Cognitive stimulation therapy as a low-resource intervention for dementia in sub-saharan africa: Initial results of a controlled trial


      The prevalence of dementia in sub-Saharan Africa (SSA) is set to rise by almost two and a half times the rate of increase in developed countries by 2040. There are currently very few doctors specialising in psychiatry, neurology or geriatrics working in SSA. Interventions and treatment for dementia in SSA are therefore very limited. Cognitive stimulation therapy (CST) is a group-based intervention for dementia shown to improve cognition and quality of life with a similar efficacy to cholinesterase inhibitors in UK trials. Since CST can be delivered by non-specialist healthcare workers, it has potential for use in the low-resource environment of rural SSA. No previous studies of CST from SSA have been published.


      This single-blind cluster randomised trial with a step-wedge design took place in rural Tanzania. Participants and their carers were recruited through a community dementia screening programme. Inclusion criteria were DSM-V diagnosis of dementia of mild/moderate severity following detailed assessment by a research doctor. No participant had a previous diagnosis of dementia and none were taking a cholinesterase inhibitor. In order to effectively deliver CST, local healthcare workers underwent CST training in the UK. The team developed and piloted an adapted CST manual for SSA, taking into account cultural differences and resource limitations. Participants were randomised to receive CST immediately, or after a two month delay. Main primary and secondary outcome measures were quality of life in patients and carers, and cognition assessed using the ADAS-COG adapted for low-literacy settings. The assessing team were blind to treatment group membership until the end of the trial. Analysis followed the intention-to-treat principle.


      Thirty four participants with mild/moderate dementia were allocated to four CST groups. Substantial improvements in cognition were noted following CST relative to controls, with smaller improvements in quality of life measures.


      CST demonstrated improvements in both cognition and quality of life in this low-resource setting in SSA. This intervention has the potential to provide access to interventions for dementia for patients and carers across SSA, particularly since it can be delivered by non-specialist health workers and trained carers.