What is CST?

Cognitive Stimulation Therapy is a formal, evidence-based group therapy for people with mild to moderate dementia. It involves 14 or more sessions of themed activities which typically run twice weekly. These group sessions are structured to stimulate different cognitive abilities, such as memory, language and thinking skills, while also benefiting from the social and supportive aspects of a small group environment. The model was developed in the UK and is now used across the world in care homes, hospitals, day centres and other settings.

Whereas many care homes rely on general “activities” such as puzzles, games, crafts, with older adults, CST is a formal therapy with a proven manual, training, and a defined structure. It is the only non-pharmacological therapy currently recommended by UK national guidelines for treating the cognitive symptoms of dementia.

What does CST involve in practice?

Typically, a CST programme runs over around seven weeks (14 sessions, twice weekly, each about 45 minutes) for small groups of five to eight people with mild to moderate dementia. Sessions are themed, for example, they might focus on “current affairs”, “word games”, “number tasks”, “music and discussion”, “practical activity” and so on. The goal is to activate cognitive functions (thinking, memory, language) but in a way that is enjoyable, social and accessible to people living with dementia.

The manual for CST emphasises a combination of cognitive challenge, stimulation and social interaction. As one group leader reports “I noticed people becoming more fluent and you could see people trying to express themselves more.” Another family carer said: “There is no argument that my wife’s brighter.”

Why is CST recommended?

Perhaps the most compelling reason is the strength of the evidence behind CST. University College London (UCL) state: “Cognitive Stimulation Therapy (CST) is an evidence-based group intervention shown to improve quality of life and cognition in people with dementia.” Economic analysis also shows CST is cost-effective, and according to UCL, the improvements in cognition compare favourably with trials of cholinesterase inhibitors for Alzheimer’s disease.

In the UK national guidelines, the National Institute for Health and Care Excellence (NICE) recommended that people with mild/moderate dementia of all types should participate in group Cognitive Stimulation and that this should be “commissioned and provided by a range of health and social care workers with training and supervision.

In other words, if you run a care home that serves people living with dementia, CST is not just an optional extra - it is increasingly seen as a standard of good practice, especially in early/mild-to-moderate phases, and certainly one that regulators and commissioners may soon expect to see.

What results are seen in practice?

Beyond the original trials, more recent real-world deployments show promising outcomes. For example, Southcare Homes used our platform, Ayla, to deliver CST to its residents, and reported that a seven-week, twice-weekly CST programme delivered via Ayla improved cognitive outcomes by 47.8 % in residents with mild to moderate dementia in two UK care homes. ‍

What this means in real terms is that your residents may have improvements in cognition, language/communication, mood, social engagement and overall wellbeing - not just tiny changes, but meaningful ones. For a care home operator, that can translate into better resident experience, positive family feedback, stronger reputation and potentially improved occupancy and retention.

Why should a care home operator consider introducing CST?

From an operational perspective, there are a number of strong arguments. Firstly, offering CST signals that your home is not just a residential setting but one that offers evidence-based therapeutic intervention for people with dementia. That can be a differentiator in a competitive market. Secondly, the improvements in resident cognition, engagement and mood can contribute to better outcomes, for example fewer distressed behaviours, better social interaction, improved quality of life, which in turn support staff morale, resident satisfaction and the environment of care. Thirdly, regulatory or commissioning bodies are increasingly looking for robust dementia-care pathways, including non-drug therapies, so being able to demonstrate CST delivery helps show you meet good practice standards.

What about the NHS and commissioning?

In the UK the NHS memory services and other dementia care pathways include non-pharmacological interventions such as CST, but this varies depending on your local services. It is offered by some NHS trusts in the UK, and people who have been diagnosed with dementia by a memory service can ask if CST is available locally. For care homes this suggests you may deliver CST in-house (or in partnership) and therefore position your home as a provider of a higher-standard therapy service.

Key take-aways

CST is a structured, evidence-based group therapy for mild/moderate dementia; it works (improving cognition, quality of life); it’s recommended in the UK national guidelines; it requires investment but offers strong return; and offering it within your home sends a powerful signal to residents, families, staff and regulators that you are delivering high-quality, contemporary dementia care.