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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

Published online by Cambridge University Press:  22 February 2017

Stella-Maria Paddick ,
Sarah Mkenda ,
Godfrey Mbowe ,
Aloyce Kisoli ,
William K. Gray ,
Catherine L. Dotchin ,
Laura Ternent ,
Adesola Ogunniyi ,
John Kissima  and
Olaide Olakehinde
...Show all authors
Stella-Maria Paddick
Affiliation:
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
Sarah Mkenda
Affiliation:
Kilimanjaro Christian Medical University College, Moshi, Tanzania
Godfrey Mbowe
Affiliation:
Kilimanjaro Christian Medical University College, Moshi, Tanzania
Aloyce Kisoli
Affiliation:
Kilimanjaro Christian Medical University College, Moshi, Tanzania
William K. Gray*
Affiliation:
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
Catherine L. Dotchin
Affiliation:
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
Laura Ternent
Affiliation:
Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
Adesola Ogunniyi
Affiliation:
University College Hospital, University of Ibadan, Ibadan, Nigeria
John Kissima
Affiliation:
Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
Olaide Olakehinde
Affiliation:
University College Hospital, University of Ibadan, Ibadan, Nigeria
Declare Mushi
Affiliation:
Kilimanjaro Christian Medical University College, Moshi, Tanzania
Richard W. Walker
Affiliation:
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
*
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: [email protected].
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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.

Keywords

dementiacognitive stimulation therapyTanzaniasub-Saharan Africalow- and middle-income countries
Type
Research Article
Information
International Psychogeriatrics , Volume 29 , Issue 6 , June 2017 , pp. 979 - 989
Copyright
Copyright © International Psychogeriatric Association 2017 

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