EBP Project Part II: Alzheimer’s Disease of Dementia
Background
The most common type of dementia is Alzheimer’s. The disorder contributes to 60 – 70% of dementia cases. The onset of Alzheimer’s disease is marked by mild memory loss and results in the loss of a person’s ability to converse or respond effectively to the environment. The disease affects brain parts that control memory, thought, cognition, and language. Lowrani, Indarwati, and Lestari (2020) argue that the disease is common among elderly people, i.e., 65 years old or above. This implies that the risk of getting Alzheimer’s disease of dementia increases with age, with at least 1 in 14 older adults aged 65 years or above being affected. A report by Alzheimer’s Association shows that approximately 6.7 million older adults (65 years or older) have Alzheimer’s disease (Zubatsky, et al., 2023). The report further shows that almost two-thirds of Alzheimer’s disease patients are women.
Given this high prevalence of Alzheimer’s disease among older adults, the need for geriatric care continues to grow. Geriatric care is meant for ageing and older adults who present with multiple conditions such as dementia, falls and diabetes mellitus, multiple chronic conditions, high blood pressure, or cardiovascular disease (Gibbor, et al., 2021). In Part I, the EBP project focused on the clinical issue of Alzheimer’s disease of dementia. This is a common condition that is treated under geriatric care. The treatment for older adults with Alzheimer’s disease of dementia involves psychotherapy, pharmacology, or a combination of both. However, as reviewed in Part I, this EBP project explores the effectiveness of cognitive stimulation therapy (I) in improving cognitive functioning (O) among older adults who present with Alzheimer’s disease of dementia (P). The goal of cognitive stimulation therapy is to help Alzheimer’s disease patients improve cognition, quality of life, and well-being.
Purpose of the EBP Project
This EBP project explores the effectiveness of therapy in treating older adults with Alzheimer’s disease of dementia. In long-term geriatric care, older adults seek therapy to feel less anxious and depressed. Therapy helps Alzheimer’s maintain a quality life and cope with dementia. There are different psychotherapies that therapists apply when working with older adults with Alzheimer’s disease of dementia. The main psychotherapy is cognitive therapy, i.e., cognitive behavioral therapy (CBT), cognitive stimulation therapy, mindfulness-based cognitive therapy, rational emotive behavioral therapy, and acceptance and commitment therapy. Studies by Carrion et al. (2018) show that cognitive therapy is an effective intervention for treating older adults experiencing dementia. For example, cognitive stimulation therapy (CST) has been proven to be effective in boosting the memory, cognition, and thinking skills of patients with mild to moderate signs of dementia. Dementia patients who complete CST report improved quality of life and well-being. This EBP project will develop a PICOT question to explore the effectiveness of cognitive stimulation therapy in the elderly having Alzheimer’s disease of dementia.
PICOT Question
Guided by the clinical issue under evaluation, this EBP project’s PICOT question is, “In older adults (aged 65 or above) with Alzheimer’s disease of dementia (P), does cognitive stimulation therapy (I), compared to standard care without cognitive stimulation therapy (C), improve cognitive functioning (O) within six months (T)?”
Significance of the Topic to Nursing Practice
The clinical issue under evaluation is Alzheimer’s disease of dementia among the elderly (65 years or above). As per the PICOT question, the current treatment for Alzheimer’s disease of dementia involves standard care without cognitive stimulation therapy. The standard care involves the prescription of medication, for example, Donepezil, Rivastigmine, and Galantamine (Ali et al. 2018). However, the use of these medications has some side effects. Examples of side effects include headache, dizziness, nausea, sleeping difficulties, diarrhea, muscle cramps, and changes in appetite. Also, standard care without cognitive stimulation therapy leads to higher levels of depression, anxiety, sleep problems, chronic fatigue, and the use of psychotropic drugs (Chen, 2022). In addition, standard care limits nurses’ confidence in dementia assessment skills causing misdiagnosis to anxiety, aggression, depression, wandering behavior, or hallucinations. As a result, standard care without cognitive stimulation therapy is ineffective in lowering cognitive impairment, functional disability, and psychological and behavioral symptoms among the elderly with Alzheimer’s disease of dementia.
