Cognitive Stimulation Therapy for Dementia

cognitive stimulation therapy dementia

If you would like to understand the link between cognitive stimulation therapy and dementia, I cover it all in this extensive article.

What if there was a treatment for mild to mid-stage dementia that could improve cognitive functioning as effectively as dementia medications, but without side effects? What if it was inexpensive, accessible and enjoyable for the person with dementia? In fact, what if there already is?

If you live in England, chances are you’re already familiar with Cognitive Stimulation Therapy.

Cognitive Stimulation Therapy and Dementia

It is considered a standard of care in the UK, and it is recommended and provided for most or all British individuals with dementia who choose to participate.

The word — and research — on CST is getting out to other countries, and cognitive stimulation therapy programs are growing around the world.

At least, that is, they were growing until the pandemic put a stop to group gatherings, especially for older adults.

However, there are adaptations being developed for this exciting therapy as scientists, experts, and group leaders explore how to best translate the program to an online format.

What is Cognitive Stimulation Therapy?

what is cognitive stimulation therapy
Cognitive stimulation therapy is an evidence-based group treatment modality designed for people with mild to moderate dementia.

It was developed in the United Kingdom by Dr. Aimee Spector and a team of dementia specialists after rigorously researching the efficacy of various non-drug dementia interventions.

Since its inception in 2003, an abundance of evidence has shown that CST significantly improves participants’ cognitive functioning, mood and quality of life.

CST Aims to Improve Cognitive Functioning

The evidence shows that CST is as effective as dementia medication for improving cognitive functioning.

CST is the only non-medical intervention that the British government for the treatment of dementia endorses.

In fact, it is considered a standard of care in the UK to be referred to a CST group upon being diagnosed with dementia.

Few barriers interfere with the implementation of cognitive stimulation therapy. CST groups can be led by essentially anyone who works with people with dementia.

It’s not restricted to highly credentialed medical professionals. There is no extensive training or special equipment necessary, so the cost of the program is low.

All that’s needed is a manual, a modest training program, and a few simple supplies.

Who can Administer Cognitive Stimulation Therapy?

who can administer cognitive stimulation therapy
Cognitive Stimulation Therapy is designed to be successfully administered by anyone who works with people with dementia.

This includes care workers, psychologists, occupational therapists and nurses.

A basic CST training program ensures that facilitators understand the guiding principles of the program. Also to understand how to apply them in a standardized, yet person-centered, and effective way.

Available training manuals offer instruction on how to lead a CST group.

They discuss the key principles of the therapy, include detailed session plans, and other instructions on how to monitor participants’ progress.

What is a CST Session Like?

what is a CST session like
Traditional Cognitive Stimulation Therapy sessions utilize a group format to capture the benefits of social interaction.

It is a set series of sessions, usually given twice per week over seven weeks.

CST sessions can occur in a variety of settings, from private homes to hospitals, facilities or day programs.

They should take place in a comfortable environment that is conducive to learning and social engagement.

CST stimulates particular cognitive skills

CST sessions are designed to exercise and stimulate specific cognitive skills. The first session begins by having the members designate a name for their group.

The same participants join throughout the series of sessions.

Attention to consistency throughout the sessions is an important feature. For example, each session begins with the same warm-up activity.

Each session has a different theme, such as “Physical Games”, “Childhood”, “Food”, “Current Affairs” or “Number Games”. Sessions typically last an hour.

A reality orientation board is posted throughout the series of sessions, which displays information about each participant.

As the participants interact with each other, they get to know one another, which contributes to feelings of friendship and support.

What are the Benefits of CST?

what are the benefits of CST
The benefits of Cognitive Stimulation Therapy are well documented and include a significant improvement in cognitive functioning.

In order to quantify data, researchers often use tools that measure memory, orientation, language and visuospatial abilities. These tools include:

  • The Mini-Mental State Examination (MMSE)
  • The Alzheimer’s Disease Scale-Cognitive Subscale (ADAS-COG)

Because these standardized forms are also often used to measure the efficacy of Alzheimer’s drugs and other modalities, it is easy to directly compare the results.

CST shows an improvement in cognitive areas measured by these tools comparable to anti-dementia drugs.

Other noted benefits of CST include a significant improvement of language skills (such as naming objects, word-finding, comprehension) and quality of life.

Quality of life is determined by the participants using the QoL-AD tool.

Caregivers of CST participants with dementia consistently report an improved quality of life for themselves, as well as for their loved ones.

They report improvements in their loved ones’ moods, confidence and ability to concentrate.

Both the participants and caregivers describe participation in the groups as feeling supportive and positive.

What are the Variations of CST?

As Cognitive Stimulation Therapy matures and becomes more widespread, more variations are innovated to meet more specific cultures or preferences of individual participants.

