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Table 1 Study characteristics

From: Psychotherapeutic interventions in individuals at risk for Alzheimer’s dementia: a systematic review

Study and country

Sample size (N)

Follow-up

Characteristics

Intervention

Control

Study design

Outcomes

Main findings

Quality

Psychotherapy for individuals with MCI

 Gildengers et al. 2016

USA

94

3/6/9/12 m post-int.

Patients:

N = 74

Dg.: MCI

Gender: 47 f, 27 m

Age: 75 yrs. (M)

MMSE: /

Caregivers:

N = 20

Gender: 16 f, 4 m

Age: 66.6 yrs. (M)

Problem-solving therapy (PST) with and without moderate-intensity physical exercise (PE)

Usual care enhanced by the same assessments as the intervention group

Single-blinded randomized controlled trial.

Couples therapy led by master’s level therapists

− Depression (Prime-MD/Mini)

− Anxiety (GAD-7)

Preliminary results: high acceptance for intervention and usefulness in managing stress and cognitive problems

Good

 Joosten-Weyn Banningh et al. 2008

Netherlands

46

2w post-int.

Patients:

N = 23

Dg: MCI

Gender: 13f, 10 m

Age: 68.7 yrs. (M)

MMSE 26.7 (M)

Caregivers:

N = 23

Gender: 12f, 11 m

Age: 70.4 yrs. (M)

Combination of cognitive behavioral therapy and psychoeducation

N/A

Non-randomized trial

Group therapy led by psychotherapists

− Depression (GDS)

− Well-being (SF-36)

− Subscales Acceptance and Helplessness (ICQ)

− Marital satisfaction (MMQ)

− Burden of Caregiver

Preliminary results: high motivation for intervention. Evidence for significant increase of acceptance and a trend for an increased marital satisfaction. The significant others reported an increased awareness of memory and behavioral problems

Good

    Joosten-Weyn Banningh et al. 2011, 2013

Netherlands

94

6–8 m post-int.

Patients:

N = 47

Dg.: MCI

Gender: 20 f, 27 m

Age: 69.9 yrs. (M)

MMSE: 25.7 (M)

Caregivers:

N = 47

Gender: 31f, 16 m

Age: 68.5 yrs. (M)

Combination of cognitive behavioral therapy and psychoeducation

Waiting-list

Non-randomized trial

Group therapy led by psychotherapists

− Depression (GDS)

− Well-being (SF-36)

− Subscales Acceptance and Helplessness (ICQ)

− Marital satisfaction (MMQ)

− Burden of Caregiver

Increase of acceptance in MCI patients was maintained at follow-up, with increased insight into cognitive decline. Increase in sense of competence increased in the significant others. Worse helplessness and well-being at follow-up compared to post-intervention in patients and significant others

Good

 Miller et al. 2007

USA

1

N/A

Dg.: MCI

Gender: 1 m

Age: 80 yrs.

MMSE: /

Interpersonal psychotherapy (IPT) for depressed elders

N/A

Individual therapy led by psychiatrists.

− Depression

Standard IPT techniques need to be modified, including active integration of the caregiver into the treatment process

Fair

 Scheurich et al. 2008

Germany

24

12 m post-int.

Patients:

N = 12,

Dg.: MCI

Gender: 7f, 5 m

Age: 66.8 yrs. (M)

MMST: 24 (M)

Caregivers

N = 12,

Gender: 7f, 5 m

Age: 61.5 yrs. (M)

Combination of cognitive behavioral therapy and psychoeducation

N/A

Non-randomized pilot trial

Group therapy, no information about the professional background of therapist

− Depression (GDS, BDI)

− Life quality (SF-36)

Reduced anxiety, anergia, and withdrawal in MCI patients. Caregivers showed reduced sleep disturbances, irritability, and aggressiveness toward the diseased family member

Good

 Tonga et al. 2016

Norway

3

N/A

Patients:

N = 3

Dg.: mild AD

Gender: 2f, 1 m

Age: 59 yrs., 66 yrs., 77 yrs.