To effectively reduce cognitive impairment, memory loss, and functional disability among the elderly with Alzheimer’s disease of dementia, cognitive stimulation therapy has been found to be an effective intervention (Allward et al. 2020). Cognitive stimulation therapy is an evidence-based approach for treating individuals with mild to moderate dementia, i.e., Alzheimer’s disease. Cognitive stimulation therapy guides people with Alzheimer’s disease through a series of interventions designed to promote constant learning to help them stay mentally, socially, and psychologically engaged and stimulated. Cognitive stimulation therapy activities include games/puzzles, group conversations with other members and program leaders, or playing instruments. Given the significance of social engagement, cognitive intervention is administered mostly in group settings. In group settings, cognitive stimulation therapy heightens the recovery process, leading to cognitive and psychological improvement (Cafferata, Hicks, & von Bastian, 2021). This psychotherapy approach is considered effective and evidence-based and is highly recommended when working with the elderly with mild to moderate dementia. The intervention is effective, like some dementia drugs, at improving the patient’s language processing, memory, and visuospatial abilities.
This topic is significant to nursing practice for it helps nurses compare the outcome that using cognitive stimulation therapy, unlike standard care without stimulation therapy, has on improving cognitive functioning among the elderly with Alzheimer’s disease. Studies by Chen (2022) posit that cognitive stimulation therapy is a cost and clinically-effective approach to treating older adults with dementia. As per the study, cognitive stimulation therapy has been proven effective in improving memory, thinking, and decision-making skills of the elderly with Alzheimer’s disease. The study participants reported improved quality of life and well-being upon successful completion of the cognitive behavioral therapy program. For patients, cognitive stimulation therapy remains a cost-effective model whose value in money is indisputable. In another study by Cafferata, Hicks, and von Bastian (2021), there are other benefits of cognitive stimulation therapy for the elderly with Alzheimer’s disease, including improved mood, daily abilities, wellness, and thinking capacity. Also, the study found that weekly cognitive stimulation therapy enhances cognitive function for the elderly with dementia.
Literature Review
Cognitive therapy effectively treats multiple disorders. Cognitive stimulation therapy (CST) is a major type of cognitive therapy largely used by clinicians when working with the elderly with Alzheimer’s disease of dementia. A study by Gibbor et al. (2021) argues that individual cognitive stimulating therapy significantly impacts on quality of life, cognition, and positive psychology for dementia patients. A qualitative study by Gibbor et al. (2021) posits that cognitive stimulation therapy is effective for the elderly with dementia. This indicates that CST is feasible, acceptable, and efficious in improving cognition levels among dementia patients. According to Leroi et al. (2019), cognitive stimulation therapy is largely utilized in healthcare settings where the elderly with dementia come to seek care. This intervention lowers the symptoms of cognitive decline by improving patients’ quality of life.
Other studies by Lowrani, Indarwati, and Lestari (2020) assert that non-pharmacological therapy prevents cognitive decline/failure among elderly patients with dementia. As per the study, there are multiple cognitive stimulation based therapies appropriate for preventing dementia. These include clock drawing, touch therapy, board games, modality therapy, story-telling, aromatherapy, musical therapy, gardening, brain gym, and bright light therapy. Other studies by Orfanos et al. (2021) argue that group-based cognitive stimulation therapy is effective in reducing symptoms of cognitive decline among the elderly with dementia. This is because group CST brings shared identity and togetherness. Further, research by Zubatsky et al. (2023) posits that cognitive stimulation therapy is appropriate in both hospital and community-based settings. In addition, Zubatsky et al. (2023) argue that post-intervention cognitive function improvements are significant in both community and hospital settings when CST is appropriately used.
Clinical Significance of the Findings
The quantitative study by Gibbor et al. (2020) finds that using individual cognitive stimulation therapy for dementia patients with Alzheimer’s disease significantly improves their cognition function and quality of life. The study results in the Lowrani, Indarwati, and Lestari (2020) article indicate that cognitive stimulation therapy effectively treats Alzheimer’s disease of dementia. The study finds that the appropriate use of CST improves the executive and cognitive functioning of older adults with dementia. In addition, Leroi et al.’s (2019) study finds that CST-PD intervention is effective in treating dementia among the elderly. The results in the Zubatsky et al. (2023) study indicate that CST is effective in improving mood, cognitive function, and quality of life for dementia people in both hospital and community-based settings.
Further, the qualitative study by Gibbor et al. (2021) finds that CST implementation improved treatment outcomes for individuals having dementia. Besides, Orfanos et al.’s (2021) study finds that group-based CST is appropriate for treating dementia among the elderly. The fact these six articles explore the effectiveness of CST in treating Alzheimer’s disease of dementia among the elderly implies that the studying findings are applicable in nursing when working with dementia patients. In long-term geriatric care, applying CST for older adults with Alzheimer’s disease of dementia enhances their cognitive functioning, quality of life, psychosocial well-being and achieves positive psychological outcomes, such as positive affect, self-efficacy, and self-esteem. Thus, psychotherapy, particularly CST, is effective when working with the elderly with Alzheimer’s disease of dementia. Thus, therapists should consider this psychotherapy approach when working with dementia patients.
