Efficacy of evidence-based individual cognitive stimulation therapy for people with dementia and their caregivers

Abstract

Background Individual cognitive stimulation therapy (iCST) is a home-based approach and there has been only one previous study on iCST delivered by family caregivers. No significant difference in the primary outcomes (cognition and quality of life for PwD, and quality of life for their carers) was found in that study; however, it was found that PwD had better quality relationships with the carers who delivered the programme, and carers had better health-related quality of life and less depression.

Objectives The aim of this study was to evaluate the effectiveness of the iCST intervention by running a randomized controlled trial (RCT), based on the hypothesis that participation in the intervention programme is beneficial for both PwD and their caregivers. The two objectives of the study were to investigate whether an iCST intervention delivered by caregivers can improve cognition and quality of life of

PwD and to explore the impact of the intervention on the well-being and burden of family caregivers.

Methods The study was comprised of quantitative and qualitative components. The quantitative study was a multi-centre, single-blind, randomized controlled trial assessing clinical effectiveness. Assessments were at baseline and post-intervention. A total of 116 dyads (PwD and their family caregivers) were recruited and were randomized into either an iCST intervention group or a control group (who received their normal treatment). Data were collected at baseline and post-intervention. A qualitative study was conducted at post-intervention to explore the experiences of PwD and caregivers participating in the iCST intervention programme.

Results In the quantitative study, primary outcomes for the PwD were cognition and quality of life. Secondary outcomes included the well-being and burden of the family caregivers. The findings indicated that iCST intervention could effectively improve cognition and enhance the quality of life of PwD compared with those who received no iCST treatment. There was significant improvement in both ADAS-Cog and QoL-AD scores of the PwD who participated the iCST intervention. With regards to the well-being and burden of family caregivers, an association was found between iCST intervention and the outcomes for family caregivers. As the PwD benefited from the intervention, the level of well-being and stress burden of their family caregivers improved compared with those in the control group.

The findings of the qualitative study also show that a conceptual framework of carer involvement in intervention comprising of interpersonal interactions, mutual sharing, participation in mentally stimulating activities, and carers’ support contributed to the enhancement of carers’ self-efficacy and well-being.

Implications This study demonstrated that iCST is a feasible method for carers to deliver therapeutic interventions and, that their involvement not only benefits PwD by improving their cognition and quality of life, but also helps to enhance the well-being of family caregivers and reduce their burden. It has already been shown that delivery of iCST by a combination of three parties (paid home care workers, volunteers, and family caregivers) led to great improvement. It is suggested that iCST can run under this mixed mode, which would offer benefits to both PwD and family caregivers.