COGNITIVE STIMULATION PROGRAMS FOR ELDERLY PEOPLE WITH AND WITHOUT DEMENTIA SYNDROMES SUPERVISED OR APPLIED BY NURSES: INTEGRATIVE REVIEW

Nóbrega, Maria do Perpétuo Socorro de Sousa; Freitas, Carolina Marques; Jesus, Brenda Gabriele Silva de; Santos, Jussara Carvalho dos; Silva, Mafalda Sofia Gomes Oliveira da

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REVIEW • Cogitare Enferm. 27 • 2022 • https://doi.org/10.5380/ce.v27i0.78943 copy

COGNITIVE STIMULATION PROGRAMS FOR ELDERLY PEOPLE WITH AND WITHOUT DEMENTIA SYNDROMES SUPERVISED OR APPLIED BY NURSES: INTEGRATIVE REVIEW

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to identify, describe and evaluate the effectiveness of Cognitive Stimulation Programs, applied and/or supervised by nurses, for older adults with and without dementia syndromes in any care setting.

Method:

integrative review with collection in PubMed, Scopus, Bdenf, Scielo, Web of Science, Cinahl and BVS, from May 2020 to November 2021, whose main descriptors were: “cognitive stimulation program”, “nursing” and “older”.

Results:

in the six selected studies, a lack of standardization was identified in the use of pre- and post-implementation instruments. The techniques were: reality orientation, reminiscence therapy and validation. The effectiveness of the program was proven by validated scales. Two studies demonstrated program applications and four were about supervision/guidance for caregivers. No Brazilian studies were found.

Conclusions:

Cognitive Stimulation programs are effective in reducing behavioral and psychological symptoms of dementia. The need for more clinical studies conducted by nurses is highlighted.

DESCRIPTORS
Memory; Dementia; Health of the Elderly; Nursing; Mental Health

Database and e-Portals	Strategy
PubMed/MEDLINE	Delirium, dementia, amnestic, cognitive disorders [MeSH Terms] AND “cognitive stimulation” OR “cognitive stimulation program” AND (older OR aged OR elderly) AND /nursing.
Scopus	(TITLE-ABS-KEY (“Cognition Disorders” OR “Dementia Delirium” OR “Amnestic Cognitive Disorders” ) ) AND ( TITLE-ABS-KEY ( older OR elderly OR aged OR geriatric OR senior ) ) AND ( TITLE-ABS-KEY ( nurse OR nurses OR nursing ) ) AND ( TITLE-ABS-KEY ( ( “cognitive stimulation” OR “cognitive stimulation therapy” OR “cognitive stimulation program” ) ) ).
BDENF	(“estimulacao cognitiva” OR “cognitive stimulation” OR “cognitive stimulation program”) AND (demencia OR “cognitive disorders” OR “disturbios cognitivos”)) AND enfermagem AND (db:(“BDENF”))).
Web of Science®	(dementia AND “cognitive stimulation” AND nursing).
Portal Regional da BVS®	tw:(tw:(“estimulacao cognitiva” OR “cognitive stimulation” OR “cognitive stimulation program”) AND (demencia OR “cognitive disorders” OR “disturbios cognitivos”)) AND (enfermagem OR enfermeria OR nursing) AND ( db:(“LILACS”)).
CINAHL®	(MH “Cognition Disorders”) OR (MH “Delirium, Dementia, Amnestic, Cognitive Disorders) AND TI (“cognitive stimulation” or “cognitive stimulation therapy” OR “cognitive stimulation program”) OR AB (“cognitive stimulation” or “cognitive stimulation therapy” OR “cognitive stimulation program”) AND older or elderly or aged or geriatric or senior.

