DESK REVIEWS | 04.06.05. Additional STRiDE questions

DESK REVIEW | 04.06.05. Additional STRiDE questions

The “Clinical Protocol of Therapeutic Guidelines about Alzheimer’s Disease” was developed in 2017 by the Ministry of Health (Brazilian Ministry of Health, 2017c).

Prior to this, the Brazilian Academy of Neurology published consensus papers regarding the diagnosis and treatment of Alzheimer’s disease, such as the “recommendations for diagnosing Alzheimer’s disease in Brazil”, developed in 2005, and the “recommendations in Alzheimer” developed in 2011.


Brazilian Ministry of Health. (2017c). PCDT Alzheimer. Brazilian Ministry of Health.

The clinical practice guideline was developed by Indonesia’s Neurologist Association (PERDOSSI) in 2015 (PERDOSSI, 2015).


PERDOSSI. (2015). Panduan Praktik Klinik: Diagnosis dan Penatalaksanaan Demensia. PERDOSSI.

The clinical practice guides are developed mainly in the Ministry of Health, through the National Centre of Technological Excellence in Health (CENETEC). Their updating depends on the identification and evaluation of new evidence, the opinion of experts, as well as the opinion of the team that developed the guide, the perception of users, and the analysis of the context. As there is no defined time to update it, it will rather depend on these points, as well as on the resources, the availability of time, the methodology used, as well as the collaboration of the institutions involved (Secretaría de Salud, 2015a).


Secretaría de Salud. (2015a). Metodología para la integración de Guías de Práctica Clínica en el Sistema Nacional de Salud.

The private sector guidelines discussed above were developed by the South African Society of Psychiatrists (SASOP) and published in 2013.

These guidelines are evidence-based and mainly developed by healthcare professionals (clinicians and managers). Although specialists and members of public may contribute for their development, once finalised, these documents are not widely available to the public. Thus, many people, including doctors (especially those working in the private sector) do not know about the existence of these guidelines.

No information on this in the guideline (PERDOSSI, 2015).


PERDOSSI. (2015). Panduan Praktik Klinik: Diagnosis dan Penatalaksanaan Demensia. PERDOSSI.


In general terms, it is proposed that the use of clinical practice guidelines should be a national reference to favour clinical and managerial decision-making based on recommendations supported by the best available evidence, aiming to reduce the variability of clinical practice, as well as the use of unnecessary or ineffective interventions, to facilitate the treatment of patients with the maximum benefit, with a lower risk and an acceptable cost (CENETEC, 2016).


CENETEC. (2016). Dirección de integración de Guías de Práctica Clìnica. CENETEC.


These guidelines currently refer to the private healthcare setting in South Africa with the expectation that various stakeholders (and hopefully policy makers and administrators) will make use of them. Practitioners are expected to use guidelines with caution and continue to be critical of approaches, maintaining their own level of expertise and keeping abreast of developments of evidence-based approaches within the field (Emsley et al., 2013).


Emsley, R., & Seedat, S. (2013). The South African Society of Psychiatrists (SASOP) treatment guidelines for psychiatric disorders. South African Journal of Psychiatry, 19(3), 127–196.

Yes, but mainly in rural and remote areas.

Mexico has a strong history of use of traditional medicine, based on different needs or services: pregnancy and deliveries, bone-healers, traditional medics. These traditions are a mix of pre-Hispanic indigenous cultures and beliefs, as well as the use of local herbs, remedies, etc., and the practices brought by the Spanish which have been widely documented (Lozoya X & Zolla, 1984). These practices are different between states and regions and their prevalence of use is highly correlated with higher percentage of rural population/localities, some of them presenting a wide diversity of “remedies”. For example, one of the first studies of traditional medicine practices in the State of Chiapas (southeast of the country) documented the use of 206 plants for a huge diversity of ailments and diseases such as stomach ache, burns, cough, wounds, head ache, tuberculosis, diabetes, diuretics, empacho (colloquial for indigestion) or verguenza (literal translation, shame) (Lozoya X & Zolla, 1984). Since these first studies, many more have documented the use of alternative or complementary medicine use in the country. Notwithstanding the fact that most likely some “remedies” are being used to manage or treat symptoms of dementia like memory loss, no information or published studies are identified on the use of these alternative practices to treat or manage dementia.


