Cognitive Stimulation Therapy (CST) for dementia: International implementation in Brazil, India and Tanzania (CST-International)

痴呆症带来了巨大的经济成本，并显著降低了人们及其家人的生活质量。然而，在低收入和中等收入国家，它在很大程度上仍然没有被认识到，也没有得到治疗。迫切需要引入简单的干预措施来弥补这一治疗缺口，包括英国在内的其他地方已经成功地做到了这一点。认知刺激疗法(CST)是一种循证的群体非药物干预方法，可显著改善认知功能和生活质量。与药物相比，它可以提供给更广泛的人群，因为它没有已知的副作用，可以由非医务人员提供，不需要专门的设备或培训，而且成本低。该项目的主要目的是制定一个持续和可持续的方案，在这三个国家的不同区域执行科技委。第二个目标是提高卫生工作者和家庭在检测和管理痴呆症方面的认识和技能。我们选择了一个中上收入国家(巴西)、中低收入国家(印度)和低收入国家(坦桑尼亚)，以应对广泛的经济、地理和文化挑战。这三个国家已经a)按照相同的(建议的)程序翻译和改编了科技委手册，b)开始或完成了初步测试，取得了积极的结果，c)让当地利益攸关方参与进来，并收集了关于实施的初步想法。我们将采访一系列人，包括临床医生、政策制定者和痴呆症患者及其家人，使他们能够有一个丰富的视角。(Ii)我们将为包括在内的每个地区制定一项实施战略，但在所有地点都有共同的主题。(Iii)我们将通过观察这一战略的成效来测试这一战略。我们将培训CST培训员，并尝试在每个国家招募50名痴呆症患者(总共150人)进入CST小组。我们将看看人们是否参加了会议，是否享受会议，以及主持人是否能够按预期开展会议。我们将测量痴呆症患者的结果，包括认知和生活质量，并研究在每种情况下管理小组的成本。作为这项研究的一部分，研究人员将向所有接受筛查和未纳入研究的人的家庭以及参与研究的人(在完成后续措施后，避免影响结果)提供三个小时的家庭教育课程。只要有可能，这将以小组形式提供，既是为了鼓励家庭成员之间的沟通，也是为了节省时间。可根据具体情况、需要和可用资源向人们提供进一步的支持，如体检(Iv)我们的测试阶段将使我们能够调整和改进我们的执行战略，然后我们将在当地、全国和国际上传播这些战略。这将包括出版的培训手册、可持续的科技委培训方案、持续开展的科技委小组和不断提供转介来源的科技委小组、财务安排，以及在适用的情况下政策的变化。我们希望，更广泛地说，这项工作将导致对筛查、诊断和治疗痴呆症的知识和认识的增加，并提出常规结果衡量标准的建议。这将通过科技委培训、筛查程序、科技委干预和家庭教育会议来实现。

Dementia presents huge financial costs and significantly reduces quality of life for people and their families. However, it remains largely unrecognised and untreated in low and middle income countries. There is an urgent need to introduce simple interventions which can address this treatment gap, something that has been done successfully in other places including the UK. Cognitive Stimulation Therapy (CST) is an evidence-based, group non-pharmacological intervention shown to significantly improve cognitive functioning and quality of life. It can be delivered to a wider population than can medication, as it has no known side-effects, can be delivered by non-medical personnel, does not require specialist equipment or training and is low cost. This key aim of this project is to create an ongoing and sustainable programme to implement CST in various regions within these three countries. A secondary objective is to increase awareness and skills in the detection and management of dementia, both for health workers and families. We have selected an upper middle income (Brazil), lower middle income (India) and low income (Tanzania) country, to provide a broad range of economic as well as geographical and cultural challenges. All three countries have already a) previously translated and adapted the CST manual, following the same (recommended) process, b) begun or completed initial testing, with positive results and c) engaged local stakeholders and gathered initial ideas on implementation.In each country, (i) we will investigate the things that are likely to help or hinder implementation of CST. We will interview a range of people including clinicians, policy makers and people with dementia and their families, enabling a rich perspective. (ii) We will develop an implementation strategy for each region included, but with shared themes across all sites. (iii) We will test this strategy through looking at how well it works. We will train CST trainers and attempt to recruit 50 people with dementia in each country (150 in total) into CST groups. We will see whether people attend the sessions, enjoy the sessions and whether facilitators are able to run sessions as intended. We will measure outcomes including cognition and quality of life in people with dementia and look at the costs of running groups in each setting. A three hour family educational session, developed as part of this study; will be offered by the researchers to all families of those who were screened and not included in the study, and to those who participate (after completion of follow-up measures, hence avoiding impact on outcomes). Wherever possible, this will be offered in a group format, both to encourage communication between family members and for the economy of time. People may be offered further support such as physical examinations, depending on the setting, needs and availability of resources (iv) Our testing phase will enable us to adapt and improve our implementation strategy, which we will then disseminate both locally, nationally and internationally. This will include published training manuals, a sustainable CST training programme, ongoing CST groups with ongoing sources of referral, financial arrangements and, if applicable, changes in policy. We hope that, more broadly, the work will result in increased knowledge and awareness of screening, diagnosing and treating dementia, with recommendations of routine outcome measures. This will be achieved through the CST training, the screening procedures, the CST intervention and the family education session.