title: Cognitive stimulation therapy as a sustainable intervention for dementia in sub-Saharan Africa: feasibility and clinical efficacy using a stepped-wedge design.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Northumbria Healthcare NHS Foundation Trust,North Tyneside General Hospital,North Shields,UK.
authors.forename: Stella-Maria
authors.initials: SM
authors.lastname: Paddick
authors.affiliation: Kilimanjaro Christian Medical University College,Moshi,Tanzania.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mkenda
authors.affiliation: Kilimanjaro Christian Medical University College,Moshi,Tanzania.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Mbowe
authors.affiliation: Kilimanjaro Christian Medical University College,Moshi,Tanzania.
authors.forename: Aloyce
authors.initials: A
authors.lastname: Kisoli
authors.affiliation: Northumbria Healthcare NHS Foundation Trust,North Tyneside General Hospital,North Shields,UK.
authors.forename: William K
authors.initials: WK
authors.lastname: Gray
authors.affiliation: Northumbria Healthcare NHS Foundation Trust,North Tyneside General Hospital,North Shields,UK.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Dotchin
authors.affiliation: Institute of Health and Society,Newcastle University,Newcastle upon Tyne,UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Ternent
authors.affiliation: University College Hospital,University of Ibadan,Ibadan,Nigeria.
authors.forename: Adesola
authors.initials: A
authors.lastname: Ogunniyi
authors.affiliation: Hai District Hospital,Boman'gombe,Kilimanjaro,Tanzania.
authors.forename: John
authors.initials: J
authors.lastname: Kissima
authors.affiliation: University College Hospital,University of Ibadan,Ibadan,Nigeria.
authors.forename: Olaide
authors.initials: O
authors.lastname: Olakehinde
authors.affiliation: Kilimanjaro Christian Medical University College,Moshi,Tanzania.
authors.forename: Declare
authors.initials: D
authors.lastname: Mushi
authors.affiliation: Northumbria Healthcare NHS Foundation Trust,North Tyneside General Hospital,North Shields,UK.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Walker
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003704:Dementia / Q000534:rehabilitation*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011615:Psychotherapy, Group; D011788:Quality of Life; D013636:Tanzania; D016896:Treatment Outcome
keywords: Tanzania; cognitive stimulation therapy; dementia; low- and middle-income countries; sub-Saharan Africa