Dora Kanellopoulos1, Paul Rosenberg2, Lisa D Ravdin3, Dalynah Maldonado4, Nimra Jamil2, Crystal Quinn5, Dimitris N Kiosses1. 1. Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, New York, NY, USA. 2. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 3. Department of Neurology & Neuroscience, Weill Cornell Medicine, New York, NY, USA. 4. Department of Medicine/Rheumatology, Albert Einstein College of Medicine, Bronx, NY, USA. 5. The Graduate Center, City University of New York, New York, NY, USA.
Abstract
OBJECTIVES: Antidepressants have limited efficacy in older adults with depression and cognitive impairment, and psychosocial interventions for this population have been inadequately investigated. Problem Adaptation Therapy (PATH) is a psychosocial intervention for older adults with major depression, cognitive impairment, and disability. DESIGN: This study tests the efficacy of PATH versus Supportive Therapy for Cognitively Impaired Older Adults (ST-CI) in reducing depression (Montgamery Asberg Depression Rating Scale [MADRS]) and disability (World Health Organization Disability Assessments Schedule-II [WHODAS-II]) and improving cognitive outcomes (Mini Mental State Examination [MMSE]) over 24 weeks (12 weeks of treatment and 12-week post-treatment follow-up). SETTING: Participants were recruited through collaborating community agencies of Weill Cornell Institute of Geriatric Psychiatry. Both interventions and all research assessments were conducted at home. PARTICIPANTS: Thirty-five older adults (age ≥ 65 years) with major depression and cognitive impairment no dementia (CIND). INTERVENTIONS: PATH aims to increase emotion regulation by incorporating a problem-solving approach, teaching compensatory strategies, and inviting caregiver participation. Supportive Therapy aims to facilitate the expression of affect, as well as promote empathy. MEASUREMENTS: Depression was measured using the MADRS, disability using the WHODAS-II, and cognition using the MMSE. RESULTS: PATH participants showed significantly greater reduction in MADRS total score (7.04 points at 24 weeks, treatment group by time interaction: F[1,24.4] = 7.61, p = 0.0108), greater improvement in MMSE total score (2.30 points at 24 weeks, treatment group by time interaction: F[1,39.8] = 13.31, p = 0.0008), and greater improvement in WHODAS-II total score (2.95 points at 24 weeks, treatment group by time interaction: F[1,89] = 4.93, p = 0.0290) than ST-CI participants over the 24-week period. CONCLUSIONS: PATH participants had better depression, cognitive, and disability outcomes than ST-CI participants over 6 months. PATH may provide relief to depressed older adults with CIND who currently have limited treatment options.
OBJECTIVES: Antidepressants have limited efficacy in older adults with depression and cognitive impairment, and psychosocial interventions for this population have been inadequately investigated. Problem Adaptation Therapy (PATH) is a psychosocial intervention for older adults with major depression, cognitive impairment, and disability. DESIGN: This study tests the efficacy of PATH versus Supportive Therapy for Cognitively Impaired Older Adults (ST-CI) in reducing depression (Montgamery Asberg Depression Rating Scale [MADRS]) and disability (World Health Organization Disability Assessments Schedule-II [WHODAS-II]) and improving cognitive outcomes (Mini Mental State Examination [MMSE]) over 24 weeks (12 weeks of treatment and 12-week post-treatment follow-up). SETTING:Participants were recruited through collaborating community agencies of Weill Cornell Institute of Geriatric Psychiatry. Both interventions and all research assessments were conducted at home. PARTICIPANTS: Thirty-five older adults (age ≥ 65 years) with major depression and cognitive impairment no dementia (CIND). INTERVENTIONS: PATH aims to increase emotion regulation by incorporating a problem-solving approach, teaching compensatory strategies, and inviting caregiver participation. Supportive Therapy aims to facilitate the expression of affect, as well as promote empathy. MEASUREMENTS: Depression was measured using the MADRS, disability using the WHODAS-II, and cognition using the MMSE. RESULTS: PATH participants showed significantly greater reduction in MADRS total score (7.04 points at 24 weeks, treatment group by time interaction: F[1,24.4] = 7.61, p = 0.0108), greater improvement in MMSE total score (2.30 points at 24 weeks, treatment group by time interaction: F[1,39.8] = 13.31, p = 0.0008), and greater improvement in WHODAS-II total score (2.95 points at 24 weeks, treatment group by time interaction: F[1,89] = 4.93, p = 0.0290) than ST-CI participants over the 24-week period. CONCLUSIONS: PATH participants had better depression, cognitive, and disability outcomes than ST-CI participants over 6 months. PATH may provide relief to depressed older adults with CIND who currently have limited treatment options.
Authors: Deanna M Barch; Gina DʼAngelo; Carl Pieper; Consuelo H Wilkins; Kathleen Welsh-Bohmer; Warren Taylor; Keith S Garcia; Kenneth Gersing; P Murali Doraiswamy; Yvette I Sheline Journal: Am J Geriatr Psychiatry Date: 2012-08 Impact factor: 4.105
Authors: Dimitris N Kiosses; Lisa D Ravdin; James J Gross; Patrick Raue; Nabil Kotbi; George S Alexopoulos Journal: JAMA Psychiatry Date: 2015-01 Impact factor: 21.596
Authors: Robert Howard; Patrick Phillips; Tony Johnson; John O'Brien; Bart Sheehan; James Lindesay; Peter Bentham; Alistair Burns; Clive Ballard; Clive Holmes; Ian McKeith; Robert Barber; Tom Dening; Craig Ritchie; Rob Jones; Ashley Baldwin; Peter Passmore; David Findlay; Alan Hughes; Ajay Macharouthu; Sube Banerjee; Roy Jones; Martin Knapp; Richard G Brown; Robin Jacoby; Jessica Adams; Mary Griffin; Richard Gray Journal: Int J Geriatr Psychiatry Date: 2010-09-16 Impact factor: 3.485
Authors: Grace J Lee; Po H Lu; Xue Hua; Suh Lee; Stephanie Wu; Ken Nguyen; Edmond Teng; Alex D Leow; Clifford R Jack; Arthur W Toga; Michael W Weiner; George Bartzokis; Paul M Thompson Journal: Biol Psychiatry Date: 2012-02-08 Impact factor: 13.382
Authors: P Murali Doraiswamy; K Ranga Rama Krishnan; Thomas Oxman; Lawrence R Jenkyn; David J Coffey; Tal Burt; Cathryn M Clary Journal: J Gerontol A Biol Sci Med Sci Date: 2003-12 Impact factor: 6.053
Authors: Rishi K Bhalla; Meryl A Butters; James T Becker; Patricia R Houck; Beth E Snitz; Oscar L Lopez; Howard J Aizenstein; Ketki D Raina; Steven T DeKosky; Charles F Reynolds Journal: Am J Geriatr Psychiatry Date: 2009-04 Impact factor: 4.105
Authors: Zvi D Gellis; Jean McGinty; Amy Horowitz; Martha L Bruce; Elizabeth Misener Journal: Am J Geriatr Psychiatry Date: 2007-09-10 Impact factor: 4.105
Authors: Emerald Jenkins; Binu Koirala; Tamar Rodney; Ji Won Lee; Valerie T Cotter; Sarah L Szanton; Janiece L Taylor Journal: Geriatr Nurs Date: 2021-07-16 Impact factor: 2.525