistent with previous reports on the influence of individual characteristics on response to CST, however ( Aguirre et al, 2013 ; Apoìstolo et al, 2014 ; Marinho et al, 2020 ). The discrepancies may relate to the different set of individual characteristics considered in the present study (vis-à-vis those explored by Aguirre et al, 2013 ; Apoìstolo et al, 2014 ), and to our having treated education as a continuous variable (whereas Marinho et al, 2020 , split their sample into individuals with a high vs. low education).…”

“…Since the present study was exploratory in nature, the extent to which individual factors -other than those examined here- might affect the benefits of CST should be further explored, especially in crucial domains like functional ability and quality of life (see Lobbia et al, 2019 ; Marinho et al, 2020 ). We also did not consider other relevant clinical details relating to dementia (such as its early or late onset and duration, and the use of medication), which warrant further study.…”

“…Another ( Apoìstolo et al, 2014 ) found no association between baseline functional dependence (measured with the Barthel Activities of Daily Living index) and the benefits of CST on cognition and mood. Two other recent studies examined whether CST benefited PwD differently depending on the severity of their dementia ( Marinho et al, 2020 ), and their estimated cognitive reserve [i.e., their lifetime exposure to mentally engaging activities that promote more efficient brain networks and processes when performing tasks ( Stern, 2002 , 2021 )]. Participants’ cognitive reserve was operationalized in terms of years of formal education ( Marinho et al, 2020 ) or level of involvement (low-medium vs. high) in cognitively-stimulating educational, occupational and leisure activities ( Alvares Pereira et al, 2020 ).…”

“…Two other recent studies examined whether CST benefited PwD differently depending on the severity of their dementia ( Marinho et al, 2020 ), and their estimated cognitive reserve [i.e., their lifetime exposure to mentally engaging activities that promote more efficient brain networks and processes when performing tasks ( Stern, 2002 , 2021 )]. Participants’ cognitive reserve was operationalized in terms of years of formal education ( Marinho et al, 2020 ) or level of involvement (low-medium vs. high) in cognitively-stimulating educational, occupational and leisure activities ( Alvares Pereira et al, 2020 ). Both studies found no impact of the factors explored on the benefits of CST, however, going against expectations that participants’ cognitive reserve would affect their brain plasticity, and capacity to engage compensatory processing mechanisms ( Stern, 2002 , 2021 ; Barulli and Stern, 2013 ).…”

The Resounding Sound of Silence: Giving Voice to Persons Living With Dementia Who Took Part in Cognitive Stimulation Therapy and Virtual Cognitive Simulation Therapy Groups

“…Understanding dementia through different perspectives others than the medical one allows us to think about nonpharmacological treatments. Psychosocial interventions have been shown to improve cognition (Mather, 2020;, alleviate behavioural symptoms (O'connor et al, 2009a), increase emotional well-being (O'connor et al, 2009b), help with depression (Teri et al, 2005,Marinho et al, 2021 and with the functionality in the activities of daily living , Marinho et al, 2021.…”