Translating iCST research evidence into inclinical practice

Reasons for translating individual Cognitive Stimulation Therapy (iCST) research evidence into clinical practice

By Dr Phuong Leung (PhD, FHEA, MSc and BSc)

Background

Dementia is the leading cause of disability in older people (Alzheimer’s Association report 2015). In 2014, in the UK alone there were 850,000 people with dementia. By 2025, the number is expected to rise to 1.14 million (Alzheimer’s Society 2014).  Dementia costs the UK economy £26 billion per year (Lewis et al., 2014).  Given its increasing prevalence, it is predicted that the cost associated with dementia will rise to £34.8 billion per year in 2026 (McCrone et al., 2008).

Being diagnosed with dementia can be a challenging experience for people with dementia, their carers and families (Sosa-Ortiz, Acosta-Castillo, & Prince, 2012).  Cognitive decline and neuropsychiatric symptoms in the person with dementia are associated with poor quality in the caregiving relationship (de Vugt et al., 2003; Spruytte, et al., 2002), which negatively contributes to further losses in carers’ quality of life and affecting patient wellbeing (Quinn, Clare, Woods, 2009).  As a result, it can often lead to short-term or  long-term hospital or care home admissions which can be costly for health care services (Orrell & Bebbington 1995).

Pharmacological treatment for dementia is very limited and primarily aims at achieving symptom control but not directly addressing the cause of the disease (Eleti 2016). Non-pharmacological therapies are hence often used to maintain or improve cognition, individuals’ ability to perform daily activities and improve quality of life (QoL) for people with dementia and their families (Bahar-Fuchs, Clare, Woods 2013; Woods et al., 2012). A single-blind, multi-centred pragmatic randomised controlled trial was conducted by the iCST research team which led by Professor Martin Orrell at the Division of Psychiatry, University College London including eight study sites across the UK to evaluate the effectiveness of iCST on people with with dementia and their carers (Orrell et al., 2017).

What is iCST?

iCST is a cognitive and psychosocial one to one intervention for people with dementia. It is based on the evidence-based group Cognitive Stimulation Therapy for people with mild to moderate dementia, which has been found to be beneficial for cognition and quality of life.

iCST offers one-to-one structured cognitive stimulation sessions (Figure 1) for people with dementia delivered by carers at their own home. There is a total of 75 activity sessions based on a variety of themes including life story, word games, quizzes, art, reminiscence, discussion of current affairs and being creative which are designed to be mentally stimulating and enjoyable. Carers are trained to deliver the intervention by using the manual guidance and the iCST key principles (Yates et al., 2015).

 
iCST session.jpg

Figure 1: one to one structured cognitive stimulation session for 30 minutes, 3 times a week for 25 weeks

iCST session photo blog.jpg

Evidence-based of iCST

The evidence-based finds that people with dementia taking part in iCST had better relationship quality with their carers (Quality of the Carer Patient Relationship Scale). Carers delivering iCST reported a significant improvement in health-related QoL (European Quality of Life–5 Dimensions [EQ-5D]).  Carers delivering more sessions had fewer depressive symptoms (Hospital Anxiety and Depression Scale [HADS]) (Orrell et al., 2017).

A qualitative study exploring the experiences of people with dementia and their carers taking part in the iCST intervention finds that iCST motivated people with dementia to keep their mind active and look for more information about mental stimulation (Leung et al., 2017).

“It (iCST) made me start thinking about doing what I used to do which was paintings over there, that I've done …I can get up and do things more easily” (Person with dementia).

Carers found iCST helped them to frame conversations and enhance the caregiving relationship.

“….Doing this kind of activities together cements our relationship and makes you stay involved in each other’s lives.”(Carer)

Drawing results showing iCST is an adaptable approach which can benefit a wide range of people with dementia and family carers. Given iCST has a positive effect on the caregiving relationship and carer well-being, the programme might be a useful part of personally tailored home care packages, which may help maintain people with dementia in their homes for longer (Yaffe et al., 2002).

In order to translate theories and evidence from iCST research into clinical practice to improve the relationship quality and well-being for people with dementia and their carers, the iCST Dementia Training Programme is developed.

