Psychological treatments and therapy adaptations for psychological distress in dementia and mild cognitive impairment: a systematic review and meta-analysis

Purpose The purpose of this paper is to evaluate the effectiveness of psychological treatments and identify required adaptations to increase acceptability and improve outcomes for people with dementia or mild cognitive impairment who experience psychological distress. Design/methodology/approach The Cochrane Dementia and Cognitive Improvement Group Specialised Register and other databases were searched for eligible studies. Inclusion criteria identified nine randomised controlled trials comparing a psychological intervention (cognitive behavioural therapy, relaxation training therapies, multimodal therapies, psychodynamic therapy, counselling and cognitive rehabilitation) with usual care, with measures of depression and/or anxiety as an outcome. The appraisal of papers was conducted using the Mixed Methods Appraisal Tool. Data was analysed using meta-analysis. Findings A small, significant effect size before to after intervention was revealed, suggesting that psychological treatments may be effective in reducing psychological distress in people with dementia, with several therapy adaptations identified. Research limitations/implications Because of methodological limitations and a small number of studies evaluated, the quality of evidence was low for outcomes for depression, and there were no significant outcomes in anxiety. Originality/value The current review offers a unique contribution in identifying specific adaptations deemed helpful in improving the accessibility and acceptability of therapy for people with dementia, suggesting therapy can be adjusted enough to support this client-group. Future studies should use high-quality trials using standardised psychological interventions, of sufficient length, with long-term follow-up and offer of specific adaptations to increase accessibility and outcomes.