Experiences of cognitive stimulation therapy (CST) in Brazil: a qualitative study of people with dementia and their caregivers.

OBJECTIVES: There is a lack of investment in psychosocial treatments for people with dementia in Brazil. Cognitive Stimulation Therapy (CST) is a group-based intervention that has shown to have benefits on activities of daily living and mood for people with dementia in Brazil. This study aims to explore the experiences and perceived changes following CST groups. METHODS: Individual interviews were conducted with the participants of the group (n = 12) and their caregivers (n = 11). Framework analysis was used to inspect the data. RESULTS: Two main themes have emerged: 'Personal benefits of being part of the group', containing two subthemes: 'Benefits for caregivers' and 'Benefits for person with dementia' and 'Day-to-day changes', containing seven subthemes; 'Memory', Sociability', 'Language', 'Mood', 'Orientation', 'Everyday activities' and 'Behavioural and psychological symptoms'. CONCLUSION: Results suggest that CST groups led to perceived personal benefits for the people with dementia and caregivers and that there are perceived changes for the participants of the groups.

Metacognitive Improvements Following Cognitive Stimulation Therapy for People with Dementia: Evidence from a Pilot Randomized Controlled Trial.

OBJECTIVES: Impaired self-awareness is a common feature of dementia, with considerable clinical impact. Some therapeutic strategies such as cognitive stimulation and psychotherapy have been suggested to mitigate loss of awareness. Nevertheless, evidence of intervention improving awareness of deficits is scarce. The present study aims to explore the impact of a Brazilian adapted version of Cognitive Stimulation Therapy (CST-Brasil), an evidence-based psychosocial intervention for people with dementia (PwD), on the level of awareness, reporting here a secondary outcome of a pilot randomized controlled trial. METHODS: 47 people with mild to moderate dementia attending an out-patient unit were randomly allocated to CST (n = 23) or treatment as usual (TAU) (n = 24) across 7 weeks, in a pilot randomized controlled trial. Awareness was measured before and after the intervention. RESULTS: Results indicated that people in both groups increased in overall awareness of the disease, but only those receiving CST exhibited improvements of awareness of cognitive ability. CONCLUSIONS: These findings suggest that CST may also improve metacognitive abilities in PwD, which could potentially be applied to other settings with beneficial effects. CLINICAL IMPLICATIONS: Considering the negative impacts of anosognosia, CST-led improvements in awareness have the potential to benefit PwD and their caregivers.

The Seven Selves of Dementia.

The self is a complex and multifaceted phenomenon, encompassing a variety of cognitive processes and psychosocial influences. Considering this, there is a multiplicity of "selves," the current review suggesting that seven fundamental self-processes can be identified that further our understanding of the experience of dementia. These include (1) an embodied self, manifest as corporeal awareness; (2) an agentic self, related to being an agent and influencing life circumstances; (3) an implicit self, linked to non-conscious self-processing; (4) a critical self, which defines the core of self-identity; (5) a surrogate self, based on third-person perspective information; (6) an extended self, including external objects or existences that are incorporated into the self; and, finally, (7) an emergent self, a property of the self-processes that give rise to the sense of a unified self. These are discussed in relation to self-awareness and their use in making sense of the experience of dementia.

Cognitive stimulation therapy for people with dementia in Brazil (CST-Brasil): Results from a single blind randomized controlled trial.

OBJECTIVE: The prevalence of dementia has been increasing particularly in developing countries but care provision is still limited in these regions. Psychosocial interventions are recognized as useful tools to improve cognitive and behavioral difficulties, as well as quality of life of people with dementia (PwD) and their caregivers. Cognitive stimulation therapy (CST) is an evidence-based psychosocial intervention, recommended and implemented in many countries. In Brazil, there is no validated psychosocial intervention for dementia care. The present study aims to explore feasibility and obtain preliminary data on the efficacy of CST-Brasil in a sample of 47 people with mild to moderate dementia attending an outpatient unit. METHODS: A single-blind design was used, with participants being randomly allocated to either 14 sessions of CST + treatment as usual (TAU; n = 23) or TAU (n = 24) during 7 weeks. Changes in cognition, quality of life, depressive symptoms, caregiver burden and functionality were measured. RESULTS: PwD receiving CST and their family caregivers expressed good acceptance of the intervention, with low attrition and high attendance. Participants receiving CST exhibited significant improvements in mood and in activities of daily living compared to TAU. There were no significant effects in cognition, quality of life and caregiver burden. CONCLUSIONS: CST-Brasil proved to be a feasible and useful intervention to improve mood in PwD, with high acceptance between study participators. CST-Brasil is a promising psychosocial intervention for dementia and should be explored in other clinical settings to allow generalization to a wider Brazilian context.

Implicit Behavioral Change in Response to Cognitive Tasks in Alzheimer Disease.

BACKGROUND AND OBJECTIVE: Lack of awareness about impairments is commonly found in Alzheimer disease (AD), but recent evidence suggests that patients may respond to the experience of illness despite limited awareness. In this study, we explored whether implicit emotional responses to experiences of failure in cognitive tasks would result in longer-term change in behavior. METHODS: Twenty-two patients with AD were seen 1 week after a previous session in which they performed computer tasks that had been manipulated to be either too difficult (failure condition) or very easy (success condition) for them. At the second session, both types of tasks were set to have medium difficulty and were administered so that the participants decided how long to persist on each task. Task persistence was determined by relative time spent doing the tasks, considering that participants would be more likely to stop performing tasks in which they had experienced failure during the first session. RESULTS: Task persistence in the second session was not affected by performance in the first session. However, when participants' awareness of performance in the first session was taken into account, differences were found in persistence between tasks in the second session. During the second session, participants stopped performing tasks after a sequence of errors. There were no self-reported changes in motivation or enjoyment in response to task failure. CONCLUSIONS: These findings suggest that implicit learning of task valence may be compromised in AD, but that initial moments of awareness of performance may influence long-term adaptation in unaware patients.