Research evaluating the effectiveness of dementia interventions in low- and middle-income countries : A systematic mapping of 340 randomised controlled trials

Maximilian SALCHER-KONRAD*, Cheng SHI, Disha PATEL, David MCDAID, Claudia Iveth ASTUDILLI-GARCÍA, Kirsten BOBROW, Jacky CHOY, Adelina COMAS-HERRERA, Andra FRY , Martin KNAPP, Dara Kiu Yi LEUNG, Mariana LOPEZ-ORTEGA, Klara LORENZ-DANT, Christine MUSYIMI, David NDETEI, Tuan Anh NGUYEN, Deborah OLIVEIRA, Aditya PUTRA, Alisha VARA, Gloria WONGHuseyin NACI, STRiDE Evidence Review Group

*Corresponding author for this work

Research output: Journal PublicationsJournal Article (refereed)peer-review

Abstract

Objectives
More people with dementia live in low- and middle-income countries (LMICs) than in high-income countries, but best-practice care recommendations are often based on studies from high-income countries. We aimed to map the available evidence on dementia interventions in LMICs.

Methods
We systematically mapped available evidence on interventions that aimed to improve the lives of people with dementia or mild cognitive impairment (MCI) and/or their carers in LMICs (registered on PROSPERO: CRD42018106206). We included randomised controlled trials (RCTs) published between 2008 and 2018. We searched 11 electronic academic and grey literature databases (MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Global Health, World Health Organization Global Index Medicus, Virtual Health Library, Cochrane CENTRAL, Social Care Online, BASE, MODEM Toolkit) and examined the number and characteristics of RCTs according to intervention type. We used the Cochrane risk of bias 2.0 tool to assess the risk of bias.

Results
We included 340 RCTs with 29,882 (median, 68) participants, published 2008–2018. Over two-thirds of the studies were conducted in China (n = 237, 69.7%). Ten LMICs accounted for 95.9% of included RCTs. The largest category of interventions was Traditional Chinese Medicine (n = 149, 43.8%), followed by Western medicine pharmaceuticals (n = 109, 32.1%), supplements (n = 43, 12.6%), and structured therapeutic psychosocial interventions (n = 37, 10.9%). Overall risk of bias was judged to be high for 201 RCTs (59.1%), moderate for 136 (40.0%), and low for 3 (0.9%).

Conclusions
Evidence-generation on interventions for people with dementia or MCI and/or their carers in LMICs is concentrated in just a few countries, with no RCTs reported in the vast majority of LMICs. The body of evidence is skewed towards selected interventions and overall subject to high risk of bias. There is a need for a more coordinated approach to robust evidence-generation for LMICs.
Original languageEnglish
Article numbere5965
Number of pages10
JournalInternational Journal of Geriatric Psychiatry
Volume38
Issue number7
Early online date10 Jul 2023
DOIs
Publication statusPublished - Jul 2023

Bibliographical note

Funding Information:
Bobrow reports a research grant from GBHI/Alzheimer's Association, for research outside the submitted work. Naci reports a grant from the National Institute for Health Research and payments from the Health Foundation and the Pharmaceutical Group of the European Union for research outside the submitted work, and is a paid advisor to The BMJ. Nguyen report funding from the Australian National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC), and the National Foundation for Science and Technology Development of Vietnam (NAFOSTED) for work contributing to the submitted work, and a travel grant from the STRiDE project (UK Research and Innovation Global Challenges Research Fund (ES/P010938/1)). Salcher‐Konrad reports unpaid membership in a trial steering committee for a dementia caregiver intervention (iSupport), outside the submitted work. Sani reports an unpaid role as Research Coordinator for Alzheimer Indonesia. All other authors report no potential conflicts of interest.

Funding Information:
In addition to named members of the STRiDE Evidence Review Group, we are grateful to all other researchers who contributed to individual stages of this review. This research was conducted as part of the STRiDE project, supported by UK Research and Innovation Global Challenges Research Fund (ES/P010938/1).

Publisher Copyright:
© 2023 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.

Keywords

  • LMIC
  • dementia
  • evidence
  • global south
  • health policy
  • low- and middle-income
  • psychosocial interventions
  • systematic review
  • traditional Chinese medicine

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