For example, Saint Louis University’s Geriatric Education Center in Missouri, USA has developed several variations of CST of their own, including an exercise-based group, a spiritual group and a caregiver-assisted group.

Individual Cognitive Stimulation Therapy (iCST)

individual cognitive stimulation therapy
Individual Cognitive Stimulation Therapy (iCST) is a newer variation of this modality.

It is designed to provide the therapeutic benefits of CST on a one-to-one basis, rather than a group setting.

It can be administered to the person with dementia by a friend or family member with iCST training.

An iCST program includes 75 activity sessions which are intended to be provided over three 30-minute sessions for 25 weeks.

Each iCST session begins with five minutes of orientation information, followed by five minutes of current news and events, and then twenty minutes of the main activity.

The main activity themes include topics such as “Life Story”, “Word Games”, “Art”, “Reminiscence” and others.

In one research study, individuals with dementia participating in iCST programs did not experience the same cognitive gains of the traditional group-based sessions, but there were significant benefits nonetheless.

The individual and their carer reported a much better quality of the relationship. The carers also reported a measurably better quality of life and fewer symptoms of depression.

Both the individuals with dementia and their carers expressed enjoying the program and felt that it ignited an interest in mentally stimulating activities.

Individual Cognitive Stimulation Therapy is an excellent alternative when group sessions aren’t available or practical. During the COVID-19 pandemic, this need has become especially widespread.

It’s also useful anytime those who don’t enjoy group interaction and people who can’t get to group sessions for reasons such as compromised health or mobility.

Maintenance CST

While Cognitive Stimulation Therapy is typically designed as a series that concludes after 14 sessions, an adaptation for ongoing “maintenance” therapy is in the works.

Designed for longer-term treatments, Maintenance CST can extend the period of benefits. One research study concluded that long term benefits of maintenance CST were especially powerful in terms of improved quality of life, with the cognitive improvements tapering off over time.

Virtual Cognitive Stimulation Therapy (vCST)

virtual cognitive stimulation therapy
Virtual Cognitive Stimulation Therapy (vCST) was born in response to an urgent need created by the COVID-19 pandemic. Still in its early stages, vCST is taking shape in various ways.

Adapting group sessions to an online format, providing iCST to an individual online (with in-person support from a family member), and training family caregivers to provide individual CST in-home sessions are areas that have been explored, and are ripe with potential.

Individual cognitive stimulation therapy sessions are now being offered online through Washington University Physicians Occupational Therapy.

Their goal is to train carers to administer sessions at home with their loved ones.

A therapist works with the individual with dementia and their caregiver over seven virtual sessions and supports them as they work through the process.

A binder of material is provided with this program.

Researchers at the University College of London and Hong Kong University have been collaborating to adapt CST into virtual sessions so people with dementia can experience the best possible benefits of the program in the alternate format.

What is Next for CST?

Already being used in at least 33 different countries, scientists are developing ways to introduce and grow Cognitive Stimulation Therapy sessions across different cultures and different socio-economic populations.

International train-the-trainer programs exist in Denmark, Norway, Germany, China, New Zealand and USA.

A three-year study is currently investigating how to best implement CST in low to middle income nations, including Brazil, India and Tanzania.

A similar program, called SAIDO Learning, exists in Japan and demonstrates comparable results.

An adapted model of CST intended for people in the moderate to severe stages of dementia is also currently under development in London.

Where to Learn About Online CST Training

To learn more about CST training opportunities, including access to a series of free online training video modules, visit the Saint Louis University website.

To learn about opportunities for online iCST training visit the iCST website.

14 Best Alternative Therapies for Dementia

alternative therapies for dementia

To date, dementia still has no cure but persons with the illness can consider alternative therapies for dementia to improve symptoms and improve quality of life.

Alternative therapies refer to the treatment that is used in place of conventional medical care.

They normally target psychological, emotional, cognition, and behavioral symptoms that persons with dementia experience.

Examine some of the therapies that individuals with dementia can benefit from below.

14 Best Alternative Therapies For Dementia

Occupational Therapy

An occupational therapist can help evaluate the strengths and weaknesses of a person who has dementia. This can assist the professional understand the areas where the affected individuals need help the most.

Working with the therapist can see a person improve some of their physical skills.

The experts can also come up with suggestions for home and living changes to make it safer and better adapted to the needs of the person with the progressive disease.

Examples of modifications that you can make include:

1. Ensuring that there is a fence surrounding the yard so that the affected person will not get away, wander, and get lost in the neighborhood.

2. Organizing the closet so that appropriate outfits for the current season are within reach.

3. Identify simpler versions of activities that the individuals used to enjoy so that they can continue spending time on them.

