ABSTRACT
Since CST can be delivered by non-specialist healthcare workers, it has potential for use in low-resource environments such as sub-Saharan Africa. Through the Identification and Interventions for Dementia in Elderly Africans (IDEA) study, we adapted CST for use in sub-Saharan Africa. This adaptation was piloted in Tanzania and Nigeria, and further modifications made prior to a formal feasibility and efficacy study using a stepped-wedge controlled trial design in a rural setting in the Kilimanjaro region of Tanzania. Thirty-four individuals with mild or moderate dementia were recruited to the trial through a community dementia screening programme. CST attendance levels were high (85%) and the CST course was delivered within the correct timeframe, suggesting that CST is feasible in this setting. Blinded clinical assessments indicated substantial improvements in cognition, anxiety, and behavioural symptoms with smaller improvements in quality of life (QoL). The number needed to treat (NNT) for a four-point improvement in a low literacy adaptation of the ADAS-Cog was two. CST therefore has the potential to be a sustainable low-cost intervention for people with dementia in rural sub-Saharan Africa, and may be easily adaptable to other similar settings.
