Cognitive Stimulation Therapy

1. Cognitive Stimulation Therapy Is it for me?

2. Background • Event management and marketing • Fronto temporal dementia • ‘I would like to meet people in a similar situation’

3. Cognitive Stimulation Therapy • CST developed by team at UCL • ‘Treatment for people with mild to moderate dementia… • …The effects of CST appear to be of a comparable size to those reported with the currently available anti-dementia drugs.’ www.cstdementia.com

4. What is it? • CST a fun programme of activity sessions, designed to improve well-being and confidence • Sessions cover topics including food, current affairs, using money and word games • Implicit learning rather than explicit teaching • Multi-sensory stimulation is used

5. Sample session - Food • Opening (10 minutes) • All members individually welcomed to the group by name • Draw attention to the name of the group • Remind everyone of the activity in the last session. As a group, sing together the group’s ‘theme song’, led by song leader (use song book or CD).

6. Discuss day, month, year, season, weather, time, name and address of the centre (use whiteboard). • Discuss something currently in the news (use newspaper, magazine or photograph) • Warm up • Play softball game for a few minutes –people may either state their own name, or, for the more able, the name of the person they are throwing the ball to. As the main activity is going to be food ask members to say their most or least favourite food when catching the ball.

7. MAIN ACTIVITY (25 to 30 minutes). • Suggested activities: • Taste foods like cream soda, ginger beer, bread pudding, Bovril • Brainstorm food categories e.g. soups; meats; puddings; fish; vegetables). • Complete names of food items e.g. Yorkshire X; Bakewell X; self-raising X; name a food beginning with a particular letter. • Using priced real or miniature replica groceries give people a budget and a scenario to plan, e.g. dinner for four or categorise the foods e.g special occasions, savoury / sweet.

8. CLOSING (10 to 15 minutes) • Thank everyone individually for attending and contributing to the session. • Summarise the discussion and ideas raised – seek feedback • Sing theme song again • Reminder of time and content of next session • Farewells

9. How was it developed? • Systematic review of the literature on the main non-pharmacological therapies • Reality Orientation • Reminiscence Therapy • Cognitive Rehabilitation • Validation Therapy • Multisensory Stimulation

10. Chat • 12 month pilot with Age Concern Horsham • Trained by Dr Spector • Funded by Awards for All • Recruited from the community • Carers course alongside • Very promising results

11. UCL based research- people with dementia: • ‘I noticed people becoming more fluent and you could see people trying to express themselves more’ • ‘we just enjoyed ourselves there’s an awful lot of laughter’ • ‘it helped all of us know we were in the same boat’ • ‘I can relax, the use of the visual aids helps think things through, we share the same problem and all like coming otherwise we wouldn’t be here.’

12. UCL based research - carers • ‘There is no argument that my wife’s brighter’ • ‘He enjoyed being with other people he could relate to’ • ‘She’s started remembering things since coming to the group’ • ‘The value of the group has been to make him more animated and motivated’

13. Who is it for? • Recommended by NICE for people with all types mild-moderatedementia regardless of any anti-dementia prescription • Flexible should be tailored to suit capabilities and interests • For people with learning difficulties • First language • Young onset dementia

14. Where could it be run? • Day hospitals, GP surgeries and memory clinics • Community locations by voluntary sector organisations • Sheltered housing and care homes

15. How is it done? • Courses can be run from guide: Making a Difference. • Facilitators - activity coordinators, psychologists, dementia care advisors, nurses, psychotherapists, occupational therapists.  • Open training is available through For Dementia (4.2.10) • In-house training can be arranged through Dr Aimee Spector at cstdementia.com

16. When can you start? • CST is available now • Simple to set up and run • Ongoing support - live well and independently • The initial course is 14 sessions run twice weekly • Continue with a weekly programme – MCST • The course also provides an umbrella for carers education, professional and peer support and regular short respite. • Funding?

17. Why CST? • National Dementia Strategy – objectives & priorities: • Early intervention • Community personal support services • New deal for carers • Living well in care homes and effective workforce • Jointly commissioned.

18. Why else? • Great introduction to day services • Positive, pro-active, self management • Validated hard work of staff • Interesting, stimulating, easy & measurable • Informed learning and development – care plans

19. Compelling economic argument • ‘Early diagnosis and treatment of Alzheimers Disease are not only socially desirable in terms of increasing economic efficiency, but also fiscally attractive from both state and federal perspectives...failure to fund effective caregiver interventions may be fiscally unsound’. • (Sager M, weimer D (2009). Early identification and treatment of alzheimer's disease: social and fiscal outcomes. Alzheimer's & dementia: the journal of the alzheimer's association. Doi:10.1016/j.Jalz.2009.01.028.

20. Next Steps? How can we increase access to CST programmes?

21. CST - further information: • www.cstdementia.com • www.careinfo.org/books/ - guide book £15 incl p&p • www.fordementia.org.uk - next open course 4.2.10 £110pp • knowlesjoanne@hotmail.com Hedgehogs – why can’t they just share the hedge?