For instance, if the said individual loved completing puzzles before a positive dementia diagnosis, the occupational therapist can look for easier puzzles that the person will continue to enjoy.

Reminiscence Therapy

reminiscence therapy for dementia
Also known as life review therapy, reminiscence therapy (RT) is one of the most common alternative therapies for dementia.

RT encourages individuals to revisit past memories.

It is a kind of talk therapy where experts use sensory aids or props to help spark memories.

Examples of these may include sounds, smells, songs, photos, or stories from an individual’s past.

The therapy can be conducted in a group setting or one-on-one sessions.

Reminiscence therapy can offer several benefits to affected individuals like:

  • Enhanced cognition
  • Improved behavior and mood
  • Higher confidence and self-worth
  • Better connection with loved ones
  • Reduced depression
  • Reduced agitation

Physical Therapy

Physical therapy is beneficial to individuals with dementia because it can help enhance their balance reducing the chances of tripping, falling, and injuring themselves.

This is because the therapy mainly focuses on strength training, endurance, flexibility, and balance.

A physical therapist can come up with appropriate exercise programs that an individual can take part in to help them with movement.

Additionally, it can help with boosting mood and decreasing aggression.

When a person is active there is an increase in the release of endorphins that soothe the brain.

Most people who take part in physical therapy also enjoy improved sleep.

Physical therapy can also help a person maintain their independence a move that can help them conduct daily living activities like bathing, eating, grooming, and toileting without too much difficulty for the longest possible time.

Studies also show that physical therapy can also help with the slowing down of memory loss. Research indicates that it is one of the best ways to enhance brain health.

Music Therapy

Sound and music play are an important part of human life whether listening to it, dancing, or taking part in its creation. People respond to music at a tender age even before language and words develop.

For years, music is in use to engage and communicate with persons who have dementia. As the illness progresses, music can help enhance well-being and communication.

This is because music stimulates different parts of the brain which can help an affected person connect with past memories and express their feelings.

There are multiple different ways of incorporating music, including:

  • Singing a person’s favorite tunes
  • Playing instruments
  • Listening to a live performance or recorded music
  • Listening to music through headphones

Music therapy is normally conducted by a trained music therapist who can work with an individual or a group. This kind of therapy is known to reduce anxiety for most people with dementia.

It can also enhance cognitive function including perception, thinking, mood, feelings, and behavior. The therapy can also encourage physical exercise if it prompts a person to dance or move around while enjoying the beat.

Music also reduces the incidences of social isolation by encouraging social interaction and promoting activity in a group setting.

Art Therapy

art therapy for dementia
Art therapy is another example of beneficial alternative therapies for dementia. Most people with this progressive disease will enjoy taking part in various creative activities including art.

Art therapy creates a platform where persons with dementia can take part in fun art projects as they express their creativity. The therapy stimulates the brain in numerous ways.

For instance, it can help encourage speech or stir dormant memories. Art therapy can also create a sense of purpose and accomplishment for persons with the illness.

Some studies report that art activities can help enhance cognitive function and social interaction. Non-verbal seniors can start smiling, laughing, moving, or speaking once they take up art therapy activities.

Experts agree that the best forms of art therapy are the ones based on personal memories and passions. Examples of art activities that individuals with dementia can take part in include pottery, paint by number projects, watercolor painting, pencil or charcoal drawing, participating in community art projects and making cards, jewelry, and many more.

These activities can help boost hand strength, relieve stress, and stimulate senses.

Bright Light Therapy

Bright light therapy is a promising treatment that can help people who have dementia. The therapy is thought to affect brain chemicals related to sleep and mood.

Most persons who have dementia will experience sleep issues at some point during the illness. Bright light therapy can help normalize a person’s sleep-wake pattern.

Studies show that this type of therapy is most effective for persons with mild to moderate dementia.

The administration of this therapy is best done during morning hours so that it can entrain the circadian rhythm in a bid to reduce interruption of the normal sleep-wake cycle. This results in increased sleeping hours at night and less daytime sleeping.

Pet Therapy

pet therapy as alternative therapies for dementia
Also known as animal-assisted therapy, this is another example of useful alternative therapies for dementia. The therapy encourages persons with the illness to spend time with various types of domestic animals like cats, trained dogs, birds, fish aquariums, or aviaries, etc.

Spending time with pets offers unconditional love, companionship, and fun for persons with dementia thanks to their friendliness and non-threatening ways. The animals can either live with the affected persons or somebody can bring them once in a while.

Other benefits associated with this type of therapy include:

  • Improving mood
  • Encouraging social interaction
  • Better nutrition
  • Offering a calming effect
  • Improved physical activity
  • Reducing behavioral problems like aggression, agitation, anxiety, loneliness, and depression

Laughter Yoga

Some studies indicate that people with dementia can benefit from laughter yoga. The primary goal of this kind of therapy is to bring more laughter into the lives of individuals with the disease.

