Effects of Culturally Adapted Cognitive Stimulation Therapy on Cognition and Behavioral and Psychological Symptoms in Chinese Older People with Mild and Moderate Dementia

Background: The number of people with dementia is large and continue to grow, with exhibiting behavioral and psychological symptoms of dementia (BPSD) that significantly affect their quality of life and advanced caregiving burdens and costs. Cognitive stimulation therapy (CST) has been developed as an evidence-based non-pharmacological treatment for enhancing cognitive function and quality of life of people with dementia in the West. However, its culturally adapted application remains underexplored in China, and cultural factors may influence outcomes of such intervention for Chinese older people. Furthermore, most CST intervention studies primarily targeted cognitive and quality-of-life outcomes, with relatively little emphasis on BPSD. This study aims to evaluate the effect of a culturally adapted CST for older individuals with mild to moderate dementia, focusing on its impact on cognitive function, and BPSD, and quality of life.

Methods: A single-blind, randomized controlled trial was conducted at an elderly nursing institution in Guangdong, China, from December 2024 to March 2025. Eligibility criteria for participation in the study included: (1) a diagnosis of mild to moderate dementia, (2) the presence of at least one BPSD, and (3) the ability to engage in communication and activities. A total of 44 older adults were enrolled in the study. Over the 7-week intervention period, 35 participants (77.1% females) were included in the final analysis: 13 in the experimental group (receiving culturally adapted CST) and 22 in the control group (receiving treatment as usual). Standardized assessment tools (including the Mini-Mental State Examination (MMSE), the Rating Scale for Behavioral Pathology in Alzheimer’s Disease (BEHAVE-AD), and the Quality of Life in Alzheimer’s Disease (ADRQL) scale) were used to evaluate the intervention effects. Additionally, participants in the experimental group were observed by assessors to document their engagement and performance during the sessions.

Results: Results of the independent samples t-test demonstrated significant post-intervention differences in BEHAVE-AD and ADRQL scores between the experimental and control groups. Findings from the Wilcoxon signed-rank test indicated that participants in the experimental group showed significant improvements across three domains after 14 CST sessions, including enhanced cognitive function, reduced BPSD, and improved quality of life. In contrast, no significant changes were observed in the control group, except for a slight improvement in MMSE scores. Qualitative data further supported these findings, revealing that CST enhanced participants’ attention, orientation, and sense of self-worth, while reducing agitation, depressive symptoms, and anxiety. Additionally, the CST intervention enhanced the participants’ social engagement and communication and positively influenced their caregivers’ attitudes and care practice.

Discussions: This study provides empirical support to demonstrate the effect of the culturally adapted CST in addressing cognitive impairment and BPSD in the Chinese long-term care settings. The findings produce significant implications for social workers and nursing practitioners to implement culturally tailored CST programs for institutionalized older people with dementia, alongside pharmacological treatments. In addition, medical institutions can incorporate CST into dementia care pathways as a standard non-pharmacological treatment, with social workers designated to coordinate and deliver the sessions. Finally, key considerations for implementing culturally adapted CST were discussed.