Z-CHAD | Neuronetwork

What is the Z-CHAD study? 

In the Zambian Cohort for Healthy Aging & Dementia (Z-CHAD) study, investigators at the NeuroNetwork for Emerging Therapies are conducting a population-based study in partnership with clinicians, academics, and public health officials from both Zambia and the United States. Funded by grants from the Center to Accelerate Population Research in Alzheimer’s, the African Studies Center, Global REACH, and the Center for Global Health Equity –- all University of Michigan organizations – this study aims to assess the prevalence of cognitive impairment among adults in and around Lusaka, the capital of Zambia.  

Why the Z-CHAD study? 

Dementia presents significant challenges for patients and families worldwide due to the limited effectiveness of available treatments and the often inadequate support for caregivers as the disease progresses. This issue is particularly pronounced in low- and middle-income countries, which are home to 60% of individuals living with dementia. Zambia, a Sub-Saharan African country with approximately 18 million residents, exemplifies these challenges. As Zambia’s aging population grows, so does the prevalence of risk factors associated with dementia. Additionally, Zambians face unique issues, such as undernutrition and HIV infection, which can also contribute to dementia. However, there is a lack of data on dementia prevalence in Zambia, likely due to limited community awareness and a shortage of healthcare providers skilled in diagnosing the condition. This gap in information hinders the development of effective programs to address the disease. The Z-CHAD study aims to provide baseline data on the burden of dementia and its risk factors, enabling the creation of targeted interventions to support Zambian patients and their caregivers.   

Key areas: 

Determine disease burden and risk factors 

In countries like Zambia, limited healthcare resources have historically been focused on combating infectious diseases and reducing maternal and childhood mortality, often at the expense of addressing chronic, non-communicable diseases. Consequently, there is a shortage of healthcare workers trained to recognize and diagnose dementia, resulting in low awareness, delayed diagnoses, and frequent misdiagnoses. To address this issue, we are conducting door-to-door visits in Lusaka to identify and screen adults over the age of 55 for dementia and related risk factors.    

Appropriately assessing dementia 

While there are clearly defined criteria to diagnose someone with dementia, many of the tools used to screen for dementia and dementia symptoms were developed for English-speaking audiences and may not be appropriate for Zambia. We are collaborating with teams working in low and lower middle-income countries around the world to ensure we can accurately assess cognitive impairment in the Zambian population where over 70 dialects are spoken. These efforts are leading to modifications in dementia tools that are directly informing our understanding and assessment of dementia symptoms among US adults.

Caregiver support 

Upon receiving a diagnosis of dementia, patients and caregivers frequently find themselves without adequate support, as there are few elder care centers, social workers, or therapists available. Additionally, the absence of caregiver education and support programs places substantial financial and social burdens on caregivers. Our aim is to identify the specific challenges caregivers face in Zambia and determine how to effectively address these issues.  

Community healthcare workers 

Community healthcare workers (CHWs) are lay members of the community who have been trained to offer valuable healthcare education and services within their communities. This deep understanding of local contexts and established trust within their communities make them ideal candidates for raising awareness, screening for dementia, and supporting dementia care. We are developing a community-based model that utilizes CHWs to screen for dementia and its risk factors among older Zambians. Preliminary findings suggest that CHWs can be effectively trained to administer dementia screening measures, potentially serving as a crucial resource in dementia care in Zambia.