Cognitive Stimulation Therapy (CST) and iCST

Saint Louis University’s Geriatric Education Center (GEC) offers cognitive stimulation therapy (CST), a support group for people experiencing memory challenges.

Cognitive stimulation therapy (CST) is an evidence-based treatment for people with mild to moderate dementia. CST was designed in the United Kingdom by Aimee Spector, Ph.D., and several dementia experts following an extensive evaluation of research evidence.

How CST Works

Group CST treatment involves 14 or more sessions of themed activities, which typically run twice weekly. Sessions aim to actively stimulate and engage people with dementia while providing an optimal learning environment and the social benefits of a group. Each session follows a general theme, with choices of activities to cater to the group's interests. Members give the group a name. Consistency is created between sessions by using the same warm-up activity, a reality orientation (RO) board (containing information about the group) and having a theme song. Although CST was designed for brief treatment, research shows that people who continue with CST can continue to improve or at least maintain improvements for longer.

CST treatment can be administered by trained health care professionals working with people with dementia, such as social workers, occupational therapists, speech-language pathologists and registered nurses. Anyone who has experience working with people with dementia can be trained to facilitate CST groups. CST groups can take place in settings such as residential homes, hospitals or day centers.

CST Results

Research shows that CST significantly benefits people's cognitive functioning, as measured by the Mini-Mental State Examination (MMSE) and the Alzheimer’s Disease Assessment Scale-Cognitive Subscale ADAS-COG. These tests primarily investigate memory and orientation but also language and visuospatial abilities. Because these outcome measures are used in dementia drug trials, direct comparisons could be made. Analysis suggests CST is equally effective as several dementia drugs.

Further research showed that CST significantly impacted language skills including naming, word-finding and comprehension. CST has led to significant improvements in quality of life, as rated by the participants themselves using the QoL-AD. Research also shows that the caregivers of these individuals with dementia reported improved quality of life. Results from interviews with CST participants and their caregivers about their experiences of CST sessions found key themes, including positive experiences of being in the groups, due to a supportive and non-threatening environment; and improvements in mood, confidence, and concentration.

Cognitive Stimulation Therapy Training Institute (CSTTI)

A CST education and training team was formed in 2014 at SLU’s Gateway Geriatric Education Center. Since 2015, the team has provided CST training and education to thousands of health care and social service professionals, learners, and caregivers; leading to the development of the CST Training Institute (CSTTI).

Main Objectives of CSTTI

The aim is to develop CSTTI in collaboration and consultation with the original CST developers at University College London. The center's main objectives are:

• To develop and implement a standard curriculum and evaluation process for training facilitators of CST and trainers of facilitators.
• To establish a leadership structure for CST training in the United States and Canada to assure fidelity and quality of program implementation.
• To adapt the CST manuals to:
  • Be culturally competent for participant groups
  • Include education/direction on implementation
• To develop and maintain a listing/registry of individuals who have successfully completed and maintained CSTTI facilitator or trainer programs. (Are currently approved)
• To provide information on CST educational resources and provision of CST interventions.
• To develop an effective evaluation method for the CSTTI to establish as a useful model for international adoption.

CSTTI Governance

• Oversight of the CSTTI is provided by the core committee from the following institutions: Perry County Memorial Hospital, A.T. Still University and Saint Louis University; in collaboration with the original developers at University College London. The core committee is responsible for, but not limited to the following:
• Ongoing program development
• Decision-making processes
• Roles/responsibilities
• Other activities as necessary

Download the CSTTI Handbook

Cognitive Stimulation Therapy at Perry County Memorial Hospital

Variations of CST

• Exercise-Based CST:  We have developed groups that have incorporated exercise into CST activities. A warm-up exercise can always be a good opening activity for many traditional CST groups. Exercise-based CST largely uses these sessions to get the body moving to help stimulate recall and brain stimulation. Groups can share a ball toss, do chair exercises or stretches to help memory and mobility.

• Spiritual CST:  Spirituality and faith are important coping areas for many older adults, especially when their memory starts to decline. SLU and other community partners have been incorporating faith-based themes into the CST activities of their groups.  The groups have also developed a “spiritual toolkit,” where participants can store scriptures, hymns, photos and other items that reflects their spiritual coping.

• Caregiver Groups for CST Participants: SLU has developed caregiver process groups that coincide with CST, called “Caregiver-Assisted CST.” These process groups help educate caregivers about the topics covered in their loved ones' CST groups. Caregivers also get a chance to share personal reflections as a caregiver and have a chance to incorporate the CST activities at home with their loved ones as well.

For more information on these variations, please contact Max Zubatsky, Ph.D., at max.zubatsky@health.slu.edu

Individual Cognitive Stimulation Therapy

Individual Cognitive Stimulation Therapy (iCST) is a one-on-one intervention derived from evidence-based group interventions for persons with dementia. iCST provides guidelines for structuring theme-based sessions to actively stimulate and engage the participant while providing an optimal learning environment.