Abstract
Background: Depression is prevalent in dementia and contributes to poor
outcomes for patients and their families. Antidepressants have limited efficacy in older
adults with major depression and dementia, and psychosocial interventions are
under-investigated.
Objective: To examine the course, predictors and moderators of depression and
suicidal ideation during 12 weeks of home-delivered Problem Adaptation Therapy (PATH)
versus Supportive Therapy for Cognitively Impaired Older Adults (ST-CI) in 39 older adults
with major depression and dementia.
Methods: Thirty-nine older adults with major depression, mild or moderate
dementia, and disability participated in a randomized controlled trial that compared the
efficacy of PATH versus ST-CI. Depression and suicidal ideation were assessed with Cornell
Scale for Depression in Dementia Total Score and Suicide Item.
Results: PATH participants had significantly greater reduction in depression
than ST-CI participants over 12 weeks of treatment. PATH participants with high social
support had the greatest reduction in depression. Both treatments had comparable reduction
in suicidal ideation.
Conclusion: PATH is more effective in reducing depression in older adults
with major depression and dementia compared to ST-CI. These results are clinically
significant as antidepressants have limited efficacy in this population. Home-delivered
psychosocial treatments may reduce suicidal ideation in this population.
