More than Stimulating Conversation

I was very excited to learn that there is a psychosocial ‘therapy’ that is as effective as several Alzheimer’s drugs at improving cognition in a way that also appears to improve quality of life for people with memory loss.

I first heard about this Cognitive Stimulation Therapy, or “CST” from Sue McDermott, the coordinator for close to 30 memory cafés in the Cornwall region of England.  She has been encouraging memory café workers there to incorporate aspects of the new therapy into their café gatherings.

Last week I attended a CST workshop in London to learn more. It was led by Dr. Aimee Spector, first author on many of the research publications describing the CST clinical trial results that have come out over the past seven years.

The basic idea behind the therapy is to get people’s minds to be more active and engaged. Although the backdrop for the program sessions involves some standard activities such as current events discussions, physical games, and creative projects, the difference lies in how conversation is stimulated by the facilitators during these activities: 

Instead of asking questions that would elicit factual, or well-rehearsed responses, the idea is to ask open-ended questions that spark new thoughts, opinions and associations. 

An example might be: If you were in charge of our government’s finances, what would you do?  In contrast, a more directed question about a specific financial issue in the news might make people feel like they need factual knowledge in order to participate. Another example from CST is to bring out two photographs and ask what similarities attendees notice between the two. Answers might range from: the subjects are both female, they both have brown hair, they appear to be famous figures, or they are both from England--but all levels of observations are valued responses.

In other words, because the questions are open-ended and intended to elicit opinions or ideas rather than facts, people with memory loss can participate in the conversation at their own comfort level.  In essence, people feel less ‘put on the spot’ about coming up with specific information, which can really get the conversation rolling!

In its clinical form, CST is an evidence-based therapy, which has been shown by clinical trial to significantly improve cognition (specifically, it improves language including spoken language, naming, and word finding). The core program consists of 14 themed sessions for groups of 5-8 people with mild to moderate memory loss and is typically facilitated by two health specialists. In one study, Aimee Spector, Martin Orrell, Bob Woods and colleagues found that the subjects’ MMSE cognitive impairment test scores improved by almost 2 points on average following a 6-month extended CST program. While these effects eventually dissipate with progression of the disease, participants and caregivers report improvement in overall quality of life during and following the program. The results have been impressive enough that the UK National Institute of Clinical Excellence recommends the use of CST for people with mild/moderate dementia of all types in the UK. You can read more details about the evidence-based CST program here.

Although it is probably not practical to include CST in its formal format within the memory café venue, it seems worth thinking about how cafés might provide this kind of stimulating conversation informally.  Even at café gatherings that do not have structured activities, having awareness about how we engage in conversation may help guests participate more actively.  And, this new way of engaging may even be carried over into the home environment through care partners who witness the value of it in practice.

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