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Alzheimer's disease (AD) is characterized by impairments across several neurocognitive domains, particularly memory and executive function. The study explored the effectiveness of an individual cognitive stimulation (iCS) program on cognitive outcomes in older adults with moderate to moderately severe AD. A multicentre randomized controlled trial was conducted with 80 Portuguese older adults (Mage: 83.0 ± 7.1 years) with AD. Participants were randomly assigned to either iCS (n = 39; 49%) or treatment as usual (n = 41; 51%). Alzheimer's Disease Severity (ADS) categorized two groups based on Mini-Mental State Examination score: 10-14 in the ADS moderately severe group and 15-20 in the ADS moderate group. In participants with moderate AD, iCS led to significant improvements in memory-related outcomes (particularly Memory Assessment Test) and a trend toward improvement in global cognition. In contrast, no significant effects were observed in participants with moderately severe AD. Meta-analytic comparisons and meta-regression confirmed a significant difference in intervention effectiveness between severity levels. iCS was significantly more effective in individuals with moderate AD than in those with moderately severe AD. This difference in responsiveness between severity levels was statistically confirmed (Q = 11.29, p < .001). iCS was effective in enhancing memory in individuals with moderate AD, with additional indications of global cognitive benefit. However, no meaningful effects were observed in participants with moderately severe impairment, suggesting diminished responsiveness to iCS as disease severity increases. La maladie d'Alzheimer (MA) se manifeste par des déficiences dans plusieurs domaines neurocognitifs, en particulier la mémoire et les fonctions exécutives. L'étude a évalué l'efficacité d'un programme de stimulation cognitive individuelle (iCS) sur les performances cognitives chez des personnes âgées présentant une maladie d'Alzheimer aux stades modéré et modérément sévère. Un essai contrôlé randomisé multicentrique a été mené auprès de 80 personnes âgées portugaises atteintes de la MA (âge moyen : 83,0 ± 7,1 ans). Les participants ont été répartis aléatoirement soit dans le groupe de stimulation cognitive individuelle (n = 39; 49 %), soit dans le groupe recevant les soins habituels (n = 41; 51 %). La sévérité de la maladie d'Alzheimer (ADS) a permis de classer les participants en deux groupes selon le score au Mini-Mental State Examination : 10 à 14 pour le groupe ADS modérément sévère et 15 à 20 pour le groupe ADS modéré. Chez les participants atteints de MA modérée, l'iCS a entraîné des améliorations significatives des résultats liés à la mémoire (en particulier le test d'évaluation de la mémoire) et une tendance à l'amélioration de la cognition globale. En revanche, aucun effet significatif n'a été observé chez les participants atteints de MA modérément sévère. Les analyses statistiques, y compris les méta-analyses et la régression, ont mis en évidence une différence significative dans l'efficacité de l'intervention en fonction du degré de gravité. L'iCS était significativement plus efficace chez les personnes atteintes de MA modérée que chez celles atteintes de MA modérément sévère. Cette différence de réactivité entre les niveaux de sévérité a été confirmée statistiquement (Q = 11,29, p < 0,001). L'iCS s'est avérée efficace pour améliorer la mémoire chez les individus atteints de MA modérée, avec des indications supplémentaires d'un bénéfice cognitif global. Cependant, aucun effet significatif n'a été observé sur les participants présentant une atteinte modérément sévère, ce qui suggère que la réactivité à l'iCS diminue avec l'aggravation de la maladie. Mots-clés : maladie d'Alzheimer, fonctions cognitives, thérapie de stimulation cognitive, fonctions exécutives, troubles de la mémoire. Public Significance Statement This study found that a cognitive stimulation program improved memory in people with moderate Alzheimer's disease. The findings also highlight the challenges and limitations of cognitive interventions in more advanced stages of the disease.

