A cost effectiveness analysis of maintenance cognitive stimulation therapy (MCST) for people with dementia: examining the influence of cognitive ability and living arrangements

Cognitive stimulation and psychosocial results in older adults: A systematic review and meta-analysis

INTRODUCTION

Cognitive stimulation (CS) is a popular and cost-effective intervention, which applies different types of techniques focused on cognitive skills and can be administered by different professionals. CS can be defined as activities that involve cognitive processing usually conducted in a social context and often in a group. Therefore, CS can improve psychosocial functioning and quality of life (QoL), depression, anxiety and activities of daily living (ADLs) independent of the pharmacological treatment such as acetylcholinesterase inhibitors. The objective of this systematic review and meta-analysis was to evaluate the effects of CS on psychosocial outcomes in older adults (aged 65 years or over), with healthy cognitive ageing, mild cognitive impairment (MCI), and dementia.

METHODS

PubMed, Scopus and Web of Science databases were examined from inception to October 2021. A total of 1,997 studies were initially identified in these databases. After discarding studies that did not meet the inclusion criteria, 30 studies were finally included in the systematic review and the meta-analysis performed with robust variance estimator (RVE) due the inclusion of studies with repeated measurements. The quality assessment tools from the National Institutes of Health were used to evaluate the quality of the studies.

RESULTS

CS was significantly associated with a higher QoL in participants who received personalized/adapted CS (RVE = 0.11±0.19 [-0.76, 0.99], t(1.86) = 0.6, p = 0.61). .

CONCLUSION

Personalized/adapted CS seems to improve QoL in older adults.

Cost-Effectiveness of Non-pharmacological Interventions for Mild Cognitive Impairment and Dementia: A Systematic Review of Economic Evaluations and a Review of Reviews

BACKGROUND

Dementia prevalence is increasing, with no cure at present. Drug therapies have potential side effects and risk of mortality. People with dementia are frequently offered non-pharmacological interventions to improve quality of life and relieve symptoms. Identifying which interventions are cost-effective is important due to finite resources in healthcare services.

AIMS

The aims were to review published economic evaluations of community and nursing home non-pharmacological interventions for people with mild cognitive impairment or dementia and assess the usefulness of these evaluations for decision making in health services, for use by policy and local and national decision makers.

METHODS

We conducted a systematic review (PROSPERO CRD42021252999) of economic evaluations of non-pharmacological interventions for dementia or mild cognitive impairment with a narrative approach to data synthesis.

EXCLUSIONS

interventions for dementia prevention/early detection/end of life care. Databases searched: Academic Search Premier, MEDLINE, Web of Science, EMBASE, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Psychology and Behavioural Sciences Collection, PsycArticles, Cochrane Database of Systematic Reviews, Business Source Premier and Regional Business News; timeframe 1 January 2011-11 May 2023. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS).

RESULTS

The review included 37 economic evaluations and four reviews worldwide across several distinct forms of care: physical activity, cognition, training, multicomponent, assistive technology and other (specialist dementia care, group living, home care vs care home). The intervention with the strongest evidence of cost-effectiveness was maintenance cognitive stimulation therapy. Case management, occupational therapy and dementia care management also showed good evidence of cost-effectiveness.

CONCLUSION

More economic evidence on the cost-effectiveness of specific dementia care interventions is needed, with consistency of methods and outcome measures. This could improve local and national decision makers' confidence to promote future cost-effective dementia interventions.

Cognitive stimulation and cognitive results in older adults: A systematic review and meta-analysis

BACKGROUND AND PURPOSE

The lack of cognitive activity accelerates age cognitive decline. Cognitive stimulation (CS) tries to enhance cognitive functioning. The purpose of this systematic review and meta-analysis was to evaluate the effects of CS on cognitive outcomes (general cognitive functioning and specific cognitive domains) in older adults (aged 65 years or older, cognitively healthy participants, or with mild cognitive impairment, or dementia).

METHODS

PubMed, Scopus and Web of Science databases were examined from inception to October 2021. A total of 1,997 studies were identified in these databases, and. 33 studies were finally included in the systematic review and the meta-analysis. Raw means and standard deviations were used for continuous outcomes. Publication bias was examined by Egger's Regression Test for Funnel Plot Asymmetry and the quality assessment tools from the National Institutes of Health.