Cod.	Title/Country	Objectives	Population /Sample	Methods	Pre/post evaluation instruments
A12	Cognitive stimulation for older people with Alzheimer’s disease performed by the caregiver. (Portugal)	Influence of Cognitive Stimulation stimulation at home, performed by the caregiver of the elderly with Alzheimer’s disease.	five elderly people and their respective caregivers	Case study with elderly people with Alzheimer’s disease. Six steps: orientation of caregivers, selection of elderly and their caregivers. Approach of the subjects at home, weekly meetings weekly meetings, and the reapplication of tests to monitor the cognitive function of the elderly.	Mini Mental State Examination Test (MMSE), KATZ Scale, LAWTON Scale, Clock Drawing Test (CDT).
A14	Cognitive stimulation of elderly residents in social protection centers in Cartagena (Colombia)	To determine the effectiveness of a CSP for elderly residents of Cartagena’s Social Protection Centers in 2014.	37 elderly people	Quasi- experimental quantitative study, using cognitive tests, consisting of ten items for mental evaluation.	Pfeiffer test and clippings about daily events. Wilcoxon test.
A15	Effect of cognitive stimulation in the elderly. (Portugal)	Analysis of the effectiveness of Cognitive Stimulation in dementia syndromes.	23 elderly people	Experimental study with pre- and post-test. The elderlies were selected by means of inclusion and exclusion criteria, and were evaluated by means of cognitive evaluation instruments	MoCA (Montreal Cognitive Assessment), the Lawton Instrumental Activity of Daily Living Scale (IADL), the Katz Scale of Daily Living Activities (AVD), and the Geriatric Depression Scale (GDS).
A16	Cognitive stimulation in elderly people. (Portugal)	To evaluate the effect of a Cognitive Stimulation Program (CSP) Program (CSP) in the elderly.	13 elderly people	Pre-test and post-test study where 13 elderly people were assessed with cognitive screening instruments and received cognitive intervention	Portuguese version of the Mini Mental State Examination (MMSE) and Barthel Index.
A17	Cognitive stimulation during hospitalization improves global cognition of older Taiwanese undergoing elective total knee and hip replacement surgery. (China)	Effects of cognitive stimulation in elderly patients undergoing elective hip and/or knee replacement. hip and/or knee replacement.	47 elderly people	Randomized clinical trial, with methods: literature review of individual in acute care settings, recruitment of patients and application of the intervention.	Mini Mental State Examination (MMSE)
A18	Managing dementia in rural Nigeria: feasibility of cognitive stimulation therapy and exploration of clinical improvements (Nigeria)	Investigate the feasibility and clinical impact of a CSP, in a rural setting.	9 elderly people	Single group feasibility study	Quality of life assessment (WHOQOL-Bref); Cognitive Illness Assessment Scale g); Zarit Caregiver Burden Interview (ZBI), WHO Disability Assessment Schedule (WHODAS), Neuropsychiatric Inventory (NPI), Hospital Anxiety and Depression Scale (HADS).

Cod.	Type of intervention/Duration	Scenario of care, executor	Effectiveness of CSP
A12	Cognitive intervention at the elderly person’s home, with activities such as object identification, calendar, clock, relationships with people, environment recognition, crochet, knitting, reading books and magazines, and leisure activities. The sessions last an hour and a half each.	Residency. Nurse.	Increased score in the orientation domain in the MMSE.
A14	The CSP was performed from orientation to reality such as day, month, current years. Followed by memory exercises, arithmetic development session, daily information, and reading aloud. The intervention had 10 sessions, lasting 50 minutes, and was carried out three times a week.	Center for Protection Center. Students nursing students, with nurse supervisor.	According to the statistical data, there was an improvement in the cognitive status of the elderly according to the Pfeiffer test.
A15	Cognitive stimulation program (making a difference) was adapted for the Portuguese version. There were 14 sessions of 45 minutes, once a week.	Day Care Center and Health Center. Students of undergraduate nursing students supervised by the nurse researcher.	Demonstration of effectiveness from analyses of dispersion, variations, and evolution between the control group and the experimental group.
A16	Cognitive stimulation intervention with reading sessions; painting; drawings; imitation; memorization; identification of figures and images; arithmetic calculations; object categorization; antonyms; identification of textures, sound, and smell; personal history; imitations; ball game; proverbs and metaphors.	Long-term care unit. Nurses and nursing students.	There was stabilization and positive results in cognition. However, due to the absence of a control group, there was a limitation in the studies, with little difference between pre- and post-testing in the Barthel index.
A17	Cognitive stimulation intervention with themes of current events; recall; word games; object categorization; orientation. Duration of 20 to 30 minutes from the end of surgery to hospital discharge.	Hospital. Nursing Team	Increased MMSE score and improvement persisted after one month of discharge. Decreased cognitive decline from 44% to 12%.
A18	Cognitive stimulation with elements of reality orientation, validation therapy, and Alzheimer’s (ADAS-Co Reminiscence). Duration 45-60 min, two sessions per week, over a period of seven weeks.	Rural community. Nurse.	Significant improvement in the physical, psychosocial, and environmental domains according to the WHPQOL-Bref. Improvement in the language domain

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[1] Corresponding author:
Maria do Perpétuo Socorro de Sousa Nóbrega Universidade de São Paulo - São Paulo, SP, Brasil E-mail: perpetua.nobrega@usp.br