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Evidence summaries

Psychological Treatments for Depression and Anxiety in Dementia

Cognitive behavioural therapies may benefit people with dementia or mild cognitive impairment by reducing depressive symptoms. Level of evidence: "C"

Summary

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.

Cognitive behavioural therapies compared to treatment as usual for depression and anxiety for people with dementia and MCI.

Outcomes post-treatmentSMD (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)BHigher 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)CA 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)DHigher 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)BHigher 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)CLower 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)CHigher 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).

Clinical comments

Note

Date of latest search:

References

  • Orgeta V, Leung P, Del-Pino-Casado R et al. Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database Syst Rev 2022;4:CD009125. [PubMed]

Primary/Secondary Keywords