The impact of individual Cognitive Stimulation Therapy (iCST) on cognition, quality of life, caregiver health, and family relationships in dementia: A randomised controlled trial
The impact of individual Cognitive Stimulation Therapy (iCST) on cognition, quality of life, caregiver health, and family relationships in dementia: A randomised controlled trial
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DOI：
10.1371/journal.pmed.1002269
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发表时间：
2017-03-01
期刊：
影响因子：
15.8
通讯作者：
Orgeta, Vasiliki
中科院分区：
文献类型：
--
作者：
Orrell, Martin;Yates, Lauren;Orgeta, Vasiliki
背景认知刺激疗法(CST)是一种成熟的团体心理社会干预方法，适用于痴呆症患者。有证据表明，由家庭照顾者提供的以家庭为基础的认知刺激方案可能对个人和照顾者都有利。然而，以前没有研究评估照顾者分娩的CST。这项研究旨在评估以家庭为基础、由照顾者主导的个人认知刺激疗法(ICST)在(I)改善痴呆症患者的认知和生活质量(QOL)以及(Ii)照顾者的身心健康(幸福感)方面的有效性。方法和发现在英国的8个研究地点进行了单盲、务实的随机对照试验(RCT)。干预和结果盲法评估是在参与者的家中进行的。从记忆服务和社区精神卫生团队招募了356名轻中度痴呆患者和他们的照顾者，参与者被随机分配到ICST(75次，30分钟)或正常治疗(TAU)对照组，持续25周。信息和通信技术中心的会议由旨在激发精神和愉快的主题活动组成。提供ICST的照顾者接受了非盲目研究人员的培训和支持。主要结果是痴呆症患者的认知(阿尔茨海默病评估量表-认知[ADAS-Cog])和自我报告的QOL(阿尔茨海默病[QOL-AD])，以及照顾者的总体健康状况(简明健康调查-12[SF-12])。次要结果包括从个人和照顾者的角度对照顾者关系的质量(照顾者患者关系质量量表)和照顾者的健康相关生活质量(欧洲生活质量-5个维度[EQ-5D])。在测试后(26wk)，ICST组和TAU组在痴呆症患者的认知结果(平均差异[MD]=-0.55，95%CI-2.00-0.90；p=0.45)和自我报告生活质量(MD=-0.02，95%CI-1.22-0.82；p=0.97)或照顾者的一般健康状况(MD=0.13，95%CI-1.65-1.91；p=0.89)方面没有差异。然而，接受ICST的痴呆症患者对与他们的照顾者的关系的评价更积极(MD=1.77，95%CI 0.26-3.28；p=0.02)，ICST改善了照顾者的生活质量(EQ-5D，MD=0.06，95%CI 0.02-0.10；p=0.01)。分配给公务员制度委员会的40%(72/180)的DYAD每周至少完成两次会议，22%(39/180)根本不完成任何会议。研究的局限性包括对干预的低依从性。结论没有证据表明ICST对痴呆症患者的认知或生活质量有影响。然而，参加ICST似乎提高了照顾者关系的质量和照顾者的生活质量。
BackgroundCognitive stimulation therapy (CST) is a well-established group psychosocial intervention for people with dementia. There is evidence that home-based programmes of cognitive stimulation delivered by family caregivers may benefit both the person and the caregiver. However, no previous studies have evaluated caregiver-delivered CST. This study aimed to evaluate the effectiveness of a home-based, caregiver-led individual cognitive stimulation therapy (iCST) program in (i) improving cognition and quality of life (QoL) for the person with dementia and (ii) mental and physical health (well-being) for the caregiver.Methods and findingsA single-blind, pragmatic randomised controlled trial (RCT) was conducted at eight study sites across the United Kingdom. The intervention and blinded assessment of outcomes were conducted in participants' homes. Three hundred fifty-six people with mild to moderate dementia and their caregivers were recruited from memory services and community mental health teams (CMHTs).Participants were randomly assigned to iCST (75, 30-min sessions) or treatment as usual (TAU) control over 25 wk. iCST sessions consisted of themed activities designed to be mentally stimulating and enjoyable. Caregivers delivering iCST received training and support from an unblind researcher.Primary outcomes were cognition (Alzheimer's Disease Assessment Scale-cognitive [ADAS-Cog]) and self-reported QoL (Quality of Life Alzheimer's Disease [QoL-AD]) for the person with dementia and general health status (Short Form-12 health survey [SF-12]) for the caregiver. Secondary outcomes included quality of the caregiving relationship from the perspectives of the person and of the caregiver (Quality of the Carer Patient Relationship Scale) and health-related QoL (European Quality of Life-5 Dimensions [EQ-5D]) for the caregiver.Intention to treat (ITT) analyses were conducted. At the post-test (26 wk), there were no differences between the iCST and TAU groups in the outcomes of cognition (mean difference [MD] = -0.55, 95% CI -2.00-0.90; p = 0.45) and self-reported QoL (MD = -0.02, 95% CI -1.22-0.82; p = 0.97) for people with dementia, or caregivers' general health status (MD = 0.13, 95% CI -1.65-1.91; p = 0.89). However, people with dementia receiving iCST rated the relationship with their caregiver more positively (MD = 1.77, 95% CI 0.26-3.28; p = 0.02), and iCST improved QoL for caregivers (EQ-5D, MD = 0.06, 95% CI 0.02-0.10; p = 0.01). Forty percent (72/180) of dyads allocated to iCST completed at least two sessions per week, with 22% (39/180) completing no sessions at all. Study limitations include low adherence to the intervention.ConclusionsThere was no evidence that iCST has an effect on cognition or QoL for people with dementia. However, participating in iCST appeared to enhance the quality of the caregiving relationship and caregivers' QoL.