Cognitive Stimulation Therapy for Residents With Dementia in Long-Term Facilities: A Quasi-Experimental Study
Phase: NA
Conditions: Dementia in Nursing Home
Sponsor: Northern Kentucky University

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Cognitive Stimulation Therapy for Residents With Dementia in Long-Term Facilities: A 
Quasi-Experimental Study  
NCT06978972 
September 19, 2025 
 
 
 
 
 
 
 
 
 
 
 
 

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Cognitive Stimulation Therapy for Residents With Dementia in Long-Term Facilities: A 
Quasi-Experimental Study Protocol  
Dementia is a widespread disease among aging individuals, with reports addressing that 
approximately 5.8 million adults, ages 65 and older, in the United States have some form of the 
condition (Zubatsky et al., 2023). The Centers for Disease Control and Prevention (CDC) 
projects that by 2060, rates of this disease will rise to 14 million people (Centers for Disease 
Control and Prevention, 2019). Dementia is a prevalent developmental and progressive brain 
disease, involving the decline of memory, language, learning, judgment, problem-solving, 
visual‐spatial skills, and attention (Kearney & Trull, 2018). The term ‘dementia’ encompasses 
various forms, with Alzheimer’s disease being the most prevalent, accounting for 60%–78% of 
cases, and vascular dementia following at 15% (Kearney & Trull, 2018). As dementia 
progresses, it is typically classified into mild, moderate, or severe stages. The stages are 
indicative of the impairment of cognition; thus, mild dementia means mild cognitive decline and 
may indicate a decrease in independence (Dementia Care Central, 2023). For people with 
dementia (PwD), various symptoms can hinder the successful and safe completion of activities of 
daily living (ADLs). Management of dementia may include pharmaceuticals, Cognitive 
Behavioral Therapy, psychotherapy, and psycho-educational interventions, Behavioral 
Management Therapy, environmental approaches/modification, dementia support groups, 
memory training, alternative therapies, and cognitive stimulating environments (Alzheimer’s 
Association, n.d.; Berg‐Weger & Stewart, 2017).  
Cognitive Stimulation Therapy 
 Among non-pharmacological interventions, Cognitive Stimulation Therapy (CST) has 
emerged as a promising approach to support cognitive functioning and promote occupational 

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engagement in individuals with mild to moderate dementia. CST is a type of holistic 
evidence-based individual or group intervention program designed to stimulate learning, 
functionality, cognition, and quality of life (QoL) in mild-to-moderate dementia (Berg‐Weger & 
Stewart, 2017; Bertrand et al., 2023; Orrell & Zarit, 2018). Research addresses that applying 
CST to the aging population can delay cognitive decline and can reduce the risk of dementia 
(Apóstolo et al., 2014; Berg‐Weger & Stewart, 2017; Bertrand et al., 2023; Bhowmik et al., 
2023; Yuill & Hollis, 2011). CST consists of structured group activities such as word games, 
hand movements, or making photo frames performed twice weekly for 7-weeks (Elmiyanti & 
Salamung, 2022). The general structure of each session includes an introduction, theme song, 
current affairs activity, the main activity, suggested activities for home, and closure (Berg‐Weger 
& Stewart, 2017; Orrell & Zarit, 2018). CST is intended to stimulate thinking, concentration, and 
memory skills in PwD (Kelly et al., 2017; Woods et al., 2012, as cited in Saragih et al., 2022). 
Activities are implemented based on the interests and abilities within the group, and trained CST 
facilitators are skilled to adjust the activities in real time based on participation and engagement 
levels (Collins et al., 2023).  
Occupational Therapy and CST 
Occupational therapy helps people of all ages participate in meaningful daily 
activities—such as self-care, work, school, and community life—by using everyday tasks 
(occupations) to promote health, well-being, and independence (AOTA, 2025). Occupational 
therapy’s scope of practice includes interventions for cognition, caregiver training, functional 
tasks, and group treatments (AOTA, 2020). Because CST incorporates interventions that 
resemble occupational therapy such as ADLs, instrumental activities of daily living (IADLs), 
leisure, health management, and social participation, it falls within occupational therapy’s scope 

