Cognitive Stimulation Therapy (CST) has been a gift both for me and my patients. As an Occupational Therapist (OT) in geriatrics, I often work with patients and families as they navigate living with dementia. My work with these patients and families is only a small window into a much broader reality facing Canadians.
As our population continues to age, dementia prevalence is increasing at an alarming rate. Approximately nine Canadians are diagnosed with dementia every hour and adults over the age of 80 face nearly six times the risk compared to those over the age of 65. These statistics highlight the growing public health burden posed by dementia. And as the prevalence of dementia increases, so does the importance of early detection to capitalize on the benefits of early interventions.
Our process for assessment and diagnosis in Canada is robust but lengthy. Following diagnosis, it often feels like there is little to offer beyond medication and lifestyle advice. Recent advancements with medication such as Lecanemab (Leqembi®), a drug that removes amyloid plaques from the brain to slow the progression of Alzheimer’s symptoms, are exciting and garnering lots of attention, but the cost and risks mean it’s out of reach for many. Lecanemab requires bi-weekly infusions at a cost of approximately $36,500 a year, as well as regular brain scans to monitor for rare side effects such as brain bleeding. Other medications on the market work to slow disease progression with limited, variable effects. These medications are not universally accessible for people with dementia. Eligibility is often limited by factors such as dementia sub-type, side effects or contraindications due to other health conditions.
CST is a cost-effective, evidence-based and scalable psychosocial intervention for the management of mild to moderate dementia. There are few exclusion criteria beyond hearing and visual impairment that would limit the person’s ability to engage in a session. Changes in language skills are a common symptom of dementia, often diminishing people’s sense of self and causing them to retreat socially.
CST is delivered in a group format designed to create opportunities to express opinions, socialize and share experiences. Each session follows the same structure – participants arrive to the group song they selected during the first session, complete a warm-up activity such as a word game, discuss a news article, complete the main themed-activity (e.g., Faces & Places, Sounds), and close the session with a short meditation. Through conversation about current events and themed activities, participants work on improving cognitive skills and coping with memory loss.
In January 2025, we began piloting CST at the Bruyère Health Geriatric Day Hospital and have successfully delivered three rounds of the program to date. The pilot is scheduled to end in July 2026, at which point a decision will be made regarding continued funding and delivery. As an OT, this pilot program has provided me with an opportunity to practice in a way that feels core to my profession – using occupation as a therapeutic intervention to address cognitive concerns.
Beyond allowing me to step fully into the heart of OT as a practitioner, it has been an immense privilege to provide patients with a place to express themselves without judgment and connect with peers, especially as stigma around dementia continues to limit opportunities for these patients to feel included. At the conclusion of our first pilot session, one participant said, “I felt seen for who I am,” a statement that stands as a true, powerful testament to the therapeutic and social values this program has to offer.
CST offers caregivers an opportunity to support their own well-being by helping to slow down cognitive decline in their loved ones. Research exploring how CST influences daily living for both participants and caregivers found that the approach was well-received and contributed positively to the day-to-day experiences of both members of the care partnership. Better caregiver wellbeing has been tied to reduced premature Long-Term Care (LTC) admissions, an area under increasing strain in the health-care system.
In 2016, the National Health Service in the U.K. estimated that CST costs approximately £30.49 per person per week over an eight-week period (two sessions per week), approximately $78 in Canada today. The UK’s NICE guidelines on dementia recommend that people with mild to moderate dementia be given the opportunity to participate in CST programming. The material has successfully been adapted to several other cultural contexts highlighting the treatment’s relevance for multicultural Canadian communities.
Currently, CST is not easy to access as it’s typically made available to patients who already have been connected with a geriatrics program or memory clinic. There is no standardized funding pathway for CST delivery in Canada, and trained CST facilitators remain few. Given the relatively low cost of implementation and training requirements, there is significant potential to scale this program across various points of the health-care continuum, including community health centres, outpatient memory and rehab clinics and long-term care.
The Public Health Agency of Canada’s Dementia Strategy calls for the development of innovative approaches to therapies across all stages of dementia including any intervention that rehabilitates, provides positive social adjustment, and improves quality of life. A study published in the International Journal of Geriatric Psychiatry concluded that CST had positive outcomes for patients irrespective of pharmacological treatment. CST aligns with the Public Health Agency’s mandate at a fraction of the cost of pharmacological options and with more consistent and holistic benefits. This is an essential advantage in a health-care system that is already strained by rising dementia care demands.
There is no cure for dementia, but a multi-faceted approach to treatment that centres the patient and bolsters their quality of life exists. Health systems across Canada need to devote more time and resources to implementing non-pharmacological programs such as CST to provide comprehensive dementia care in an equitable way.
The investment is low and the benefits in terms of quality of life, symptom management and caregiver support are immeasurable.