Antidepressant Effects of a Multimodal Group Therapy Program for Mild Dementia: A Retrospective Evaluation of Clinical Routine Data

Article type: Research Article

Authors: Bartels, Claudia^{a; *} | Abdel-Hamid, Mona^{a; b} | Wiltfang, Jens^{a; c; d} | Schneider, Anja^{e; f} | Belz, Michael^a

Affiliations: [a] Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany | [b] Department of Psychiatry and Psychotherapy, University of Duisburg-Essen, LVR-Hospital Essen, Essen, Germany | [c] German Center for Neurodegenerative Diseases (DZNE), Goettingen, Germany | [d] Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal | [e] German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany | [f] Department of Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany

Correspondence: [*] Correspondence to: Claudia Bartels, PhD, Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, von-Siebold-Str. 5, D-37075 Goettingen, Germany. Tel.: +49 551 3962795; E-mail:claudia.bartels@med.uni-goettingen.de.

Abstract: Background:The multimodal CORDIAL treatment concept for mild dementia, combining cognitive rehabilitation, cognitive behavioral and humanistic psychology interventions, has proven its feasibility and demonstrated a reduction of depressive symptoms in individual dyadic/triadic settings. Objective:We investigate antidepressant effects of an adapted group-based CORDIAL program in clinical routine care. Methods:During 2013 and 2017, 51 outpatients with mild dementia (45% female, mean age 72.4 years, 67% Alzheimer’s dementia, mean MMST 24.8) periodically received a modified CORDIAL group treatment as part of our regular outpatient care. Treatment comprised 10 bi-weekly sessions, partly involving caregivers. Systematic pre- and post-treatment assessments of clinical routine data were evaluated retrospectively (median time-interval of 6.6 months). Results:Depressive symptoms as measured by the Geriatric Depression Scale significantly decreased over time (p = 0.007, Cohen’s d = 0.39), and irrespective of gender. Patients with longer disease duration before treatment start showed significantly higher initial levels of depressive symptoms (p = 0.044), followed by a reduction to a level of those with shorter disease duration (ns). Most secondary outcomes (cognitive symptoms, disease severity, quality of life, caregiver burden) remained unchanged (ns), while competence in activities of daily living declined from pre- to post-measurement (p = 0.033). Conclusion:A group-based CORDIAL treatment is feasible in a clinical routine setting and demonstrated antidepressant effects comparable to those of the individual treatment design, further suggesting its implementation in regular care. Future trials might also investigate its potentially preventive effects by reducing depressive symptoms in pre-dementia stages, even at a subsyndromal level.

Keywords: Dementia, depression, cognitive rehabilitation, cognitive behavioral therapy, reminiscence, group therapy, activities of daily living, caregiver burden

DOI: 10.3233/JAD-220578

Journal: Journal of Alzheimer's Disease, vol. 90, no. 4, pp. 1725-1737, 2022