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of practice (AOTA, 2020). Occupational therapists possess specialized training that equips them 
for supporting PwD and facilitating the implementation of CST. With their therapeutic expertise, 
holistic approach, and client-centered focus, occupational therapists are equipped to deliver CST, 
especially in  group settings, where they can manage group dynamics, address group and 
individual needs, prioritize client-centered care, and provide encouragement (Spector et al., 
2008, as cited in Collins et al., 2023).  
Expanding CST: The Need for Occupational Therapy Involvement 
Research addresses the benefit of using CST with PwD in various settings such as 
outpatient, residential communities, inpatient, and virtual, but majority of these studies do not 
include occupational therapists administering CST (Aguirre et al., 2013; Apóstolo et al., 2014; 
Bertrand et al., 2023; Bhowmik et al., 2023; Cove et al., 2014; Gibbor et al., 2021; Gil et al., 
2022; Lok et al., 2020; Orfanos et al., 2021; Zubatsky et al., 2023). International studies support 
the combination of occupational therapy and CST for the treatment of mild-to-moderate 
dementia (Collins et al., 2023; Yuill & Hollis, 2011). However, there is limited research on the 
efficacy of CST in the United States. According to University College London (2023), there are 
two U.S. contacts registered with the International CST Center who have administered CST in 
research studies. Currently, the St. Louis University and Perry County Memorial Hospital within 
St. Louis, Missouri are administering CST and hosting CST training sessions for professionals in 
the United States. Even though Perry County Memorial Hospital does provide CST as an 
occupational therapy service, research has not been implemented beyond Missouri nor includes 
outcome measurements in the long-term care setting. 
Research in memory care aims to enhance care, cognition, independence, and QoL for 
PwD. The efficacy of CST in enhancing cognition in people with mild-to-moderate dementia has 

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been established (Woods et al., 2012, as cited in Orrell & Zarit, 2018). The cognitive and social 
stimulation provided during CST promotes occupational engagement and improvement in ADLs 
(Ryan & Brady, 2023). As dementia progresses, PwD often experience functional decline which 
can impact their ability to perform their ADLs (Chen, 2022). CST is an intervention that can help 
improve an individual's ability to perform and engage in their meaningful occupations. As 
healthcare and knowledge of dementia evolves, it is important to assess the effectiveness of CST 
and evaluate the qualifications needed to administer it within settings. 
Study Summary and Objectives 
This research examined the effectiveness of CST while aiming to support and validate the 
role of occupational therapy and promote its integration into long-term care settings across the 
United States. Currently, there is limited research on occupational therapists implementing CST 
with older adults living with dementia in long-term care facilities. The purpose and aims of this 
research study were to: 1) investigate the preliminary effect of CST on cognition and 
engagement in individuals with mild-to-moderate dementia, and 2) assess the feasibility of 
implementing CST in LTC facilities in the Cincinnati metropolitan area. The objective of this 
research was to answer the following question: Does CST improve cognitive functioning and 
increase engagement levels in individuals with mild-to-moderate dementia residing in long-term 
care facilities? We hypothesized that individuals with mild-to-moderate dementia who 
participated in a 7-week CST program in a long-term care facility would exhibit significantly 
higher levels of engagement and cognitive functioning compared to baseline. 
Methods 
A quasi-experimental, single-group pretest-posttest design was used to evaluate the 
effects of engagement and cognitive functioning in a group CST program. The study was 

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conducted as a student-led research project by occupational therapy doctoral students from 
Northern Kentucky University (NKU) who had completed their didactic coursework, including a 
group intervention course, and their first Level II fieldwork prior to engaging in on-site activities.  
Although a randomized controlled trial (RCT) was initially planned, recruitment 
challenges, time constraints, and logistical limitations led to a modification of the study design. 
The modification addressed an ethical concern regarding the control group not receiving the 
intervention, as a delayed intervention was not logistically feasible for the researchers. Due to the 
nature of the study design, no blinding of participants or researchers occurred. The study was 
approved by NKU’s Institutional Review Board for human subjects research (IRB # 2562) and 
revisions to the study protocol were approved prior to the start of the intervention. The study was 
registered at ClinicalTrials.gov (NCT06978972) and made public in June 2025. The study was 
conducted from May to August 2025 at a long-term care facility in southeast Indiana that 
provides memory care, assisted living (ALF), and skilled nursing (SNF) care. Data was collected 
between June and August 2025. 
Participants 
Recruitment, data collection, consenting, and CST-related activities took place at 
Ridgewood Health Campus, including–Legacy Lane (memory care), the assisted living facility, 
and the health campus building, all located on the same site in Lawrenceburg, Indiana– using a 
convenience sampling approach. This is a facility owned and operated by Trilogy Health 
Services, LLC in Lawrenceburg, Indiana. Ridgewood Health Campus has facilities dedicated to 
memory care, skilled nursing, and assisted living. All facilities provide residents with 
apartments, 24/7 on-site healthcare staff, dining halls, transportation services, salons, indoor and 
outdoor common areas, and community gardens. Cognitive stimulation activities were held in the 

