title: Maintenance Cognitive Stimulation Therapy (CST) for dementia: a single-blind, multi-centre, randomized controlled trial of Maintenance CST vs. CST for dementia.
abstract: BACKGROUND
  Psychological treatments for dementia are widely used in the UK and internationally, but only rarely have they been standardised, adequately evaluated or systematically implemented. There is increasing recognition that psychosocial interventions may have similar levels of effectiveness to medication, and both can be used in combination. Cognitive Stimulation Therapy (CST) is a 7-week cognitive-based approach for dementia that has been shown to be beneficial for cognition and quality of life and is cost-effective, but there is less conclusive evidence for the effects of CST over an extended period.
  
  
  METHODS
  This multi-centre, pragmatic randomised controlled trial (RCT) to assess the effectiveness and cost-effectiveness of Maintenance CST groups for dementia compares a intervention group who receive CST for 7 weeks followed by the Maintenance CST programme once a week for 24 weeks with the control group who receive CST for 7 weeks, followed by treatment as usual for 24 weeks.The primary outcome measures are quality of life of people with dementia assessed by the QoL-AD and cognition assessed by the ADAS-Cog. Secondary outcomes include the person with dementia's mood, behaviour, activities of daily living, ability to communicate and costs; as well as caregiver health-related quality of life. Using a 5% significance level, comparison of 230 participants will yield 80% power to detect a standardised difference of 0.39 on the ADAS-Cog between the groups. The trial includes a cost-effectiveness analysis from a public sector perspective.
  
  
  CONCLUSIONS
  A pilot study of longer-term Maintenance CST, offering 16 weekly sessions of maintenance following the initial CST programme, previously found a significant improvement in cognitive function (MMSE) for those on the intervention group. The study identified the need for a large-scale, multi-centre RCT to define the potential longer-term benefits of continuing the therapy. This study aims to provide definitive evidence of the potential efficacy of maintenance CST and establish how far the long-term benefits can be compared with antidementia drugs such as cholinesterase inhibitors.
authors.affiliation: Department of Mental Health Sciences, University College London, Charles Bell House, 67-73 Riding House Street, London, UK. e.aguirre@ucl.ac.uk
authors.forename: Elisa
authors.initials: E
authors.lastname: Aguirre
authors.forename: Aimee
authors.initials: A
authors.lastname: Spector
authors.forename: Juanita
authors.initials: J
authors.lastname: Hoe
authors.forename: Ian T
authors.initials: IT
authors.lastname: Russell
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
authors.forename: Robert T
authors.initials: RT
authors.lastname: Woods
authors.forename: Martin
authors.initials: M
authors.lastname: Orrell
mesh_terms: D000203:Activities of Daily Living; D000339:Affect; D017028:Caregivers / Q000523:psychology; D002800:Cholinesterase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000191:economics; D003131:Combined Modality Therapy; D003142:Communication; D003362:Cost-Benefit Analysis; D003704:Dementia / Q000191:economics / Q000523:psychology / Q000628:therapy*; D016527:Drug Costs; D017048:Health Care Costs; D006801:Humans; D011788:Quality of Life; D012107:Research Design; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors