What is individual Cognitive Stimulation Therapy (iCST) for people with dementia?
Dr Phuong Leung (Dementia Research Fellow - Fellow of the Higher Education Academy)
What is Individual Cognitive Stimulation Therapy (iCST)?
iCST is an evidence-based cognitive and psychosocial intervention offering mentally stimulating and enjoyable activities to people with dementia. iCST can be delivered by family carers, relatives of the person with dementia or health care professionals,
iCST intervention consists of 75 structured activity sessions with a variety of themes including life story, word games, quizzes, art, reminiscence, discussion of current affairs and being creative. There are iCST key principles must be incorporated in the sessions. (1)
iCST brings many benefits for all involved
Quantitative results
1. People with dementia taking part in iCST had better relationship quality with their carers.
2. Carers delivering iCST reported a significant improvement in health-related quality of life. (QoL)
3. Carers delivering more sessions had fewer depressive symptoms. (2)
Qualitative results
Most people with dementia taking part in the iCST were motivated to keep their mind active and look for more information about mental stimulation.
"Yeah even though like things might not stay with me… but it's brilliant" (Person with dementia) and iCST "made my relative more alert" (Carer)
“It (iCST) made me start thinking about doing what I used to do, which was painting over there, that I've done …I can get up and do things more easily” (Person with dementia).
Maintaining strong relationships between family carers and those they care for is crucial. Carers found iCST helped them to frame conversations.
“… Just opening topics of conversation, maybe listening to her, encouraging her to express herself and talk about things.” (Carer)
People with dementia reported that iCST enhanced the caregiving relationship.
“…You can get a laugh out of it, the barriers come down… We enjoyed that time together!”. (Person with dementia) (3)
From a clinical perspective, reduction in depressive symptoms and improvements in QoL of the carer may result in a low-cost, non-drug intervention. (4) This may prolong their ability to provide care for the person with dementia and contribute to the cost-effectiveness of dementia care. (5) Enhancing the caregiving relationship through iCST may reduce carers’ role constraint and the risk of requiring more support and resources from healthcare services. (6)
iCST intervention
To deliver iCST to people with dementia in a standardised and person centred way
References
1. Yates, L. A., Leung, P., Orgeta, V., Spector, A., & Orrell, M. (2015). The development of individual cognitive stimulation therapy (iCST) for dementia. Clin Interv Aging, 10, 95-104.
2. Orrell, M., Yates, L., Leung, P., Kang, S., Hoare, Z., Whitaker, C.,Orgeta, V. (2017). The impact of individual Cognitive Stimulation Therapy (iCST) on cognition, quality of life, caregiver health, and family relationships in dementia: A randomised controlled trial. Plos Medicine,14(3), 22.
3. Leung, P., Orgeta, V., & Orrell, M. (2017). The experiences of people with dementia and their carers participating in individual cognitive stimulation therapy. Int J Geriatr Psychiatry DOI: 10.1002/gps.4648
4. Yaffe K, Fox P, Newcomer R, Sands L, Lindquist K, Dane K, (2002) Patient and caregiver characteristics and nursing home placement in patients with dementia. 287(16):2090±2097. PMID:11966383
5. Yang, C. T., Liu, H. Y., & Shyu, Y. I. L. (2014). Dyadic relational resources and role strain in family caregivers of persons living with dementia at home: A cross-sectional survey. International Journal of Nursing Studies, 51(4), 593-602.
6. Orrell M, Bebbington P. (1995) Life events and senile dementia. I. Admission, deterioration and social environment change. Psychol Med. 25(02):373±386.
CAN DEMENTIA EDUCATION TRAINING ALONE IS SUFFICIENT TO IMPROVE THE QUALITY OF CARE?
Dr Phuong Leung (Dementia Research Fellow-Fellow of the Higher Education Academy)
Critical Workforce Gaps
in Dementia Education and Training
The growing numbers of people being diagnosed with dementia have led to the high demands in care. Preparing the dementia health and social care workforce with improvement of dementia knowledge and awareness to deliver best quality of care is paramount. One of the key features of National Dementia Strategies is to focus on dementia education training for the dementia health care and social workforce to deliver high quality of care (Department of Health 2009).
Recent research investigating the impact of dementia education and training on the knowledge, attitudes and confidence of health and social care professionals finds that dementia education training had limited impact on the knowledge, attitudes and confidence of health and social care professionals. This finding is in line with previous studies that may influence health care professionals' feeling of confidence and competence to deliver the best practice such as the provision of practical support, staff promotion of autonomy and trust. Therefore, education training alone is insufficient to improve the quality of care (Parveen et al., 2021).
It is essential to improve health and social care professionals’ dementia knowledge as well as their feelings of confidence and competence in delivering the quality of care. Weiss and colleagues (2020) identified a range of critical gaps in dementia education training and recommended research focus areas to increase the size and level of expertise of a dementia-capable workforce.
Dementia Education Training
Translating theories and implementing research evidence into clinical practice.
References
Department of Health. Living well with dementia: a national dementia strategy. London: Department of Health, 2009.
Parveen, S., Smith, S. J., Sass, C., Oyebode, J. R., Capstick, A., Dennison, A., & Surr, C. A. (2021). Impact of dementia education and training on health and social care staff knowledge, attitudes and confidence: a cross-sectional study. Bmj Open, 11(1). doi:10.1136/bmjopen-2020-039939
Weiss, J., Tumosa, N., Perweiler, E., Forciea, M. A., Miles, T., Blackwell, E., .Worstell, M. (2020). Critical Workforce Gaps in Dementia Education and Training. Journal of the American Geriatrics Society, 68(3), 625-629. doi:10.1111/jgs.16341
Implementing Individual Cognitive Stimulation Therapy for people with dementia during COVID-19
Dr Phuong Leung (PhD in Psychiatry-Fellow of the Higher Education Academy)
Challenges for people with dementia and their carers during
the covid-19 pandemic
Dementia is a chronic neurodegenerative brain disease. People living with dementia may experience many challenges in everyday living due to loss of memory, ability to perform everyday tasks, communication skills, and social participation. During the covid-19 pandemic, people with dementia are hardest hit due to the lockdown and social distancing. Having limited access to invaluable sources and support which take away people with dementia social skills and opportunities of participation in cognitive and psychosocial activities.
The covid-19 pandemic may further lower well-being and increase anxiety and depressive symptoms in people living with dementia. As a result, they may need extra support from their family carers. Higher caring demands may increasingly cause emotional distress and burden amongst family carers. Therefore, it is important to support people with dementia to be mentally active during this challenging time.
Implementing home-based iCST for people with dementia
and their carers
Currently there is no “cure” for dementia. Therefore, cognitive, and psychosocial interventions play a vital role to maintain mentally active and promote independence in dementia. Home-based iCST is an evidence intervention offering mentally stimulating and enjoyable activities for people with dementia and their carers.
iCST consists of 75 structured cognitive stimulation sessions with a variety of themes including life story, word games, quizzes, art, reminiscence, discussion of current affairs and being creative. There are 13 iCST key principles which facilitators must incorporate when delivering sessions. Taking part in iCST provides opportunities for people with dementia to engage in mentally stimulating activities and promote being active in every-day life. Evidence shows that iCST significantly improved the quality of caregiving relationship from the person with dementia perspectives and carer well-being.
Whilst many day centres and activities groups for people with dementia remained closed during the covid-19 pandemic, home-based iCST is increasing importance for many people with dementia and their carers. The iCST intervention can be delivered by family carers or health professionals. It is great to see increasing numbers of health professionals including dementia advisors, supporters, nurses, occupational therapists, psychologists, physiotherapists and home care managers from NHS Trusts and voluntary organisations attending the iCST dementia training. Their enthusiasm in learning how to deliver the iCST intervention to people with dementia and their carers has been inspirational. A specialist nurse practitioner for dementia reported that she had seven families of people with dementia participating in the iCST intervention within a month of attending the training.
