Cognitive stimulation therapy helps people with dementia thrive | Health & Wellness

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Twice a week from June through mid-August, 12 residents of Allegro Richmond Heights, a local senior living facility, gathered together with Dr. Patricia Nellis, a Washington University in St. Louis occupational therapist. The group always followed the same routine: briefly review the day, date, weather, season and what happened in the last meeting; sing the group theme song; and warm up with some light exercises to help increase oxygen to the brain.

Nellis directs Allegro’s Cognitive Stimulation Therapy program, which used these small-group gatherings to help improve cognition and communication skills among residents with mild to moderate dementia.

“Overall, CST groups are brief, themed activity groups that draw upon implicit learning and are client-centered,” Nellis explains. “It is a non-drug intervention designed to foster the strengthening of remaining cognitive skills through participation and doing.”

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Wash U occupational therapist Anna Perlmutter co-facilitated the Allegro program with Nellis. The themed sessions are tailored to the group members, allowing them to interact and practice cognitive and social skills.

“For example, at Allegro, we had all women who were similar in age, most of whom worked, but all of whom raised families,” Nellis says. “We developed themes around those characteristics and incorporated reminiscence therapy components, plus designed hands-on activities or ‘doing’ activities.”

Each session increases cognitive demand slightly over the previous one, but it is not concerned with regaining memory or accessing accurate memories, Nellis notes. Instead, the group members share stories and opinions, and participate in group activities.

Over the course of the 14 sessions, Nellis noted a number of changes among participants, including improved handwriting, likely due to practicing the skill by writing their names on their name tags at the beginning of each session. She adds that the practice “led to a great discussion about handwriting skills today and how our digital world has changed what we do.”

Language skills also improved as participants became more willing to talk spontaneously, sharing stories and opinions. At the same time, friendships strengthened.

“They looked out for each other and were concerned when someone was late or did not show up,” Nellis says, noting that her observations were anecdotal and not part of a formal study. “Overall, one could say, we saw improvement in quality of life through a standard routine that provided a group focus twice-weekly.”

The U.S. Centers for Disease Control and Prevention estimates that by 2060, there will be about 14 million Americans living with dementia, which is not part of normal aging but caused by a number of conditions including Alzheimer’s disease, vascular disorders and neurological problems.

CST is becoming more common around the world and is currently the only non-drug dementia treatment recommended by the National Institute for Health and Care Excellence in the U.K. It was developed by British researchers in the early 2000s, and a growing body of scientific evidence attests to its benefits.

After the success of the first program, Allegro plans to offer a second series of sessions in late January.

“With approximately 40 percent of people with dementia living in senior living communities, this type of partnership is critical to help expand access to [CST] and improve patients’ lives,” says Elizabeth Dodd, assistant vice president of sales and marketing for Allegro. Dodd drove the partnership between Allegro and Wash U. “Allegro is thankful for this amazing partnership with Washington University, and we look forward to offering the next session in early 2023.”

Allegro Richmond Heights, 1055 Bellevue Ave., Richmond Heights, 314-202-5721,


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