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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