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 |
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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 |