RESULTS

CS significantly improves general cognitive functioning (mean difference=MD = 1.536, 95%CI, 0.832 to 2.240), memory (MD = 0.365, 95%CI, 0.300 to 0.430), orientation (MD = 0.428, 95%CI, 0.306 to 0.550), praxis (MD = 0.278, 95%CI, 0.094 to 0.462) and calculation (MD = 0.228, 95%CI, 0.112 to 0.343).

CONCLUSION

CS seems to increase general cognitive functioning, memory, orientation, praxis, and calculation in older adults.

Non-drug Therapies for Alzheimer's Disease: A Review

Alzheimer's disease (AD) is a debilitating disease leading to great social and economic burdens worldwide. During the past decades, increasing understanding of this disease enables dynamic trials for disease interventions. Unfortunately, at present, AD still remains uncurable, and therefore, developing intervention strategies for improving symptoms and slowing down the disease process becomes a practical focus in parallel with searching for a disease-modifying medication. The aim of this review is to summarize the outcomes of AD clinical trials of non-drug therapies published in the past decade, including cognitive-oriented interventions, physical exercise interventions, brain stimulation, as well as nutrition supplementations, to find out the most effective interventions in the category by looking through the primary and secondary outcomes. The outcomes of the trials could be varied with the interventional approaches, the tested cohorts, the settings of observing outcomes, and the duration of follow-ups, which are all discussed in this review. Hence, we hope to provide crucial information for application of these interventions in real-world settings and assist with optimization of clinical trial designs in this area.

Comparative Effectiveness of 3 Settings of Cognitive Stimulation Therapy on Cognition and Quality of Life for People With Dementia: A Systematic Review and Network

OBJECTIVE

To compare and rank the effectiveness of group cognitive stimulation therapy (group CST), maintenance cognitive stimulation therapy (MCST), and individual cognitive stimulation therapy (iCST) on cognition and quality of life (QoL) in people with dementia.

DESIGN

Systematic review and network meta-analysis (NMA).

SETTING AND PARTICIPANTS

All published randomized controlled trials (RCTs) that compared the differences among 3 different settings of CST or a control group in treating people with dementia.

METHODS

Relevant electronic databases, including PubMed, Embase, Cochrane Library for clinical trials, Web of Science, CINAHL, PsycINFO, Chinese National Knowledge Infrastructure (CNKI), and Wanfang Data were systematically searched from inception to March 2021. RCTs that compared the differences among 3 different settings of CST or a control group in treating people with dementia were included. Then, a pairwise and network meta-analysis was conducted to evaluate the relative effects and rank probability of different CST settings. PRISMA guidelines were used for abstracting data, and the Cochrane Risk of Bias tool was used to assess data quality.

RESULTS

In total, 17 studies were included, which enrolled 1680 participants. Compared with the control group, MSCT [standardized mean difference (SMD) = 1.39, 95% CI 0.86, 1.91; low-quality evidence] and group CST (SMD 0.62, 95% CI 0.39, 0.84; very low-quality evidence) could significantly improve cognitive function. MCST (SMD 1.00, 95% CI 0.16, 1.85; low-quality evidence) and group CST (SMD 0.53, 95% CI 0.13, 0.92; low-quality evidence) demonstrated a statistically significant effect in improving the QoL, whereas iCST was not significantly inferior to the control condition. None of the treatments were significantly different from each other with respect to acceptability.

CONCLUSIONS AND IMPLICATIONS

For people with dementia, group CST and MCST seems to promote more consistent benefits in terms of cognition and QoL than the iCST, and MCST was likely to be the most effective CST setting. Further RCTs with respect to the MCST and iCST efficacy are needed.

Effects of the cognitive stimulation therapy based on Roy's adaptation model on Alzheimer's patients' cognitive functions, coping-adaptation skills, and quality of life: A randomized controlled trial

PURPOSE

This study aims to specify the effects of Cognitive Stimulation Therapy based on Roy's adaptation model (RAM) on Alzheimer's patients' coping and adaptation skills, cognitive functions, and quality of life (QOL).

DESIGN AND METHODS

This is an experimental and randomized controlled trial. Patients in the experimental group received cognitive stimulation therapy (CST) based on RAM.

FINDINGS

The cognitive function level of the experimental group was found to be higher than that of the control group at the end of the measurements (performed in the 7th week); the difference was found to be statistically significant (P < .05). In the experimental group, dimensions of troubleshooting and focusing, making physical decisions, attention processing, systematizing, learning, and establishing relationships were found to be better than those of the control group after the application, and the difference was found to be statistically significant (P < .05). However, after the application, QOL of the experimental group was found to be better than that of the control group following the measurements; the difference was found to be statistically significant (P < .05).

