Should we use individual cognitive stimulation therapy to improve cognitive function in people with dementia?BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e633 (Published 15 February 2012) Cite this as: BMJ 2012;344:e633
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Re: Should we use individual cognitive stimulation therapy to improve cognitive function in people with dementia?
Orrell and colleagues speculate upon the efficacy of individual cognitive stimulation therapy (CST) to improve cognitive function in dementia. They confirm the evidence that group CST works but the effect size is modest and the, possibly hugely significant, placebo effect of social engagement is not mentioned.1 In their own trial of group CST, they state that controls received “usual activities” which generally meant inactivity.2 The principles of CST entail a focussed process in the context of supportive relationships (with fellow participants and the facilitator), an expectation of helpfulness and the prospect of an enjoyable experience. These features are not unique to CST but are embedded in numerous social activities e.g. sing-alongs, group exercise, religious services and intergenerational gatherings. Unless trials of CST are rigorously controlled, there is a danger of unduly attributing beneficial outcomes to CST which could derive instead from a host of already available activities thus negating any additional training or expense.
Well-being in later life is associated with strong community affiliation, a sense of purpose and the opportunity to contribute to the lives of others 3- all of these are fostered by group CST. It is difficult not to conclude, therefore, that the efficacy of group CST over individual CST results from the convergence of these associations.
Advocates of specific technologies and procedures are clamouring to join a burgeoning “marketplace of memory” 3 whilst, as Orrell et al acknowledge, evidence suggests little transfer of the improvements effected by brain fitness training to more general performance. Dementia is a socially ostracising condition and bridging the gap between the sufferer and wider society is the compelling task.
1 Orrell M, Woods B and Spector A. Should we use individual cognitive stimulation therapy to improve cognitive function in people with dementia? BMJ 2012;344:e633
2 Spector A, Thorgrimsen L, Woods B, Royan L, Davies S, Butterworth M, et al. Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia. Br J Psychiatry2003;183:248-54
3 George DR, Whitehouse PJ. The Marketplace of Memory: What the Brain Fitness Technology Industry Says About Us and How We Can Do Better. The Gerontologist 2011; 51: 590-596.
Competing interests: No competing interests