MMSE: 27, 23, 20

Cognitive Rehabilitation and Cognitive behavioral therapy (Cordial Manual) [72]

N/A

Individual therapy led by a psychologist

− Depression (HADS)

− Anxiety (HADS)

− Client Satisfaction (CSQ-8)

− Burden of Caregiver (RSS)

Apathy and anosognosia hindered treatment adherence, while caregivers were essential for treatment and homework completion. Psychotherapy for individuals with AD needs to allow flexibility of the manual, according to the resources and preferences of the patients

Fair

 Tonga et al. 2021

Norway

198

4/10 m post-baseline

Intervention group:

N = 100

Dg.: MCI (n = 32) and dementia (n = 68)

Gender: 45f, 55 m

Age: 69.4 (M)

MMSE: 24.7 (M)

Caregivers:

N = 100

Gender: 66f, 34 m

Age: 66.8 yrs. (M)

Control group:

N = 98

Dg.: MCI (n = 48), dementia (n = 48)

Gender: 47f, 51 m

Age: 70.7 yrs. (M)

MMSE: 24.5 (M)

Caregivers:

N = 98

Gender: 67f, 31 m

Age: 65.7 yrs. (M)

Cognitive Rehabilitation and Cognitive-behavioral therapy (Cordial Manual) [72]

Treatment as usual

Randomized controlled trial

Group therapy led by nurses, psychiatrists, occupational therapists and psychologists

− Depression (MADRS)

− Neuropsychiatric Inventory

− Quality of life (QoL-AD)

Significant improvement in depression within the intervention group compared to the control group. No group differences with regard to neuropsychiatric symptoms or quality of life

Good

Psychoeducational intervention for Individuals with MCI

 Barton et al. 2017

UK

16

8w post-int.

Patients:

N = 16

Dg.: MCI

Gender: 9f, 7 m

Age: 74.2 yrs. (M)

MMSE: /

Psychosocial group intervention based on the recovery model and psychoeducation

N/A

Non-randomized trial

Group therapy led by facilitators trained in group therapy

− Mental Well-Being (Warwick Edinburgh Scale)

− Goal Attainment Scale

Well-being improved significantly and satisfaction with the intervention was high

Fair

 Bier et al. 2015

(study protocol)

 Belleville et al. 2018

Canada

145

3/6 m post-int.

Psychosocial intervention group:

N = 43,

Dg.: MCI

Gender: 24f, 19 m

Age: 72.1 yrs. (M) MMSE: /

Cognitive intervention group:

N = 40

Dg.: MCI

Gender: 20f, 20 m

Age: 71.3 yrs. (M) MMSE: /

Control group:

N = 44,

Dg.: MCI

Gender:26f, 18 m

Age: 73.1 yrs. (M) MMSE: /

Cognitive intervention according to the MEMO program (MEMO-program) [59]

Psychosocial intervention with a CBT approach and psychoeducation

No contact group (no intervention)

Single-blinded randomized controlled trial

Group therapy led by therapists (qualified clinicians)

− Depression (GDS)

− Anxiety (GAI)

− General well-being (GWBS)

No significant effect on mood or well-being in neither group

Good

 Diamond et al. 2015

Australia

64

2w post-int.

Intervention group:

N = 36,

Dg.: MCI and/or MDD

Gender: 27f, 9 m

Age: 67.3 yrs. (M),

MMSE: /

Control group:

N = 28, Dg.: MCI and/or MDD

Gender: 16f, 12 m

Age: 65.6 yrs. (M)

MMSE: 28.5 (M)

Multifaceted Healthy Brain Ageing Cognitive Training (HBA-CT) with psychoeducation and computerized cognitive training

Treatment as usual

Single-blinded randomized controlled trial

Group intervention led by multidisciplinary specialists (psychiatrists,

neurologists, neuropsychologists, clinical

psychologists)

− Depression (GDS)

− Subjective memory (EMQ)

− Pittsburgh Sleep Quality Index (PSQI)

Improvements in self-reported memory, mood, and sleep in the intervention group

Good

 Kurz et al. 2009

Germany

40

N/A

Intervention group:

Dg.: MCI

N = 18

Gender: 11f, 7 m

Age: 70.4 yrs. (M) MMSE: 27,8 (M)

Dg.: mild AD N = 10

Age: 66 yrs. 8 M) Gender: 5f, 5 m

MMSE: 23.9 (M)

Control group: Dg.: MCI

N = 12

Dg.: MCI

Gender: 6f, 6 m

Age: 70.8 yrs. (M)

MMSE: 28.0 (M)

Cognitive rehabilitation program

Waiting list

Non-randomized trial

Group therapy, no information about the professional background of therapist

− Depression (BDI)

− Cognition (MMSE)

− Activities of daily living (ADL)

Significant improvements on mood and ADL in individuals with MCI

Good

 Larouche et al. 2019

 Chouinard et al. 2019

Canada

48

3 m post-int.

