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，并显着降低了人们及其家庭的生活质量。然而，在低收入和中等收入国家，它在很大程度上仍未得到承认和治疗。迫切需要引入简单的干预措施，以解决这一治疗差距，这在包括英国在内的其他地方已经取得了成功。认知刺激疗法（CST）是一种以证据为基础的团体非药物干预，可显着改善认知功能和生活质量。它可以提供给比药物更广泛的人群，因为它没有已知的副作用，可以由非医务人员提供，不需要专门设备或培训，成本低。该项目的主要目标是建立一个持续和可持续的方案，在这三个国家的不同区域执行国家技术服务小组。第二个目标是提高卫生工作者和家庭对痴呆症的检测和管理的认识和技能。我们选择了一个中上收入国家（巴西），一个中低收入国家（印度）和一个低收入国家（坦桑尼亚），以提供广泛的经济以及地理和文化挑战。所有这三个国家都已经a）遵循相同的（建议的）程序，先前翻译和改编了CST手册，B）开始或完成了初步测试，取得了积极成果，c）与当地利益攸关方接触，并收集了关于实施的初步想法。我们将采访一系列的人，包括临床医生，政策制定者和痴呆症患者及其家人，使丰富的观点。(ii)我们将为每个地区制定一个实施战略，但所有网站都有共同的主题。(iii)我们将通过观察它的效果来测试这一策略。我们将培训CST培训人员，并尝试在每个国家招募50名痴呆症患者（共150人）加入CST小组。我们将看到人们是否参加会议，享受会议，以及主持人是否能够按照预期运行会议。我们将测量结果，包括痴呆症患者的认知和生活质量，并研究在每种环境下运行团体的成本。作为本研究的一部分，研究人员将为所有接受筛查但未纳入研究的家庭以及参与者（在完成随访措施后，因此避免对结果产生影响）提供三小时的家庭教育课程。在可能的情况下，这将以小组形式提供，既鼓励家庭成员之间的沟通，又节省时间。根据环境、需求和资源的可得性，人们可能会得到进一步的支持，如体检。这将包括出版培训手册、可持续的国家技术服务小组培训方案、具有持续转介来源的现有国家技术服务小组、财务安排，以及在适用的情况下改变政策。我们希望，更广泛地说，这项工作将增加对筛查、诊断和治疗痴呆症的知识和认识，并提出常规结果测量的建议。这将通过儿童支助小组的培训、筛选程序、儿童支助小组的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.