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  • Print publication year: 2020
  • Online publication date: January 2020

Chapter 9 - Psychotherapy and Cognitive Disorders

from Part 3 - Special Topics in Psychotherapy in Later Life

Summary

This chapter reviews the most researched psychotherapeutic interventions for individuals with cognitive impairment (CI) and common symptoms targeted by these interventions. Elements of assessment and psychotherapy modifications to consider when working with individuals with dementia are also discussed. Assessment components might include clarification of medical symptom overlap, collateral information, assessment instruments developed for individuals with cognitive difficulties, and incorporating consultation with other specialties. In general, clinicians should consider using simplified skills, increasing the number and frequency of sessions, shortening sessions, reducing group size, and providing more guidance during skill instruction and practice when working with individuals with cognitive impairments. Despite their promise and recommendations for their use, nonpharmacological therapies for individuals with dementia have a small research base and warrant continued development and evaluation.

1.World Health Organization. Dementia. Retrieved from: www.who.int/news-room/fact-sheets/detail/dementia (October 18, 2018).
2.American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
3.Kales, HC, Gitlin, LN, Lyketsos, CG. Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. J Am Geriatr Soc. 2014;62:762769.
4.Rehm, IC, Stargatt, J, Willison, AT, Reser, MP, Bhar, SS. Cognitive behavioral therapy for older adults with anxiety and cognitive impairment: Adaptations and illustrative case study. J Cogn Psychother. 2017;31(1):7288.
5.Folstein, MF, Folstein, SE, McHugh, PR. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12 :189198.
6.Nasreddine, ZS, Phillips, NA, Bédirian, V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005 ; 53(4):695699.
7.Seignourel, PJ, Kunik, ME, Snow, L, Wilson, N, Stanley, M. Anxiety in dementia: a critical review. Clin Psychol Rev. 2008;28:10711082.
8.Lopez, O. L., Becker, I. T., Sweet, R. A.. Non-cognitive symptoms in mild cognitive impairment subjects. Neurocase. 2005;11:6571.
9.Enache, D, Winblad, B, Aarsland, D. Depression in dementia: epidemiology, mechanisms, and treatment. Curr Opin Psychiatry. 2011;24(6):461472.
10.Palmer, K, Berger, AK, Monastero, R, Winblad, B, Bäckman, L, Fratiglioni, L. Predictors of progression from mild cognitive impairment to Alzheimer disease. Neurology. 2007;68:15961602.
11.Solfrizzi, V, D’Introno, A, Colacicco, AM, et al. Incident occurrence of depressive symptoms among patients with mild cognitive impairment–the Italian Longitudinal Study on Aging. Dement Geriatr Cogn Disord. 2007;24:5564.
12.Neville, C, Teri, L. Anxiety, anxiety symptoms, and associations among older people with dementia in assisted-living facilities. Int J Ment Health Nurs. 2011;20:195201.
13.Schultz, SK, Hoth, A, Buckwalter, K. Anxiety and impaired social function in the elderly. Ann Clin Psychiatry. 2004;16(1):4751.
14.Gibbons, LE, Teri, L, Logsdon, R, et al. Anxiety symptoms as predictors of nursing home placement in patients with Alzheimer’s disease. J Clin Geropsychol. 2002;8(4):335342.
15.Lyketsos, CG, Carillo, MC, Ryan, JM, et al. Neuropsychiatric symptoms in Alzheimer’s disease. Alzheimers Dement. 2011;7:532539. doi:10.1016/j.jalz.2011.05.2410
16.Shankar, KK, Walker, M, Frost, D, et al. The development of a valid and reliable scale for rating anxiety in dementia (RAID). Aging Ment Health. 1999;3:3949.
17.Alexopoulos, GS, Abrams, RC, Young, RC, Shamoian, CA. Cornell scale for depression in dementia. Biol Psychiatry. 1998;23 :271–84.
18.Teri, L, Gallagher-Thompson, D. Cognitive-behavioral interventions for treatment of depression in Alzheimer’s patients. Gerontologist. 1991;31(2):413416.
19.Hunt, LJ, Covinsky, KE, Yaffe, K, et al. Pain in community-dwelling older adults with dementia: results from the National Health and Aging Trends Study. J Am Geriatr Soc. 2015;63:15031511.
