University of Maryland School of Nursing
Cognitive Stimulation Therapy for Mild to Moderate Dementia
Health Care Systems
CaringKind
University of Connecticut Health Center
Yale Memory Center
Dr. Lepore is a professor at the University of Maryland School of Nursing, where he co-directs the Center for Health Equity and Outcomes Research. For over 20 years, Dr. Lepore's work has spanned dementia care, research, measurement, and capacity development, starting as a nurse aide in a special care unit for people living with dementia. Building on his hands-on care work experience, Dr. Lepore’s scholarship emphasizes the value of care work, including the impacts of care work practices on clinical outcomes and the impacts of health and social policy on the value of care work. His research addresses dementia care, quality measurement, and long-term care policy and practice in the United States and internationally. Presently, he serves as associate editor of the Gerontological Society of America’s Public Policy & Aging Report.
RATIONALE: Cognitive Stimulation Therapy (CST) is an evidence-based non-pharmacological group therapy shown to benefit people with mild to moderate dementia. Despite increasing availability of CST worldwide, access remains limited in the United States.
OBJECTIVE: To embed CST into the standard care protocol of diverse health care settings that serve people living with dementia. This pilot study will assess the acceptability of CST to people living with dementia, evaluate online delivery of CST, and determine the feasibility of routinely collecting patient-reported outcome measures in electronic health record systems.
SETTING: Two university-based healthcare systems will refer patients for CST to be delivered by a community-based partner staffed with Dementia Specialists.
POPULATION: Approximately 168 people living with mild to moderate dementia.
INTERVENTION: CST group therapy delivered over 14 sessions by occupational therapist using a virtual meeting platform. People living with mild to moderate dementia will be identified at each clinical site and randomly assigned for CST referral (vs no referral). Pre- and post-intervention data will be collected on primary and secondary clinical outcomes from the electronic health record.
OUTCOMES: Primary clinical outcome is change in cognitive status pre-post the intervention based on standardized cognitive measures (e.g. MoCA) obtained and documented in the electronic health records during the course of usual care by the health care systems. Secondary clinical outcome is prescribed medications. Outcomes to assess implementation feasibility will include recruitment, adherence, attrition, attendance, and acceptability.
IMPACT: This pilot study will inform the design of a large-scale embedded pragmatic clinical trial within health care systems nationwide that serve people living with mild to moderate dementia. Our long-term goals are for health care systems to routinely offer CST to people living with dementia to improve cognition and to routinely ascertain patient-reported outcome measures in electronic health records.