Sharing experiences of taking part in the iCST intervention
and attending iCST dementia training
A qualitative study was conducted to explore the experiences of people with dementia and their family carers taking part in the iCST intervention. The findings show that iCST provided the opportunities for people with dementia to engage in mentally stimulating and enjoyable activities that kept “the brain going” and staying alert. They enjoyed doing iCST “even though things might not stay with me… but it’s brilliant”. People with dementia found that doing iCST with their carers “…can get a laugh out of it and the berries come down”. Carers, on the other hand perceived iCST as a tool to frame conversations and enhance the quality of caregiving relationship “…doing this kind of activities together cements our relationship and stay involved in each other’s lives”.
Health professionals and family carers attending the iCST dementia online training found the training provided an interactive platform for group discussions and role play exercises. They also valued the training as “A good mix of group exercises and teaching by going through a process of looking at the evidence base and theory and then moving onto practical application was really useful”. iCST dementia training is also seen as a process of continuing professional development.
Benefits of involving iCST
By Dr Phuong Leung (PhD and FHEA)
Individual CST brings many benefits for all involved
Maintaining strong relationships between family carers and those they care for is crucial, but how? Phuong Leung says carer delivered cognitive stimulation therapy could be an answer.
Many thanks to the Journal of Dementia Care for sharing this article of exploring the experiences of people with dementia and their carers participating in Individual Cognitive Stimulation Therapy.
Individual CST intervention is reaching out to the community
By Dr Phuong Leung (PhD and FHEA)
It was great to see a group of volunteers from Wendover Dementia Support with a variety of health professional backgrounds such as dementia advisors, nurses and GPs attending the Individual Cognitive Stimulation Therapy (iCST) in dementia training on 21st January 2020. Fascinating to hear Dr Philippa Moreton, the founder of Wendover Dementia Support that she would like iCST to be implemented in everyday life of people with dementia and their carers.
We would like to take this opportunity to thank Dr Philippa Moreton and her team for sharing their range of knowledge, skills and experiences during the group discussions, particularly their enthusiasm in supporting people with dementia and family carers in their community.
Our upcoming iCST dementia training is on 24th March 2020. For more information about iCST dementia training and online booking please visit the Eventbrite link
iCST dementia training
iCST training provided an interactive learning environment for trainees to learn relevant theories, knowledge and communication skills to deliver iCST.
Experiences of attending iCST dementia training
By Dr Phuong Leung (PhD, FHEA, MSc and BSc)
A recent iCST dementia training on 11th July 2019 was well received by a diverse group of trainees including family carers of people with dementia, carer support coordinators, dementia advisors, occupational therapists and psychologists. Trainees found the training very useful and commented on the usefulness of relevant theories, knowledge and communication skills to deliver iCST.
“Being able to ask and learn from the experts! Feeling that I can do something positive for both dad and for myself. Understanding that there is time to make a positive difference. I found it all useful. A privilege to be able to be part of the training…It would be wonderful to see this valuable technique rolled out more widely”. (Dementia family carer)
Most trainees found the training was interesting and stimulating. It provided them with opportunities to learn through practical exercises.
“The training gave me a detailed understanding of iCST and some training in its practical application…I really enjoyed the training today. It has been inspirational” (Dementia Advisor)
iCST training on Thursday 11th July 2019
iCST training on Thursday 11th July 2019
The training provided the opportunity for trainees to learn various techniques and communication skills to deliver iCST sessions through active participation and group interactions and as well as meet others in the field.
“Learning different techniques for asking questions to stimulate a response” (Dementia Volunteer Coordinator)
“Understanding a new/adopted approach to support patient/carer, meeting others within the field”. (Occupational Therapist)
Individual Cognitive Stimulation (iCST) Therapy Dementia Training
Tuesday 17th September from 10am to 3.30pm
Led by Dr Phuong Leung
82 Brockley Rise, Forest Hill, London SE23 1LN, England
Join us for this training, please book your place online using the link below
Translating iCST research evidence into inclinical practice
Translating the iCST evidence-based into clinical practice to improve the relationship quality and well-being for people with dementia and their carers.