The iCST Dementia Training programme aims

To equip trainees with knowledge and skills to deliver iCST in a standardised, person-centred and effective way

Learning objectives:

• Recognise various cognitive and psychosocial interventions in dementia

• Learn about carer involvement in cognition-based interventions; a theoretical framework and interventions

• Learn how iCST was designed and evaluated and the iCST trial results

• Learn how to apply the key principles of iCST

• Familiarise with the 75 iCST sessions

• Learn techniques and practice effective communication skills

• Develop problem-solving strategies to deliver iCST sessions

The training programme provides opportunities for trainees to interact and create interactive learning environments to translate theories and research evidence into clinical practice. 

iCST training photos July 19_2.jpg

iCST dementia training programme is suitable for

Carers of people living with dementia, professional carers, healthcare professional and anyone with an interest in the carer-delivered individual Cognitive Stimulation therapy for people dementia

For more information about the iCST Dementia Training, please visit our website https://www.icstdementiatraining.co.uk/

Individual Cognitive Stimulation (iCST) Therapy Dementia Training

Tuesday 17th September from 10.00 to 15.30 with registration from 9.30 (BST)

Led by Dr Phuong Leung

82 Brockley Rise, Forest Hill, London SE23 1LN, England

Join us for this training, please book your place online using the link below

Eventbrite

References

Alzheimer’s Association report (2015). 2015 Alzheimer’s Disease Facts and Figures. Alzheimer’s & Dementia 11(3), 332-384

Alzheimer’s Society (2014). Dementia UK: 2014 second edition. London: Alzheimer’s Society. https://www.alzheimers.org.uk/dementia 2014 (Accessed on 8th June 2015)

Bahar-Fuchs, A., Clare, L., & Woods, B. (2013). Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer's disease and vascular dementia. Cochrane Database of Systematic Reviews, 6, CD003260.

de Vugt, M. E., Stevens, F., Aalten, P., Lousberg, R., Jaspers, N., Winkens, I., Verhey, F. R. (2003). Behavioural disturbances in dementia patients and quality of the marital relationship. Int J Geriatr Psychiatry, 18(2), 149-154.

Eleti, S. (2016). Drugs in Alzheimer’s disease dementia: an overview of current pharmocological management and future directions. Psychiatria Danubina, 28, S136-S140.

Leung, P., Orgeta, V., & Orrell, M. (2017). The experiences of people with dementia and their carers participating in individual cognitive stimulation therapy. Int J Geriatr Psychiatry DOI: 10.1002/gps.4648

Lewis, F., Schaffer, S K, Sussex, J, O’Neill, P and Cockcroft, L (2014), The Trajectory of Dementia in the UK - Making a Difference. Report for Alzheimer’s Research UK by Office Health Economics Consulting

McCrone, P., Dhanasiri, S., Patel, A., Knapp, M., & Lawton-Smith, S. (2008). Paying the price. The cost of mental health care in England to, 2026.

https://www.kingsfund.org.uk/publications/paying-price (Access 1st July 2019)

Orrell, M., Yates, L., Leung, P., Kang, S., Hoare, Z., Whitaker, C.,Orgeta, V. (2017). The impact of individual Cognitive Stimulation Therapy (iCST) on cognition, quality of life, caregiver health, and family relationships in dementia: A randomised controlled trial. Plos Medicine,14(3), 22.

Quinn, C., Clare, L., & Woods, B. (2009). The impact of the quality of relationship on review. Aging & Mental Health, 13(2)

Spruytte, N., Van Audenhove, C., Lammertyn, F., & Storms, G. (2002). The quality of the caregiving relationship in informal care for older adults with dementia and chronic psychiatric patients. Psychology and Psychotherapy-Theory Research and Practice, 75, 295-311

Sosa-Ortiz, A. L., Acosta-Castillo, I., & Prince, M. J. (2012). Epidemiology of dementias and Alzheimer's disease. Arch Med Res, 43(8), 600-608.

Verhey, F. R. (2003). Behavioural disturbances in dementia patients and quality of the experiences and wellbeing of caregivers of people with dementia: A systematic the marital relationship. Int J Geriatr Psychiatry, 18(2), 149-154.

Woods, B., Aguirre, E., Spector, A. E., & Orrell, M. (2012). Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database of Systematic Reviews, 2, CD005562

Yaffe K, Fox P, Newcomer R, Sands L, Lindquist K, Dane K, (2002) Patient and caregiver characteristics and nursing home placement in patients with dementia. 287(16):2090±2097. PMID:11966383

Yates, L. A., Leung, P., Orgeta, V., Spector, A., & Orrell, M. (2015). The development of individual cognitive stimulation therapy (iCST) for dementia. Clin Interv Aging, 10, 95-104.