The use of ecologically oriented approaches with virtual reality (VR) depicting instrumental activities of daily living (IADL) is a promising approach for interventions on acquired brain injuries. However, the results of such an approach on dementia caused by Alzheimer’s disease (AD) are still lacking. This research reports on a pilot randomized controlled trial that aimed to explore the effect of a cognitive stimulation reproducing several IADL in VR on people with mild-to-moderate dementia caused by AD. Patients were recruited from residential care homes of Santa Casa da Misericórdia da Amadora (SCMA), which is a relevant nonprofit social and healthcare provider in Portugal. This intervention lasted two months, with a total of 10 sessions (two sessions/week). A neuropsychological assessment was carried out at the baseline and follow-up using established neuropsychological instruments for assessing memory, attention, and executive functions. The sample consisted of 17 patients of both genders randomly assigned to the experimental and control groups. The preliminary results suggested an improvement in overall cognitive function in the experimental group, with an effect size corresponding to a large effect in global cognition, which suggests that this approach is effective for neurocognitive stimulation in older adults with dementia, contributing to maintaining cognitive function in AD.

Cognitive stimulation therapy is a group-based psychological treatment for people with dementia as well as those with mild cognitive impairment (MCI) and is shown to improve both cognition and quality of life. Previous studies have indicated the potential to benefit from the use of technological devices in group interventions. The pilot study aimed to assess the effectiveness of a tablet- and group-based multicomponent cognitive stimulation therapy (MCST) for enhancing cognitive functions among older adults with MCI. The following study aims to report the protocol for a trial evaluating whether the MCST program is affecting individuals with MCI. In the first study, 30 individuals with MCI participated in 10 sessions of the tablet- and group-based MCST group. A subsequent protocol study will compare tablet-based MCST, tablet-based cognitive stimulation therapy, and control groups among 93 individuals with MCI. All participants will be recruited from older adults living in semiurban communities. Intervention groups will be facilitated by trained therapists, nurses, or psychologists. The study will be assessed by a pre- and posttest evaluation, including computer-based neuropsychological tests and electroencephalography assessment. The effects of several indicators, such as cognitive functions, behavioral, and emotional, will be analyzed as being indexed by their neurophysiological data. The pilot study showed significant cognitive improvement (P<.001), reduced depression (P=.002), and decreased state anxiety (P=.001) post intervention. Quality of life remained unchanged (P=.18). The randomized controlled trial study was funded in March 2023. Enrolling began in August 2023 and was completed in December 2023. The data analysis was started, and the results are expected to be published by mid- to late-2025. The study is the first tablet-group-based MCST for older adults with MCI in middle-income countries. It will provide deeper insight into participants' neuropsychological data, thus identifying specific processes underlying physiologically measured positive outcomes. Furthermore, the project will deliver solid and integrative results to mental health professionals in terms of knowledge and guidance for implementing the tablet- and group-based MCST in people with MCI. Thai Clinical Trials Registry TCTR20230829004; https://tinyurl.com/3wuaue3e. DERR1-10.2196/64465.

We investigate the effectiveness of three types of IT-enabled cognitive stimulation tools for enhancing creative problem solving: mind mappers, process guides, and stimuli providers. Based on the dual pathway to creativity models, the authors examine the extent to which these tools are capable of stimulating individuals to explore their knowledge base more deeply (i.e., the persistence pathway) and more broadly (i.e., the flexibility pathway) and, hence, help to produce more novel ideas. In a laboratory study with business students, they find that, as compared to unaided individuals, IT-enabled stimuli providers enhance individual creativity more than process guides and mind mappers. As for the underlying creative process, stimuli providers push individuals to explore their knowledge base more deeply and more broadly, leading to more novel but, unexpectedly, also more useful ideas. The reported findings may facilitate the development of creativity support systems and their assignment to individuals and tasks.

