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

Published online by Cambridge University Press:  08 January 2020

Dora Kanellopoulos ,
Paul Rosenberg ,
Lisa D. Ravdin ,
Dalynah Maldonado ,
Nimra Jamil ,
Crystal Quinn  and
Dimitris N. Kiosses Open the ORCID record for Dimitris N. Kiosses [Opens in a new window]
Dora Kanellopoulos
Affiliation:
Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, New York, NY, USA
Paul Rosenberg
Affiliation:
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Lisa D. Ravdin
Affiliation:
Department of Neurology & Neuroscience, Weill Cornell Medicine, New York, NY, USA
Dalynah Maldonado
Affiliation:
Department of Medicine/Rheumatology, Albert Einstein College of Medicine, Bronx, NY, USA
Nimra Jamil
Affiliation:
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Crystal Quinn
Affiliation:
The Graduate Center, City University of New York, New York, NY, USA
Dimitris N. Kiosses*
Affiliation:
Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, New York, NY, USA
*
Correspondence should be addressed to: Dimitris N. Kiosses, Weill-Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, 21 Bloomingdale Road, White Plains, NY 10605, USA. Phone: +1 914 997 4381; Fax: +1 914 682 5430. Email: dkiosses@med.cornell.edu.
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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.

Keywords

cognitive impairmentlate-life mood disordersdisabilitypsychotherapy
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 4: Issue Theme: Serious Mental Illnesses in Older Adults , April 2020 , pp. 485 - 493
Copyright
© International Psychogeriatric Association 2020

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