Cognitive Stimulation Therapy for Dementia: International implementation

Background

Dementia is a global public health priority, yet largely untreated in lower and middle income countries due to limited awareness, resources or care pathways. Pharmacotherapy, requiring ongoing monitoring for effect and adverse effects, is of limited applicability in the context of scarce specialist medical professionals. Cognitive Stimulation Therapy (CST) is an evidence based non-pharmacological group intervention, using themed activities to exercise cognitive skills. It results in significant improvements in cognition (comparable to medication), quality of life; is cost-effective and is now the main intervention implemented in the UK NHS. Crucially, it is culturally adaptable and can be offered by health workers with no specialist equipment or training at low cost.

Aims

The key aim was to develop, test, refine and disseminate implementation strategies in three diverse countries; Brazil (upper middle income), India (lower middle income) and Tanzania (low income). Each have translated and adapted the CST manual, engaged local stakeholders and begun or completed feasibility/pilot work, with positive outcomes. A secondary aim was to increase awareness and skills in the detection and management of dementia for health workers and families.

Project plan

• Phase 1 to investigate barriers and facilitators of implementation using meetings, qualitative interviews and consensus conferences with stakeholders including people with Dementia (PwD)/families, clinicians and policy makers.

• Phase 2 to develop implementation strategies, with generic themes and unique considerations for each setting.

• Phase 3 to test this strategy through establishing cascade training models and a minimum of eight CST groups / 50 PwD in each country, in a range of settings including urban/rural, hospital/community. Additionally, families were offered a brief dementia awareness course. The team aimed to examine feasibility (adherence, attendance, acceptability and attrition), agreed parameters of success (numbers of trained facilitators, numbers of groups run), outcomes (cognition, quality of life, behaviour, carer burden) and costs/affordability of models.

• Phase 4 to refine and disseminate implementation strategies, enabling ongoing and sustainable CST practice. Key stakeholders, including those who provide services and influence health policy, have committed to involvement at every stage including contributing to implementation plans and disseminating findings.

This project sought to achieve successful cross-cultural implementation of an effective and cost effective intervention for mental health (dementia). The team aimed to produce and publish implementation plans and CST manuals for each country, aiming to establish a system of ongoing CST groups, cascade training models and changes in policy and care pathways. Ultimately, this work could lead to improved cognition and quality of life for PwD, reduce costs of care; and create a more skilled workforce and educated communities worldwide.

Impact

The project team are supporting widespread Cognitive Stimulation Therapy (CST) implementation. In each of the settings, there are now CST trainers who can cascade in-country CST training to new facilitators. In Tanzania, the team has delivered a Dementia Awareness Course to healthcare professionals at a regional hospital, and family members of people with dementia in the community. In Chennai, India, Cognitive Stimulation Therapy is now delivered in routine practice by the non-government organization, SCARF. In Brazil, the team has been involved in the 1st National Report on Dementia for Brazil and is continuing to deliver Cognitive Stimulation Therapy following the end of the funding period.

Publications and output

You may visit the project website for more information.

Principal investigators

Funding organisations

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