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Maintenance cognitive stimulation therapy for dementia: single-blind, multicentre, pragmatic randomised controlled trial

  • Martin Orrell (a1), Elisa Aguirre (a1), Aimee Spector (a2), Zoe Hoare (a3), Robert T. Woods (a4), Amy Streater (a1), Helen Donovan (a5), Juanita Hoe (a1), Martin Knapp (a6), Christopher Whitaker (a3) and Ian Russell (a7)...



There is good evidence for the benefits of short-term cognitive stimulation therapy for dementia but little is known about possible long-term effects.


To evaluate the effectiveness of maintenance cognitive stimulation therapy (CST) for people with dementia in a single-blind, pragmatic randomised controlled trial including a substudy with participants taking acetylcholinesterase inhibitors (AChEIs).


The participants were 236 people with dementia from 9 care homes and 9 community services. Prior to randomisation all participants received the 7-week, 14-session CST programme. The intervention group received the weekly maintenance CST group programme for 24 weeks. The control group received usual care. Primary outcomes were cognition and quality of life (clinical trial registration: ISRCTN26286067).


For the intervention group at the 6-month primary end-point there were significant benefits for self-rated quality of life (Quality of Life in Alzheimer's Disease (QoL-AD) P = 0.03). At 3 months there were improvements for proxy-rated quality of life (QoL-AD P = 0.01, Dementia Quality of Life scale (DEMQOL) P = 0.03) and activities of daily living (P = 0.04). The intervention subgroup taking AChEIs showed cognitive benefits (on the Mini-Mental State Examination) at 3 (P = 0.03) and 6 months (P = 0.03).


Continuing CST improves quality of life; and improves cognition for those taking AChEIs.


Corresponding author

Martin Orrell, Unit of Mental Health Sciences, University College London, Charles Bell House, 67–73 Riding House Street, London W1W 7EJ, UK. Email:


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Declaration of interest

Royalties from the sale of the Making a Difference manuals are paid to the Dementia Services Development Centre, Bangor University.



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Maintenance cognitive stimulation therapy for dementia: single-blind, multicentre, pragmatic randomised controlled trial

  • Martin Orrell (a1), Elisa Aguirre (a1), Aimee Spector (a2), Zoe Hoare (a3), Robert T. Woods (a4), Amy Streater (a1), Helen Donovan (a5), Juanita Hoe (a1), Martin Knapp (a6), Christopher Whitaker (a3) and Ian Russell (a7)...
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" A Different Form of Cognitive Stimulation Therapy for Dementia"- Sri Lankan Experience

K.A.L.A. Kuruppuarachchi, Senior Professor of Psychiatry
17 August 2014

The article on maintenance cognitive stimulation therapy for dementia: single -blind , multicentre , pragmatic randomised controlled trial ( Orrell et al. 2014) has been read with interest. It has a global relevance in the management of dementing patients.

Old age population is increasing all over the world and developing countries are no exception. For instance those over 60 years of age in Sri Lanka was 12.7% in the year 2013 and expected to be 25.7% by 2050 (United Nations, Department of Economic and Social Affairs, Population Division 2013).

Elderly people are generally looked after by the family members ( particularly female) in many low- and middle- income countries at present as the services are poorly developed. There are benefits as well as disadvantages of this. The values and social expectations seem to be changing even in our part of the world due to industrialization. The belief of better care and respect for the elderly due to cultural factors in lower income countries seems to be a misunderstanding ( Skuse 2010). As a result of societal change many females are also seeking employment. Many carers are burdened and stressed as they have to play a dual role of caring and working. This aspect has been highlighted even in Sri Lanka (Kuruppuarachchi & Wijesinghe 2010). Carers distress is obviously contributing to poor cognitive stimulation of the dementing patients. On the other hand our over concerned , overprotective families tend to restrict the usual activities done by their elderly relatives in good faith believing that they are providing a good care which could compromisecognitive stimulation.The benefits of the cognitive stimulation therapy in the management of dementing patients have been discussed/ shown previously also ( Spector et al. 2003, Woods et al. 2012, Tripathi & Tiwari 2009).

It is vital to engage the family members when organizing care plansfor the elderly patients in developing countries keeping in mind the social expectations and available resources. Incorporating culturally accepted and feasible interventions such as religious activities in the management of elderly with psychiatric problems and positive outcomes have been demonstrated (Kuruppuarachchi & Lawrence 2006).

We believe that a different form of cognitive stimulation therapy - stimulation of the elderly dementing patients at the home environment by using natural resources, nature and engaging them in activities with the support of family members may be feasible in our part of the world. It is essential to educate the people regarding the benefits of engaging the oldage people in activities as much as possible whilst minimizing the unnecessary restrictions imposed in good faith. It is note-worthy that a "mass scale cognitive stimulation therapy" in the form of religious activities in temples may be possible in countries such as Sri Lanka as many elderly people tend to visit the religious places frequently.


Orrell M, Aguirre E, Spector A, Hoare Z, Woods RT et al. Maintenance cognitive stimulation therapy for dementia: single-blind, multicenter, pragmatic randomised controlled trial. British Journal of Psychiatry 2014;204: 454-461.

United Nations, Department of Economic and Social Affairs, PopulationDivision (2013). World Population Prospects: The 2012 Revision, Highlightsand Advance Tables. Working Paper No.ESA/P/WP.228.

Skuse D. Care for elderly people with mental illness: a global problem. International Psychiatry 2010 ; 7(2):29-30.

Kuruppuarachchi KALA, Wijesinghe CA. Elder abuse and carer abuse: Twosides of the same coin. Ceylon Medical Journal 2010 ; 55(1): 34-35.

Spector A, Thorgrimsen L, Woods B, Royan L, Davies S, Butterworth M, Orrell M. Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial. British Journal of Psychiatry 2003; 183:248-54.

Woods B, Aguirre E, Spector AE, Orrell M. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD005562. DOI: 10.1002/14651858.CD005562.pub2.

Tripathi RK, Tiwari SC. Psychotherapeutic Approaches in the Management of Elderlies with Dementia: An Overview. Delhi Psychiatry Journal 2009; 12(1): 31-41.

Kuruppuarachchi KALA, Lawrence TS. Incorporating spiritual and religious beliefs in taking care of the elderly with psychiatric problems - some personal experiences. Indian Journal of Geriatric Mental Health 2006; 2(1): 51-54.

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