Cognitive Stimulation Therapy is an evidence-based treatment that aims to stimulate and engage people with dementia (University College London, n.d.)
It draws from best practices to make a difference with this unique population.
While the program is sold online, in this article you’ll learn:
- The pros (and cons) of Cognitive Stimulation Therapy
- How to use it in your treatment
- Example Cognitive Stimulation Therapy activities
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What is Cognitive Stimulation Therapy?
Cognitive Stimulation Therapy (CST) is an evidence-based, 14-session treatment program for people with mild to moderate dementia.
It was developed by Aimee Spector, a dementia researcher and clinical psychologist specializing in old age and dementia, along with a team of other dementia specialists.
CST uses activities to stimulate cognitive skills in a way that targets people with dementia’s cognitive weaknesses while drawing on their strengths.
The activities are designed to be fun and engaging, ranging from discussions, to word games and trivia, to cooking and crafts.
CST is best known as a small group program, though they also have a one-on-one version.
You can buy the small group manual, the instructor’s manual, and/or the one-on-one treatment manual from the University College London.
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Pros (and Cons) Of Cognitive Stimulation Therapy
Healthcare systems and clinicians worldwide use Cognitive Stimulation Therapy.
Research shows that CST may improve:
- Language comprehension and production (Lobbia, et al. 2019)
- Cognition
- Communication
- Social interaction
- Well-being
- Overall quality of life (Aguirre et al. 2013)
- Self-awareness of cognitive deficits (Bertrand et al. 2013)
But there are limitations.
A systematic review found that caregivers were frustrated by a lack of caregiver education in the CST program. Plus, their loved one with dementia didn’t always want to go to the group (Gibbor et al, 2020).
The study also noted that people with dementia preferred activities that are practical, physical, and outdoors. This is in contrast to CST activities, which are mainly indoor games.
Keep these pros and cons in mind whether you follow the program or plan your own treatment. Be sure to interview the patient and caregivers to learn what they like, want, and need from speech therapy.
You’ll find practical cognition worksheets and treatment activities in our shop.
Principles of Cognitive Stimulation Therapy
As mentioned earlier, CST targets areas of cognition impacted by dementia while drawing from remaining strengths.
In CST, the targets include memory, language, and executive functioning. Strengths include reminiscing, reading, social enjoyment, and routines.
Below are some of the principles of CST to use in your treatments:
- Mental stimulation. Challenge patients with cognitively stimulating tasks. They should put in some cognitive effort but still feel successful.
- New Ideas. Encourage patients to come up with new ideas. Use associations to link old thoughts with new ideas.
- Opinions. Focus on sharing opinions (versus asking for facts).
- Language. Encourage conversation and other language games to stimulate language.
- Executive functioning. Choose activities that involve sequencing, planning, and organizing to stimulate executive functioning.
- Reminiscence. Use reminiscence by comparing the present to the past.
- Routine. Stick to a routine during your session.
- Visual Aids. Use visual aids (calendar, written information) to subtly orient and keep patients on track.
- Senses. Stimulate the senses to improve memory.
- Physical activity. Add in physical activity, like light exercises or activities that require movement.
- Person-centered. Adjust for each patient. Give choices and modify activities as needed. Give enough time and help for patients to be successful. Choose grown-up (vs childish) tasks and materials. And keep it fun!
(List adapted from Aguirre et al, 2012)
Read Dementia Treatment in Speech Therapy for more evidence-based ideas.
Cognitive Stimulation Therapy Activities
So what does a cognitive stimulation therapy session look like? You can visit University College London to buy the evidence-based program. Below, we summarize the basics.
- Meet in the same space and have a routine
- Remind the patient of the last session’s theme
- Introduce today’s theme
- Subtly orient the patient. “It’s raining today. Is that common weather for July?”
- Have a fun and stimulating discussion
- Do a fun yet appropriately challenging main activity
- Summarize the session’s discussion and ask for feedback about the session
Here are example cognitive stimulation therapy activities to use in your practice. Follow the principles above to help you come up with more ideas.
- Use a percussion instrument to play along with familiar music (senses, physical, reminiscing, mental stimulation)
- Discuss current events using a magazine for visual support (language, visual aid, mental stimulation, language, new ideas)
- Make a flower arrangement (mental stimulation, executive functioning, senses)
- Make a snack (mental stimulation, executive functioning, senses)
- Do chair yoga (mental stimulation, physical activity, senses)
Remember to keep Cognitive Stimulation Therapy activities fun, simple, and individualized. Your patient should enjoy participating!
More Resources
Adult Speech Therapy Starter Pack
The Starter Pack is 900+ pages of print-and-go adult speech therapy worksheets, handouts, and templates.
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Excellent resource for any grad student who doesn’t know where to start!
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Adult Speech Therapy Roadmap Course
The Adult Speech Therapy Roadmap is an online course that teaches you how to assess, treat, and document all major areas of adult speech therapy, from Day 1 to Discharge.
References
- Aguirre E., Spector A., Streater A., Hoe J., Woods B., and Orrell M. (2012). Making a Difference 1: An evidence-based group programme to offer maintenance cognitive stimulation therapy (CST) to people with dementia. (2nd ed.). Hawker Publication.
- Aguirre, E., Woods, R. T., Spector, A., & Orrell, M. (2013). Cognitive stimulation for dementia: A systematic review of the evidence of effectiveness from randomised controlled trials. Ageing Research Reviews, 12(1), 253-262. https://doi.org/10.1016/j.arr.2012.07.001
- American Speech-Language-Hearing Association (n.d.). Dementia (Practice Portal). Retrieved June 15, 2024, from www.asha.org/Practice-Portal/Clinical-Topics/Dementia/.
- Bertrand, E., Marinho, V., Naylor, R., Bomilcar, I., Laks, J., Spector, A., & Mograbi, D. C. (2023). Metacognitive Improvements Following Cognitive Stimulation Therapy for People with Dementia: Evidence from a Pilot Randomized Controlled Trial. Clinical gerontologist, 46(2), 267–276. https://doi.org/10.1080/07317115.2022.2155283
- Gibbor, L., Yates, L., Volkmer, A., & Spector, A. (2020). Cognitive stimulation therapy (CST) for dementia: a systematic review of qualitative research. Aging & Mental Health, 25(6), 980–990. https://doi.org/10.1080/13607863.2020.1746741.
- Lobbia, A., Carbone, E., et al. (2019). The Efficacy of Cognitive Stimulation Therapy (CST) for People With Mild-to-Moderate Dementia. European Psychologist. 24(3,, 257-277. https://doi.org/10.1027/1016-9040/a000342
- University College London. (n.d.) International Cognitive Stimulation Therapy (CST) Centre. https://www.ucl.ac.uk/international-cognitive-stimulation-therapy
