Spector, Aimee; (2001) The development and evaluation of an evidence-based psychological therapy programme for people with dementia. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

A variety of psychological therapies for dementia have been described over the years. However, research into their effectiveness has been variable, with many studies showing methodological weaknesses. In order to consolidate the existing evidence, systematic reviews on Reality Orientation and Reminiscence Therapy, and a general literature review of the common psychological therapies for dementia were conducted. The results of these were used to design an evidence-based therapy programme for people with dementia, which focused on cognitive stimulation, incorporating elements of reminiscence and multi-sensory stimulation. It was hypothesised that when comparing participants of the programme to no-treatment controls, significant benefits in cognition, behaviour and global functioning would be demonstrated. Pilot studies in both residential care and day care indicated positive effects of the programme. The pilot studies also resulted in the programme being modified. A multicentre trial was conducted, involving running the programme in 16 centres and recruiting 142 participants (80 treatment, 62 controls). Groups ran twice weekly for 7 weeks. Assessments were blind, conducted by a separate researcher to the one running the groups. The results showed significant improvements in both measures of cognition and communication for the treatment group compared to the control group. There were also positive trends in depression in favour of the treatment group, but no change in behaviour. A further analysis was conducted excluding the first 3 centres, which had been involved in the programme development and training of the second researcher. Analyses of the remaining 13 centres found significant improvements in cognition and depression. Males improved significantly more than females in behaviour and communication. Another factor associated with the effectiveness of the programme was the particular centre where the group was located. This trial has demonstrated that an evidence-based psychological therapy programme can improve cognition, communication and depression in people with dementia, with positive trends in anxiety. The programme should be able to be used by a variety of staff after training in residential or day care settings. Further research could include the evaluation of a staff training package, the possible benefits of a maintenance programme and the potential advantages of combining cognitive stimulation with anti-dementia drugs. Promoting the use of the programme can offer real hope for people with dementia and their carers.

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