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memory care building (Legacy Lane) on the Ridgewood Health Campus. The memory care 
building includes open and accessible common areas that provide adequate space for conducting 
CST sessions without interfering with other facility operations. On-site nursing and medical staff 
were available as needed to support participant care. Researchers collaborated closely with 
facility staff to address any concerns related to the intervention, environment, or individual 
participants, ensuring the safety and well-being of everyone involved. In the event of an adverse 
incident during the study or treatment, researchers planned to follow HIPAA regulations and the 
facility’s established protocols. Incidents were planned to be promptly reported to the Principal 
Investigator (PI) and the facility staff. 
An occupational therapy student researcher collaborated with staff on-site during the 
spring of 2025 to review the study information to prepare the staff to identify individuals who 
meet the inclusion criteria. The student performed recruitment, which involved convenience 
sampling within the SNF, ALF, and memory care units, contacting the participant and, when 
applicable, their power of attorney (POA) using approved recruitment scripts, information 
handouts, and consent forms, in person or by phone. The informed consent forms and participant 
handout were developed at an 8th-grade reading level to ensure accessibility and understanding 
for individuals with cognitive impairments or limited health literacy. The POA is an individual 
who is legally responsible for an individual and was able to provide consent for the study 
alongside their family member with dementia. Two consent processes were used: a dual consent 
form for individuals with a POA, requiring signatures from both parties in recognition of the 
cognitive considerations associated with dementia, and a standard form for those without a POA. 
Consent was obtained either electronically or in person with physical signatures. All participants 
and their POAs (if applicable) provided written or verbal reconsent prior to the intervention due 

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to the study design change. The student repeated this process with multiple participants and 
﻿POAs until the sample size was achieved. Before recruitment, researchers established a target 
sample size based on the CST Making a Difference 1 Manual, which recommends 5 to 8 
participants per group. To account for potential variability in attendance due to scheduling 
conflicts, mood fluctuations, or health-related absences, a sample size of 10 participants (N = 10) 
was set to help maintain a consistent group size of 5 to 8 participants per session. 
Characteristics of individuals enrolled in the intervention group included individuals who 
were: 18 years or older with diagnosed mild-to-moderate dementia according to The Diagnostic 
and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), confirmed by medical 
records, or a score in the mid-range (18–55) on the Alzheimer's Disease Assessment 
Scale-Cognitive Subscale (ADAS-Cog), live in a long-term care facility, and were engaging in at 
least 45 minutes a week of recreational or social activities. Additional characteristics included 
proficiency in English, adequate vision, hearing, and speech to participate in groups. All 
participants and their POAs (if applicable) who provided consent were included.  
Characteristics of individuals that were to be excluded from the study were: 17 years of 
age or younger; were not receiving maintenance or recreational services; have communication 
barriers such as aphasia; do not speak English as a first or second language; have a severe case of 
dementia; receiving hospice care; score in the high range (56–70) or no impairment range (0–17) 
on the ADAS-Cog; prior CST treatment; history of traumatic brain injury or learning disability; 
and participation in a concurrent clinical trial that could influence outcomes that are being 
assessed. 
Study Procedures  
Before the start of the study, participants underwent a screening measure where they 

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performed the ADAS-Cog–a neuropsychological test designed to assess the severity of cognitive 
impairment–to assess for cognitive impairment (Schafer et al., 2013). Another occupational 
therapy student researcher from the NKU Occupational Therapy program demonstrated 
competency in administering the ADAS-Cog under the supervision of a licensed occupational 
therapist prior to conducting the screenings. Participants who scored within the mild-to-moderate 
range (18–55) on the screening were eligible for admission into the study and proceeded to 
pretesting. Pre-testing and post-testing were conducted by a different NKU occupational therapy 
doctoral student, also supervised by a licensed occupational therapist, who had demonstrated 
competency in administering the Montreal Cognitive Assessment (MoCA) and The 
Observational Measurement of Engagement-Modified (OME-Modified) to minimize bias. The 
MoCA and OME-Modified were administered to participants as primary outcome measures to 
evaluate levels of cognitive impairment and engagement. The MoCA is a standardized tool that 
assesses cognitive domains: attention, executive functions, short-term and working memory, 
language, visuospatial, and orientation (Nasreddine, 2017). Scores range from 0 to 30, with 
scores of 18 to 25 indicating mild impairment, 10 to 17 indicating moderate, and 0 to 9 
indicating severe (Nasreddine, 2017). The MoCA was selected due to its sensitivity to changes in 
cognition (Julayanont et al., 2013).  
 The OME-Modified assessed engagement through the assessment of a participant’s 
response to a stimulus during an activity, taking note of their attention and attitude using 
standardized rating scales. The OME-Modified was selected due to its focus on the core 
outcomes, ease of use in an applied setting, high intra-class correlation value (.78), and high 
inter-rater reliability (0.84 – 0.92) (Cohen-Mansfield et al., 2010). Participants performed each 
assessment on alternate days to limit cognitive fatigue. 