PRACTICE IMPLICATIONS

Psychiatric nurses should evaluate the patients using Standardize Mini-Mental Test Examination before applying RAM-based CST, and they should apply CST to early- and mid-stage Alzheimer's disease (AD) patients at the end of the evaluation and work with groups consisting of six persons at most. Since the cognitive functions of individuals with AD decline from the first stage, coping-adaptation, and QOL levels will also be affected, so it is recommended to evaluate the cognitive functions, coping-adjustment and QOL levels of individuals before applying RAM-based CST.

TRIAL REGISTRATION NUMBER

NCT02229474.

Economics and mental health: the current scenario

Economics and mental health are intertwined. Apart from the accumulating evidence of the huge economic impacts of mental ill-health, and the growing recognition of the effects that economic circumstances can exert on mental health, governments and other budget-holders are putting increasing emphasis on economic data to support their decisions. Here we consider how economic evaluation (including cost-effectiveness analysis, cost-utility analysis and related techniques) can contribute evidence to inform the development of mental health policy strategies, and to identify some consequences at the treatment or care level that are of relevance to service providers and funding bodies. We provide an update and reflection on economic evidence relating to mental health using a lifespan perspective, analyzing costs and outcomes to shed light on a range of pressing issues. The past 30 years have witnessed a rapid growth in mental health economics, but major knowledge gaps remain. Across the lifespan, clearer evidence exists in the areas of perinatal depression identification-plus-treatment; risk-reduction of mental health problems in childhood and adolescence; scaling up treatment, particularly psychotherapy, for depression; community-based early intervention and employment support for psychosis; and cognitive stimulation and multicomponent carer interventions for dementia. From this discussion, we pull out the main challenges that are faced when trying to take evidence from research and translating it into policy or practice recommendations, and from there to actual implementation in terms of better treatment and care.

Family and Caregiver Spillover Effects in Cost-Utility Analyses of Alzheimer's Disease Interventions

BACKGROUND AND OBJECTIVE

Alzheimer's disease or dementia can impose a significant burden on family and other informal caregivers. This study investigated how the inclusion of family/informal caregiver spillover effects in a cost-utility analysis may influence the reported value of Alzheimer's disease/dementia interventions.

METHODS

We used PubMed to identify Alzheimer's disease or dementia cost-utility analyses published from 1 January, 2000 to 31 March, 2018. We reviewed and abstracted information from each study using a two-reader consensus process. We investigated the frequency and methods in which family/caregiver spillover costs and health effects were incorporated into cost-utility analyses, and examined how their inclusion may influence the reported incremental cost-effectiveness ratios.

RESULTS

Of 63 Alzheimer's disease/dementia cost-utility analyses meeting inclusion criteria, 44 (70%) considered at least some family/caregiver spillover costs or health effects. Thirty-two studies incorporated spillover costs only, two incorporated spillover health effects only, and ten incorporated both. The most common approach for accounting for spillover was adding informal caregiving time costs to patient costs (n = 36) and adding informal caregiver quality-adjusted life-years to patient values (n = 7). In a subset of 33 incremental cost-effectiveness ratio pairs from 19 studies, incorporating spillover outcomes made incremental cost-effectiveness ratios more favorable (n = 15; 45%) or kept the intervention cost saving (n = 13; 39%) in most cases. In fewer cases, including spillover increased incremental cost-effectiveness ratios (n = 2; 6%), kept the intervention dominated [more costs/less quality-adjusted life-years] (n = 2; 6%), or changed incremental cost-effectiveness ratio from dominated to less cost/less quality-adjusted life-years (n = 1; 3%). In 11 cases (33%), adding spillover effects into analyses resulted in a lower incremental cost-effectiveness ratio that crossed a common cost-effectiveness threshold, which could have downstream implications for programs or policies that are adopted based on cost-effectiveness analysis results.

DISCUSSION

Most Alzheimer's disease/dementia cost-utility analyses incorporated spillover costs, often as caregiver time costs, but considered spillover health impacts less often. In about 85% of the analyses, including Alzheimer's disease/dementia spillover cost or health effects decreased incremental cost-effectiveness ratios or kept the intervention cost saving. The broader value of an Alzheimer's disease/dementia intervention to society may in some cases be underestimated without considering these spillover effects on family and informal caregivers.