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Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: Randomised controlled trial

  • Aimee Spector (a1), Lene Thorgrimsen (a2), Bob Woods (a3), Lindsay Royan (a4), Steve Davies (a5), Margaret Butterworth (a5) and Martin Orrell (a5)...



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.


Corresponding author

Dr Martin Orrelll, Department of Psychiatry and Behavioural Sciences, UCL, Wolfson Building, 48 Riding House Street, London W1N 8AA, UK. Tel: 0207679 9452; fax: 020 7679 9426; e-mail:


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Declaration of interest

None. Funding detailed in Acknowledgements.



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Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: Randomised controlled trial

  • Aimee Spector (a1), Lene Thorgrimsen (a2), Bob Woods (a3), Lindsay Royan (a4), Steve Davies (a5), Margaret Butterworth (a5) and Martin Orrell (a5)...
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Neurobiology of cognitive stimulation in dementia

Ernest H. Friedman, Psychiatrist
15 September 2003

Spector et al (2003;183:248-254) in a randomised trial of cognitive stimulation therapy in dementia, demonstrated improvement in assessments of cognitive function and quality of life in the treated group. Neurobiological features are suggested by dopamine (DA)D2 receptors, but not D3 or D4 receptors, involved in the rewarding effects of brain stimulation through attention to temporal signals highlighting significantstimuli (1). This hypothesis is supported by: a reduced density of D2 receptors in dementia (2,3); optimum response organisation and working memory at intermediate DA tone in a mediofrontostriatal activation system;and a study demonstrating that auditory training induces asymmetrical changes in cortical neural activity.

This strategy is supported by: the association of the reduction of blood pressure with longer, less recurrent speech hesitation pauses of about 2 seconds linked to prefrontal cortex modulation of DA during the delayed alternation task; reports that the microvascular response to the onset of neuronal activity is delayed consistently by about 3 seconds and is linked toincreased coherence of electroencephalograph gamma-band activity (30-50 Hzor broader, centered on 40 Hz) associated with the execution of more complex tasks; and a 2.5- to 3-second delay period for inhibition shapes the temporal flow of information in the prefrontal cortex. The fact that rate and variability in duration of speech hesitation pausescorrelate with the left and right hemisphere respectively (1), promptsthe analysis of pauses on a time-base to determine the benefit ofcognitive stimulation therapy versus anti-dementia drugs on asymmetricalbrain functions.


1. Friedman EH. Re: pulse pressure and risk of Alzheimer disease in persons aged 75 years and older. Stroke 2003;34:e107.2. Barbanti P, Fabbrini G, Ricci A, et al. Reduced density of dopamine D2-like receptors on peripheral blood lymphocytes in Alzheimer's disease. Mech Ageing Dev 2000;120:65-75.3. Allard P, Englund E, Marcusson J. Caudate nucleus dopamine d(2) receptors in vascular dementia. Dement Geriatr Cogn Disord 2002;14:22-25.


Ernest H. Friedman, MDIntellectual property: US patent 4,543,957 and related US and global patents and software copyrights.
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Conflict of interest: None Declared

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