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Depression, cognitive, and functional outcomes of Problem Adaptation Therapy (PATH) in older adults with major depression and mild cognitive deficits

  • Dora Kanellopoulos (a1), Paul Rosenberg (a2), Lisa D. Ravdin (a3), Dalynah Maldonado (a4), Nimra Jamil (a2), Crystal Quinn (a5) and Dimitris N. Kiosses (a1)...

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.

Copyright

Corresponding author

Correspondence should be addressed to: Dimitris N. Kiosses, Weill-Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, 21 Bloomingdale Road, White Plains, NY 10605, USA. Phone: +1 914 997 4381; Fax: +1 914 682 5430. Email: dkiosses@med.cornell.edu.

References

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Alexopoulos, G. S. (2002). Frontostriatal and limbic dysfunction in late-life depression. The American Journal of Geriatric Psychiatry, 10, 687695.
Alexopoulos, G. S., Kiosses, D. N., Heo, M., Murphy, C. F., Shanmugham, B. and Gunning-Dixon, F. (2005). Executive dysfunction and the course of geriatric depression. Biological Psychiatry, 58, 204210.
Alexopoulos, G. S. et al. (2011). Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability. Archives of General Psychiatry, 68, 3341.
Arean, P. A., Raue, P., Mackin, R. S., Kanellopoulos, D., McCulloch, C. and Alexopoulos, G. S. (2010). Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. American Journal of Psychiatry, 167, 13911398.
Arve, S., Tilvis, R. S., Lehtonen, A., Valvanne, J. and Sairanen, S. (1999). Coexistence of lowered mood and cognitive impairment of elderly people in five birth cohorts. Aging Clinical and Experimental Research, 11, 9095.
Barch, D. M. et al. (2012). Cognitive improvement following treatment in late-life depression: relationship to vascular risk and age of onset. The American Journal of Geriatric Psychiatry, 20, 682690.
Bhalla, R. K. et al. (2009). Patterns of mild cognitive impairment after treatment of depression in the elderly. The American Journal of Geriatric Psychiatry, 17, 308316.
Blazer, D. (2019). Measuring and intervening to instill purpose in life for older adults to prevent cognitive decline. The American Journal of Geriatric Psychiatry, 27, 602603.
Butters, M. A. et al. (2000). Changes in cognitive functioning following treatment of late-life depression. American Journal of Psychiatry, 157, 19491954.
Cacciatore, F. et al. (1998). Morbidity patterns in aged population in southern Italy. A survey sampling. Archives of gerontology and geriatrics, 26, 201213.
Cooper, C., Sommerlad, A., Lyketsos, C. G. and Livingston, G. (2015). Modifiable predictors of dementia in mild cognitive impairment: a systematic review and meta-analysis. American Journal of Psychiatry, 172, 323334.
Culang, M. E. et al. (2009). Change in cognitive functioning following acute antidepressant treatment in late-life depression. The American Journal of Geriatric Psychiatry, 17, 881888.
Devanand, D. P. et al. (2003). Sertraline treatment of elderly patients with depression and cognitive impairment. International Journal of Geriatric Psychiatry, 18, 123130.
Doraiswamy, P. M. et al. (2003). Does antidepressant therapy improve cognition in elderly depressed patients? The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 58, M1137M1144.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Ganguli, M., Dodge, H. H. and Mulsant, B. H. (2002). Rates and predictors of mortality in an aging, rural, community-based cohort: the role of depression. Archives of General Psychiatry, 59, 10461052.
Gellis, Z. D., McGinty, J., Horowitz, A., Bruce, M. L. and Misener, E. (2007). Problem-solving therapy for late-life depression in home care: a randomized field trial. The American Journal of Geriatric Psychiatry, 15, 968978.
Greenberg, M. S., Tanev, K., Marin, M. F. and Pitman, R. K. (2014). Stress, PTSD, and dementia. Alzheimer’s & Dementia, 10, S155S165.
Howard, R. et al. (2011). Determining the minimum clinically important differences for outcomes in the DOMINO trial. International Journal of Geriatric Psychiatry, 26, 812817.
Joosten-Weyn Banningh, L. W., Prins, J. B., Vernooij-Dassen, M. J., Wijnen, H. H., Olde Rikkert, M. G. and Kessels, R. P. (2011). Group therapy for patients with mild cognitive impairment and their significant others: results of a waiting-list controlled trial. Gerontology, 57, 444454.
Kim, G., Shin, S. H., Scicolone, M. A. and Parmelee, P. (2019). Purpose in life protects against cognitive decline among older adults. The American Journal of Geriatric Psychiatry, 27, 593601.
Kiosses, D. N., Ravdin, L. D., Gross, J. J., Raue, P., Kotbi, N. and Alexopoulos, G. S. (2015). Problem adaptation therapy for older adults with major depression and cognitive impairment: a randomized clinical trial. JAMA Psychiatry, 72, 2230.
Koenig, A. M., Butters, M. A., Begley, A., Ogbagaber, S., Wahed, A. S. and Reynolds, C. F. 3rd (2014). Response to antidepressant medications in late-life depression across the spectrum of cognitive functioning. The Journal of Clinical Psychiatry, 75, e100e107.
Kohler, S., Thomas, A. J., Barnett, N. A. and O’Brien, J. T. (2010). The pattern and course of cognitive impairment in late-life depression. Psychological Medicine, 40, 591602.
