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.

Keywords

• rehabilitation
• dementia
• occupational therapy
• cognitive stimulation therapy
• sonas