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After screening and pre-testing were completed, the participants received CST in a group 
setting twice weekly, on Monday and Wednesday mornings, for 45 to 60 minutes each for 7 
weeks. Sessions were co-facilitated by two doctoral occupational therapy students under the 
supervision of a licensed occupational therapist in the state of Indiana to ensure proper 
implementation of the intervention and adherence to professional and ethical standards. 
Additionally, the co-facilitators were trained in CST by the North American CST Training 
Institute through the Saint Louis University School of Medicine prior to the start of the 
intervention. The general structure of each session followed the Making a Difference 1 CST 
manual for consistency and accurate delivery of the intervention. Each session was based on a 
theme and included an introduction, theme song, current affairs activity, the main activity, and 
closure. 
Based on previous research involving CST, there is no documentation of any harmful side 
effects following participation. Therefore, this indicates minimal risk of harm for participants 
who receive CST. However, there are potential risks of psychological and emotional effects 
during group participation, which could lead to feelings of anxiety, stress, and altered behavior. 
However, previous research has indicated that CST can improve psychological well-being in this 
population instead of causing harm/distress. There is also a risk that participants’ identifiable 
information could be accidentally disclosed in a group setting. 
Monitoring and Participation Forms from the CST Making a Difference 1 manual were 
used to document attendance and session-level ratings of participant enjoyment, mood, interest, 
and communication (Spector et al., 2021). The forms were completed after each session by two 
occupational therapy doctoral students who co-facilitated the sessions. Participant ratings for 
enjoyment, communication, and interest were recorded on a 4-point scale of 1 (none) to 4 (lots) 

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(Spector et al., 2021). Mood was rated using a separate 4-point scale: 1 (anxious/depressed) to 4 
(happy/relaxed) (Spector et al., 2021). The forms were not distributed to participants but were 
discussed at the end of each session. The feedback surveys involved participants raising their 
hands to indicate if they liked the session "a lot," "a little," or "not at all," followed by two 
open-ended questions: what they enjoyed and what could be improved (Spector et al., 2021). The 
CST Monitoring Forms data will be explored in a future retrospective study. 
At the end of the 7-week period, participants performed the OME-Modified and MoCA 
for the posttest outcome measures again. During post-test administration of the OME-Modified, 
participants who demonstrated limited interest in the initial stimulus were retested using an 
alternative stimulus. This adjustment was made because the high stimulation of CST sessions 
may have reduced the appeal of the pre-test stimulus, potentially affecting the accuracy of 
results. 
Ethical Considerations 
During the study, participants were free to change their minds and withdraw from the 
study at any time without penalty. Participants were allowed to refuse treatment on any given day 
for any reason. During sessions, participants also had the right to leave the study or decline to 
participate in specific group activities (e.g., warm-up song) without any negative consequences. 
During evaluation and assessment, participants could skip any questions they did not wish to 
answer. Whatever the participant decided would not result in any loss of benefits or services to 
which they were otherwise entitled.  
Data Collection and Management 
Data were collected between June and August 2025 using participant ID codes. Names 
were excluded from data collection sheets, which included only ID codes and initials to prevent 