Reasons for translating individual Cognitive Stimulation Therapy (iCST) research evidence into clinical practice
By Dr Phuong Leung (PhD, FHEA, MSc and BSc)
Background
Dementia is the leading cause of disability in older people (Alzheimer’s Association report 2015). In 2014, in the UK alone there were 850,000 people with dementia. By 2025, the number is expected to rise to 1.14 million (Alzheimer’s Society 2014). Dementia costs the UK economy £26 billion per year (Lewis et al., 2014). Given its increasing prevalence, it is predicted that the cost associated with dementia will rise to £34.8 billion per year in 2026 (McCrone et al., 2008).
Being diagnosed with dementia can be a challenging experience for people with dementia, their carers and families (Sosa-Ortiz, Acosta-Castillo, & Prince, 2012). Cognitive decline and neuropsychiatric symptoms in the person with dementia are associated with poor quality in the caregiving relationship (de Vugt et al., 2003; Spruytte, et al., 2002), which negatively contributes to further losses in carers’ quality of life and affecting patient wellbeing (Quinn, Clare, Woods, 2009). As a result, it can often lead to short-term or long-term hospital or care home admissions which can be costly for health care services (Orrell & Bebbington 1995).
Pharmacological treatment for dementia is very limited and primarily aims at achieving symptom control but not directly addressing the cause of the disease (Eleti 2016). Non-pharmacological therapies are hence often used to maintain or improve cognition, individuals’ ability to perform daily activities and improve quality of life (QoL) for people with dementia and their families (Bahar-Fuchs, Clare, Woods 2013; Woods et al., 2012). A single-blind, multi-centred pragmatic randomised controlled trial was conducted by the iCST research team which led by Professor Martin Orrell at the Division of Psychiatry, University College London including eight study sites across the UK to evaluate the effectiveness of iCST on people with with dementia and their carers (Orrell et al., 2017).
What is iCST?
iCST is a cognitive and psychosocial one to one intervention for people with dementia. It is based on the evidence-based group Cognitive Stimulation Therapy for people with mild to moderate dementia, which has been found to be beneficial for cognition and quality of life.
iCST offers one-to-one structured cognitive stimulation sessions (Figure 1) for people with dementia delivered by carers at their own home. There is a total of 75 activity sessions based on a variety of themes including life story, word games, quizzes, art, reminiscence, discussion of current affairs and being creative which are designed to be mentally stimulating and enjoyable. Carers are trained to deliver the intervention by using the manual guidance and the iCST key principles (Yates et al., 2015).
Figure 1: one to one structured cognitive stimulation session for 30 minutes, 3 times a week for 25 weeks
Evidence-based of iCST
The evidence-based finds that people with dementia taking part in iCST had better relationship quality with their carers (Quality of the Carer Patient Relationship Scale). Carers delivering iCST reported a significant improvement in health-related QoL (European Quality of Life–5 Dimensions [EQ-5D]). Carers delivering more sessions had fewer depressive symptoms (Hospital Anxiety and Depression Scale [HADS]) (Orrell et al., 2017).
A qualitative study exploring the experiences of people with dementia and their carers taking part in the iCST intervention finds that iCST motivated people with dementia to keep their mind active and look for more information about mental stimulation (Leung et al., 2017).
“It (iCST) made me start thinking about doing what I used to do which was paintings over there, that I've done …I can get up and do things more easily” (Person with dementia).
Carers found iCST helped them to frame conversations and enhance the caregiving relationship.
