Cognitive Stimulation in Daily Activities for People Living With Early to Middle Stage Dementia

ADL performance will be measured using the Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) scale. This scale was designed for the assessment of ADL outcomes for individuals with Alzheimer's disease in clinical trials. The scale consists of 23 items that includes 6 BADL and 17 IADL outcomes, scored on a range from 0 (patient does not perform the activity), to the highest score (patient is independent in the activity). The scale is administered with caregivers who are asked to rate the degree to which their care-recipient performs each item in the last four weeks. The ADCS-ADL has been identified to be a reliable and valid instrument, with high internal consistency and sensitivity to functional changes in individuals with mild-to-moderate dementia.

This outcome will be measured using Montreal Cognitive Assessment (Blind). The MoCA-Blind is scored on a scale of 22 points as visual elements are excluded. Specificity remains on par with the original MoCA. Scores from the MoCA-Blind are converted to align with the scores of the original MoCA using the following equation (result multiplied by 30) divided by 22. The interpretation ranges of scores are as follows: a score of 18-25 points indicates mild cognitive impairment; 10-17 points indicates moderate cognitive impairment; and fewer than 10 points indicates severe cognitive impairment. Scores ranging from 26 to 30 are considered as normal.

Cognition will be assessed using the Repeatable Battery for Assessment of Neuropsychological Status (RBANS). The RBANS is a commonly used brief battery of cognitive function for individuals with dementia. This battery consists of 12 subtests which assess five cognitive domains: immediate memory, visuospatial-constructional ability, language and delayed memory. This battery has demonstrated good reliability and adequate validity indicators. Scores on the RBANS can range from 40 to 160, with a lower score indicating more severe cognitive impairment.

Communication ability will be assessed using the Holden Communication Scale (HCS). This scale includes 12 items assessing the domains of conversation, awareness, humour, and responsiveness. Each items contains five response options ranging from 0 to 4. Total scores can range from 0 to 48 with higher scores indicating more communication difficulties. The HCS was initially developed to assess communication outcomes in reality orientation and reminiscence programs and has demonstrated good reliability and validity for use with PLwD. While there are limitations to reliability and validity data outside of the original development of the tool, the HCS has been used in various CS studies to assess communication.

QOL will be assessed using the Quality of Life-Alzheimer's Disease Scale (QOL-AD). This scale consists of 13 items spanning the domains of physical health, energy, mood, living situation, memory, family, marriage, friends, chores, fun, money, self, and life as a whole. Response options include 1 (poor), 2 (fair), 3 (good) and 4 (excellent), with total scores ranging from 13-52. Higher scores indicate better quality of life. Assessment is delivered through an interview format and separate ratings are obtained from the participant themselves and the caregiver. Higher scores indicate a better quality of life. The QOL-AD has demonstrated good reliability and internal consistency and has been found to detect improvements in QOL in previous CS studies.

Mood will be assessed through the presence of neuropsychiatric symptoms as measured by the Neuropsychiatric Inventory Questionnaire (NPI-Q), a version of the Neuropsychiatric Inventory (NPI). The NPI-Q is a caregiver-based questionnaire that measures the presence and severity of 12 neuropsychiatric symptoms in PLwD, including delusions, hallucinations, apathy, disinhibition, and agitation/aggression. The severity scale runs from 1 to 3 points (1=mild, 2=moderate, 3=severe). The questionnaire also measures the respective level of caregiver distress associated with each symptom, with the scale running from 0 to 5 points (0=no distress, 5=extreme distress). The minimum score is 0 and the maximum score is 36, with higher scores indicating increased presence of neuropsychiatric symptoms. The scale is widely used in research, has demonstrated acceptable levels of internal consistency.

Occupational performance within a group setting will be measured after each session using the Occupational Therapy Task Observation Scale (OTTOS). The OTTOS contains two parts, with 10 items for evaluation of specific task functions and 5 items for rating general behavior. The maximum total scores for both task behavior and general behavior are 100, with the minimum being 0 for both. Higher scores indicate greater functional behavior, with lower scores indicating dysfunctional behavior. The reliability and validity of the OTTOS has been demonstrateD.