Intervention group:

N = 23;

Dg.: MCI

Gender: 9f, 14 m

Age: 71.4 yrs. (M)

MMSE: /

Control group

N = 22;

Dg: aMCI

Gender: 10f, 12 m

Age: 70.5 yrs. (M)

MMSE: /

Mindfulness-based intervention (MBI)

Psychoeducation-based intervention (PBI)

Single-blinded randomized controlled pilot trial

Group intervention led by trained psychologists

− Depression (GDS)

− Anxiety (GAI)

− Life quality (WHOQOL-Brief and WHOQOL-Brief OLD)

Both interventions had positive effects on anxiety, depression, and age-related QoL

Good

 Lu et al. 2013

USA

20

3 m post-int.

Patients:

N = 10

Dg: MCI

Gender: 3f, 7 m

Age: 69.2 yrs. (M)

MMSE: 27.1 (M)

Caregivers:

N = 10

Gender: 7f, 3 m

Age: 66 yrs. (M)

Daily Enhancement of Meaningful Activity (DEMA) intervention with components of problem-solving therapy (PST)

N/A

Non-randomized pilot trial

Individual and Couples therapy led by trained nurses

− Depression (PHQ-9)

− Well-being (SF-36)

− Quality of life (QoL-AD)

− Caregiver Burden Scale (CBS)

Evidence for acceptance and feasibility for the program. No significant effects on depression, quality of life and caregiver burden

Good

 Lu et al. 2016

 Ellis et al. 2019

USA

72

3 m post-int.

Intervention group

Patients:

N = 17

Dg.: MCI

Gender: /

Age: 71.6 yrs. (M)

MMSE: /

Caregivers:

N = 17

Gender: /

Age: 65.5 yrs. (M)

Control group:

Patients:

N = 19

Dg: MCI

Gender: /

Age: 76.8 yrs. (M)

MMSE: /

Caregivers:

N = 19

Gender: /

Age: 70.8 yrs. (M)

Daily Enhancement of Meaningful Activity (DEMA) intervention with components of problem-solving therapy (PST)

Information support attention control group

Randomized controlled pilot trial

Individual and couples therapy led by trained nurses

− Depression (PHQ-9)

No significant effect on mood in neither group. The intervention group indicated significantly higher usefulness, ease of use, and total satisfaction than the control group. No significant group difference in the caregivers’ ratings regarding satisfaction with the treatment

Good

 Rovner et al. 2012, 2016, 2018

USA

221

6/12/18/24 m post-int.

Intervention group:

N = 111

Dg: MCI

Gender: 86 f, 25 m

Age: 75.5 yrs. (M)

MMSE: 25.8 (M)

Control group:

N = 110

Dg: MCI

Gender: 89 f, 21 m

Age: 76.2 yrs. (M)

MMSE: 25.6 (M)

Behavioral activation therapy: a manual-based behavioral treatment to increase cognitive, physical and/or social activity

Supportive therapy offered a structured, nondirective psychological treatment

Single-blinded randomized controlled trial

Individual intervention led by trained community health workers

− Depression (GDS)

− Quality of life

No significant group difference on depression in both treatment groups

Good

 Schmitter-Edgecombe et al. 2014

USA

46

3 m post-int.

Intervention group:

N = 23 care-dyads

Patients:

Dg.: MCI

Gender: 16f, 7 m

Age: 72.96 yrs. (M)

MMSE: /

Control group:

N = 23 care-dyads

Patients:

Dg: MCI

Gender: 11f, 12 m

Age: 73.35 yrs. (M)

MMSE: /

Cognitive rehabilitation multi-family group intervention, including problem-solving therapy and psychoeducation

Standard care

Randomized controlled trial

Group intervention led by trained clinical psychology doctoral students and community professionals (i.e., psychologists, social workers)

− Quality of Life-Alzheimer’s disease (QOL-AD)

− Depression (GDS)

− Coping (CSE)

No significant group differences on psychological measures. Caregivers reported improved coping behavior

Good

 Smith et al. 2017 (study protocol)

 Chandler et al. 2019

USA

272

6/12/18 m post-int.

