DESK REVIEWS | 07.05.05. Are non-pharmacological interventions, such as Cognitive Stimulation Therapy available for people with dementia? Are such interventions evidence based?

DESK REVIEW | 07.05.05. Are non-pharmacological interventions, such as Cognitive Stimulation Therapy available for people with dementia? Are such interventions evidence based?

Not in the public system, but it is available in the private sector via out-of-pocket payments. For example, cognitive training, cognitive stimulation, exergaming, physiotherapy, and psychotherapy.

Some of the dementia centres across the country follow non-pharmacological interventions such as cognitive stimulation therapy for people with dementia (ARDSI, 2010). DEMCARES by SCARF Chennai runs The Centre for Active Ageing (CAA) which provides psychosocial non-pharmacological interventions (DEMCARES, 2019).

Cognitive stimulation therapy, reality orientation, and reminiscence therapy are some of the commonly used non-pharmacological interventions used to reduce the behavioural, cognitive, and emotional symptoms of dementia which have proven to be effective (Tripathi and Tiwari 2009; Shaji et al., 2018).

References:

Alzheimer’s and Related Disorders Society of India. (2010). THE DEMENTIA INDIA REPORT 2010: Prevalence, impact, cost and services for dementia. New Delhi. Available from: https://ardsi.org/pdf/annual%20report.pdf

DEMCARES. (2019). Centre for Active Aging. Available from: https://dementia.scarfindia.org/centre-for-active-aging/

Shaji, K.S., Sivakumar, P.T., Rao, G.P., Paul, N., (2018). Clinical Practice Guidelines for Management of Dementia. Indian J. Psychiatry 60, S312–S328. https://doi.org/10.4103/0019-5545.224472

Tripathi, R.K., Tiwari, S.C., (2009). Psychotherapeutic Approaches in the Management of Elderlies with Dementia: An Overview, DELHI PSYCHIATRY JOURNAL.

So far, Cognitive Stimulation Therapy has been implemented in Indonesia only in research/academic settings. The 2019 study that was conducted in nursing homes shows a significant difference in the cognitive function within attention domain and memory domain measured after participation in the CST intervention (Triestuning & Sipollo, 2019).  Another study published in 2019 also finds significant differences in cognitive functions between the CST group compared to the control group (Komalasari, 2014). However, a pre-post study published in 2014 with a small sample showed no significant impact of CST in improving cognition (Jakarta Smart City, 2015).

References:

Jakarta Smart City. (2015). Laporkan Kinerja Pemerintah Melalui Qlue.

Komalasari, R. (2014). Domain Fungsi Kognitif Setelah Terapi Stimulasi Kognitif. Jurnal Keperawatan Indonesia, 17(1), 11–17.

Triestuning, E., & Sipollo, B. V. (2019). Cognitive Stimulation Therapy on Elderly with Dementia in Panti Werdha Pandaan, Pasuruan. International Conference of Kerta Cendekia Nursing Academy, 1, 139–144.

None. Interventions such as mhGAP-IG have been implemented by the AMHRTF (Africa Mental Health Training and Research Foundation, 2020) using task sharing approaches i.e., the TEAM project (Mutiso et al., 2018). The focus on delivery of interventions by non-mental health specialists (health care workers) after training was on priority mental health problems (including dementia) listed under the mhGAP-IG which includes dementia (World Health Organization, 2016).

References:

Africa Mental Health Training and Research Foundation. (2020). Welcome to AMHRTF. https://africamentalhealthresearchandtrainingfoundation.org

Mutiso, V. N., Gitonga, I., Musau, A., Musyimi, C. W., Nandoya, E., Rebello, T. J., … Ndetei, D. M. (2018). A step-wise community engagement and capacity building model prior to implementation of mhGAP-IG in a low-and middle-income country: a case study of Makueni County, Kenya. International Journal of Mental Health Systems, 12(1), 1–13.  https://doi.org/10.1186/s13033-018-0234-y

World Health Organization. (2016). mhGAP Intervention Guide version 2.0. Geneva, Switzerland. https://www.who.int/publications/i/item/9789241549790

At the moment, these are not available at large scale through public health services.

The International Cognitive Stimulation Therapy centre at the University College of London (UCL) has South Africa listed as one of its countries that form part of the international CST group and reported to be used in the country by speech-language pathologists in the Johannesburg area with regards to adult neuro-rehabilitation. It is unclear from the desk review to what extent these services are available to persons living with dementia; however, specialised services in general are usually skewed/restricted to the private sector (and accessible to those who can afford private health-and specialist care). No research studies were found to date that provide an evaluation of CST as an intervention for South Africa specifically.

Other non-pharmacological approaches used in South Africa relate to the support and monitoring of the well-being of carers. The NGO-sector plays a critical role in training carers on how to care for persons living with dementia, also providing or linking to community-based respite care and home-care where possible (Emsley & Seedat, 2013).

References:

Emsley, R., & Seedat, S. (2013). The South African Society of Psychiatrists (SASOP) treatment guidlelines for psychiatric disorders. South African Journal of Psychiatry, 19(3), 127–196. https://doi.org/10.4102/sajpsychiatry.v19i3.942