Māori are the indigenous people of Aotearoa New Zealand. Cognitive Stimulation Therapy (CST) was initially developed in the UK, lacking in Māori cultural content and values. Cultural adaptation is needed to ensure Māori with dementia can benefit from this evidence-based treatment. This paper reports the outcome of a project aimed to adapt CST for Māori. We followed the five phases of international guidelines using the formative method for adapting CST to other cultures, including a critical cultural examination of the 18 CST principles. We piloted two CST-Māori programmes and collected pre- and post-outcome measures using the RUDAS and the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. Written qualitative feedback was sought from participants and their family at the end of the CST-Māori programme. A total of 15 Māori (female: 53.3%) participated in the two programmes. Their mean age was 75.9 years (SD = 6.6) and mean baseline RUDAS scores was 17.7 (SD = 2.3). There was a statistically significant improvement in cognition (RUDAS: pre = 17.7, post = 19.4, p  = 0.003) and in the WHOQOL subscales of physical (pre = 75.9, post = 88.5, p  = 0.003), psychological (pre = 72.7, post = 81.3, p  = 0.024) and environment (pre-80.6, post = 88.0, p  = 0.006). Written feedback confirmed the acceptability of this culturally adapted programme by Māori living with dementia and their whanau (families). CST was successfully adapted for Māori with dementia. It is a culturally acceptable cognitive intervention and preliminary data confirmed the effectiveness of CST-Māori in improving cognition and quality of life.

ABSTRACTBackgroundCognitive stimulation therapy (CST) is an evidence-based, cost-effective psychosocial intervention for people with dementia but is currently not a standard part of post-diagnostic care. This qualitative study explored the views and experiences of dementia care providers on the barriers and facilitators to its implementation in usual care. MethodThirty four semi-structured interviews (24 participants) were conducted across four dementia care sites in the North of England; ten were follow-up interviews. Data were analyzed using thematic analysis and then mapped to the Normalization Process Theory framework. ResultsParticipants considered CST a “good fit” with their “preferred” ways of working and goals of dementia care namely the provision of person-centered services. For facilitators delivering the intervention, compared to other behavioral interventions, CST was seen to offer benefits to their work and was easy to understand as an intervention. Training in CST and seeing benefits for clients were important motivators. Time and resources were crucial for the successful implementation of CST. Participants were keen to objectively measure benefits to participants but unsure how to do this. ConclusionsCST is a cost-effective psychosocial intervention for people with dementia, recommended by national guidance. Despite our findings which show that, using the NPT framework, there are more facilitators than barriers to the implementation of CST, it is still not a standard part of post-diagnostic dementia care. Further research is needed to explore the reasons for this implementation gap in ensuring evidence-based care in translated into practice.

AbstractIntrinsic capacity(IC) is a measure of physical, cognitive, vitality, psychological, and sensory abilities which determines functional ability. Decline in IC has been shown to accelerate the trajectory of frailty. We aim to show the impact of exercise (Ex) and cognitive stimulation therapy (CST) on (i) IC domains and composite score (ii) frailty and functional ability in pre-frail older adults. Secondary analysis of data from a pre-post intervention study of pre-frail older adults ≥ 65 years attending primary care clinic. Control (CON) and 2 intervention groups ((i) Ex 6 months (ii) CST 3 months with Ex 6 months (Ex+CST)) were recruited. Pre-frailty was determined using the FRAIL scale. Questionnaires (on demographics, functional ability, and depression) were administered and physical function assessment (gait speed (GS), short physical performance battery (SPPB) test, handgrip strength, five times sit-to-stand (5x-STS)) was conducted at 0, 3, 6 and 12 months. Four domains of IC were evaluated: locomotion (GS and 5x-STS), vitality (nutrition and muscle mass), cognition (MoCA and subjective cognitive decline) and psychological (depression and anxiety). Each domain was scored from 0 to 2 (no decline) with total IC score ranging from 0 to 8. 187 participants completed baseline and 3 months assessments, 109 (58.3%) were allocated to CON, 37 (19.8%) to Ex and 41 (21.9%) to Ex + CST groups. At 3 months, both Ex and Ex +CST showed improvement in IC composite scores, locomotion, and psychological domain scores but improvement in cognition domain only in Ex + CST group. At 6 months, there were improvements in total IC score, locomotion, vitality, and psychological domain in both Ex and Ex + CST groups. At 12 months, significant improvement was evident in total IC score for Ex and Ex+CST groups, vitality when fatigue (in addition to muscle mass and nutrition) was added and instrumental activities of daily living. Multidomain intervention incorporating exercise and CST resulted in significant improvement in IC composite scores, locomotion, vitality, cognition, and psychological domains.