Patients:

N = 272

Dg.: MCI

Gender: 112f, 160 m

Age: 75 yrs. (M),

MMSE: 28.36 (M)

Mayo Clinic Healthy Action to Benefit Independence and Thinking (HABIT) program, a 50-h group intervention including psychoeducation, memory compensation training, computerized cognitive training, yoga, patient and partner support groups, and wellness education

N/A

Multisite, cluster randomized trial

Group intervention led by therapist (neuropsychologists, dementia educators, exercise specialists, nurse practitioners, social workers)

− Quality of Life-Alzheimer’s disease (QOL-AD)

− Depression (CES-D)

− Modified chronic disease Self-Efficacy Scale

No significant effects on the outcomes could be determined in neither intervention group by 12 months. Wellness education had a greater effect on mood than computerized cognitive training, and yoga had a greater effect on activities of daily living than support groups at 12 months. Cognitive training had the least effect on these outcomes

Good

 Wells et al. 2013, 2019

USA

14

2 m post-baseline

Intervention group:

N = 9

Dg: MCI

Gender: /

Age: 73 yrs. (M)

MMSE: 27 (M)

Control group:

N = 5,

Dg: MCI

Gender: /

Age: 75 yrs. (M),

MMSE: 27 (M)

Mindfulness Based Stress Reduction (MBSR), standardized mindfulness meditation intervention, with psychoeducation on stress and stress relief

Waiting list

Randomized controlled pilot trial

Group intervention, no information about the professional background of therapist

− Quality of Life-Alzheimer’s disease (QOL-AD)

− Depression (CES-D)

− Perceived Stress Scale (PSS)

− Resilience Scale (RS)

− Mindful Attention Awareness Scale (MAAS)

No significant group differences with regard to psychological outcomes. The qualitative interviews revealed positive perceptions of class attendance, development of mindfulness skills, including meta-cognition, importance of the group experience, enhanced well-being, shift in MCI perspective, decreased stress reactivity and increased relaxation, improvement in interpersonal skills

Fair

Psychotherapy for Individuals with SCD

N/A

Psychoeducational intervention for Individuals with SCD

 Cohen-Mansfield et al. 2015

Israel

44

10 weeks post-baseline

Health promotion:

N = 15,

Dg.: SCD

Gender: 13f, 2 m

Age: 74.44 yrs. (M),

MMSE: 28.67 (M)

Cognitive Training:

N = 15,

Dg.: SCD

Gender: 9f, 6 m

Age: 72.8 yrs. (M),

MMSE: 27.93 (M)

Participation-centered:

N = 14,

Dg.: SCD

Gender: 10f, 5 m

Age: 73.21 yrs. (M)

MMSE: 28.93 (M)

Health promotion course: psychoeducation on health behaviors and lifestyle modification; dementia and delirium; age-related cognitive decline and MCI, such as cognitive activities to keep the mind fit.

Cognitive training course: the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) with focus on memory, reasoning, and speed of processing

Participation centered course: CBT-based delivery of memory, cognitive, and organizational strategies

Waiting list

Single-blinded randomized controlled pilot trial

Group intervention, no information about the professional background of therapist

− Well-being (UCLA Loneliness Scale)

− Depression (GDS)

All three interventions resulted in significant improvement in cognitive function as measured by the computerized cognitive assessment. Self-report of memory difficulties decreased significantly in the cognitive training group participants. All approaches seemed to decrease loneliness

Good

 Hoogenhout et al. 2012

Netherlands

50

4w post-int.

