Managing depressive symptoms in people with mild cognitive impairment and mild dementia with a multicomponent psychotherapy intervention: a randomized controlled trial

Abstract

Objective: To evaluate the feasibility and effectiveness of the CORDIAL program, a psychosocial intervention consisting of cognitive behavioral therapy (CBT), cognitive rehabilitation, and reminiscence to manage depressive symptoms for people with mild cognitive impairment (MCI) or dementia. Design: We conducted a randomized controlled trial, based on a two-group (intervention and control), pre-/post-intervention design. Setting: Participants were recruited from five different old age psychiatry and memory clinics at outpatients’ hospitals. Participants: Hundred and ninety-eight people with MCI or early-stage dementia were included. Intervention: The intervention group (n = 100) received 11 individual weekly sessions of the CORDIAL program. This intervention includes elements from CBT, cognitive rehabilitation, and reminiscence therapy. The control group (n = 98) received treatment-as-usual. Measurements: We assessed Montgomery–Åsberg Depression Rating Scale (MADRS) (main outcome), Neuropsychiatric Inventory Questionnaire, and Quality of Life in Alzheimer’s disease (secondary outcomes) over the course of 4 months and at a 10-month follow-up visit. Results: A linear mixed model demonstrated that the depressive symptoms assessed by MADRS were significantly more reduced in the intervention groups as compared to the control group (p < 0.001). The effect persisted for 6 months after the intervention. No significant differences between groups were found in neuropsychiatric symptoms or quality of life. Conclusion: Our multicomponent intervention, which comprised 11 individual sessions of CBT, cognitive rehabilitation, and reminiscence therapy, reduced depressive symptoms in people with MCI and dementia.

The effectiveness of non‐pharmacological interventions targeting neuropsychiatric symptoms among persons with preclinical and mild dementia: A systematic review and network meta‐analysis

“…The positive effects were attributable to the active application of psycho‐behavioral strategies to boost patients' outlook and emotional control. Behavioral activation emphasizes life engagement by reconstructing their daily schedule with enjoyable activities that they were less able to pursue due to their compromised cognitive abilities 67,72,91 . Moreover, the progressive nature of dementia leads patients' psychological state into a downward spiral 91 .…”

“…A high level of performance bias and insufficient reporting of methods were the major concerns. Twelve studies indicated that no blinding strategy was adopted, [58][59][60][61][62][63][64][65][66][67][68][69] and the others had inadequate documentation of the blinding strategy. [70][71][72][73][74][75][76][77][78] Detection bias was unclear in six studies due to missing assessor blinding status.…”

“…59,66,70,[74][75][76] One study 63 did not blind the post-test outcome assessors, resulting in a high risk of detection bias. For selection bias, unclear methods for allocation concealment (n ¼ 11) [59][60][61][65][66][67]69,73,74,76,77 and the generation of random sequences (n ¼ 6) 59,60,65,66,69,76 were reported. Four studies 65,70,75,76 had unclear risks of attrition bias due to missing reasons for participant dropout.…”

“…Table S2 outlines the study characteristics. The included studies were grouped into four categories: (1) art-based intervention (n ¼ 1) 73 incorporating drawing; (2) psycho-behavioral educative intervention (n ¼ 9) 62,64,[68][69][70][75][76][77][78] to enhance participants' understanding of their condition and engage them in positive thinking, effective coping, behavioral activation, a more active lifestyle, and better social relationships; (3) cognitive training (n ¼ 4) 58,61,63,66 consisting of strategies to compensate for cognitive deficits; and (4) multimodal interventions (n ¼ 7) 59,60,65,67,71,72,74 including a combination of cognitive training and psycho-behavioral educative intervention. The funnel plot (Table S3) indicated that two studies 62,72 were beyond the inverted funnel, which implied potential publication bias.…”

“…Seven studies 59,60,65,67,71,72,74 compared multimodal interventions (n ¼ 520) to attention control using phone calls, 71,74 waitlist control 59,65,72 and usual care, 60,67 with dosage ranging from 8 to 120 h. Six studies measured depression using either the Beck Depression Inventory, 71 Montgomery-Åsberg Depression Rating Scale, 67 GDS 59,65 or CSDD. 72,74 Data pooling of five studies ( Figure 3 (Figure 4).…”