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Table of Contents
CONCEPT PAPER
Year : 2021  |  Volume : 18  |  Issue : 2  |  Page : 125-128

Cognitive stimulation (an approach to cognitive impairment) time for action now!


Department of Psychiatric Nursing, College of Nursing, SRHU, Dehradun, Uttarakhand, India

Date of Submission13-Jun-2021
Date of Decision07-Jul-2021
Date of Acceptance13-Jul-2021
Date of Web Publication21-Dec-2021

Correspondence Address:
Ms. Sonia Singh
Assistant Professor, Galgotias School of Nursing, Galgotias University, Greater Noida, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iopn.iopn_52_21

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  Abstract 


"Gold agers are our worthy blessing, value, and assist them to live with dignity" Aging is a natural unrestrictive and irreversible process and an age of change in all dimensions including physical, psychological, social, and environmental. Cognition simply means to the psychological processes and activities related to understanding things, making judgments, memory, and reasoning in comparison to emotional and volitional process. The decrement of this cognitive function is known as cognitive impairment. Old age is the age of cognitive impairment the time for action is now! As increasing age is the greatest risk factor for cognitive impairment as its prevalence rate is found high worldwide, and as the baby boomer generation passes age 65, the number of people living with cognitive impairment is expected to jump dramatically. The prevention and treatment of cognitive impairment have been an important need and responsibility of the health sector area. Apart from the pharmacotherapy, there are other approaches and programs such as occupational therapy, environmental approach, brain training, dietary plan, executive cognitive structuring program, and cognitive stimulation therapy (CST) found effective in improving cognitive functions. CST has been popular, cost-effective, and successful for improving cognitive function and it is theme-based multicomponent therapy which focuses on cognitive abilities and can be given by the professional nurses, an occupational therapist, or a caregiver. The current concept article throws a flashlight on CST as a therapeutic approach to stimulate cognitive functions in geriatrics.

Keywords: Cognitive impairment, cognitive stimulation, elderly


How to cite this article:
Singh S, Gaikwad AD. Cognitive stimulation (an approach to cognitive impairment) time for action now!. Indian J Psy Nsg 2021;18:125-8

How to cite this URL:
Singh S, Gaikwad AD. Cognitive stimulation (an approach to cognitive impairment) time for action now!. Indian J Psy Nsg [serial online] 2021 [cited 2022 Jul 6];18:125-8. Available from: https://www.ijpn.in/text.asp?2021/18/2/125/332801




  Cognitive Stimulation Therapy Top


Cognitive stimulation is defined to be "engagement in a range of activities and discussion (usually in a group) aimed at general enhancement of cognitive and social functioning" Clare and Woods 2004, p: 387). Cognitive stimulation therapy (CST) is one of the group-based interventions which is popular, cost-effective, and successful for improving cognitive abilities. It is theme-based multicomponent program which focuses on cognitive functions and can be given by the various personnel who are expert in the field such as professional nurses, an occupational therapist, or a caregiver. Each session in it will cover a unique theme and topic.[1] The national institute for clinical excellence also recommended this nonpharmacological approach which can be easily carried out in nursing homes, old age homes, or in community. This therapy is fruitful to restructure and build the intellectual power and memory ability as similar as that of medicinal treatment given for the loss or treating the symptoms related to the loss of memory and also significantly improves both mental ability and quality of life in senior resident having cognitive difficulties. Enhancement in cognition by CST was similar to those seen in studies of acetylcholinesterase inhibitors[2] (Spector et al.) [Table 1], [Table 2], [Table 3].
Table 1: Principles of cognitive stimulation therapy

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Table 2: Key elements of the development and evaluation process (based on MRC framework 2008)

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Table 3: Various theme of cognitive stimulation therapy

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  Theoretical Paradigm Top


The prevalence rate of cognitive decline is so high that multidomain theoretical-based outcome is need for an hour.[3] The outcome of CST research and studies exploring individual and group cognitive stimulation may be understood in the context of biopsychosocial model of dementia, which basically explains how various psychological and biological factors intervene and influence outcome.[4] Cognitive stimulation is identified in the model as psychosocial technique that can change factors such as mental activity, social psychology, and personal psychology.


