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Cognitive stimulation therapy as a sustainable intervention for dementia in sub-Saharan Africa: feasibility and clinical efficacy using a stepped-wedge design

  • Stella-Maria Paddick (a1) (a2), Sarah Mkenda (a3), Godfrey Mbowe (a3), Aloyce Kisoli (a3), William K. Gray (a1), Catherine L. Dotchin (a1) (a4), Laura Ternent (a5), Adesola Ogunniyi (a6), John Kissima (a7), Olaide Olakehinde (a6), Declare Mushi (a3) and Richard W. Walker (a1) (a5)...
  • Please note a correction has been issued for this article.
Abstract
Background:

Cognitive stimulation therapy (CST) is a psychosocial group-based intervention for dementia shown to improve cognition and quality of life with a similar efficacy to cholinesterase inhibitors. Since CST can be delivered by non-specialist healthcare workers, it has potential for use in low-resource environments, such as sub-Saharan Africa (SSA). We aimed to assess the feasibility and clinical effectiveness of CST in rural Tanzania using a stepped-wedge design.

Methods:

Participants and their carers were recruited through a community dementia screening program. Inclusion criteria were DSM-IV diagnosis of dementia of mild/moderate severity following detailed assessment. No participant had a previous diagnosis of dementia and none were taking a cholinesterase inhibitor. Primary outcomes related to the feasibility of conducting CST in this setting. Key clinical outcomes were changes in quality of life and cognition. The assessing team was blind to treatment group membership.

Results:

Thirty four participants with mild/moderate dementia were allocated to four CST groups. Attendance rates were high (85%) and we were able to complete all 14 sessions for each group within the seven week timeframe. Substantial improvements in cognition, anxiety, and behavioral symptoms were noted following CST, with smaller improvements in quality of life measures. The number needed to treat was two for a four-point cognitive (adapted Alzheimer's Disease Assessment Scale-Cognitive) improvement.

Conclusions:

This intervention has the potential to be low-cost, sustainable, and adaptable to other settings across SSA, particularly if it can be delivered by non-specialist health workers.

Copyright
Corresponding author
Correspondence should be addressed to: William K. Gray, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK. Phone: +49 23 02-926 226; Fax: +49 23 02-926 239. Email: franziska.laporte-uribe@dzne.de.
References
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Bower, J. H. and Zenebe, G. (2005). Neurologic services in the nations of Africa. Neurology, 64, 412415.
Bruckner, T. A. et al. (2011). The mental health workforce gap in low- and middle-income countries: a needs-based approach. Bull World Health Organ, 89, 184194.
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082314.
Dewhurst, F. et al. (2012). The prevalence of disability in older people in Hai, Tanzania. Age Ageing, 41, 517523.
Dotchin, C. L. et al. (2014). A comparison of caregiver burden in older persons and persons with Parkinson's disease or dementia in sub-Saharan Africa. International Psychogeriatrics, 26, 687692.
Dotchin, C. L., Akinyemi, R. O., Gray, W. K. and Walker, R. W. (2013). Geriatric medicine: services and training in Africa. Age Ageing, 42, 124128.
George-Carey, R. et al. (2012). An estimate of the prevalence of dementia in Africa: a systematic analysis. Journal of Global Health, 2, 20401.
Gray, W. K. et al. (2016). Community validation of the IDEA study cognitive screen in rural Tanzania. International Journal of Geriatric Psychiatry.
Hindley, G. et al. (2017). The role of traditional and faith healers in the treatment of dementia in Tanzania and the potential for collaboration with allopathic healthcare services. Age Ageing, 46, 130--137.
Howitt, S. C. et al. (2011). A cross-sectional study of quality of life in incident stroke survivors in rural northern Tanzania. Journal of Neurology, 258, 14221430.
Knapp, M. et al. (2006). Cognitive stimulation therapy for people with dementia: cost-effectiveness analysis. The British Journal of Psychiatry, 188, 574580.
Kowal, P. et al. (2010). Ageing and adult health status in eight lower-income countries: the INDEPTH WHO-SAGE collaboration. Global Health Action, 3.
Livingston, G. and Katona, C. (2000). How useful are cholinesterase inhibitors in the treatment of Alzheimer's disease? A number needed to treat analysis. International Journal of Geriatric Psychiatry, 15, 203207.
Longdon, A. R. et al. (2013). The prevalence of dementia in rural Tanzania: a cross-sectional community-based study. International Journal of Geriatric Psychiatry, 28, 728737.
Mkenda, S. et al. (2016). Cognitive stimulation therapy as a low-resource intervention for dementia in sub-Saharan Africa (CST-SSA): adaptation for rural Tanzania and Nigeria. Dementia. Epub ahead of print. DOI: 10.1177/1471301216649272.
Mushi, D., Rongai, A., Paddick, S. M., Dotchin, C., Mtuya, C. and Walker, R. (2014). Social representation and practices related to dementia in Hai District of Tanzania. BMC Public Health, 14, 260.
Paddick, S. M. et al. (2014). The prevalence of dementia subtypes in rural Tanzania. The American Journal of Geriatric Psychiatry, 22, 16131622.
Paddick, S. M. et al. (2015a). Validation of the identification and intervention for dementia in elderly Africans (IDEA) cognitive screen in Nigeria and Tanzania. BMC Geriatrics, 15, 53.
Paddick, S. M. et al. (2015b). The prevalence and burden of behavioural and psychological symptoms of dementia in rural Tanzania. International Journal of Geriatric Psychiatry, 30, 815823.
Paddick, S. M. et al. (2016). An ADAS-COG for sub- Saharan Africa: adaptation and validation in a low-literacy Tanzanian population. Acta Neuropsychiatrica, Accepted for publication.
Prince, M., Ali, G. C., Guerchet, M., Prina, A. M., Albanese, E. and Wu, Y. T. (2016). Recent global trends in the prevalence and incidence of dementia, and survival with dementia. Alzheimer's Research & Therapy, 8, 23.
Saxena, S., Thornicroft, G., Knapp, M. and Whiteford, H. (2007). Resources for mental health: scarcity, inequity, and inefficiency. Lancet, 370, 878889.
Spector, A. et al. (2003). Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial. The British Journal of Psychiatry, 183, 248254.
Spector, A., Orrell, M. and Woods, B. (2010). Cognitive stimulation therapy (CST): effects on different areas of cognitive function for people with dementia. International Journal of Geriatric Psychiatry, 25, 12531258.
Spector, A., Thorgrimsen, L., Woods, B. and Orrell, M. (2006). Making a Difference: An Evidence based Group Program to Offer Cognitive Stimulation to People with Dementia. Manual for Group Leaders. London, UK: Hawker Publications.
The WHOQOL Group (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28, 551558.
The World Bank (2017). Data: Tanzania. Available at: http://data.worldbank.org/country/tanzania; last accessed 20th January.
Woods, B., Aguirre, E., Spector, A. E. and Orrell, M. (2012). Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database of Systematic Reviews, 2, CD005562.
Woods, B., Thorgrimsen, L., Spector, A., Royan, L. and Orrell, M. (2006). Improved quality of life and cognitive stimulation therapy in dementia. Aging & Mental Health, 10, 219226.
World Health Organization (2010). mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings. Geneva, Switzerland: World Health Organization.
Zigmond, A. S. and Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361370.
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International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
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A correction has been issued for this article: