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Development of a maintenance CST programme for dementia

Development of a maintenance CST programme for dementia. Elisa Aguirre Research Assistant & PhD student e.aguirre@ucl.ac.uk. OC081. Overview. Background Phase I development (MRC, 2008) Identifying the evidence (Cochrane Review) Identifying, developing theory (Delphi consensus process)

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Development of a maintenance CST programme for dementia

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  1. Development of a maintenance CST programme for dementia Elisa Aguirre Research Assistant & PhD student e.aguirre@ucl.ac.uk OC081

  2. Overview • Background • Phase I development (MRC, 2008) • Identifying the evidence (Cochrane Review) • Identifying, developing theory (Delphi consensus process) • Modelling process (Focus Groups) • Future work: evaluation of the programme Phase III (MRC, 2008)

  3. Why?Long-term benefits: Maintenance CST (Orrell et al, 2005) • CST improves cognition and quality of life of people with dementia (Spector et al., 2003) • MCST pilot involved 16 weekly session following CST programme (~ 6 months) • Piloted in 2 experimental homes, 2 control homes • Conclusion: MCST led to continuous cognitive benefits. CST only led to gradual decline. • No sig. findings in QoL • Limitations: Small sample (35), homes volunteered

  4. MRC council guidelines Phase I: Programme Development

  5. Development of the programme

  6. Step 1: Identifying the evidence Cochrane Review • 6 studies from previous RO review (Spector et al., 2000) • RCTs • include only participants with dementia • have a treatment duration of at least a month • Compare cognitive stimulation with no treatment, treatment as usual or placebo treatment • Include at least one measure of cognition • New studies from UK, Spain, USA, Italy , Brazil • 4/6 report a comparison where TAU is ACHEI therapy

  7. Results – MMSE (CST vs. TAU)

  8. Results – ADAS-Cog (CST vs. TAU)

  9. Cochrane Review Conclusions • The small, beneficial effects of cognitive stimulation on cognitive function are now well-documented • These are over and above any medication effects • Some studies suggest this may be maintained for a year (Requena 2006, Chapman 2004). • Effects on other areas of function need more exploration, but self-rated QoL-AD data is promising

  10. New included studies

  11. Non Included- High Quality St.

  12. Step II: Identifying the theoryConsensus Workshop: Draft Version II • To provide an update and summary of the evidence related to MCST • To assess MCST development and establish agreement amongst experts about its possibilities, potential and implications for practice • To look at the draft version I of MCST sessions and assess the feasibility and suitability of introducing these into practice

  13. . Step III: ModellingService users involvement • 17 people with dementia, 13 staff and 18 family carers • Inductive thematic analysis to examine user perceptions of the Maintenance CST programme • Mental stimulation highly valued by PWD • Most family carers and staff rated very highly mental stimulation BUT some concerns were raised: - When lose it or lose it doesn’t apply - Concerns with regards lose of confidence, anxiety or sense of inferiority.

  14. Qualitative study results • Positive agreement was found among 14 themes and suggestions were made for the 5 new remaining themes. • Carers and staff very low rated themes: - using money could be a sensitive topic - current affairs was a theme that people with dementia wouldn't relate to • In contrast people with dementia expressed a great interest in the using money theme and in the news

  15. Final Delphi Survey • A Delphi survey was sent to the consensus conference attendees • All of them were satisfied with the draft version 3 of the programme that was sent to them • Amendments to the programme were made including: - Extension of appendixes/ more user friendly - Inclusion of a guidance for co facilitators • Amendments to the programme lead to the final version of the maintenance CST programme

  16. Intervention: CST & Maintenance CST

  17. Phase III: Programme Evaluation

  18. Evaluation of the programme RECRUITMENT OF CENTRES SCREENING CONSENT BASELINE ASSESSMENT 7 WEEKS CST Twice a week (14 session) FOLLOW UP 1 3 MONTH Follow Up 2 24 WEEKS MCST Once a week (24 session) 6 MONTH Follow Up 3 1ST STAGE Randomisation 8 to 10 Participants CST group A 8 to 10 Participants CST group B 2ND STAGE Randomisation 8 to 10 participants TAU 8 to 10 participants MCST

  19. Thank you! Maintenance Cognitive Stimulation Programme(ISRCTN26286067)) is part of the Support at Home - Interventions to Enhance Life in Dementia (SHIELD) project (Application No. RP-PG-0606-1083) which is funded by the NIHR Programme Grants for Applied Research funding scheme. The grantholders are Professors Orrell (UCL), Woods (Bangor), Challis (Manchester), Moniz-Cook (Hull),Russell (Swansea), Knapp (LSE) and Dr Charlesworth (UCL). This report/article presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research sheme (RP-PG-060-1083). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. CONFLICT OF INTEREST: NONE

  20. References Spector A, Orrell M, Davies S & Woods B (2000). A systematic Review of the use of Reality Orientation in dementia. The Gerontologist, 40 (2): 206-212. Spector A, Orrell M, Davies S & Woods B (2001). Can reality Orientation be rehabilitated? Development and piloting of an evidence-based programme of cognition-based therapies for People with dementia. Neuropsychological Rehabilitation, 11: 377-397. Spector A, Thorgrimsen L, Woods B, Royan L, Davies S, Butterworth M & Orrell M (2003). Efficacy of an evidence-based Cognitive stimulation therapy programme for people with dementia: Randomised controlled trial. British Journal of Psychiatry, 183: 248-254

  21. References Spector A, Thorgrimsen L, Woods B & Orrell M (2005). Making a difference…An evidence-based group programme to offer cognitive stimulation therapy (CST) to people with dementia. UK: Hawker Publications. Orrell M, Spector A, Thorgrimsen L & Woods B (2005). A pilot Study examining the effectiveness of maintenance Cognitive Stimulation Therapy (MCST) for people with dementia. International Journal of Geriatric Psychiatry, 20:446-451 Knapp M, Thorgrimsen L, Patel A, Spector A, Hallam A, Woods B and Orrell M (2006). Cognitive Stimulation Therapy for people with dementia: Cost Effectiveness Analysis. British Journal of Psychiatry, 188:574-580.

  22. References Woods B, Thorgrimsen L, Spector A, Royan L and Orrell M (2006). Improved quality of life and cognitive stimulation therapy in dementia. Ageing and Mental Health, 10 (3): 219-226. CST website: www.cstdementia.com

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