  Principles of Cognitive stimulation therapy Top


As CST is a multicomponent approach, so there are certain principles to be followed in delivering this therapy.[4],[12]


  Benefits of the Cognitive Stimulation Program Top


Stimulate the cognitive function (attention, concentration, memory, and executive functioning)

As with aging, there is a definite loss in the number and functioning of neurons, which correlates with lessen in brain weight of about 10% by age 90 years (Murray et al., 2009). Cognitive stimulations program is one of the most economical strategies which stimulate brain functioning each theme utilized in such a program has focused on cognitive abilities.[4],[12]

Refine their quality of life (focus all components)

It inculcates a person's physical health, psychological state, social, economical, and the activities in the therapy found effective not only in improving cognition but also quality of life.[4],[12]

Build up and strengthen their mental health

As geriatric mental health is need of hour and by improving their cognitive abilities it found to strengthen their psychological health status.[15] Cognitive stimulation in the elderly as an innovative good practice helpful in successful aging and self-care.[13]

Develop a self-help group (as a group-based intervention)

These programs were found more effective as group-based intervention and by developing groups for delivering activities not only improve social functioning but also emphasized them to practice the activities in groups and helpful in forming self-help groups which is again the best part of therapy.[5]


  Development of Cognitive Stimulation Program Top


Due to declining cognitive functioning, there is a disturbance in geriatric life and there is a need to focus on mental health care of the elderly so that there is successful cognitive aging. For effective implementation of such therapy, they need to be developed and designed appropriately.[3] CST is an evidence-based psychosocial intervention which is developed by various stages, identifying the evidence base (theoretical base), Cochrane reviews, expert suggestions, workshops, and surveys. Multidomain program for at risk older adults has benefit the elderly in successful cognitive aging.[11],[12]

The original CST program was developed in the United Kingdom (UK), due to the limited efficacy of medication prescribed for dementia.[6] It is evidenced for improving cognition and quality of life for people with dementia.[7] While many programs similar to CST have since been developed, the original UK version remains the most consistently evidenced, and development of such program is needed to be modulated with the proper time framework of activities. Such cognitive stimulation program can be varying from 45 to 90 min that depends on the themes and activities so far planned in program. Furthermore, their session may vary from activities to activities and delivering of these program requires proper skills and practice activities designed to be enjoyable for participants.[8]


  Various Themes can be Used in Programs Top


As a cognitive stimulation program is to be developed, it should be based on several themes and developing various themes can be used and modified as per the component of cognitive function.[4]


  How to Deliver Therapy Top


CST can be administered by a range of nonprofessional and professional staff in the centers also in community area; it can be provided by caregiver after giving them the proper training.[3] The success of CST is depending on the way it is delivered to the elderly also there is CST training which teaches practitioners to apply the key principles during CST, encouraging its use in a standardized, person-centered, and effective way. It is to be delivered in a structured way by adopting a flexible approach.[14]


  Applications of Cognitive Stimulation Program in Nursing Top


Cognitive stimulation programs can help all professionals dealing with elderly in various settings such as hospitals, old age homes, and community centers.

General application

Rapport building, developing interpersonal relationships, early diagnosis, screening, and management of cognitive impairment issues.

Specific applications

In hospitals and in old age homes settings: psychiatric nurses and other psychological professionals working with elderly can use this intervention to help gold agers with cognitive impairment in building their cognitive functioning.[9],[11]

In community settings

Nurses working in community at different levels such as subcenters, primary health centers cannot only use this intervention but also can teach caregiver of elderly about such strategies to deal with issues of cognitive impairment and also help the senior citizen for successful cognitive aging at grassroot level.


  Conclusion Top


Globally, as per the Indian Ageing Report-2017, there is a significant jump in the number of seniors citizens and Indian community also facing the same challenge as in old age prevalence rate of decline cognitive functioning is high.[3],[10] The person with poor cognitive functioning face a number of problems such as difficulty in holding attention both divided and selected, fall of processing speed, difficulty in organizing the task, decrease in the ability of decision-making skills, memory problems, difficulty in finding right words to express oneself, losing thinking, and thoughts and even social withdrawal which eventually affect their activities of daily living.[11] It is impossible to ignore geriatric mental health care so in health framework; there is a necessity to adopt nonpharmacological approach such as of cognitive stimulation program which is a group-based multicomponent theme-based approach that is effective in building up of cognitive function, mood, and also the quality of life in elderly.