Conclusion
The PICOT question was “In older adults (aged 65 or above) with Alzheimer’s disease of dementia (P), does cognitive stimulation therapy (I), compared to standard care without cognitive stimulation therapy (C), improve cognitive functioning (O) within six months (T)?” Literature review of the six research articles clearly responds to this PICOT question. Studies have shown that using individual CST when working with older adults with dementia significantly improves their cognitive function, positive psychology, and quality of life (Gibbor et al., 2020). Also, Parkinson’s-adapted CST was proved to be an effective non-pharmacologic approach especially for older adults with mild cognitive impairment (Leroi et al. 2019). In addition, the study by Lowrani, Indarwati, and Lestari’s (2020) findings responds to the PICOT question, concluding that CST is suitable and significantly improves the cognitive status of older adults with dementia. Similarly, Gibbor et al.’s (2021) study asserted CST’s efficacy in improving cognition and quality of life for dementia patients. The studies by Zubatsky et al. (2022) and Orfanos et al. (2020) also responded to the research question, affirming that group-based CST is effective for the elderly with dementia, whether in hospital or community-based settings. Thus, unlike standard care without CST, treating elderly people with dementia using CST improves their cognitive function.
References
- Ali, A., Brown, E., Spector, A., Aguirre, E., & Hassiotis, A. (2018). Individual cognitive stimulation therapy for people with intellectual disability and dementia: protocol of a feasibility randomized controlled trial. BMJ Open, 8(12), e022136. https://doi.org/10.1136/bmjopen-2018-022136
- Allward, C., Dunn, R., Forshaw, G., Rewston, C., & Wass, N. (2020). Mental wellbeing in people with dementia following cognitive stimulation therapy: innovative practice. Dementia, 19(2), 496-504. https://doi.org/10.1177/1471301217722443
- Alzheimer’s Association. (2023). Alzheimer’s Disease Facts and Figures. Alzheimer’s Association.
- Cafferata, R. M., Hicks, B., & von Bastian, C. C. (2021). Effectiveness of cognitive stimulation for dementia: A systematic review and meta-analysis. Psychological Bulletin, 147(5), 455. doi:https://doi.org/10.1037/bul0000325
- Carrion, C., Folkvord, F., Anastasiadou, D., & Aymerich, M. (2018). Cognitive therapy for dementia patients: a systematic review. Dementia and Geriatric Cognitive Disorders, 46(1-2), 1-26. https://doi.org/10.1159/000490851
- Chen, X. (2022). Effectiveness of cognitive stimulation therapy (CST) on cognition, quality of life and neuropsychiatric symptoms for patients living with dementia: A meta-analysis. Geriatric Nursing, 47, 201-210. https://doi.org/10.1016/j.gerinurse.2022.07.012
- Gibbor, L., Forde, L., Yates, L., Orfanos, S., Komodromos, C., Page, H., & Spector, A. (2021). A feasibility randomized control trial of individual cognitive stimulation therapy for dementia: impact on cognition, quality of life and positive psychology. Aging & Mental Health, 25(6), 999-1007.
- Gibbor, L., Yates, L., Volkmer, A., & Spector, A. (2021). Cognitive stimulation therapy (CST) for dementia: a systematic review of qualitative research. Aging & Mental Health, 25(6), 980-990.
- Leroi, I., Vatter, S., Carter, L. A., Smith, S. J., Orgeta, V., Poliakoff, E., & McCormick, S. A. (2019). Parkinson’s-adapted cognitive stimulation therapy: a pilot randomized controlled clinical trial. Therapeutic advances in neurological disorders, 12, 1756286419852217.
- Lowrani, M., Indarwati, R., & Lestari, P. (2020). Non-pharmacological therapy for the elderly to prevent dementia through cognitive stimulation therapy: A systematic review. Jurnal Ners, 15(2), s221 – s229.
- Orfanos, S., Gibbor, L., Carr, C., & Spector, A. (2021). Group-based cognitive stimulation therapy for dementia: a qualitative study on experiences of group interactions. Aging & Mental Health, 25(6), 991-998.
- Zubatsky, M., Khoo, Y. M., Lundy, J., Blessing, D., Berg-Weger, M., Hayden, D., & Morley, J. E. (2023). Comparisons of cognitive stimulation therapy between community versus hospital-based settings: A multi-site study. Journal of Applied Gerontology, 42(2), 185-193.