“….Doing this kind of activities together cements our relationship and makes you stay involved in each other’s lives.”(Carer)
Drawing results showing iCST is an adaptable approach which can benefit a wide range of people with dementia and family carers. Given iCST has a positive effect on the caregiving relationship and carer well-being, the programme might be a useful part of personally tailored home care packages, which may help maintain people with dementia in their homes for longer (Yaffe et al., 2002).
In order to translate theories and evidence from iCST research into clinical practice to improve the relationship quality and well-being for people with dementia and their carers, the iCST Dementia Training Programme is developed.
The iCST Dementia Training programme aims
To equip trainees with knowledge and skills to deliver iCST in a standardised, person-centred and effective way
Learning objectives:
• Recognise various cognitive and psychosocial interventions in dementia
• Learn about carer involvement in cognition-based interventions; a theoretical framework and interventions
• Learn how iCST was designed and evaluated and the iCST trial results
• Learn how to apply the key principles of iCST
• Familiarise with the 75 iCST sessions
• Learn techniques and practice effective communication skills
• Develop problem-solving strategies to deliver iCST sessions
The training programme provides opportunities for trainees to interact and create interactive learning environments to translate theories and research evidence into clinical practice.
iCST dementia training programme is suitable for
Carers of people living with dementia, professional carers, healthcare professional and anyone with an interest in the carer-delivered individual Cognitive Stimulation therapy for people dementia
For more information about the iCST Dementia Training, please visit our website https://www.icstdementiatraining.co.uk/
Individual Cognitive Stimulation (iCST) Therapy Dementia Training
Tuesday 17th September from 10.00 to 15.30 with registration from 9.30 (BST)
Led by Dr Phuong Leung
82 Brockley Rise, Forest Hill, London SE23 1LN, England
Join us for this training, please book your place online using the link below
References
Alzheimer’s Association report (2015). 2015 Alzheimer’s Disease Facts and Figures. Alzheimer’s & Dementia 11(3), 332-384
Alzheimer’s Society (2014). Dementia UK: 2014 second edition. London: Alzheimer’s Society. https://www.alzheimers.org.uk/dementia 2014 (Accessed on 8th June 2015)
Bahar-Fuchs, A., Clare, L., & Woods, B. (2013). Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer's disease and vascular dementia. Cochrane Database of Systematic Reviews, 6, CD003260.
de Vugt, M. E., Stevens, F., Aalten, P., Lousberg, R., Jaspers, N., Winkens, I., Verhey, F. R. (2003). Behavioural disturbances in dementia patients and quality of the marital relationship. Int J Geriatr Psychiatry, 18(2), 149-154.
Eleti, S. (2016). Drugs in Alzheimer’s disease dementia: an overview of current pharmocological management and future directions. Psychiatria Danubina, 28, S136-S140.
Leung, P., Orgeta, V., & Orrell, M. (2017). The experiences of people with dementia and their carers participating in individual cognitive stimulation therapy. Int J Geriatr Psychiatry DOI: 10.1002/gps.4648
Lewis, F., Schaffer, S K, Sussex, J, O’Neill, P and Cockcroft, L (2014), The Trajectory of Dementia in the UK - Making a Difference. Report for Alzheimer’s Research UK by Office Health Economics Consulting
McCrone, P., Dhanasiri, S., Patel, A., Knapp, M., & Lawton-Smith, S. (2008). Paying the price. The cost of mental health care in England to, 2026.
https://www.kingsfund.org.uk/publications/paying-price (Access 1st July 2019)
Orrell, M., Yates, L., Leung, P., Kang, S., Hoare, Z., Whitaker, C.,Orgeta, V. (2017). The impact of individual Cognitive Stimulation Therapy (iCST) on cognition, quality of life, caregiver health, and family relationships in dementia: A randomised controlled trial. Plos Medicine,14(3), 22.
