Cognitive Stimulation Therapy

What Cognitive Stimulation Therapy is

Cognitive Stimulation Therapy is a structured psychosocial group intervention developed at University College London for people with mild to moderate dementia. It runs over 14 sessions, twice a week, in groups of around six to eight people, led by a trained facilitator (often an occupational therapist, psychologist, dementia advisor or trained volunteer). Each session is built around a different theme (childhood, food, current affairs, sounds, faces, useful tips, word association, being creative, categorising objects, orientation, money, number games, word games, team quiz) and uses multi-sensory stimulation, reminiscence and gentle cognitive challenge in a sociable, supportive setting.

A "maintenance" CST programme of weekly sessions is offered to people who complete the initial 14-session course, continuing the benefits.

The evidence

Cognitive Stimulation Therapy is the only non-pharmacological intervention specifically recommended in NICE NG97 (recommendation 1.5.5) for cognitive symptoms in mild to moderate dementia. The Cochrane review of CST consistently finds:

• Small to moderate improvements in cognition (similar in scale to Cholinesterase Inhibitors);
• Improvements in quality of life and social communication;
• Improvements in mood and engagement;
• Improvements that endure for some weeks after the programme finishes, and longer with maintenance sessions.

Benefit appears across Alzheimer's Disease, Vascular Dementia, Mixed Alzheimer's and Vascular Dementia and Dementia with Lewy Bodies. It is not designed for Frontotemporal Dementia, where the group format may not suit the behavioural profile.

Who can join Cognitive Stimulation Therapy

The programme is designed for adults with mild to moderate dementia (ACE-III roughly in the 60 to 88 range, MMSE 12 to 24) who can communicate in the group's language and who are able to participate in a group setting. People who are deeply depressed, who are experiencing acute Delirium, or who have very advanced dementia may be better suited to a different intervention.

What a session looks like

Sessions last about 45 minutes. They follow a consistent format with a unique theme each session, designed to engage attention, language, executive function, social cognition and memory. Each session includes:

• A warm-up activity (often a soft ball game, group song or quiz);
• Review of the previous session;
• The themed activity (varied each session);
• Refreshment break with social conversation;
• A closing activity that highlights what worked well.

The atmosphere is deliberately upbeat and non-pressurising. There is no "right answer" approach and no testing. Most people enjoy the group format.

How to access Cognitive Stimulation Therapy in the UK

Access varies by region. The main routes are:

• Through your memory clinic at the time of diagnosis. Many NHS memory services run CST groups and will refer you;
• Through the local Alzheimer's Society, which co-ordinates many community CST groups;
• Through Age UK and similar charities in some areas;
• Privately through an occupational therapist or independent provider, where NHS access is unavailable or delayed.

The international training organisation maintains a register of trained facilitators and provides a global directory of CST groups.

How Cognitive Stimulation Therapy fits with medication

Cognitive Stimulation Therapy can be combined with medication; the benefits are additive. Many people on Donepezil or other Cholinesterase Inhibitors find CST adds something the medication alone cannot.

Cognitive Stimulation Therapy at home

Individual Cognitive Stimulation Therapy (iCST), delivered at home by a family carer using a structured manual, has also been studied. Benefits in cognition were not consistently demonstrated, but iCST improved the quality of the relationship between the carer and the person with dementia, which is itself valuable. Suitable for families who cannot access a group programme.

Related and complementary approaches

• Reminiscence Therapy, which uses memories, photographs and music to support engagement and identity. See Reminiscence Therapy.
• Music and singing groups, which have a strong evidence base for mood, communication and engagement.
• Art therapy, which supports expression and engagement, often through paint, clay or collage.
• Validation Therapy, an approach to communication that validates feelings rather than correcting facts. See Validation Therapy.

Where to ask if CST is right for you

Your memory clinic or GP is the best first port of call. If you are a private patient of The Dementia Service, your structured letter will set out whether Cognitive Stimulation Therapy is appropriate and the most direct route to access locally.