LaMonica, H. M. et al. (2019). Disability in older adults across the continuum of cognitive decline: unique contributions of depression, sleep disturbance, cognitive deficits and medical burden. International Psychogeriatrics. doi: 10.1017/S1041610218002144.
Lee, G. J. et al. (2012). Depressive symptoms in mild cognitive impairment predict greater atrophy in Alzheimer’s disease-related regions. Biological Psychiatry, 71, 814821.
Lenze, E. J. et al. (2008). Incomplete response in late-life depression: getting to remission. Dialogues in Clinical Neuroscience, 10, 419430.
Lucassen, P. J. et al. (2014). Neuropathology of stress. Acta Neuropathologica, 127, 109135.
Luck-Sikorski, C. et al. (2017). Treatment preferences for depression in the elderly. International Psychogeriatrics, 29, 389398.
Mackin, R. S. et al. (2014). Cognitive outcomes after psychotherapeutic interventions for major depression in older adults with executive dysfunction. The American Journal of Geriatric Psychiatry, 22, 14961503.
Montgomery, S. A. and Asberg, M. (1979). A new depression scale designed to be sensitive to change. The British Journal of Psychiatry, 134, 382389.
Mowla, A., Mosavinasab, M. and Pani, A. (2007). Does fluoxetine have any effect on the cognition of patients with mild cognitive impairment? A double-blind, placebo-controlled, clinical trial. Journal of Clinical Psychopharmacology, 27, 6770.
Munro, C. A. et al. (2012). Cognitive outcomes after sertaline treatment in patients with depression of Alzheimer disease. The American Journal of Geriatric Psychiatry, 20, 10361044.
Nebes, R. D. et al. (2003). Persistence of cognitive impairment in geriatric patients following antidepressant treatment: a randomized, double-blind clinical trial with nortriptyline and paroxetine. Journal of Psychiatric Research, 37, 99108.
Nelson, J. C., Delucchi, K. and Schneider, L. S. (2008). Efficacy of second generation antidepressants in late-life depression: a meta-analysis of the evidence. The American Journal of Geriatric Psychiatry, 16, 558567.
Palmer, K. et al. (2010). Neuropsychiatric predictors of progression from amnestic-mild cognitive impairment to Alzheimer’s disease: the role of depression and apathy. Journal of Alzheimer’s Disease, 20, 175183.
Portella, M. J., Marcos, T., Rami, L., Navarro, V., Gasto, C. and Salamero, M. (2003). Residual cognitive impairment in late-life depression after a 12-month period follow-up. International Journal of Geriatric Psychiatry, 18, 571576.
Raskin, J. et al. (2007). Efficacy of duloxetine on cognition, depression, and pain in elderly patients with major depressive disorder: an 8-week, double-blind, placebo-controlled trial. American Journal of Psychiatry, 164, 900909.
Reynolds, C.F. 3rd, Alexopoulos, G. S., Katz, I. R. and Lebowitz, B. D. (2001). Chronic depression in the elderly: approaches for prevention. Drugs & Aging, 18, 507514.
Roberts, R. O., Knopman, D. S., Geda, Y. E., Cha, R. H., Roger, V. L. and Petersen, R. C. (2010). Coronary heart disease is associated with non-amnestic mild cognitive impairment. Neurobiology of Aging, 31, 18941902.
SAS. (2013). SAS for Windows Version 9.4. Cary, NC: SAS Institute, Inc.
Simon, S. S., Cordas, T. A. and Bottino, C. M. (2015). Cognitive Behavioral Therapies in older adults with depression and cognitive deficits: a systematic review. International Journal of Geriatric Psychiatry, 30, 223233.
Sneed, J. R., Roose, S. P., Keilp, J. G., Krishnan, K. R., Alexopoulos, G. S. and Sackeim, H. A. (2007). Response inhibition predicts poor antidepressant treatment response in very old depressed patients. The American Journal of Geriatric Psychiatry, 15, 553563.
Tuokko, H. A., Frerichs, R. J. and Kristjansson, B. (2001). Cognitive impairment, no dementia: concepts and issues. International Psychogeriatrics, 13 Supp 1, 183202.
Ustun, B. (2003). WHODAS-II Disability Assessment Schedule. NIMH Mental Health Research Conference Washington, DC: National Institute of Mental Health.
Van der Mussele, S. et al. (2014). Depression in mild cognitive impairment is associated with progression to Alzheimer’s disease: a longitudinal study. Journal of Alzheimer’s Disease, 42, 12391250.
van Ojen, R., Hooijer, C., Jonker, C., Lindeboom, J. and van Tilburg, W. (1995). Late-life depressive disorder in the community, early onset and the decrease of vulnerability with increasing age. Journal of Affective Disorders, 33, 159166.
Verdelho, A. et al. (2013). Depressive symptoms predict cognitive decline and dementia in older people independently of cerebral white matter changes: the LADIS study. Journal of Neurology Neurosurgery & Psychiatry, 84, 12501254.
Wang, S. and Blazer, D. G. (2015). Depression and cognition in the elderly. Annual Review of Clinical Psychology, 11, 331360.
Wuthrich, V. M., Rapee, R. M., Draper, B., Brodaty, H., Low, L. F. and Naismith, S. L. (2018). Reducing risk factors for cognitive decline through psychological interventions: a pilot randomized controlled trial. International Psychogeriatrics, 31, 10151025.

Keywords

Depression, cognitive, and functional outcomes of Problem Adaptation Therapy (PATH) in older adults with major depression and mild cognitive deficits

  • Dora Kanellopoulos (a1), Paul Rosenberg (a2), Lisa D. Ravdin (a3), Dalynah Maldonado (a4), Nimra Jamil (a2), Crystal Quinn (a5) and Dimitris N. Kiosses (a1)...

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