INTEGRATIVE COGNITIVE BEHAVIOR THERAPY FOR PEOPLE WITH MILD ALZHEIMER’S DISEASE: RESULTS OF AN RCT

Abstract

About 90% of all mild Alzheimer dementia (AD) cases experience neuropsychiatric symptoms. Although some research has supported the effectiveness of specific psychotherapeutic approaches for mild AD, there are only few attempts to evaluate a multi-component treatment programme. This randomized controlled trial evaluates the effect of an integrative psychotherapy approach on the health of patients with mild AD and their caregivers. It consists of 25 weekly sessions, including eight modules: goal setting; psychoeducation; engagement in pleasant activities; cognitive restructuring; live review; behavior management; interventions for the caregiver; and couples counselling. 50 participants and their caregivers have been randomized to either the CBT-based intervention group (CBT) or to the control group, which received treatment-as-usual (TAU). Before and after the treatment phase, participants have been assessed. Follow-ups took place at 6, and 12 months post-treatment. The primary outcome was depression in the patient with AD. The secondary outcome measures were apathy, other neuropsychiatric symptoms, functional abilities, quality of life, and quality of the relationship to the caregiver. CBT reduced depression significantly more than TAU (interaction: F = 5.3, p < .05), with a moderate-to-large effect size (d = 0.76). There were also a significant advantage for CBT with regard to apathy (F = 4.7, p <.05; d = 0.71) and quality of the relationship to the caregiver (F = 4.3, p <.05; d = 0.77). There was no advantage with regard to other neuropsychiatric symptoms, functional abilities, and quality of life. The results are very encouraging and stimulate an adequately powered multi-center-study.