Recommendations

  • It is recommended to use as group approach
  • Proper session outlines need to be prepared with the proper timeline and knowledge[12],[13]
  • It must be a positive and fun-based experience for both elderly and staff[16]
  • Feedback must be obtained from elderly to improve its delivery and practice.[13]


Acknowledgment

We would like to acknowledge the administrative authorities of District Panipat Haryana and Associate Prof. Dr. Achala College of Nursing, SRHU University, Dehradun, for guiding me to conduct the study in their deemed area. Most sincere thanks to all the elderly who promptly took part in the study. We appreciate their keen interest and cooperation shown during the conduction of the research study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Available from: https:/www.unforgetable.org/blog/what-is-cognitive-stimulation-therapy/. [Last accessed on 2021 May 28].  Back to cited text no. 1
    
2.
Spector A, Thorgrimsen L, Woods B, Royan L, Davies S, Butterworth M, et al. Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: Randomised controlled trial. Br J Psychiatry 2003;183:248-54.  Back to cited text no. 2
    
3.
Pais R, Ruano L, P Carvalho O, Barros H. Global cognitive impairment prevalence and incidence in community dwelling older adults – A systematic review. Geriatrics (Basel) 2020;5. [Last accessed on 2021 May 28].  Back to cited text no. 3
    
4.
Aguirre E, Hoare Z, Streater A, Spector A, Woods B, Hoe J, et al. Cognitive stimulation therapy (CST) for people with dementia – who benefits most? Int J Geriatr Psychiatry 2013;28:284-90.  Back to cited text no. 4
    
5.
Cheung G, Peri K, Barbara F. The effect of individual cognitive stimulation therapy delivered by trained volunteers on cognition and quality of life in people with mild to moderate dementia: A pilot randomized controlled trial. International Journal of Geriatric Psychiatry 2012;13;72. Available from: http://www.anzctr.org.au/AnzctrAttachments/373118.iCST%20Pilot%20Study%20Protocol%20FINAL.pdf. [Last accessed on 2021 May 28].  Back to cited text no. 5
    
6.
Orrell M, Yates LA, Burns A, Russell I, Woods RT, Hoare Z, et al. Individual cognitive stimulation therapy for dementia (iCST): Study protocol for a randomized controlled trial. Trials 2012;13:172.  Back to cited text no. 6
    
7.
National Institute for Health and Care Excellence (NICE). Dementia: Supporting People with Dementia and Their Careers in Health and Social Care. London: NICE; 2006.  Back to cited text no. 7
    
8.
Lobbia A, Carbone E, Faggian S, Gardini S, Piras F, Spector A, et al. The efficacy of cognitive stimulation therapy (CST) for people with mild-to-moderate dementia: A review. Europ Psychol 2018;11:434-41.  Back to cited text no. 8
    
9.
Gibbor L, Yates L, Volkmer A, Spector A. Cognitive stimulation therapy (CST) for dementia: A systematic review of qualitative research. Aging Ment Health 2021;25:980-90.  Back to cited text no. 9
    
10.
Orrell M, Woods B. Editorial comment. Tacrine and psychological therapies in dementia – no contest? Int J Geriatr Psychiatry 1996;11:189-92.  Back to cited text no. 10
    
11.
Available from: http://www.indiaenvironmentportal.org.in/files/file/India%20Ageing%20Report%20-%202017.p. [Last accessed on 2021 May 28].  Back to cited text no. 11
    
12.
Ng PE, Nicholas SO, Wee SL, Yau TY, Chan A, Chng I, et al. Implementation and effectiveness of a multi-domain program for older adults at risk of cognitive impairment at neighborhood senior centres. Sci Rep 2021;11:3787.  Back to cited text no. 12
    
13.
Apóstolo J, Bobrowicz-Campos E, Gil I, Silva R, Costa P, Couto F, et al. Cognitive stimulation in older adults: An innovative good practice supporting successful aging and self-care. Transl Med UniSa 2019;19:90-4.  Back to cited text no. 13
    
14.
Stoner CR, Chandra M, Bertrand E, Du B, Durgante H, Klaptocz J, et al. A new approach for developing "Implementation Plans" for cognitive stimulation therapy (CST) in low and middle-income countries: Results from the CST-international study. Front Public Health 2020;8:342.  Back to cited text no. 14
    
15.
Apóstolo JL, Cardoso DF, Rosa AI, Paúl C. The effect of cognitive stimulation on nursing home elders: A randomized controlled trial. J Nurs Scholarsh 2014;46:157-66.  Back to cited text no. 15
    
16.
Comas-Herrera A, Knapp M. Cognitive Stimulation Therapy (CST): Summary of Evidence on Cost Effectiveness. England: NHS; 2016. p. 125.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Abstract
Cognitive Stimul...
Theoretical Paradigm
Principles of Co...
Benefits of the ...
Development of C...
Various Themes c...
How to Deliver T...
Applications of ...
Conclusion
References
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