Rehabilitation in dementia: CST and Sonas group interventions for people with moderate cognitive impairment. A pilot study

Abstract

Purpose Dementia is a complex, progressively degenerative condition. It results in loss of cognitive and functional capabilities, along with a significant increase in the level of dependency. A reduction in the use of pharmacological interventions correlates with an increased in good quality non-pharmacological interventions in dementia care. The purpose of this study is to examine the impact of 14-session face-to-face cognitive stimulation therapy (CST) and Sonas group interventions on individuals living with dementia with moderate cognitive impairment, from pre-intervention to post-intervention in terms of their cognition, communication, neuropsychiatric symptoms, activities of daily living and quality of life. Design/methodology/approach A pilot single blind prospective controlled trial evaluated two group intervention approaches, cognitive stimulation therapy (CST) and Sonas, with 28 participants with moderate dementia. Pseudorandomisation and single blinding were implemented. CST has a solid evidence base. Sonas is a widely used multi-sensory intervention in Ireland with an emerging evidence base. Participants were recruited from a mental health service. Participants who had a formal diagnosis of dementia, moderate cognitive impairment and some ability to communicate and understand communication were included. Findings Results supported CST to a greater extent than Sonas. The CST group showed significant changes in cognition (p = 0.032) and communication (p = 0.006). Both groups had significant changes in carer quality of life (CST, p = 0.019; Sonas, p = 0.035). Results support the recommendations for a future definitive trial. Research limitations/implications Rehabilitation potential of individuals living with moderate dementia was demonstrated. This study suggests that group interventions like these impact on the trajectory of dementia. Practical implications Rehabilitation interventions impact on the trajectory of dementia. CST and Sonas have no impact on activities of daily living. Future studies with larger sample sizes, 16 weeks intervention period and control groups are required. Social implications This pilot study supports CST over Sonas interventions for individuals living with moderate dementia. Multiple outcome measures demonstrated trends towards significance for both interventions. Future definitive trials may detect a significant effect of both interventions. Originality/value A dementia diagnosis is devastating and generally creates negative perceptions and associations (Alvira, 2014). In contrast, the outcomes of this study are positive. This study provides evidence that occupational therapist intervention can impact on the trajectory of the condition with people with dementia demonstrating that they do have rehabilitation potential by responding to treatment and improving and maintaining their abilities as they progress through the condition.

Cognitive stimulation and activities of daily living for individuals with mild-to-moderate dementia: A scoping review

“…Neither Spector et al (2003) or Coen et al (2011) found significant between-group differences in functional ability when compared to a usual-care control group. No significant between-group differences in ADL performance were also reported in Dolan et al’s (2022) study comparing CST to Sonas.…”

“…Eight papers included in this review evaluated an intervention of CST. Spector et al’s (2003) RCT originally trialled the English format of CST ( N = 201), which two smaller-scale, Irish-based trials further evaluated (Coen et al, 2011; Dolan et al, 2022). All three studies involved 45-minute group sessions run twice weekly for a duration of 7 weeks.…”

“…This question was framed using the Population, Concept and Context (PCC; Peters et al 2020). The question was based on gaps in knowledge noted previously by Dolan et al (2022).…”

“…In contrast, Garrido-Pedrosa et al’s (2017) systematic review of cognitive-focused interventions for dementia provided evidence of benefits of CS groups in maintaining performance in ADL. However, Dolan et al’s (2022) more recent pilot study comparing CST to Sonas, a non-pharmacological, multi-sensory stimulation treatment approach, disputed these findings, as no significant between-group differences were found for ADL performance.…”

“…However, a pilot RCT ( N = 58) investigating the effects of an occupational therapy CS programme on ADL skills reported significant improvements in the ADLs of feeding, dressing, continence and stair mobility (Jiménez Palomares et al, 2021). These results are promising, indicating more research is needed to investigate whether CS is more effective for occupational therapy goals when used as part of an ADL-focused, multi-faceted intervention (Dolan et al, 2022).…”