20.Husebo, BS, Achterberg, WP, Lobbezoo, F, et al. Pain in patients with dementia: A review of pain assessment and treatment challenges. Norsk Epidemiologi. 2012;22(2):243251.
21.Kraus, CA, Seignourel, P, Balasubramanyam, V, et al. Cognitive behavioral treatment for anxiety in patients with dementia: two case studies. J Psychiatr Pract. 2008;14:186192.
22.Stanley, MA, Calleo, J, Bush, AL, et al. The peaceful mind program: a pilot test of a cognitive-behavioral therapy-based intervention for anxious patients with dementia. Am J Geriatr Psychiatry. 2013;21(7):696708. doi: 10.1016/j.jagp.2013.01.007
23.Paukert, AL, Kraus-Schuman, C, Wilson, N, et al. The peaceful mind manual: a protocol for treating anxiety in persons with dementia. Behav Modif. 2013;37(5):631664.
24.Kipling, T, Bailey, M, Charlesworth, G. The feasibility of a cognitive behavioural therapy group for men with mild/moderate cognitive impairment. Behav Cogn Psychother. 1999;27(02):189193.
25.Koder, DA. Treatment of anxiety in the cognitively impaired elderly: Can cognitive-behavior therapy help? Int Psychogeriatr. 1998:10(02):173182.
26.García-Alberca, JM. Cognitive-behavioral treatment for depressed patients with Alzheimer’s disease. An open trial. Arch Gerontol Geriatr. 2017;71:18.
27.Spector, A, Charlesworth, G, King, M, et al. Cognitive-behavioral therapy for anxiety in dementia: pilot randomized controlled trial. Br Jf Psychiatry. 2015;206:509516. doi:10.1192/bjp.bp.113.140087
28.Teri, L, Logsdon, RG, Uomoto, J, McCurry, SM. Behavioral treatment of depression in dementia: a controlled clinical trial. J Gerontol. 1997;52B(4):159166.
29.Snow, AL, Jacobs, ML. Pain in persons with dementia and communication impairment. In: Pachana, NA, Laidlaw, K, editors. The Oxford handbook of clinical geropsychology. New York: Oxford University Press; 2014. p. 876908.
30.Clifford, PA, Cipher, DJ, Roper, KD, Snow, AL, Molinari, V. Cognitive-behavioral interventions for long-term care residents with physical and cognitive disabilities. In: Gallagher-Thompson, D, Steffen, AM, Thompson, LW, editors. Handbook of behavioral and cognitive therapies with older adults. New York: Springer; 2008. p. 76101.
31.Cipher, DJ, Clifford, PA, Roper, KD. The effectiveness of geropsychological treatment in improving pain, depression, behavioral disturbances, functional disability, and health care utilization in long-term care. Clin Gerontol. 2007;30(3):2340.
32.Charlesworth, G, Sadek, S, Schepers, A, Spector, A. Cognitive behavior therapy for anxiety in people with dementia: a clinician guideline for a person-centered approach. Behav Modif. 2015;39(3):390412.
33.Nezu, AM, Nezu, CM. Problem-solving training home based primary care treatment manual. Washington, DC: Veteran’s Health Administration; 2015.
34.Kiosses, DN, Ravdin, LD, Gross, JJ, et al. Problem adaptation therapy for older adults with major depression and cognitive impairment: A randomized clinical trial. JAMA Psychia. 2015;72(1):2230.
35.Renn, BN, Areán, PA. Psychosocial treatment options for major depressive disorder in older adults. Curr Treat Options Psychiatry. 2017;4(1):112.
36.Alexopoulos, G, Raue, P, Kiosses, D, et al. Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction effect on disability. Arch Gen Psychiatry. 2011;68(1):3341.
37.Alexopoulos, G, Raue, P, Arean, P. Problem-solving therapy versus supportive therapy in geriatric major depression with executive dysfunction. Am J Geriat Psychiatry. 2003;11(1):4652.
38.Arean, PA, Raue, P, Mackin, RS, et al. Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. Am J Psychiatry. 2010;167(11):13911398.
39.Gustavson, KA, Alexopoulos, GS, Niu, GC, et al. Problem-solving therapy reduces suicidal ideation in depressed older adults with executive dysfunction. Am J Geriatr Psychiatry. 2016;24(1):1117.
40.Arean, P, Hegel, M, Vannoy, S, et al. Effectiveness of problem-solving therapy for older, primary care patients with depression: results from the IMPACT project. Gerontologist. 2008;48(3):311323.
