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A recent Cochrane review of reality orientation therapy identified the need for large, well-designed, multi-centre trials. To test the hypothesis that cognitive stimulation therapy (CST) for older people with dementia would benefit cognition and quality of life. A single-blind, multi-centre, randomised controlled trial recruited 201 older people with dementia. The main outcome measures were change in cognitive function and quality of life. An intention-to-treat analysis used analysis of covariance to control for potential variability in baseline measures. One hundred and fifteen people were randomised within centres to the intervention group and 86 to the control group. At follow-up the intervention group had significantly improved relative to the control group on the Mini-Mental State Examination (P=0.044), the Alzheimer's Disease Assessment Scale - Cognition (ADAS-Cog) (P=0.014) and Quality of Life - Alzheimer's Disease scales (P=0.028). Using criteria of 4 points or more improvement on the ADAS-Cog the number needed to treat was 6 for the intervention group. The results compare favourably with trials of drugs for dementia. CST groups may have worthwhile benefits for many people with dementia.

Psychological therapy groups for people with dementia are widely used, but their cost-effectiveness has not been explored. To investigate the cost-effectiveness of an evidence-based cognitive stimulation therapy (CST) programme for people with dementia as part of a randomised controlled trial. A total of 91 people with dementia, living in care homes or the community, received a CST group intervention twice weekly for 8 weeks; 70 participants with dementia received treatment as usual. Service use was recorded 8 weeks before and during the 8-week intervention and costs were calculated. A cost-effectiveness analysis was conducted with cognition as the primary outcome, and quality of life as the secondary outcome. Cost-effectiveness acceptability curves were plotted. Cognitive stimulation therapy has benefits for cognition and quality of life in dementia, and costs were not different between the groups. Under reasonable assumptions, there is a high probability that CST is more cost-effective than treatment as usual, with regard to both outcome measures. Cognitive stimulation therapy for people with dementia has effectiveness advantages over, and may be more cost-effective than, treatment as usual.

Background. A recent Cochrane review of reality orientation therapy identified the need for large, well-designed, multi-centre trials. Aims. To test the hypothesis that cognitive stimulation therapy (CST) for older people with dementia would benefit cognition and quality of life. Method. A single-blind, multi-centre, randomised controlled trial recruited 201 older people with dementia. The main outcome measures werechange in cognitive function and quality of life. An intention-to-treat analysis used analysis of covariance to control for potential variability in baseline measures. Results. One hundred and fifteen people were randomised within centres to the intervention group and 86 to the control group. At follow-up the intervention group had significantly improved relative to the control group on the Mini-Mental State Examination (P = 0.044), the Alzheimer's Disease Assessment Scale - Cognition(ADAS-Cog) (P = 0.014) and Quality of Life - Alzheimer's Disease scales (P = 0.028). Using criteria of 4 points or more improvement on the ADAS-Cog the number needed to treat was 6 for the intervention group. Conclusion. The results compare favourably with trials of drugs for dementia. CST groups may have worthwhile benefits for many people with dementia. Declaration of interest. None. Funding detailed in Acknowledgements. (Original abstract)

Dementia is no longer perceived as an exclusively cognitive disorder, but encompassing other significant elements, such as functioning, the person's ability to cope with difficulties, and the person's subjective experience of her/his quality of life (QoL). As such, QoL is increasingly seen as one of the variables in need of identification and evaluation when assessing the outcomes of interventions for people with dementia. This thesis attempts to define and conceptualise QoL in dementia, and considers issues surrounding the assessment of this. This thesis investigates QoL in dementia in the context of an evidence-based psychological group therapy programme. It examines variables associated with QoL in dementia, as well as the effects of the intervention conducted on QoL in dementia. A conceptual model of QoL in dementia is proposed. Additionally, the thesis evaluates a standardised scale for the assessment of QoL in dementia in terms of its reliability, validity, and sensitivity to change. The thesis includes three studies conducted: (1) Factors Associated with Quality of Life in Dementia (n = 201); (2) Factors Associated with Change in Quality of Life in Dementia (n = 201); and (3) The Validity and Reliability of the Quality of Life - Alzheimer's Disease Scale (QOL-AD; n = 201 and n = 60). The results from these studies show that QoL in dementia is significantly correlated with functioning and depression, but not with cognitive abilities. They also show that QoL in dementia is significantly predicted by dementia severity. Furthermore, the results show that an evidence-based psychological group therapy programme had a significant positive effect on QoL for people with dementia. Change in QoL in dementia was found in the studies reported in this thesis to be significantly correlated with improvements in cognitive functioning, level of depression, communication abilities and baseline level of QoL, and to be significantly predicted by having a lower QoL at baseline and being female. Lastly, the QOL-AD was found to be valid, reliable and sensitive to change. As such, the evidence-based psychological group therapy programme was shown in a scientifically rigorous trial to make a significant difference to the QoL for people with dementia. Furthermore, the possibility of measuring QoL in dementia reliably, without proxy input, was demonstrated. Although some correlations between QoL and other variables in dementia was found, the results presented here suggest that QoL in dementia is a largely independent variable that needs to be measured in its own right.