450 Psychological treatments for depression and anxiety effective in dementia and mild cognitive impairment

February 12, 2015

written by Brian R McAvoy

Clinical question
How effective are psychological treatments in reducing depression and anxiety in dementia and mild cognitive impairment?

Bottom line
Psychological treatments added to usual care reduced symptoms of depression and clinician-rated anxiety for people with dementia. It was not possible to tell whether psychological treatments had an effect on patients' quality of life, ability to perform activities of daily living, overall psychiatric symptoms or cognition, or on carers’ self-rated depressive symptoms; most studies did not measure these outcomes. The psychological treatments used were based on established psychological models, such as cognitive behavioural therapy, counselling and interpersonal psychodynamic therapy. In 2 trials, the psychological treatment was combined with other interventions. Psychological treatments for people with dementia appeared to be safe, with no adverse events reported in the literature.

Caveat
There were only a small number of studies, and there was variation between them in the type and duration of psychological treatment. There were no trials of participants with mild cognitive impairment. Five of the 6 trials were at unclear or high risk of bias due to uncertainties around randomisation, blinding and selective reporting of results.

Context
Symptoms of depression and anxiety are common in people with dementia and mild cognitive impairment. Although treatment of these symptoms is widely recommended in guidelines, the best way to do this is not clear. Drugs are thought to have limited effectiveness in this context and carry the risk of significant side effects. Psychological treatments can be adapted for use with people with cognitive impairment and may offer an alternative.

Cochrane Systematic Review
Orgeta V et al. Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Reviews. 2014, Issue 1. Art. No.: CD009125.DOI: 10.1002/14651858. CD009125.pub2. This review contains 6 studies involving 439 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.