Older Adults With Depression, Cognitive Impairment May Benefit From Psychosocial Therapy

Because studies have shown antidepressant treatment to bring remission to less than 40 percent of elderly patients with depression—and even less among those who are also experiencing cognitive deficits—some researchers in geriatric mental health are beginning to adapt existing nonpharmacological approaches and explore new ones to alleviate specific psychiatric symptoms in older adults.

At this year’s annual meeting of the American Association for Geriatric Psychiatry in New Orleans in March, researchers from the University of Pittsburgh School of Medicine (UPSOM) and Weill Cornell Medical College led a session on psychosocial interventions to help individuals mentally adapt to changes that often occur in late life.

“New onset or recurrent depression is common in older patients experiencing retirement, relocation, disabilities, or loss of important people in their lives,” said Mark Miller, M.D., a professor of psychiatry at UPSOM, as he discussed interpersonal psychotherapy for cognitive impairment (IPTci).

“Interpersonal psychotherapy to treat depression has been around for a while,” Miller told Psychiatric News, “but we have adapted it for use in patients with cognitive impairment as well as depression.” Some of the adaptations include assessing the mental health of the caregiver, shortening sessions to ease physical discomfort of patients, accommodating for hearing loss, arranging transportation, and conducting sessions by telephone when patients are ill or shut in by inclement weather.

Though IPTci has yet to be extensively studied, Miller expressed optimism that clinicians are likely to find IPTci to be easy to use and well suited for addressing depression stemming from common late-life issues, such as medical illnesses, marital strains from taking care of an ill partner, and income reductions due to retirement. Caregivers of those with cognitive impairment are also included in IPTci treatment, which lasts 12 to 16 weeks. Miller and colleagues are recruiting participants for a study on the efficacy of IPTci.

Dimitris Kiosses, Ph.D., an associate professor in clinical psychiatry at Weill Cornell Medical College, discussed Problem Adaption Therapy (PATH), a home-delivered nonpharmacological intervention focusing on emotional regulation.

“People with mild cognitive impairment often have behavioral and functional limitations that trigger a lot of negative emotions,” Kiosses told Psychiatric News. These negative emotions include feelings of worthlessness, hopelessness, and helplessness, he added. “Our intervention aims to help them adapt and adjust emotionally to their current situation—such as a recent move in with a family member—by reducing those [negative] emotions and, at the same time, trying to increase positive emotions through engagement in activities that the patients may find pleasurable.”

PATH focuses on the patient’s ecosystem, which includes the patient, caregiver, and home environment, to address the needs of depressed, cognitively impaired, and disabled elderly adults. Kiosses and colleagues tested the intervention by randomly assigning PATH or supportive therapy (ST-CI) to 74 patients aged 65 and older with major depressive disorder and cognitive impairment for 12 weeks.

The results, published January 1 in JAMA Psychiatry, showed that the PATH cohort had a significantly greater reduction in depression than the ST-CI group. In addition, participants receiving PATH were also three times more likely to acheive remission of depressive symptoms after the study’s endpoint than their counterparts who received ST-CI.

Kiosses and his research team are now testing PATH in elderly depressed patients who have reported suicidal thoughts. They are also looking into adapting PATH for older adults with cognitive impairment and depression in addition to other comorbid psychiatric illnesses.

“Rates for adults with cognitive impairment with and without depression are increasing,” said Kiosses. “With the PATH approach, we are trying to come up with one of the best interventions to reduce depression and increase executive function in our patients.” ■

An abstract of “Problem Adaptation Therapy for Older Adults With Major Depression and Cognitive Impairment” can be accessed here.