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UCL and HKU working to deliver dementia therapy virtually

20 July 2020 

UCL and HKU are collaborating to deliver Cognitive Stimulation Therapy to people with dementia over Zoom during COVID-19

FaceCog

People with dementia and their families are one of the groups hit hardest by the Covid-19 crisis. To keep people with dementia engaged and supported during lockdown, Professor Aimee Spector (UCL Department of Clinical, Educational & Heath Psychology) has been working closely with colleagues at the University of Hong Kong (HKU) to test the virtual delivery of Cognitive Stimulation Therapy (CST) to patients in their homes.

CST was developed at UCL by Professor Spector and is the main and often only therapy offered to people with dementia by the NHS. It involves group therapy sessions, typically run twice weekly, aimed at actively stimulating patients to maintain cognition, while providing an optimal learning environment and social benefits. However, since the lockdown began in the UK, CST services have not been able to run.

Many people with dementia have been left with limited support and do not understand what is happening or why there is a need to social distance. The vast majority of people with dementia, and the family members who look after them, are over the age of 65, often with co-morbid health problems. This means they are likely to be among the last to resume social contact and get the health and social support they need.

In response to the current clinical service gap and need to keep people with dementia engaged whilst remaining safe at home, Professor Spector and Assistant Professor Gloria Wong (HKU Department of Social Work and Social Administration) have been working to launch virtual CST groups through Zoom. Assistant Professor Wong has been leading the FaceCog study in Hong Kong, a two-year funded programme testing the feasibility of delivering CST virtually; UCL is looking to rapidly begin a partner project to deliver FaceCog here in the UK.

This is the latest collaboration in the partnership between UCL and HKU who are leading innovations in non-pharmacological interventions for dementia, with initial funding from UCL Grand Challenges. While awaiting the development of new drugs that may eventually help the growing number of people affected by dementia, clinical and social sciences researchers at UCL and HKU, as well as Peking University (PKU) in Beijing, have been using CST to tackle the issue.

In the video below, UCL’s Professor Aimee Spector and HKU’s Assistant Professor Gloria Wong explain how they have been working together to develop CST to help maintain cognition and wellbeing in people with dementia.

YouTube Widget Placeholderhttps://www.youtube.com/watch?v=utJxltdF1Ho&feature=emb_title

Adapting Cognitive Stimulation Therapy for moderate to severe dementia

PhD student: Esther Hui   Principal Supervisor: Professor Aimee Spector

Esther Hui
Dementia currently affects 40 to 50 million individuals worldwide. Whilst there is an evidence-based non-pharmacological treatment for people with mild to moderate dementia—Cognitive Stimulation Therapy (CST), there is little guidance on how to maximise cognition and quality of life for those with its severe forms. Treatments for mild dementia are not feasible, because people with moderate to severe have different needs; for example, they might not be able to communicate verbally. With the increasing prevalence of dementia and the global ageing population, there is a pressing need for effective treatments for later-stage dementia.

 

Esther Hui, Professor Spector's PhD student, is developing a novel complex intervention for moderate to severe dementia within the Medical Research Council (MRC) Framework, and building upon the key principles of Cognitive Stimulation Therapy (CST). She is funded by UCL's Overseas Research Scholarship and Doctoral School Fellowship. She is also the founder of the Peer Support Group for PhD/Doctoral Student Dementia Researchers at UCL. 

COVID-19 Disruption

Due to the pandemic, this project is currently on hold. Esther is now developing and evaluating a virtual version of Individual Cognitive Stimulation Therapy (viCST) to respond to COVID-19. Routine non-pharmacological treatments, such as CST, are suspended as a result of lockdown. Reduced social contact, increased isolation, disruption of routine, exacerbated by the lack of respite and key support networks, are likely to be detrimental to people with dementia's mental health, and overall wellbeing.  An accessible treatment is vital. As part of her PhD project, she is running two feasibility randomised controlled trials (RCT) in Hong Kong and the United Kingdom. 

Cognitive Stimulation Therapy for people with dementia: International Implementation in Brazil, India and Tanzania (CST-International). 

Chief Investigator: Prof Aimee Spector Programme Manager: Dr Charlotte R. Stoner

CST in Tanzania
CST-International is a three-year research programme supported by the Global Alliance for Chronic Diseases (GACD) and funded by the UK Medical Research Council (MRC) and the Indian Council of Medical Research (ICMR). The programme commenced on 10th September 2018 and is due to finish on the 9th of September 2021. 

 

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Aims

Over the course of three years, we aim to develop, test, refine and disseminate implementation strategies for CST for people with dementia in three diverse parts of the world: Brazil, India and Tanzania. We also aim to create an ongoing and sustainable CST programme which ultimately increases quality of life and cognition for people with dementia.

Methods

We're drawing on implementation science theories and frameworks over four phases of work to investigate the barriers and facilitators to CST provision in each setting. Based on our findings, we'll develop unique strategies to support CST implementation and we'll test the effectiveness of these strategies using a feasibility trial of CST in each country. We are also examining the cost-affordability of CST, taking into account each countries healthcare systems.

Latest Findings

We regularly update this page to disseminate our findings. Click here to see the latest news.

CST-International Teams in Brazil, India and Tanzania

Publications

The protocol for CST-International has recently been published open access by BMJ-Open. We have submitted another manuscript detailing the methodology for Phases 1 and 2 to a different journal and plan to submit two systematic reviews in the coming months. The systematic reviews will explore the effectiveness and implementation readiness of psychosocial interventions in low- and middle-income countries (LMICs) and the quality of the outcome measures used in these interventions respectively. 

  1. Stoner, C. R., Lakshminarayanan, M., Durgante, H., & Spector, A. (2019). Psychosocial interventions for dementia in low- and middle-income countries (LMICs): A systematic review of effectiveness and implementation readiness. Aging & Mental Health, Dec9. DOI: 10.1080/13607863.2019.1695742.
  2. Spector, A., Stoner, C. R., Chandra, M., Vaitheswaran, S., Du, B., Comas-Herrera, A., Dotchin, C., Ferri, C., Knapp, M., Krishna, M., Laks, J., Michie, S., Mograbi, D., Orrell, M., Paddick, S., Shaji, K. S., Rangawsamy, T., & Walker, R. (2019).  Mixed methods implementation research of Cognitive Stimulation Therapy (CST) for dementia in lower and middle-income countries: Study protocol for Brazil, India and Tanzania (CST-International). BMJ Open, 9(8), e030933. doi:10.1136/bmjopen-2019-030933.

Contact

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