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confusion. Physical documents were stored in a password-protected file folder, and digital data 
sheets are on two encrypted flash drives. Informed consent forms and medical records are 
secured in the faculty advisor’s office in the locked file folder due to identifiable information 
being present; no identifiable data are stored on flash drives. Access is limited to the research 
team and faculty advisor. Data will be retained for six years and then paper documents will be 
shredded and digital storage devices securely wiped. 
Statistical Analysis Plan 
Data were analyzed using IBM SPSS Statistics (Version 29). Demographic characteristics 
were analyzed using descriptive statistics. Normality of the data was assessed using the 
Shapiro-Wilk test, which indicated that the majority violated assumptions of parametric testing 
(Gil et al., 2022). A one-tailed Wilcoxon signed-rank test was conducted to assess pre- and 
post-intervention outcomes (Gil et al., 2022; Lok et al., 2020). To reduce a Type Ⅰ error from 
multiple comparisons, a Bonferroni correction was applied to adjust the significance level to p  ≤ 
.0045 for the OME-Modified and p ≤ .05 for the MoCA. Effect sizes (r) were calculated using 
Z/√N (0.1 = small effect, 0.3 = medium, 0.5 = large). Confidence intervals for r could not be 
computed due to sample size and software limitations. Due to the statistical probability of change 
in subtests, descriptive statistics were used to determine whether the performance in MoCA and 
OME-Modified subtests increased, decreased, or maintained.  
Data inclusion was predetermined at 50% attendance, equivalent to attending at least 
two-thirds of each session and 7/14 sessions. Participants outside this criterion were classified as 
dropouts and excluded, with their data removed. This approach ensured that the analysis 
reflected outcomes from participants who meaningfully engaged in the intervention. 

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References 
Aguirre, E., Woods, R. T., Spector, A., & Orrell, M. (2013). Cognitive stimulation for dementia: 
A systematic review of the evidence of effectiveness from randomised controlled trials. 
Ageing Research Reviews, 12(1), 253–262. https://doi.org/10.1016/j.arr.2012.07.001  
Alzheimer’s Association. (n.d.). What is dementia?. 
https://www.alz.org/alzheimers-dementia/what-is-dementia 
American Occupational Therapy Association. (2025). What is occupational therapy? Retrieved 
July 22, 2025, from https://www.aota.org/about/what-is-ot 
Apóstolo, J. L. A., Cardoso, D. F. B., Rosa, A. I., & Paúl, C. (2014). The effect of cognitive 
stimulation on nursing home elders: A randomized controlled trial. Journal of Nursing 
Scholarship, 46(3), 157–166. https://doi.org/10.1111/jnu.12072 
Berg‐Weger, M., & Stewart, D. B. (2017). Non-pharmacologic interventions for persons with 
dementia. PubMed, 114(2), 116–119. https://pubmed.ncbi.nlm.nih.gov/30228557 
Bertrand, E., Marinho, V., Naylor, R., Bomilcar, I., Laks, J., Spector, A., & Mograbi, D. C. 
(2023). Metacognitive improvements following cognitive stimulation therapy for people 
with dementia: Evidence from a pilot randomized controlled trial. Clinical Gerontologist, 
46(2), 267–276. https://doi.org/10.1080/07317115.2022.2155283 
Bhowmik, S., Chandra, M., Anand, K., & Dahuja, S. (2023). A single-blind randomized control 
trial on the effectiveness of adjunct cognitive stimulation therapy on cognitive outcomes 
in dementia. Annals of Indian Academy of Neurology, 26(3), 225–234. 
https://doi.org/10.4103/aian.aian_928_22 

14 
Centers for Disease Control and Prevention. (2019). Minorities and women are at greater risk for 
Alzheimer's disease. 
https://www.cdc.gov/aging/publications/features/Alz-Greater-Risk.html 
Cohen-Mansfield, J., Thein, K., Dakheel-Ali, M., & Marx, M. S. (2010). The underlying 
meaning of stimuli: Impact on engagement of persons with dementia. Psychiatry 
research, 177(1-2), 216–222. https://doi.org/10.1016/j.psychres.2009.02.010 
Collins, K., Hanna, M., Makarski, J., & Kastner, M. (2023). Occupational therapist led cognitive 
stimulation therapy: Feasibility of implementation. Canadian Journal of Occupational 
Therapy, 90(1), 68–78. https://doi.org/10.1177/00084174221115284 
Cove, J., Jacobi, N., Donovan, H., Orrell, M., Stott, J., & Spector, A. (2014). Effectiveness of 
weekly cognitive stimulation therapy for people with dementia and the additional impact 
of enhancing cognitive stimulation therapy with a carer training program. Clinical 
Interventions in Aging, 9, 2143–2150. https://doi.org/10.2147/CIA.S66232 
Dementia Care Central. (2023, January 26). Stages of Alzheimer’s & dementia: Durations & 
scales used to measure progression (GDS, FAST & CDR). 
https://www.dementiacarecentral.com/aboutdementia/facts/stages/ 
Elmiyanti, N. K., & Salamung, N. (2022). Effects cognitive stimulation therapy for dementia: 
Systematic review. Indonesian Nursing Journal of Education & Clinic (INJEC), 7(2), 
270–281. https://doi.org/10.24990/injec.v7i2.539 
Gibbor, L., Yates, L., Volkmer, A., & Spector, A. (2021). Cognitive stimulation therapy (CST) 
for dementia: A systematic review of qualitative research. Aging & Mental Health, 25(6), 
980–990. https://doi.org/10.1080/13607863.2020.1746741 
Gil, I., Santos-Costa, P., Bobrowicz-Campos, E., Silva, R., de Lurdes Almeida, M., & Apóstolo, 

