Constructive engagement in cognitive stimulation therapy groups among people with dementia: A mixed-methods study

IF 4.9 Q1 CLINICAL NEUROLOGY

Alzheimer''s and Dementia: Translational Research and Clinical Interventions Pub Date : 2025-04-24 DOI:10.1002/trc2.70075

Anna Yan Zhang, Gloria Hoi Yan Wong, Terry Yat Sang Lum, Bob Woods, Aimee Spector

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引用次数: 0

Abstract

Introduction

Clinical guidelines recommend personalized activities and group cognitive stimulation therapy (CST) for promoting cognition, independence, and well-being in persons with dementia. Constructive engagement (CE), the state of being occupied positively in purposeful activities, is theoretically an essential process in personalized activities and CST. However, whether CE develops over time and what contributes to it are unknown. We investigated changes in CE during CST and its contributors.

Methods

This is a mixed-methods study. We used time sampling to record the time proportion of persons with dementia (n = 113) spent in constructive, passive, non–task-related engagement and non-engagement during early, middle, and late phases in a 14-session group CST. We tested changes in time proportion between phases using repeated analysis of variance (ANOVA). We analyzed qualitative interviews of CST facilitators (n = 12) thematically to explore contributors to CE.

Results

Persons with dementia spent 51% and 46% of their time in constructive and passive engagement, respectively. Time of engagement in non–task-related activities and non-engagement was minimal. CE remained stable at around 50% of activity time throughout the intervention course, except for a slight increase from the early to middle phase (48% to 55%, F (2224) = 3.779, p < 0.05). Age (r = −0.26, p < 0.01), cognitive function (r = −0.29, p < 0.01), and activities of daily living (r = 0.20, p < 0.05) at baseline were significantly correlated with CE, but gender and education were not. Contributors to CE include (1) tailoring activities, (2) using group dynamics, and (3) promoting positive experiences.

Discussions

Group CST engages persons with dementia well, regardless of their differences in gender and literacy levels. CE remained relatively stable during CST, and younger, more physically and cognitively able people showed slightly greater CE. In group-based interventions, facilitators' skills and techniques could enhance CE. Future studies may focus on how CE as a plausible change mechanism further improves the intervention outcomes of persons with dementia.

Highlights

Cognitive stimulation therapy (CST) is a non-pharmacological intervention that involves group-based activities and exercises to improve cognition and quality of life for persons with dementia, but the specific mechanisms behind it are not yet fully understood.
This study is the first to investigate constructive engagement (CE), which describes active involvement in meaningful activities or complex interventions, specifically CST, for persons with dementia.
CST engages them well, regardless of gender and literacy differences. CE time increases at the early intervention phase and stabilizes later on. CE occupies around half of the intervention time throughout CST, which can still be further increased by activity design and facilitators' skills.

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痴呆患者认知刺激治疗组的建设性参与：一项混合方法研究

导言：临床指南推荐通过个性化活动和团体认知刺激疗法（CST）来促进痴呆症患者的认知能力、独立性和幸福感。建设性参与（Constructive Engagement，CE），即积极投入到有目的的活动中的状态，理论上是个性化活动和 CST 的一个基本过程。然而，建设性参与是否会随着时间的推移而发展，以及是什么因素促成了建设性参与，这些都是未知数。我们调查了 CST 期间 CE 的变化及其促成因素。方法这是一项混合方法研究。我们采用时间取样法记录了痴呆症患者（n = 113）在 14 节小组 CST 的早期、中期和晚期阶段用于建设性、被动、与任务无关的参与和不参与的时间比例。我们使用重复方差分析（ANOVA）检验了不同阶段之间时间比例的变化。我们对 CST 促进者（n = 12）的定性访谈进行了专题分析，以探讨 CE 的促成因素。结果痴呆症患者用于建设性参与和被动参与的时间分别为 51% 和 46%。参与与任务无关的活动和不参与的时间很少。在整个干预过程中，CE 在活动时间中所占比例稳定在 50%左右，只是从早期到中期略有增加（48% 到 55%，F (2224) = 3.779，p < 0.05）。基线时的年龄（r = -0.26，p <0.01）、认知功能（r = -0.29，p <0.01）和日常生活活动（r = 0.20，p <0.05）与 CE 显著相关，但性别和教育程度与 CE 无关。促进 CE 的因素包括：（1）量身定制活动；（2）利用小组动力；（3）促进积极体验。讨论小组 CST 能很好地吸引痴呆症患者参与，无论他们的性别和文化水平如何。在 CST 期间，CE 保持相对稳定，年龄较小、身体和认知能力较强的人表现出的 CE 略高。在以小组为基础的干预中，促进者的技能和技巧可以提高 CE。未来的研究可能会侧重于认知刺激疗法作为一种合理的改变机制如何进一步改善痴呆症患者的干预效果。要点认知刺激疗法（CST）是一种非药物干预措施，它通过以小组为基础的活动和练习来改善痴呆症患者的认知能力和生活质量，但其背后的具体机制尚未完全明了。本研究首次对建设性参与（CE）进行了调查。建设性参与是指痴呆症患者积极参与有意义的活动或复杂的干预措施，特别是 CST。无论性别和文化程度有何差异，CST 都能很好地吸引他们。在早期干预阶段，CE 时间会增加，之后会趋于稳定。在整个 CST 中，CE 约占干预时间的一半，但仍可通过活动设计和引导者的技能进一步增加。

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来源期刊

Alzheimer''s and Dementia: Translational Research and Clinical Interventions Medicine-Psychiatry and Mental Health

CiteScore

10.10

自引率

2.10%

发文量

134

审稿时长

10 weeks

期刊介绍： Alzheimer''s & Dementia: Translational Research & Clinical Interventions (TRCI) is a peer-reviewed, open access,journal from the Alzheimer''s Association®. The journal seeks to bridge the full scope of explorations between basic research on drug discovery and clinical studies, validating putative therapies for aging-related chronic brain conditions that affect cognition, motor functions, and other behavioral or clinical symptoms associated with all forms dementia and Alzheimer''s disease. The journal will publish findings from diverse domains of research and disciplines to accelerate the conversion of abstract facts into practical knowledge: specifically, to translate what is learned at the bench into bedside applications. The journal seeks to publish articles that go beyond a singular emphasis on either basic drug discovery research or clinical research. Rather, an important theme of articles will be the linkages between and among the various discrete steps in the complex continuum of therapy development. For rapid communication among a multidisciplinary research audience involving the range of therapeutic interventions, TRCI will consider only original contributions that include feature length research articles, systematic reviews, meta-analyses, brief reports, narrative reviews, commentaries, letters, perspectives, and research news that would advance wide range of interventions to ameliorate symptoms or alter the progression of chronic neurocognitive disorders such as dementia and Alzheimer''s disease. The journal will publish on topics related to medicine, geriatrics, neuroscience, neurophysiology, neurology, psychiatry, clinical psychology, bioinformatics, pharmaco-genetics, regulatory issues, health economics, pharmacoeconomics, and public health policy as these apply to preclinical and clinical research on therapeutics.