Advanced Cognitive Stimulation Therapy Hong Kong (ACST-HK)
Study Details
Study Description
Brief Summary
This study is a feasibility randomized controlled trial (RCT) for an evidence-based intervention for people with moderate to severe dementia in Hong Kong. The psychosocial intervention is adapted from Cognitive Stimulation Therapy (CST), translated and adapted for the Hong Kong Chinese population, and developed within the Medical Research Council (MRC) framework.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
The World Health Organization calls for an increase of psychosocial interventions for dementia-a global epidemic. Cognitive Stimulation Therapy (CST) is the only non-pharmacological therapy recommended by the National Institute for Health and Care Excellence for improving cognition for mild to moderate dementia. However, there is little guidance on how to maximise cognition for severe dementia. Advanced Cognitive Stimulation Therapy (ACST) will be the first evidence-based complex intervention for moderate to severe dementia developed within the Medical Research Framework and building upon CST's key principles. This feasibility randomised controlled trial (RCT) aims to 1) translate and adapt ACST for the Chinese population; 3) evaluate the feasibility of Advanced Cognitive Stimulation Therapy - Hong Kong (ACST-HK). A sample of 32 participants will be recruited, where 16 will be randomly allocated to ACST, and 16 to treatment as usual (TAU). Data will be collected pre and post the 7-week intervention period. Improving the cognition and QoL for people with moderate to severe dementia is vital because dementia's prevalence is projected to reach 152 million by 2050, resulting in excessive excess disability. Developing an intervention targeting Chinese-the largest aging population-is also novel and allows ACST-HK to impact internationally from its infancy.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Advanced Cognitive Stimulation Therapy Hong Kong Advanced Cognitive Stimulation Therapy Hong Kong (ACST-HK), a psychosocial intervention, is the modified version of CST for people with moderate and severe dementia. Activities consist of more multisensory stimulation elements than the original CST. It has also been translated and adapted for the Hong Kong Chinese population. ACST-HK will be prescribed to participants 45-minutes per week, biweekly for 7 weeks. The intervention will be delivered by two facilitators, such as a research staff, clinical psychologist trainee, or care home staff. |
Other: Advanced Cognitive Stimulation Therapy Hong Kong
A modified version of Cognitive Stimulation Therapy for people with moderate to severe dementia translated and culturally adapted for the Hong Kong Chinese population.
Other Names:
|
| No Intervention: Treatment as usual Standard care in care homes |
Outcome Measures
Primary Outcome Measures
- Recruitment (feasibility of ACST-HK) [Descriptive data will be collected during the study and analysed post-intervention; through study completion, 2 years]
Feasibility of recruitment by successful recruitment of the target sample of 32 in a 24-month period.
- Retention rate (feasibility of ACST-HK) [Descriptive data will be collected during the study and analysed post-intervention; at 8-week follow-up]
Retention rate of at least 75% of participants at 8-week follow-up.
- Negative of adverse events (acceptability of ACST-HK) [Descriptive data will be collected during the study and analysed post-intervention; through study completion, 2 years]
Any negative or adverse events related to the intervention
- Intervention fidelity (acceptability of ACST-HK) [Descriptive data will be collected during the study and analysed post-intervention; through study completion, 2 years]
Facilitator's completion of the fidelity checklist following each session
- Intervention fidelity (acceptability of ACST-HK) [Descriptive data will be collected during the study and analysed post-intervention; through study completion, 2 years]
Video recording of all sessions and an independent researcher rating fidelity with a random 10% of the recordings.
Secondary Outcome Measures
- Change in cognitive function [Pre test (baseline: week 0) and post test (week 8)]
Exploratory primary outcome; measured pre and post intervention with Standardised Mini-Mental State Examination (Molloy & Standish, 1997) and Test for Severe Impairment (Albert & Cohen, 1992). SMMSE has 11 questions with scores from 0 to 30, where a low score indicates poor performance. TSI has six domains: motor performance, language comprehension, language production, memory, general knowledge, and conceptualisation. Each domain has a maximum score of 4, and a higher score indicates better cognitive ability.
- Change in quality of life [Pre test (baseline: week 0) and post test (week 8)]
Exploratory primary outcome; measured pre and post test with Quality of Life in Alzheimer's Disease (QoL-AD) (Logsdon et al., 2002). QoL-AD has 13-items, and a sum score range from 13 to 52; higher score denotes better quality of life.
