Distinctive effects between cognitive
stimulation and reminiscence therapy on
cognitive function and quality of life for
different types of behavioral problems in
dementia
Hsiu-Ching Lin Postdoctoral Fellow
Department of Nursing, College of Medicine, National Cheng Kung University
Background
•
Behavioral and psychological symptoms of dementia
(BPSD) affect up to 90% people with dementia (PwD)
during the course of the disease.
•
No studies have examined the use of complementary
therapies, such as
cognitive stimulation therapy (CST)
and
reminiscence therapy (RT)
applied to different
types of BPSD in PwD.
3 types of behavioral problems defined by Takeuchi
•
the dispute type
– undetermined between the past and present, so they act abnormally to the corresponding context
– aggression, anger, anxiety, excitement, and hoarding etc.
•
the return type
– cannot accept their self in the present, and look for a better time in the past
– Wandering and
•
the dissociate type
– PwD hide themselves in their own inner worlds and ignore or give up their current lives
Purpose
•
To investigate the distinctive effects of CST
and RT on cognitive function and quality of life
for PwD with 3 types of behavioral
problems-the dispute, return, and dissociate types
Methods
• Subjects and setting
– A quasi-experimental design was employed
– Inclusion criteria: Elderly residents who met the Chinese version of Mini-Mental State Examination (MMSE) score
• < 17 for those with an education below senior high school • < 24 for those with an education above senior high school
– Exclusion criteria: if the severity of behavioral problems prohibited interactions with the researchers or other participants
• Interventions
– A total of PwD residing in 10 long-term care institutions (LTCIs) participated in the study and were divided into 3 groups.
– The CST and RT groups received 50-minute sessions of intervention therapy once a week for 10 continuous weeks, and the control group participated in regular activities.
Methods-Cont.
•
Themes and activities designed for CST
– Physical games, Sound, Face/Scenes, Food, Words Association, Number Game, Being Creative,
Categorizing Objects, Orientation and Team Quiz.
•
Themes and activities designed for RT
– Nice to See You, Childhood Experience Sharing,
Favorite Taste, The Melody of Past time, Celebrating Holidays and Festivals, My Favorite Relatives, My Job, Most Memorable Thing, Hometown, and My Pride. The control group participated in regular activities
Methods-Cont.
•
The pre-test (week 1), post-test (week 12), and
follow-up (week 24) data were collected using
MMSE and Quality of Life–Alzheimer’s Disease
(QOL-AD).
•
The “Classification Form of BPSD in PwD,”
developed by Wang (2012) based on observation
of the behavioral problems of PwD defined by
Takeuchi (10), was applied to categorize
participants into 3 types: the dispute, return and
dissociate types
Methods-Cont.
•
Data analysis
–
One-way ANOVA for continuous variables and
Chi-square test or Fisher’s Exact test for categorical
variables were used to analyze differences in
demographic data among the three intervention
groups
–
Two-way ANOVA were used to compare the
effects of cognitive stimulation and reminiscence
therapy on cognitive function and quality of life in
PwD with three types of behavioral problems
Discussion
•
Short-term intervention effects by groups
– The results of our study revealed CST and RT interventions did have positive effects on the participants’ cognition and quality of life.
– consistent with some studies
• Woods et al. (2012) and Woods et al. (2006), they found that a CST intervention had effects on the patients’ cognitive
function shortly after the treatment sessions, as well as their self-reported quality of life.
• Cotelli et al. (2012) and Wang (2007) found RT was effective in improving cognitive function and mood for PwD. This
might be because they were encouraged to talk and record memories to others during the treatment sessions, and so their cognitive abilities were stimulated and depressive symptoms alleviated through such interactions.
Discussion-Cont.
•
Short-term effects on cognitive function by types
of behavioral problems
– the result indicated that CST intervention significantly improved the cognitive abilities of the dispute type patients, and much more so than seen with the other two types of behavioral problems.
– This may be because CST was designed based on
reality orientation, and thus is beneficial to those who encounter difficulties in struggling with their
Discussion-Cont.
•
Short-term effect of quality of life by types of
behavioral problems
– After receiving the CST, we failed to detect significant differences with regard to the effects on quality of life for 3 types of behavioral problems. However, greater improvements on the dispute type were found.
– This might be because patients with the dispute type interacted with the environment in a more aggressive way, and so may be more responsive to the CST when reality orientation and cognitive stimulation activities were performed.
Discussion-Cont.
• Follow-up effects of CST and RT :may have potentially sustained effects
– CST
• Woods et al. (2012) suggests the effects of the CST intervention lasted 1-3 months after treatment, and they thus suggested the need to investigate how long the effects of CST are sustained, and the appropriate length of the CST program.
• Our study provided the evidence for the optimal time of continuing CST for PwD, i.e., one time per week for consecutive 10 weeks, and also indicated that there might be potential sustained effects after 12 weeks’ follow-up.
– RT
• Woods et al. (2005) found that RT was associated with significant improvements in cognition at 4-6 weeks’ follow-up, which was inconsistent with our findings. • This may be because no study has ever investigated a longer period of follow-up
in PwD, and particularly focusing on the 3 types of behavioral problems. • This promising discovery provides an indication of the potential sustained
treatment effect of RT, and might have a cost-saving effect with regard to designing a structural therapeutic program for PwD.
