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.

Keywords:

• Developing countries
• Alzheimer’s disease
• cognition
• quality of life

Acknowledgements

The authors thank all CST-International investigators including: Mina Chandra, Adelina Comas-Herrera, Catherine Dotchin, Cleusa P. Ferri, Sarah Hawkes, Martin Knapp, Murali Krishna, Jerson Laks, Susan Michie, Daniel C. Mograbi, Martin Orrell, Stella-Maria Paddick, Kunnukattil Sivaraman Shaji, Thara Rangawsamy, Sarah Urasa, Sridhar Vaitheswaran, and Richard Walker.

Disclosure statement

Prof. Aimee Spector offers Cognitive Stimulation Therapy (CST) training courses on a consultancy basis.

Additional information

Funding

This work is supported by the following Global Alliance for Chronic Diseases (GACD) funding agencies: The United Kingdom Medical Research Council (MRC: MR/S004009/1) and the Indian Council of Medical Research (ICMR: Indo-foreign/67/M/2018-NCD-I). No funding bodies were involved in the design, collection, analysis, interpretation or writing of the research or manuscript. The views expressed are those of the authors and not necessarily those of GACD, the MRC or ICMR.