Lozoya X, & Zolla C. (1984). Medicina Tradicional en México. Boletín de La Oficina Sanitaria Panamericana (OSP), 96(4).

South Africa is a multi-cultural country with a myriad of beliefs and practices. The use of traditional medicine and healers is a socially accepted practice amongst some cultures in the country, with the belief that the cause of some conditions/diseases/misfortune (especially mental, emotional and neurological conditions) is social (Mkhonto & Hanssen, 2018). Traditional healers are believed to be able to diagnose and treat conditions caused by social misconduct, spirits, spells and witchcraft where biomedicine is unable to ‘identify’ and treat (Audet et al., 2017). Traditional healers speak the local languages of the person seeking help, they often live within close proximity, they are easily available for consultation and they are believed to spend more time explaining diagnoses, causes and treatments to patients – hence preferred over mainstream biomedical approaches or used in conjunction with bio-medicine (Audet et al., 2017). A review of studies on plants used to treat Alzheimer’s disease in South Africa has found the following plants used to treat memory loss in the form of aqueous or ethanol extracts (Stafford et al., 2008), (see p. 533 for more detail):

  • Malva parviflora (leaves),
  • Boophone disticha (L.f.) Herb. (leaves and bulbs),
  • Albizia adianthifolia (Schumach.) W. Wright (stem bark),
  • Albizia suluensis Gerstner (root bark) and
  • Crinum moorei f. (bulbs) for acetylcholinesterase (AChE) inhibitory activity.

Audet, C. M., Ngobeni, S., Graves, E., & Wagner, R. G. (2017). Mixed methods inquiry into traditional healers’ treatment of mental, neurological and substance abuse disorders in rural South Africa. PLoS ONE, 12(2), 1–14.

Mkhonto, F., & Hanssen, I. (2018). When people with dementia are perceived as witches. Consequences for patients and nurse education in South Africa. Journal of Clinical Nursing, 27(1–2), e169–e176.

Stafford, G. I., Pedersen, M. E., van Staden, J., & Jäger, A. K. (2008). Review on plants with CNS-effects used in traditional South African medicine against mental diseases. Journal of Ethnopharmacology, 119(3), 513–537.

Natural medicines are used by the population, although there is no evidence of their effect. Some of them are:  ginkgo biloba, selegiline, vitamin E, and omega 3 (Brazilian Alzheimer’s Association, 2019). Faith healers are not widely used in Brazil for treating and managing dementia, in some cases, sporadic prayer groups may exist for that aim.


Brazilian Alzheimer’s Association. (2019). ABRAZ. ABRAZ.

As previously mentioned, traditional medicine is widely used. No studies are yet available/published on its particular use for dementia and its related symptoms.

Natural medicines are communicated by “word of mouth” and can be purchased in pharmacies or natural products stores without prescription. Traditional/Faith healers are not common in Brazil, but there are the so called ‘benzedeiras’ (blessers), who were common in the past, and generally prescribe teas or pray for someone who is ill.

Subjectively, the use of traditional medicine and spiritual healers seems to be quite popular among the general public. Pratono & Maharani (2018) report the preference of many older people in the Malang Regency of consulting traditional medicine/healers as opposed to modern healthcare providers, although this work did not specifically focus on dementia. There has been no information on how traditional or alternative medicine for dementia are communicated or how the patients access them. However, other study on traditional medicine for other health problems reported that most patients find the information about it from family (33.3%), friends (25%), religious group (22.2%), mass media (16.7%), and neighbours (2.7%) (Devy & Aji, 2006).


Devy, S. R., & Aji, B. (2006). Faktor Predisposing, Enabling dan Reinforcing pada Pasien di Pengobatan Alternatif Radiesthesi Medik Metode Romo H. Loogman di Purworejo Jawa Tengah. Indonesian Journal of Public Health, 3(2), 35–44.

Pratono, A. H., & Maharani, A. (2018). Long-Term Care in Indonesia: The Role of Integrated Service Post for Elderly. Journal of Aging and Health, 30(10), 1556–1573.