Cognitive stimulation therapy as a sustainable intervention for dementia in sub-Saharan Africa: feasibility and clinical efficacy using a stepped-wedge design
Open accessAbstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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Cognitive stimulation therapy has been evaluated in Tanzania and Nigeria, appears feasible and beneficial, and is becoming available in Tanzania.
“Cognitive stimulation therapy (CST) has been evaluated in Tanzania and Nigeria, appears feasible and beneficial and is becoming available in Tanzania.25,26”
From Effectiveness of App-Based Cognitive Screening for Dementia by Lay Health Workers in Low Resource Settings. A Validation and Feasibility Study in Rural Tanzania (2021) · cites this paper as [26]
The Methods report that CST was adapted and piloted in Tanzania and Nigeria, but specify that this paper presents trial results only for Tanzania. The Results report high attendance and improvements following CST, supporting feasibility and benefit in Tanzania. The paper says the manual is freely available online, but does not establish that CST services are becoming available in Tanzania. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe fewest steps used in an SWD study was 1, as seen in Stella-Maria Paddick (2017).
“The fewest steps used in an SWD study was 1, as seen in Stella-Maria Paddick (2017) (102).”
From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [102]
Behavioural and psychosocial interventions benefited from SWD's staged rollout, which is often advantageous for interventions that require time to demonstrate effects.
“Behavioural and psychosocial interventions—such as Women's Health CoOp (63) and Cognitive Stimulation Therapy (102)—also benefited from SWD's staged rollout, which is often advantageous for interventions that require time to demonstrate effects (120, 121).”
From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [102]
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- Authors
- Paddick, S.-M., Mkenda, S., Mbowe, G., Kisoli, A., Gray, W. K., Dotchin, C. L., Ternent, L., Ogunniyi, A., Kissima, J., Olakehinde, O., Mushi, D., & Walker, R. W.
- Affiliations
- North Tyneside General Hospital (GB)
- Kilimanjaro Christian Medical Centre (TZ)
- Newcastle University (GB)
- University of Ibadan (NG)
- Corresponding author
- Gray, William K.
- ORCID
- Venue
- International Psychogeriatrics
- Publisher
- Elsevier BV
- Published
- 2017-06
- Volume
- 29
- Issue
- 6
- Pages
- 979-989
- ISSN
- 1041-6102 (ISSN-L)
- OpenAlex
- W2589535393
- Cited by
- 58
- References
- 28
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 7 · 2023: 5 · 2022: 6 · 2021: 9 · 2020: 10 · 2019: 4 · 2018: 3 · 2017: 4
- FWCI
- 4.71
- Type
- journal article
- Language
- en
- Update notices
- erratum (2017-06-01)
- Open access
- gold
- doi.org
- Licence
- Locations
- International Psychogeriatrics (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- Grand Challenges Canada (0086-04)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Down syndrome and intellectual disability research
- Keywords
- cognitive stimulation therapy, dementia, sub-Saharan Africa, rural Tanzania, feasibility, clinical efficacy, non-specialist health workers, resource-limited settings, quality of life, cognitive function, behavioral symptoms, anxiety, number needed to treat
- MeSH terms
- Activities of Daily Living, Aged, Aged, 80 and over, Dementia, Feasibility Studies, Female, Humans, Male, Psychiatric Status Rating Scales, Psychotherapy, Group, Quality of Life, Tanzania, Cognitive Behavioral Therapy, Treatment Outcome, Caregivers
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