International Cognitive Stimulation Therapy (CST) Centre



CST for people with dementia: International implementation in Brazil, India and Tanzania (CST-International)

Chief Investigator: Prof Aimee Spector Programme Manager: Emily Fisher 

CST International team image

CST-International is a three-year research programme supported by the Global Alliance for Chronic Diseases (GACD) and funded by the UK Medical Research Council (MRC) and the Indian Council of Medical Research (ICMR). The programme commenced on 10th September 2018 and is due to finish on the 9th of September 2021. Due to COVID-19 disruption, the study has been extended until September 2022.


Over the course of three years, we aim to develop, test, refine and disseminate implementation strategies for CST for people with dementia in three diverse parts of the world: Brazil, India and Tanzania. We also aim to create an ongoing and sustainable CST programme which ultimately increases quality of life and cognition for people with dementia.


We're drawing on implementation science theories and frameworks over four phases of work to investigate the barriers and facilitators to CST provision in each setting. Based on our findings, we'll develop unique strategies to support CST implementation and we'll test the effectiveness of these strategies using a feasibility trial of CST in each country. We are also examining the cost-affordability of CST, taking into account each countries healthcare systems.

CST International team image


  • Du B, Lakshminarayanan M, Krishna M, Vaitheswaran S, Chandra M, Kunnukattil Sivaraman S, Goswami SP, Rangaswamy T, Spector A, Stoner CR. (2021) Psychometric properties of outcome measures in non-pharmacological interventions of persons with dementia in low-and middle-income countries: A systematic review. Psychogeriatrics. Epub 2020 Dec 17. PMID: 33336529; PMCID: PMC7986620. doi: 10.1111/psyg.12647.
  • Lakshminarayanan M, Vaitheswaran S, Srinivasan N, Nagarajan G, Ganesh A, Shaji KS, Chandra M, Krishna M, Spector A. (2021) Cultural adaptation of Alzheimer's disease assessment scale-cognitive subscale for use in India and validation of the Tamil version for South Indian population. Aging and Mental Health. Epub ahead of print. PMID: 33491464. doi: 10.1080/13607863.2021.1875192.
  • Morrish, J., Walker, R., Dotchin, C., Spector, A., Orfanos, S., Mkenda, S., & Shali, E. P. (2021). Group experiences of cognitive stimulation therapy (CST) in Tanzania: a qualitative study. Aging & Mental Health, 1-10. doi:10.1080/13607863.2021.1872489
  • Spector, A., Stoner, C. R., Chandra, M., Vaitheswaran, S., Du, B., Comas-Herrera, A., Dotchin, C., Ferri, C., Knapp, M., Krishna, M., Laks, J., Michie, S., Mograbi, D., Orrell, M., Paddick, S., Shaji, K. S., Rangawsamy, T., & Walker, R. (2019).  Mixed methods implementation research of Cognitive Stimulation Therapy (CST) for dementia in lower and middle-income countries: Study protocol for Brazil, India and Tanzania (CST-International). BMJ Open, 9(8)doi:10.1136/bmjopen-2019-030933.
  • Stoner, C. R., Chandra, M., Bertrand, E., Du, B., Durga, H., Klaptocz, J., ... & Orrell, M. (2020). A new approach for developing ‘Implementation Plans’ for Cognitive Stimulation Therapy (CST) in low and middle-income countries: Results from the CST-International study. Frontiers in Public Health, 8, 342. doi:10.3389/fpubh.2020.00342
  • Stoner, C. R., Lakshminarayanan, M., Durgante, H., & Spector, A. (2019). Psychosocial interventions for dementia in low- and middle-income countries (LMICs): A systematic review of effectiveness and implementation readiness. Aging & Mental Health, Dec9. doi:10.1080/13607863.2019.1695742
  • Stoner CR, Lakshminarayanan M, Mograbi DC, Vaitheswaran S, Bertrand E, Schimidt Brum P, Durgante H, Ferri CP, Mkenda S, Walker R, Dotchin C, Paddick SM, Chandra M, Krishna M, Du B, Shaji KS, Fisher E, Spector A. (2021) Development and acceptability of a brief, evidence-based Dementia Awareness for Caregivers course in low- and middle-income countries. Dementia. Epub ahead of print. PMID: 34886707. doi: 10.1177/14713012211055316.

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