PurposeThe development and clinical application of digital devices to support individuals with dementia can be challenging due to difficulties meeting the needs of a patient population with largely heterogeneous and progressive symptoms. Memjo Ltd has developed a digital interactive prototype tablet to promote cognitive stimulation and reminiscence. This proof-of-concept case-study aims to understand whether the engagement of individuals with dementia and Huntington's disease (HD) at an early stage is a useful approach to inform the initial development of meaningful digital activities and ultimately its potential introduction into clinical practice.Design/methodology/approachFive patients with dementia and HD at different stages of progression were recruited from an inpatient secure psychiatric hospital. Engagement, usability and preliminary benefits were assessed using a mixed-methods approach through observations, open-ended questions and subjective ratings.FindingsThe content of the tool triggered reminiscence, discussion and positive behavioural and emotional responses. The participants were confident using the tablet but needed support interacting with the touchscreen and, at times, to encourage communication. “Music” and “Videos”, were particularly successful in engaging most participants despite their cognitive and physical difficulties.Originality/valueThis case-study shows that co-production in clinical practice can be successfully implemented to develop activities that meet the interests and needs of patients with dementia and Huntington's disease. The varied and flexible assessment provided rich feedback that will be used to improve the device. This highlights avenues of focus for the development of future pools of activities.

Adopting a systematic approach to the development of an intervention, supported by robust theoretical, empirical, and clinical rationales represents best practice. The Medical Research Council (MRC) provides a framework for a systematic step-wise approach to the evaluation of complex interventions. This study describes the development phase of the individual cognitive stimulation therapy (iCST) for dementia trial, within this framework. In the preclinical phase, a recent Cochrane Review of cognitive stimulation for dementia and the current literature on individual cognitive stimulation interventions were examined to establish an evidence base. In addition, people with dementia, carers, and care staff were consulted regarding the acceptability of iCST, and a panel was put together to advise the team on the adaptation of group cognitive stimulation therapy (CST). Phase I (modeling) involved consultations with service users and experts in a series of focus groups, interviews, an online survey, and a consensus conference. Finally, Phase II field testing of the intervention was carried out. Two drafts of the materials were produced before a final version ready for use in the main randomized controlled trial (RCT). Key changes between the drafts included: editorial amendments to improve the clarity of instructions, emphasize the person centeredness of the approach, and reduce the overall length of the introduction section; the simplification of academic terminology and activities deemed \"too difficult\"; adjustments made to the monitoring-progress forms and session rating scale to enhance user-friendliness; the addition of a \"Getting started\" section; amendments made to the content of the toolkit; and clearer distinction made between the level of difficulty of activities. The rigorous development of the intervention was beneficial as the feasibility of the intervention was explored both in theory and practice, and consulting with service users ensured that materials were appropriately tailored to their needs. A Phase III RCT is currently being conducted to determine the effectiveness of iCST.

Purpose This paper aims to underline the importance of using a collaborative approach when designing and adapting a post diagnostic psychosocial intervention of cognitive stimulation therapy (CST) for people with intellectual disability and dementia. Design/methodology/approach As part of a service improvement, a manual of CST was adapted, for delivery in clinical practice. A qualitative co-production method allowed participants with a lived experience to provide regular feedback relating to the development of the adapted CST manual and intervention programme. This feedback was used to make continual development changes to the CST manual. Findings The study demonstrated co-production with those who provide care is valuable in adapting psychosocial therapies for people with an intellectual disability and dementia. Additional findings identified the need for carer education in ageing, dementia care and the physical health needs for older people with intellectual disability. Originality/value To the best of the authors’ knowledge, this is the first study that has used a co-production approach with families and carers in adapting a group therapy programme for people with an intellectual disability. This paper underlines the need for post diagnostic clinical interventions for people with dementia and those who provide care.