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

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.

Trial registration: ClinicalTrials.gov NCT00368940.

Keywords: cognitive impairment; disability; late-life mood disorders; psychotherapy.

Conflict of interest statement

Conflict of Interest Declaration

Figures

Figure 1

Flow Diagram of the PATH vs. ST Trial For This Analysis

Figure 2. Course of Depression of PATH vs. ST-CI in 35 Older Adults with Major Depression and CIND.

Depression scores (MADRS Total Score) over 24 weeks of PATH (grey) versus ST-CI (black) in 35 elders (PATH=16; ST-CI=19) with major depression and CIND based on the least squares means of the mixed effects model: time + time squared + treatment + treatment x time.

Figure 3. Course of Overall Cognitive Functioning of PATH vs. ST-CI in 35 Older Adults with Major Depression and CIND.

Overall cognitive functioning (MMSE Total scores) over 24 weeks of PATH (grey) versus ST-CI (black) in 35 Older Adults with Major Depression and CIND (PATH=16; STCI=19) based on the least squares means of the mixed effects model: time + treatment + treatment × time.