Hui, Esther K.; (2023) The Development and Evaluation of Virtual Individual Cognitive Stimulation Therapy, an Evidence-based Teletherapy Programme for People with Dementia. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: Dementia, a global epidemic, currently affects 50 million people worldwide, and its prevalence is projected to reach 152 million by 2050. However, there is no cure. Psychosocial interventions are recommended for being as effective as pharmacological treatments without side effects. Unfortunately, the COVID-19 restrictions led to the suspension of community-based services where established psychosocial interventions, e.g., Cognitive Stimulation Therapy (CST), were delivered. Access to treatment is paramount during the pandemic and beyond. I aimed to develop and evaluate the feasibility and acceptability of Virtual Individual Cognitive Stimulation Therapy (V-iCST), an evidence-based and manualised intervention for mild to moderate dementia in Hong Kong and the UK, using the key principles of CST within the Medical Research Council framework for complex interventions. / Methods: I conducted stakeholder consultations internationally to develop V-iCST. I translated and culturally adapted V-iCST for people with dementia (PwD) in Hong Kong and tested it in a mixed methods case series. In the UK, V-iCST was evaluated in a feasibility randomised controlled trial (RCT) (N=34) (Note: the systematic review was on moderate to severe dementia – project before COVID-19). / Results: V-iCST was feasible and acceptable. Participants in the Hong Kong study had reliable improvements in cognition, quality of life, communication and/or mood. Six improved or remained stable in cognition, and four had clinically significant changes in depression, but treatment efficacy cannot be inferred. Qualitative findings suggest that while the intervention was convenient, technical assistance was required. The UK RCT had a high attendance (90.33%), low attrition (12%) and moderate fidelity (78%). While all mean differences in exploratory outcomes were non-significant, there was a slightly positive trend in cognition. / Conclusions: V-iCST can be used for PwD in Hong Kong and the UK and potentially improve their cognitive function, quality of life, mood and/or communication. Future studies could focus on confirming treatment efficacy in larger trials and/or implementation.

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