Impact of Infection Control Measures on Effectiveness of Cognitive Stimulation Therapy

Abstract

AbstractBackgroundPeople living with dementia are at higher risk of contracting and dying from SARS‐CoV‐2. Protection measures such as wearing a mask remained necessary in dementia service facilities, despite their limiting effects on communication and interactions. Their impacts on existing evidence‐based psychosocial interventions offered in these facilities, such as Cognitive Stimulation Therapy (CST), are yet unknown.MethodMixed‐methods study using data from a larger randomised controlled trial partially disrupted by the COVID‐19 pandemic. People with mild or moderate dementia randomised into receiving CST (n = 72) were compared with those receiving usual care (n = 72) for cognitive (ADAS‐Cog) and quality of life (QoL‐AD) changes. To investigate the impact of infection control measures on CST effectiveness, interaction effect between timing of enrolment (before vs after COVID‐19 outbreak) and intervention group was tested. Focus groups were conducted with persons with dementia who have received CST and their families (n = 22).ResultParticipants who received CST reported better quality of life (B = 4.195, F = 28.159, p <0.001) compared with those who received usual care, controlling for demographics and antidementia medications. For cognition, an interaction effect was observed (F = 4.557, p = 0.036) between timing of enrolment and group. CST maintained cognition only in groups before COVID‐19 outbreak (marginal means of ADAS‐Cog improvement: +0.453 in CST vs ‐1.465 in usual care) but not in groups after the outbreak (‐2.104 vs +0.716). Persons living with dementia and their families reported difficulties hearing, being heard, recognising and interacting with other CST group members, and reduced efforts in participation due to discomfort wearing a mask,ConclusionInfection control measures may reduce the cognitive benefits of CST, which may be due to their effects on speech intelligibility and other interactions in a psychosocial intervention group. In the post‐COVID era, alternative measures such as virtual CST delivered via an online meeting platform should be investigated.