Intervention group:

N = 24

Dg.: SCD

Gender: 24f

Age: 66.0 yrs. (M)

MMSE: 29.24 (M)

Control group:

N = 26

Dg.: SCD

Gender: 26f

Age: 66.1 yrs. (M)

MMSE: 29.11 (M)

Psychoeducation about cognitive aging and contextual factors (negative age stereotypes, beliefs, health and lifestyle), focusing on skills and compensatory behavior

Waiting list

Randomized controlled trial

Group intervention, no information about the professional background of therapist

− Maastricht Metacognition Inventory (MMI)ESQ

− Psychological Well-being Quotient (PWQ)

Participants in the experimental group reported less emotional reactions towards cognitive functioning than participants in the control condition. The intervention improved an important aspect of metacognition. No significant differences between the groups in psychological well-being

Good

 Marchant et al. 2018 (study protocol)

 Marchant et al. 2021

Multi-center (France, Germany, Spain, UK)

147

2/6 m post-baseline.

Intervention group:

N = 73

Dg.: SCD

Gender: 47f, 26 m

Age: 72.1 yrs. (M)

MMSE: 28.7 (M)

Control group:

N = 74

Dg.: SCD

Gender: 48f, 26 m

Age: 73.3 yrs. (M)

MMSE: 28.9 (M)

Mindfulness based approach for seniors [76] with psychoeducational components

Health self-management program to promote engagement in activities to improve health and well-being

Multi-center, observer-blind randomized controlled trial

Group interventions led by clinically trained facilitators (mindfulness-based teachers, clinical psychologist or equivalent degree)

− Anxiety (STAI)

− Depression (GDS)

− Emotion regulation

− Mindfulness (FFMQ)

− Life quality (WHOQOL-Brief)

− Well-being (Loneliness Scale)

− Pittsburgh Sleep Quality Index (PSQI)

No significant group differences with regard to psychological outcomes. Both interventions showed a reduction in trait anxiety on follow-up

Good

 Smart et al. 2016

 Smart and Segalowith 2017

Canada

38

2w post-int.

Patients:

N = 15

Dg.: SCD

Gender: 11f, 4 m

Age: 69.6 yrs. (M)

MMSE: 28 (M)

Control:

N = 23

Dg.: healthy control

Gender: 9f, 14 m

MMSE: 27.78 (M)

Mindfulness Based Stress Reduction (MBSR) based on Kabat-Zinn, standardized mindfulness meditation intervention, with psychoeducation on stress and stress relief

Psychoeducation on cognitive aging

Single-blinded randomized controlled pilot trial

Group intervention, no information about the professional background of therapist

− Depression (GDS)

− Mindfulness (FFMQ)

− Anxiety (AMAS)

− Negative mood regulation (NMR)

No significant group differences with regard to psychological outcomes. Both interventions improved psychological findings (reduction of cognitive complaint, reduction of anxiety and self-judgment of one’s own mental functioning)

Good

  1. AD Alzheimer’s disease; ADL Activities of Daily Living; AMAS Adult Manifest Anxiety Scale; BDI Beck Depression Inventory; CBS Caregiving Burden Scale; CES-D Center of Epidemiology Depression Scale; CSE Coping Self-efficacy scale; CSQ-8 Client Satisfaction Scale; Dg. diagnosis; f, female; FFMQ Five-Facet Mindfulness Questionnaire; FU follow-up; GAD-7 Generalized Anxiety Questionnaire; GAI Geriatric Anxiety Inventory; GDS Geriatric Depression Scale; GSE General Self-Efficacy Scale; GWBS General Well-Being Schedule; HADS Hospital Anxiety and Depression Scale; ICQ Illness Cognition Questionnaire; m male; M mean; MAAS Mindful Attention Awareness Scale; MADRS Montgomery–Asberg Depression Rating Scale; MBSR, mindfulness based stress reduction; MCI mild cognitive impairment; MDD major depressive disorder; Maudsley Marital Questionnaire; MMSE Mini Mental State Exam; MoCA Montreal Cognitive Assessment; MSEQ Memory Self-Efficacy Questionnaire; N, number; NMR Negative Mood Regulation Scale; PHQ Patient Health Questionnaire; post-int. post-intervention; PSQI Pittsburgh Sleep Quality Index; PSS Perceived Stress Scale; QoL Quality of Life; QOL-AD, Quality of Life in Alzheimer’s disease; RSS Relatives’ Stress Scale; SCD subjective cognitive decline; SF-36 Short Form Health 36; STAI State-Trait Anxiety Inventory; yrs years; w week; WHOQOL World Health Organization Quality of Life Brief scale