41.Choi, NG, Marti, CN, Bruce, ML, et al. Six-month postintervention depression and disability outcomes of in-home telehealth problem-solving therapy for depressed, low-income homebound older adults. Depress Anxiety. 2014;31:653661.
42.Kiosses, DN, Alexopoulos, GS. Problem-solving therapy in the elderly. Curr Treat Options Psychiatry. 2014;1(1):1526.
43.Gellis, ZD, Nezu, AM. Integrated depression care for homebound medically ill older adults: using evidence-based problem-solving therapy. In: Sorocco, KH, Lauderdale, S, editors. Cognitive behavior therapy with older adults: innovations across care settings. New York: Springer; 2011. p. 391420.
44.Arean, PA, Raue, P, Mackin, RS, et al. Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. Am J Psychiatry. 2010;167(11):13911398.
45.Kabat-Zinn, J. Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Dell; 1990.
46.Serpa, JG, Taylor, SL, Tillisch, K. Mindfulness-based stress reduction (MBSR) reduces anxiety, depression, and suicidal ideation in veterans. Med Care. 2014;52:S19S24.
47.Wong, WP, Coles, J, Chambers, R, et al. The effects of mindfulness on older adults with mild cognitive impairment. J Alzheimers Dis Rep. 2017;1(1):181193.
48.Wells, RE, Kerr, CE, Wolkin, J. Meditation for adults with mild cognitive impairment: a pilot randomized trial. J Am Geriatr Soc. 2013;61(4):642645.
49.Churcher Clarke, A, Chan, JMY, Stott, J, et al. An adapted mindfulness intervention for people with dementia in care homes: feasibility pilot study. Int J Geriatr Psychiatry. 2017;32(12):e123e131.
50.Kovach, CR, Evans, C, Sattell, L, et al. Feasibility and pilot testing of a mindfulness intervention for frail older adults and individuals with dementia. Res Gerontol Nurs. 2018;11(3):137150.
51.Paller, KA, Creery, JD, Florczak, SM, et al. Benefits of mindfulness training for patients with progressive cognitive decline and their caregivers. Am J Alzheimers Dis Other Dement. 2014;30(3):257267.
52.Wetherell, JL, Hershey, T, Hickman, S, et al. Mindfulness-based stress reduction for older adults with stress disorders and neurocognitive difficulties. J Clin Psychiatry. 2017;78(7):e734e743.
53.McBee, L. Mindfulness practice with the frail elderly and their caregivers. Top Geriatr Rehabil. 2003;19(4):257264.
54.Subramanian, P, Woods, B. The impact of individual reminiscence therapy for people with dementia: systematic review. Expert Rev Neurother. 2012:12(5):545555.
55.Haight, BK, Gibson, F, Michel, Y. The Northern Ireland life review/life storybook project for people with dementia. Alzheimers Dement. 2006;2:5658.
56.Subramanian, P, Woods, B, Whitaker, C. Life review and life story books for people with mild to moderate dementia: a randomized controlled trial. Aging Ment Health. 2014;18(3):363375.
57.Thorgrimsen, L, Schweitzer, P, Orrell, M. Evaluating reminiscence for people with dementia: a pilot study. Arts Psychother. 2002;29(2):9397.
58.Bohlken, J, Weber, SA, Siebert, A, et al. Reminiscence therapy for depression in dementia. GeroPsych. 2017;30:145151. doi: 10.1024/1662-9647/a000175
59.Woods, B, Spector, AE, Jones, CA, Orrell, M, Davies, SP. Reminiscence therapy for dementia. Cochrane Database Syst Rev. 2009;2:136.
60.Moniz Cook, E, De Vugt, M, Verhey, F, James, I. Functional analysis‐based interventions for challenging behavior in dementia. Cochrane Database Syst Rev. 2009;3:17.
61.Cummings, JL, Mega, MS, Gray, K, et al. The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44:23082314.
62.Cohen-Mansfield, J. Nonpharmacologic interventions for inappropriate behaviors in dementia: a review, summary, and critique. Am J Geriatr Psychiatry. 2001;9(4):361381.
63.McGee, JS, Bratkovich, KL. Assessment and cognitive-behaviorally oriented interventions for older adults with dementia. In: Sorocco, KH, Lauderdale, S, editors). Cognitive behavior therapy with older adults: innovations across settings. New York: Springer; 2011. p. 219261.
64.Karel, MJ, Teri, L, McConnell, E, Visnic, S, Karlin, BE. Effectiveness of expanded implementation of STAR-VA for managing dementia-related behaviors among veterans. Gerontologist. 2015;56(1):126134. doi:10.1093/geront/gnv068