Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-24T22:33:00.514Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  08 January 2020

Dora Kanellopoulos ,
Paul Rosenberg ,
Lisa D. Ravdin ,
Dalynah Maldonado ,
Nimra Jamil ,
Crystal Quinn  and
Dimitris N. Kiosses Open the ORCID record for Dimitris N. Kiosses [Opens in a new window]
Dora Kanellopoulos
Affiliation:
Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, New York, NY, USA
Paul Rosenberg
Affiliation:
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Lisa D. Ravdin
Affiliation:
Department of Neurology & Neuroscience, Weill Cornell Medicine, New York, NY, USA
Dalynah Maldonado
Affiliation:
Department of Medicine/Rheumatology, Albert Einstein College of Medicine, Bronx, NY, USA
Nimra Jamil
Affiliation:
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Crystal Quinn
Affiliation:
The Graduate Center, City University of New York, New York, NY, USA
Dimitris N. Kiosses*
Affiliation:
Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, New York, NY, USA
*
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: [email protected].
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

cognitive impairmentlate-life mood disordersdisabilitypsychotherapy
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 4: Issue Theme: Serious Mental Illnesses in Older Adults , April 2020 , pp. 485 - 493
Copyright
© International Psychogeriatric Association 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopoulos, G. S. (2002). Frontostriatal and limbic dysfunction in late-life depression. The American Journal of Geriatric Psychiatry, 10, 687–695.CrossRefGoogle ScholarPubMed
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, 204–210.CrossRefGoogle ScholarPubMed
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, 33–41.CrossRefGoogle ScholarPubMed
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, 1391–1398.CrossRefGoogle ScholarPubMed
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, 90–95.CrossRefGoogle ScholarPubMed
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, 682–690.CrossRefGoogle ScholarPubMed
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, 308–316.CrossRefGoogle ScholarPubMed
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, 602–603.CrossRefGoogle ScholarPubMed
Butters, M. A.et al. (2000). Changes in cognitive functioning following treatment of late-life depression. American Journal of Psychiatry, 157, 1949–1954.CrossRefGoogle ScholarPubMed
Cacciatore, F.et al. (1998). Morbidity patterns in aged population in southern Italy. A survey sampling. Archives of gerontology and geriatrics, 26, 201–213.CrossRefGoogle ScholarPubMed
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, 323–334.CrossRefGoogle ScholarPubMed
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, 881–888.CrossRefGoogle ScholarPubMed
Devanand, D. P.et al. (2003). Sertraline treatment of elderly patients with depression and cognitive impairment. International Journal of Geriatric Psychiatry, 18, 123–130.CrossRefGoogle ScholarPubMed
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, M1137–M1144.CrossRefGoogle ScholarPubMed
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, 189–198.CrossRefGoogle Scholar
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, 1046–1052.CrossRefGoogle Scholar
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, 968–978.CrossRefGoogle ScholarPubMed
Greenberg, M. S., Tanev, K., Marin, M. F. and Pitman, R. K. (2014). Stress, PTSD, and dementia. Alzheimer’s & Dementia, 10, S155–S165.CrossRefGoogle ScholarPubMed
Howard, R.et al. (2011). Determining the minimum clinically important differences for outcomes in the DOMINO trial. International Journal of Geriatric Psychiatry, 26, 812–817.CrossRefGoogle ScholarPubMed
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, 444–454.Google ScholarPubMed
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, 593–601.CrossRefGoogle ScholarPubMed
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, 22–30.CrossRefGoogle ScholarPubMed
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, e100–e107.CrossRefGoogle ScholarPubMed
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, 591–602.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Lee, G. J.et al. (2012). Depressive symptoms in mild cognitive impairment predict greater atrophy in Alzheimer’s disease-related regions. Biological Psychiatry, 71, 814–821.CrossRefGoogle ScholarPubMed
Lenze, E. J.et al. (2008). Incomplete response in late-life depression: getting to remission. Dialogues in Clinical Neuroscience, 10, 419–430.Google Scholar
Lucassen, P. J.et al. (2014). Neuropathology of stress. Acta Neuropathologica, 127, 109–135.CrossRefGoogle ScholarPubMed
Luck-Sikorski, C.et al. (2017). Treatment preferences for depression in the elderly. International Psychogeriatrics, 29, 389–398.CrossRefGoogle ScholarPubMed
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, 1496–1503.CrossRefGoogle ScholarPubMed
Montgomery, S. A. and Asberg, M. (1979). A new depression scale designed to be sensitive to change. The British Journal of Psychiatry, 134, 382–389.CrossRefGoogle ScholarPubMed
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, 67–70.CrossRefGoogle ScholarPubMed
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, 1036–1044.CrossRefGoogle ScholarPubMed
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, 99–108.CrossRefGoogle ScholarPubMed
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, 558–567.CrossRefGoogle Scholar
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, 175–183.CrossRefGoogle ScholarPubMed
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, 571–576.CrossRefGoogle ScholarPubMed
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, 900–909.CrossRefGoogle Scholar
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, 507–514.CrossRefGoogle ScholarPubMed
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, 1894–1902.CrossRefGoogle ScholarPubMed
SAS. (2013). SAS for Windows Version 9.4. Cary, NC: SAS Institute, Inc.Google Scholar
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, 223–233.CrossRefGoogle ScholarPubMed
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, 553–563.CrossRefGoogle ScholarPubMed
Tuokko, H. A., Frerichs, R. J. and Kristjansson, B. (2001). Cognitive impairment, no dementia: concepts and issues. International Psychogeriatrics, 13 Supp 1, 183–202.CrossRefGoogle ScholarPubMed
Ustun, B. (2003). WHODAS-II Disability Assessment Schedule. NIMH Mental Health Research Conference Washington, DC: National Institute of Mental Health.Google Scholar
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, 1239–1250.CrossRefGoogle ScholarPubMed
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, 159–166.CrossRefGoogle ScholarPubMed
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, 1250–1254.CrossRefGoogle ScholarPubMed
Wang, S. and Blazer, D. G. (2015). Depression and cognition in the elderly. Annual Review of Clinical Psychology, 11, 331–360.CrossRefGoogle ScholarPubMed
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, 1015–1025.CrossRefGoogle Scholar