Laughter offers numerous health perks for complete mind and body wellness. It can help to relieve stress as a person gets to feel happy, positive, and relaxed after a session of genuine laughter.

The best part about this therapy is the fact that a person does not even have to comprehend a joke or punch line to start laughing.

Laughter is stimulated as a form of exercise ensuring that people just burst out laughing for no reason.


aromatherapy as an alternative therapies for dementia
Aromatherapy can be defined as an ancient healing practice where essential oils from herbs, trees, plants, and flowers are used to enhance the spiritual, mental, and physical well-being of affected people.

Essential oils can be applied to the skin or inhaled. Improving cognitive function in persons with dementia is one of the health benefits that come from aromatherapy. Needless to say, the therapy boosts brain performance and improves the ability to remember events.

Aromatherapy can also help to relieve some common dementia symptoms like depression and anxiety.

Numerous studies reveal that essential oils from lemon balm, bergamot, and lavender can help a person with dementia suppress agitation, aggression, and a host of other psychotic symptoms.

Massage Therapy

Massage therapy is one of the alternative therapies for dementia that continues to attract increased attention when it comes to medication alternatives that ease dementia behavioral symptoms.

Moreover, massage can be incorporated in dementia care to offer a human touch that offers a wide range of benefits to individuals with the progressive illness such as:

  • Reduced feelings of anxiety, isolation, and insecurity
  • Increased feelings of care and reassurance
  • Decreased levels of agitation
  • Improve sleep
  • Ease pain
  • Reduce physical expressions like wandering, pacing, and resisting care
  • Decreased heart rate and blood pressure
  • Inducing deep levels of relaxation

Massage therapy is also known to communicate comfort and support in palliative care. There are different types of massages that persons with dementia can benefit from including back massage, hand massage, and foot massage.


Acupuncture is considered one of the safe and effective alternative therapies for dementia. It is an ancient Chinese method that is in use to treat various medical conditions for years. Acupuncture mostly involves the insertion of needles in specific locations of the human body to help restore proper energy flow to treat symptoms.

Controlled investigations divulge that acupuncture helps to enhance the flow of blood to the brain ensuring that the organ gets adequate nutrients and oxygen. Several studies show that acupuncture can also help in enhancing mood as well as cognitive skills.

Others indicate that acupuncture can help increase both motor and verbal skills as well as attention and memory. One of the studies also revealed that acupuncture can help treat depression and anxiety in people with dementia.

The studies, however, do not give conclusive results on whether acupuncture can help cure dementia; hence, more research still needs to be done on this treatment option.

Doll Therapy

Many people with dementia can also benefit from doll therapy. This normally involves the use of soft toy animals or life-like dolls. These offer “companionship” to the persons with the illness especially in the later stages of the illness providing perks like pleasure and relaxation without the responsibility of taking care of the dolls.

For some, holding a doll or soft toy helps them remember when they were holding their children or when they were caring for their beloved pets. This sensation that comes with holding something soothing can help offer a connection to the outer world renewing a sense of purpose in persons with the progressive illness.

This can also lead to an increased level of liveliness and activity levels. There is evidence that confirms that the use of soft toys or dolls can be especially helpful to persons who do not engage with others or are constantly struggling with anxiety, and restlessness.

Validation Therapy

validation therapy
A brief description of validation therapy would be a kind of counseling. A professional therapist will hold the hand of the person with the illness paying close attention to their feelings.

The experts are trained to study body language and the voice of the weak. This helps the professionals to communicate with persons with the disease in a manner that acknowledges their actions and words with empathy and respect instead of anger, embarrassment, or dismissiveness.

This type of therapy is normally offered to people who are in the last stage of dementia nearing the end of life. It usually helps the affected individuals feel sage, useful, loved, and at peace before breathing the last breathe.

Reality Orientation

When it comes to reality orientation, a person with dementia will work closely with a professional therapist who will repeat details about the place, time, and other crucial details regularly.

This helps the person with the illness stay oriented to the present moment a move that can help reduce confusion. Using large calendars and clocks can also help make things easier.

It is important to understand that reality orientation does not work for everyone who has dementia. This is especially for persons who believe that they are in a different place or time. In such instances, this type of therapy ends up upsetting the affected individuals.

Closing Remarks

Caregivers and persons who have dementia must approach the use of alternative therapies for dementia with care. This is because the therapies usually have different results on different people.

It is best to consult an individual’s doctor before trying out any therapy to be on the safe side. After trying out one option and it does not work, it is best to abandon it and look for the ones that will give the suffering individual the best results.

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