15 
J. (2022). Effectiveness of reminiscence therapy versus cognitive stimulation therapy in 
older adults with cognitive decline: A quasi experimental pilot study. Nursing Reports, 
12(2), 339–347. https://doi.org/10.3390/nursrep12020033 
Julayanont, P., Phillips, N., Chertkow, H., & Nasreddine, Z. S. (2013). Montreal Cognitive 
Assessment (MoCA): Concept and clinical review. In A. J. Larner (Ed.), Cognitive 
screening instruments: A practical approach. (pp. 111–151). Springer-Verlag Publishing. 
https://doi.org/10.1007/978-1-4471-2452-8_6 
Kearney, C. A., & Trull, T. J. (2018). Abnormal psychology & life: A dimensional approach. 
Cengage Learning.  
Lok, N., Buldukoglu, K., & Barcin, E. (2020). 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. Perspectives 
in Psychiatric Care, 56(3), 581–592. https://doi.org/10.1111/ppc.12472 
Nasreddine, Z. S. (2017). Montreal Cognitive Assessment (MoCA) version 8.1: Administration 
and scoring instructions. MoCA Test Inc. https://www.mocatest.org 
National Institute for Health and Care Excellence (NICE). (2018). Dementia: Assessment, 
management and support for people living with dementia and their carers. (NICE 
Guideline NG97). https://www.nice.org.uk/guidance/ng97 
Orfanos, S., Gibbor, L., Carr, C., & Spector, A. (2021). Group-based cognitive stimulation 
therapy for dementia: A qualitative study on experiences of group interactions. Aging & 
Mental Health, 25(6), 991–998. https://doi.org/10.1080/13607863.2020.1746740 
Orrell, M., & Zarit, S. (2018). Cognitive stimulation therapy for dementia: History, evolution, 
and internationalism (Yates, L. A., Yates, J., Orrell, M., Spector, A., & Woods, B., Eds.). 

16 
Routledge. 
Saragih, I. D., Tonapa, S. I., Saragih, I. S., & Lee, B.-O. (2022). Effects of cognitive stimulation 
therapy for people with dementia: A systematic review and meta-analysis of randomized 
controlled studies. International Journal of Nursing Studies, 128. 1–12. 
https://doi.org/10.1016/j.ijnurstu.2022.104181 
Schafer, K., Aisen, P., Böhm, P., Connor, D. J., Gessert, D., Greco, N., Jenkins, C., Landen, J., 
LaPlante, B., Miller, D. S., Mohs, R. C., Ryan-Jones, R., Salmon, D., Sano, M., 
Schneider, L. S., Silverman, A., Thomas, R. G., Veroff, A. E., Walter, S., & Weber, C. J. 
(2013). Administration and Scoring Manual Alzheimer’s Disease Assessment Scale - 
Cognitive (ADAS-Cog). Alzheimer’s Disease Cooperative Study.  
University College London. (2023). CST by country: USA. International Cognitive Stimulation 
Therapy (CST) Centre. Retrieved from 
https://www.ucl.ac.uk/international-cognitive-stimulation-therapy/cst-country/usa 
Yuill, N., & Hollis, V. (2011). A systematic review of cognitive stimulation therapy for older 
adults with mild to moderate dementia: An occupational therapy perspective. 
Occupational Therapy International, 18(4), 163–186. https://doi.org/10.1002/oti.315 
Zubatsky, M., Khoo, Y. M., Lundy, J., Blessing, D., Berg-Weger, M., Hayden, D., & Morley, J. 
E. (2023). Comparisons of cognitive stimulation therapy between community versus 
hospital-based settings: A multi-site study. Journal of Applied Gerontology, 42(2), 
185–193. https://doi.org/10.1177/07334648221130676