Psychosocial interventions for dementia in low- and middle-income countries (LMICs): a systematic review of effectiveness and implementation readiness

Abstract

Introduction: Despite wide uptake in high-income countries (HICs), less is known about the effectiveness and implementation of psychological, social and cognitive interventions in low-and middle-income countries (LMICs). Despite this, such interventions are increasingly used. The aim of this review was to appraise the effectiveness and implementation readiness of psychosocial interventions for people with dementia in LMICs. Methods: A systematic search of databases from 1998-2019. Studies were rated on two scales assessing quality and implementation readiness. Results: Seventeen articles describing 11 interventions in six countries were evaluated. Interventions included Cognitive Stimulation Therapy (CST), a Multidisciplinary Cognitive Rehabilitation Programme (MCRP), singing interventions, occupational therapy and reminiscence therapy. The quality of included studies was variable, and many had low sample sizes. Evidence for improving both cognition and quality of life was found in two interventions: Cognitive Stimulation Therapy (CST) and a Multidisciplinary Cognitive Rehabilitation Programme (MCRP). Implementation issues were more likely to be explored in studies of Cognitive Stimulation Therapy (CST) than in any other intervention. Conclusions: Of the included studies here, CST appears to be the most implementation ready, improving both cognition and quality of life with implementation readiness effectively explored in two LMIC countries: India and Tanzania.

A New Approach for Developing “Implementation Plans” for Cognitive Stimulation Therapy (CST) in Low and Middle-Income Countries: Results From the CST-International Study

“…Using an innovative methodology developed using the CFIR and extensive stakeholder engagement, five Implemention Plans for CST were produced for three countries. The systematic development of methods in implementation research in LMICs has previously been suggested as an important means of facilitating cross-culturally valid research in this setting (27). The methods described here represent a first step in achieving this goal.…”

Cognitive stimulation therapy for people with dementia in Brazil (CST‐Brasil): Results from a single blind randomized controlled trial

“…Considering the above, there is a case for urgent social and clinical need to validate interventions for PwD in developing regions. Indeed, non‐pharmacological treatment options are not offered routinely in developing countries 11 and little is known about their effectiveness in these regions 15 . There is limited data regarding CST efficacy in low‐ and middle‐income countries 16 and the current study may add valuable information for future development in this field.…”

Montessori intervention for individuals with dementia: feasibility study of a culturally adapted psychosocial intervention in Pakistan (MIRACLE)

“…18 Cultural adaptation enhances the appropriateness, uptake and chance for subsequent 'scale-up' of the intervention. 19 Thus, to adapt the original Montessori method therapy manual (with permission) to the context of a care home in Pakistan, we followed a modified cultural adaptation approach, based on a more complex framework of adaptations outlined by Barrera and Castro. 20 According to this framework, cultural adaptation should involve four phases, namely information gathering, preliminary adaptation design, preliminary adaptation testing and adaptation refinement.…”