Dementia Clinical Trial
Official title:
Identification and Intervention for Dementia in Elderly Africans (IDEA) Study: CST Trial
This trials of cognitive stimulation therapy (CST) in Tanzania is part of the larger
Identification and Intervention for Dementia in Elderly Africans (IDEA) study.
The overall aim of the IDEA study is to set up and evaluate sustainable programmes to
facilitate diagnosis of, and therapy for, people with dementia led by local communities in
sub-Saharan Africa. We aim seek to improve quality of life for people with dementia and their
caregivers.
Within this trial of CST, we hypothesise that CST can significantly improve the quality of
people with dementia and their carers living in Africa
Our project will address three specific challenges: 1) Integrate screening and core packages
of services into routine primary health care. 2) Provide effective and affordable
community-based care and rehabilitation. 3) Develop effective treatment for use by
non-specialists, including lay healthcare workers with minimal training.
Dementia is under-diagnosed in sub-Saharan Africa (SSA) and treatment is rarely accessed or
available. The burden of dementia on caregivers is high, with loss of income, and
psychosocial stress common. However, large scale screening for dementia in such a setting is
neither affordable nor sustainable. The purpose of this 3 year project is to provide a
sustainable mechanism for diagnosis and therapeutic intervention for people with dementia. We
will use 2 complimentary, rural study sites, 1 in Nigeria, West Africa and 2 in Tanzania,
East Africa. As a consequence our results should be generalizable to all SSA. Our approach is
inexpensive and will have applicability to other low- and middle-income countries.
During Phase I we will validate a screening tool, previously developed by members of our
study team from data collected in Tanzania, and carry out a pilot study of the benefits of
cognitive stimulation therapy (CST) when used in SSA for those already identified with
dementia. During both of these activities we will initiate training of local healthcare
workers in diagnosis and management of people with dementia. In Phase II we will engage with
local communities to raise awareness of dementia. Building on previous work at both study
sites, we will initiate poster, newspaper and radio advertising and use mobile phone text
messaging services (for relevant healthcare personnel) to increase awareness of the need to
diagnose and intervene at an early stage. We will empower local private pharmacies to help
identify people with dementia, a relationship which will ultimately be mutually beneficial
through the supply of medicines to treat risk factors for dementia, such as hypertension. We
will engage with local community leaders and government officials to assist us in this
awareness raising, an approach that has proven successful in previous studies by our team in
SSA. One of our study team (Dr Mushi (DM)) is a social scientist based in Tanzania and during
Phase II we will conduct qualitative research into attitudes and beliefs surrounding dementia
and identify any barriers to diagnosis in both sites. The results of this research will be
fed back to inform other phases of the study. Finally, in phase III we will initiate a
program of community based CST led by local occupational therapists (OTs) and nurse
specialists. OTs and nurses will train caregivers in CST techniques and we hope that the
training will ultimately be led by caregivers allowing such therapy to become sustainable
within communities in the longer term. We will evaluate changes in cognition in people with
dementia, and quality of life (QOL) in both people with dementia and their caregivers,
post-intervention. We will carry out a full economic evaluation of the effect of our program,
to be led by a heath economist based at Newcastle University, United Kingdom.
This protocol cover the CST trial (Phase III of the study) in Tanzania
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