- Change in behaviour [Pre test (baseline: week 0) and post test (week 8)]
Exploratory secondary outcome; measured pre and post test with the Cantonese Version of Neuropsychiatric Inventory (CNPI) (Cummings et al., 1997; Leung et al., 2001). CNPI consists of 12 domains. Each question asks for a frequency of symptoms on a 4-point score, severity on a 3-point score, and distress on a 5-point scale. Higher score denotes higher frequency and severity.
- Change in engagement [Evaluated by facilitator after every other session, and independent researcher through recordings; through study completion, up to 24-months]
Exploratory secondary outcome; measured with the Group Observational Measurement of Engagement Tool (Cohen-Mansfield et al., 2017). GOME consists of 5-domains: attendance, engagement, active participation, attitude, and sleep. Each item is measured on a 4- or 7-point Likert scale from 0, none of the time, to 6, all of the time.
- Change in overall well-being [Evaluated by assessor through video recordings for every session; week 1 to until end of study]
Exploratory secondary outcome; measured with the Adapted Greater Cincinnati Chapter Well-Being Observation Tool (Adapted GCCWBOT) (Kinney & Rentz, 2005). The facilitator or independent researcher will assess 4 participants at a time. Each evaluation will be 62 minutes, and 8 domains will be assessed: interest, attention, pleasure, self-esteem, normalcy, disengagement, sadness, and negative affect.
- Change in communication abilities [Pre test (baseline: week 0) and post test (week 8)]
Exploratory secondary outcome; measured pre and post test with the Holden Communication Scale (Holden & Woods, 1995). Each item contains is on a 5 point scale, and the questionnaire has a maximum score of 48, where a higher score indicates difficulties in communication.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Age ≥ 18
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Diagnosis of dementia, according to the DSM-V
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CMMSE ≤ 12
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Ability to communicate in English
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Ability to complete outcome measures
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Not having major physical illness or disability that affects participation
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Consultee willing and able to provide written informed consent, if participant is not able to provide consent.
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Ability to remain in a group for around an hour (e.g. no challenging behaviour)
Exclusion Criteria:
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Illness and disability that affects participation (as deemed by researcher or attending
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care home staff)
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CMMSE < 5
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Participation in other psychosocial intervention studies
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- University College, London
- The University of Hong Kong
Investigators
- Principal Investigator: Aimee Spector, PhD, DClinPsych, University College, London
- Principal Investigator: Gloria Wong, PhD, The University of Hong Kong
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
- Albert M, Cohen C. The Test for Severe Impairment: an instrument for the assessment of patients with severe cognitive dysfunction. J Am Geriatr Soc. 1992 May;40(5):449-53.
- Chiu H, Lee HC, Chung WS, Kwong PK. Reliability and validity of the Cantonese Version of Mini-Mental State Examination - a preliminary study. JHKCPsych. 1994;4(2).
- Cohen-Mansfield J, Hai T, Comishen M. Group engagement in persons with dementia: The concept and its measurement. Psychiatry Res. 2017 May;251:237-243. doi: 10.1016/j.psychres.2017.02.013. Epub 2017 Feb 6.
- Cummings JL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology. 1997 May;48(5 Suppl 6):S10-6. Review.
- Holden UP, Woods RT. Positive approaches to dementia care. Edinburgh: Churchill Livingstone, 1995.
- Kinney JM, Rentz CA. Observed well-being among individuals with dementia: Memories in the Making, an art program, versus other structured activity. Am J Alzheimers Dis Other Demen. 2005 Jul-Aug;20(4):220-7.
- Leung VP, Lam LC, Chiu HF, Cummings JL, Chen QL. Validation study of the Chinese version of the neuropsychiatric inventory (CNPI). Int J Geriatr Psychiatry. 2001 Aug;16(8):789-93.
- Logsdon RG, Gibbons LE, McCurry SM, Teri L. Assessing quality of life in older adults with cognitive impairment. Psychosom Med. 2002 May-Jun;64(3):510-9.
- Wood S, Cummings JL, Hsu MA, Barclay T, Wheatley MV, Yarema KT, Schnelle JF. The use of the neuropsychiatric inventory in nursing home residents. Characterization and measurement. Am J Geriatr Psychiatry. 2000 Winter;8(1):75-83.
- EA2006026