Quinn, C., Clare, L., & Woods, B. (2009). The impact of the quality of relationship on review. Aging & Mental Health, 13(2)
Spruytte, N., Van Audenhove, C., Lammertyn, F., & Storms, G. (2002). The quality of the caregiving relationship in informal care for older adults with dementia and chronic psychiatric patients. Psychology and Psychotherapy-Theory Research and Practice, 75, 295-311
Sosa-Ortiz, A. L., Acosta-Castillo, I., & Prince, M. J. (2012). Epidemiology of dementias and Alzheimer's disease. Arch Med Res, 43(8), 600-608.
Verhey, F. R. (2003). Behavioural disturbances in dementia patients and quality of the experiences and wellbeing of caregivers of people with dementia: A systematic the marital relationship. Int J Geriatr Psychiatry, 18(2), 149-154.
Woods, B., Aguirre, E., Spector, A. E., & Orrell, M. (2012). Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database of Systematic Reviews, 2, CD005562
Yaffe K, Fox P, Newcomer R, Sands L, Lindquist K, Dane K, (2002) Patient and caregiver characteristics and nursing home placement in patients with dementia. 287(16):2090±2097. PMID:11966383
Yates, L. A., Leung, P., Orgeta, V., Spector, A., & Orrell, M. (2015). The development of individual cognitive stimulation therapy (iCST) for dementia. Clin Interv Aging, 10, 95-104.
The effects of iCST in Dementia
iCST is an evidence-based intervention showing people with dementia had better relationship quality with their carers; carers delivering iCST reported a significant improvement in health-related quality of life.
Individual Cognitive Stimulation Therapy (iCST)
By Dr Phuong Leung (PhD, FHEA, MSc and BSc)
Background
There is a wide range of cognitive and psychosocial interventions focusing on maintaining or improving cognition and quality of life (QoL) for people with dementia and their carers (Bahar-Fuchs, Clare, Woods 2013; Woods et al., 2012). Evidence shows that cognitive stimulation therapy (CST) improved cognition and QoL for people with dementia (Woods et al., 2012). CST is becoming more widely available both in the United Kingdom (UK) and internationally. However, some people may not have access to CST groups because of transport, health and mobility problems, lack of available local CST groups or not so keen on participating in a group setting. Furthermore, receiving CST individually may provide opportunities for family carers to be involved. A recent review finds that carer involvement in psychosocial interventions may enhance mutual understanding, communication, relationship quality and well-being for both people with dementia and their carers (Moon and Adams, 2013).
In response to the government's emphasis on improving early interventions and home care for people with dementia, a home-based individual Cognition Stimulation Therapy (iCST) package delivered by family carers was developed by adapting group CST. This study aimed to evaluate the clinical effectiveness of carer-delivered iCST for people with dementia and their family carers. A single-blind, pragmatic randomised controlled trial (RCT) was conducted at eight study sites across the UK. The development and evaluation of this study followed the Medical Research Council (MRC) guidance for complex psychosocial interventions (Craig et al., 2008). The research team produced the iCST programme (including a manual, activity workbook, and materials such as maps and dominoes) in collaboration with people with dementia, carer, healthcare professionals and dementia experts.
Methods
A total of 356 pairs of people with dementia and carers participated in the study. Participants were randomly assigned to iCST receiving a total of 75 activity sessions (30 minute-session for 3 times a week) or treatment as usual control over 25 weeks. iCST sessions consisted of a variety of themes including current affairs, being creative, word games and quizzes which were designed to be mentally stimulating and enjoyable. Carers were trained to deliver iCST by using the manual with guidance and key principles (Yates et al., 2015). A total of 23 pairs of people with dementia and their family carers who completed the iCST intervention took part in semi-structured in-depth interviews exploring their experiences in iCST sessions (Leung, Orgeta, & Orrell, 2017).
Quantitative results
The study finds that iCST did not improve cognition or QoL for people with dementia. However, people with dementia taking part in iCST had better relationship quality with their carers (Quality of the Carer Patient Relationship Scale). Carers delivering iCST reported a significant improvement in health-related QoL (European Quality of Life–5 Dimensions [EQ-5D]). Carers delivering more sessions had fewer depressive symptoms (Hospital Anxiety and Depression Scale [HADS]) (Orrell et al., 2017).
