A Cochrane review [Abstract] 1 included 29 studies with a total of 2599 patients with dementia (24 studies) or mild cognitive impairment (MCI, 5 studies). Most of the studies were conducted in the community setting. There were 15 trials of cognitive behavioural therapies (4 cognitive behavioural therapy CBT, 8 behavioural activation BA, 3 problem-solving therapy PST), 11 trials of supportive and counselling therapies, three trials of mindfulness-based cognitive therapy (MBCT), and one of interpersonal therapy. The comparison groups received either usual care, attention-control education, or enhanced usual care incorporating an active control condition that was not a specific psychological treatment.
Summary of findings for cognitive behavioural therapies T1. Supportive and counselling interventions may have little or no effect on depressive symptoms compared to usual care (SMD -0.05, 95% CI -0.18 to 0.07; 9 trials, n=994). There were very few data on MBCT and interpersonal therapy and the effects are uncertain.
| Outcomes post-treatment | SMD (95% CI) meta-analysis/ relative effect (95% CI) | №of participants(studies) | Certainty of the evidence(GRADE) | Comments |
|---|---|---|---|---|
| Depressive symptomsassessed with: GDS, HDRS, MADRS, PHQ-9, and CSDD(Follow-up 8 weeks to 24 months) | SMD -0.23 (-0.37 to -0.10) | 893(13 RCTs) | B | Higher scores indicate higher symptoms of depression. |
| Depression remission assessed with: MADRS, and DSM-III-R(Follow-up 10 to 12 weeks) | RR 1.84(1.18 to 2.88) | 146(2 RCTs) | C | A RR > 1 favours the intervention group. |
| Anxiety symptoms assessed with: GAI, RAID, and NPI-A(Follow-up 3 months to 15 weeks) | SMD -0.03 (-0.36 to -0.30) | 143(3 RCTs) | D | Higher scores indicate higher symptoms of anxiety. |
| Quality of life assessed with: DEMQOL, QoL-AD, LSI-A, and QoL-AD NH(Follow-up 8 to 15 weeks) | SMD 0.31 (0.13 to 0.50) | 459(7 RCTs) | B | Higher scores indicate better quality of life. |
| Activities of daily living assessed with: ADL-PI, SDS, WHODAS 2.0, B-ADL, ADCS-ADL, BADLS, and UPSA(Follow-up 12 weeks to 2 years) | SMD -0.25 (-0.40 to -0.09) | 680(7 RCTs) | C | Lower scores indicate better performance of ADL. |
| Cognition assessed with MMSE(Follow-up 10 weeks to 2 years) | SMD 0.13 (-0.04 to 0.30) | 535(5 RCTs) | C | Higher scores indicate better cognition. |
Comment: The quality of the evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes) and imprecise results (few patients for each comparison).
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