CS-ADL is a multi-component cognitive stimulation program that aims to enhance performance of activities of daily living (ADL) for people living with mild-to-moderate dementia.

The control group continue to receive their usual care. This may differ between individuals, but may include physiotherapy, occupational therapy, nursing, medication or attendance at a day-care centre/day hospital. This treatment is decided by their healthcare provider who is external to the research team. It is possible that 'TAU' for some individuals dictates no treatment.

CS-ADL sessions are delivered once weekly, for seven weeks. Sessions last approximately 2 hours. Sessions are themed around domains of everyday activities, for example 'Morning routine', ' Domestic Activities', 'Leisure'. Activities in each session follow this theme. A typical session begins with introductions, reality orientation, a group song and discussion of the news of the week. This is followed by a physical activity/game and ADL-focused cognitive stimulation activities. These activities include the identification and categorization of everyday items, discussion, reminiscence, planning and sequencing of ADLs and the completion of everyday writing/calculation tasks. This is followed by practice of an ADL. Examples of activities include making a breakfast, a simple gardening activity or sorting laundry. The session then ends with a summary and repeat of the group song, and a plan for the next session.

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.

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.