From a clinical perspective, reduction in depressive symptoms and improvements in QoL of the carer may result in a low-cost, non-drug intervention. This may prolong their ability to provide care for the person with dementia and contribute to the cost-effectiveness of dementia care (Yaffe et al., 2002). Enhancing the caregiving relationship through iCST may reduce carers’ role constrain (Yang, Liu, & Shyu, 2014) and the risk of requiring more support and resources from healthcare services (Orrell and Beddington 1995).
Dr Phuong Leung, the founder of iCST Dementia Training and Consultancy and a dementia researcher at the Division of Psychiatry at University College London
Dr Phuong Leung, a keynote speaker at the 1st International Colloquium "Aging, Health and Citizenship" conference 2018 in Coimbra Portugal
Qualitative findings
A qualitative study of Leung and colleagues (2017) shows that most people with dementia perceived mental stimulation as an activity that provided opportunities to keep ‘the brain going’, reflect, concentrate and stay alert. They also emphasised the importance of being mentally active as ‘if you do not use it you lose it’
"Yeah even though like things might not stay with me… but it's brilliant" (Person with dementia) and iCST "made my relative more alert" (Carer)
Taking part in the iCST intervention motivated people with dementia to keep their mind active and look for more information about mental stimulation.
“It (iCST) made me start thinking about doing what I used to do which was paintings over there, that I've done …I can get up and do things more easily” (Person with dementia).
Carers found iCST helped them to frame conversations and enhance the caregiving relationship.
“… Just opening topics of conversation, maybe listening to her, encouraging her to express herself and talk about things.” (Carer)
“…You can get a laugh out of it, the barriers come down… We enjoyed that time together!”. (Person with dementia)
Conclusion
Given iCST has a positive effect on the caregiving relationship and carer well-being, the programme might be a useful part of personally tailored home care packages, which may help maintain people with dementia in their homes for longer (Yaffe et al., 2002).
References
Bahar-Fuchs, A., Clare, L., & Woods, B. (2013). Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer's disease and vascular dementia. Cochrane Database of Systematic Reviews, 6, CD003260.
Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2008). Developing and evaluating complex social interventions: the new Medical Research Council guidance. Bmj, 337, a1655. doi:10.1136/bmj.a1655
Leung, P., Orgeta, V., & Orrell, M. (2017). The experiences of people with dementia and their carers participating in individual cognitive stimulation therapy. Int J Geriatr Psychiatry DOI: 10.1002/gps.4648
Moon H, Adams KB. 2013. The effectiveness of dyadic interventions for people with dementia and their caregivers. Dementia (London) 12(6): 821–839.
Orrell M, Bebbington P. (1995) Life events and senile dementia. I. Admission, deterioration and social environment change. Psychol Med. 25(02):373±386.
Orrell, M., Yates, L., Leung, P., Kang, S., Hoare, Z., Whitaker, C.,Orgeta, V. (2017). The impact of individual Cognitive Stimulation Therapy (iCST) on cognition, quality of life, caregiver health, and family relationships in dementia: A randomised controlled trial. Plos Medicine,14(3), 22.
Woods, B., Aguirre, E., Spector, A. E., & Orrell, M. (2012). Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database of Systematic Reviews, 2, CD005562
Yaffe K, Fox P, Newcomer R, Sands L, Lindquist K, Dane K, (2002) Patient and caregiver characteristics and nursing home placement in patients with dementia. 287(16):2090±2097. PMID:11966383
Yang, C. T., Liu, H. Y., & Shyu, Y. I. L. (2014). Dyadic relational resources and role strain in family caregivers of persons living with dementia at home: A cross-sectional survey. International Journal of Nursing Studies, 51(4), 593-602.
Yates, L. A., Leung, P., Orgeta, V., Spector, A., & Orrell, M. (2015). The development of individual cognitive stimulation therapy (iCST) for dementia. Clin Interv Aging, 10, 95-104.