The finalised programme Sessions:

1) Physical game(s). Examples: • Skittles or indoor boules.

• Throwing a soft ball around, and asking people to say things about themselves as they caught the ball; such as their name, where they lived, their former occupation or their favourite food.

This aimed to be a gentle introduction to the programme, helping to familiarise people with each other and the setting. A cognitive element could be introduced, such as getting people to calculate their scores in certain games. People would be asked to give the group a name, and the nature of the programme over the next seven weeks would be explained.

2) Sound. Examples:

• Matching the sounds of different animals and occupations to corresponding pictures. • Playing of different percussion instruments along to familiar music.

3) Childhood. Examples:

• Individual completion of a copy of the first page of the memory diary (name of mother, father, siblings; schools attended etc).

• Reconstruction of a person’s house or bedroom on the board, through discussion. • Demonstration of childhood toys, such as jacks and hoopla.

4) Food. Examples:

• Use of imitation or real groceries to categorise objects (eg. special occasions, savory, sweet).

• Demonstration of how the above would have been used to make a meal.

• Tasting of food with reminiscent value, eg. cream soda, ginger beer, bread pudding.

5) Current day. Examples:

• Discussion of contemporary issues such as abortion, royalty and adoption, using multiple, laminated copies of interesting articles.

• Use of cue cards to stimulate discussion. Questions include ‘who do you most admire?’ and ‘what is your favourite charity?’

6) Faces / scenes. Examples:

• Use of multiple, laminated pictures of famous people. Individuals are given one or more picture at a time, and asked to comment on factors such as oldest / youngest looking, most attractive, etc.

• Use of a Polaroid camera.

7) Associated words.

• Word completion tasks. E.g. proverbs (‘a stitch in tim e....), famous couples (‘Punch an d ...’).

• Song completion. Present the first few words of a song (e.g. ‘W e’ll meet again...’), and ask the group to sing a few lines.

8) Using objects. Examples: • Cookery.

• Seasonal collage.

9) Categorizing objects. Examples:

• Playing of a game (e.g. ‘Topix’), in which one person picks a card with a letter on it and another picks a category (which can be made up by the facilitator to make the activity more easy.) Examples are countries, mens’ names and colours.

• Brainstorming within a category (e.g. ‘Christmas things’, ‘alcoholic drinks’), to be written on the board.

10) Orientation. Examples:

• Construction of a map of England, the local area or the home / day centre on the board, through people’s responses to prompts, (e.g. ‘where would the post office be?’)

• Use of enlarged London tube map or map of England to prompt discussion.

11) Using money. Examples:

• Guessing the price of objects or pictures of objects. • Matching the price-tag with the object.

• Demonstration of old coins, and discussion of how much people used to get paid, the price of a loaf of bread, etc.

12) Number-related activity. Examples: • Bingo

• Pelmanism

13) Word-related activity. Examples: • Large crossword or word-search.

• ‘Hangman’, which involves guessing the letters to complete a word. Category would be provided, e.g. ‘a type of drink.’

14) Quiz / consolidation. Activities:

• Discussion of how the groups went, bringing back material from popular sessions. • Quiz (with prizes for all) and tea party.

6.2.0. Assessment measures

a) Mini-Mental State Examination (MMSE), (Folstein et al, 1975). The original version of the MMSE is an 11-item set of simple tasks presented informally to the participant. It involves orientation to time, orientation to place, registration of three words, attention and calculation, recall, language and visual construction. It has a maximum score of 30 points, with 23 normally considered as the border between cognitive impairment (23 or less) and normal performance (24 or more). Reliability and validity are satisfactory. The MMSE is well known worldwide and is frequently used in the evaluation of psychological therapies and drug trials, enabling this study to easily be compared to others.

b) Alzheimer’s Disease Assessment Scale - Cognition (ADAS-Cog), (Rosen et al, 1984). This is a more sensitive scale administered to the participant, measuring cognitive function and including more items which assess short-term memory. The ADAS is divided into two parts, a cognitive part (ADAS-Cog) and a non-cognitive part, which may be used separately and has not been included. ADAS-Cog includes word recall and recognition, naming objects, following commands, orientation, praxis, drawing and observations of language ability. Inter-rater reliability, test-retest reliability and validity are high (Rosen et al, 1984). It was chosen because it is frequently used in drug trials as the principal cognitive measure, allowing the effects of the programme to be compared to anti-dementia drugs. The standardised scoring method (used in drug trials) from 0-70, with 70 indicating the most impairment, was used for the main study. However in the

pilot studies, the alternative method (summation of correct responses) was used as a result of earlier advice from a local researcher working in the memory clinic.

c) Holden Communication Scale (Holden and Woods, 1995). This is a 12-item scale, completed by staff. It covers a range of social behaviour and communication variables, including conversation, attempts at communication, awareness, pleasure, humour and responsiveness. Staff circle one of 5 responses for each variable (scoring from 0-4), which most adequately describes the person’s behaviour in the two weeks prior to assessment. It correlates well with measures of dependency and cognition, and was chosen because it includes variables which might be particularly responsive to change following small-group work.

d) Clinical Dementia Rating (CDR), (Hughes et al, 1982). This provides a global rating of dementia severity and is commonly used in clinical settings and treatment trials. Based on the interview with the participant and staff / carer, it assesses dementia in six domains: memory, orientation, judgement & problem solving, communication skills, domestic skills and personal care. It stages dementia in five levels, 0 = no impairment, 0.5 = questionable dementia, 1 = mild dementia, 2 = moderate dementia, 3 = severe dementia. Good reliability and validity have been demonstrated.

e) Cornell Scale fo r Depression in Dementia (Alexopoulos et al, 1988). This rates symptoms and signs of depression in dementia in the week prior to assessment, using information from interviews with staff and participants. It scores symptoms from 0-2,

where 0 = absent, 1 = mild / intermittent and 2 = severe (and a = unable to evaluate.) It includes eighteen items under five broad categories: mood related signs, behavioural disturbance, physical signs, biological functions and ideational disturbance. It was included to assess any improvements in mood related to the intervention. A score of 7 or more suggests clinical depression. Good reliability and validity have been demonstrated.

f) Rating Anxiety in Dementia (RAID), (Shankar et al, 1999). This rates symptoms and signs of the participant’s anxiety in the two weeks prior to assessment, using interviews with staff and participants. It scores symptoms from 0 to 3, where 0= absent, 1= mild or intermittent, 2 = moderate and 3 = severe (and u = unable to evaluate). There are eighteen questions in four main categories: worry, apprehension and vigilance, motor tension and autonomic hypersensitivity. Additionally, there are two questions on phobias and panic attacks. A total score of eleven and above indicates significant clinical anxiety (Shankar et al, 1999). It has good inter-rater and test-retest reliability, and was included to measure whether the intervention has any effects on anxiety.

g) Behaviour Rating Scale (from the Clifton Assessment Procedures for the Elderly (CAPE); Pattie and Gilleard, 1979). The eighteen questions of the CAPE BRS cover general behaviour, personal care and behaviour towards others. Questions include an evaluation of the person’s ability to bathe and dress, walk, take care of personal appearance, socialize, keep active, communicate, understand communication, help out in the home / ward, and sleep. Staff or carers are asked to circle one of three given answers.

in response to each question. It has good reliability and validity, and was included to assess the overall level of functional impairment and dependency.