Problem Adaptation Therapy For Depression in Dementia
Research type
Research Study
Full title
Problem Adaptation Therapy For Individuals with Mild to Moderate Dementia and Depression. The PATHFINDER Trial.
IRAS ID
238724
Contact name
Robert Howard
Contact email
Sponsor organisation
Camden and Islington NHS Foundation Trust
ISRCTN Number
ISRCTN11185706
Duration of Study in the UK
4 years, 5 months, 31 days
Research summary
Research Summary
Depression is very common in people with Alzheimer’s disease and other dementias, causing them distress as well as reducing their quality of life and that of their carers. Unfortunately, antidepressant drugs do not have clear effectiveness in these patients and it appears that the most commonly available psychological therapies such as cognitive behavioural therapy or CBT are also not consistently useful. This study will investigate whether an adapted form of problem-solving therapy called Problem Adaptation Therapy (PATH), which has been reported to be helpful in the very early stages of dementia in an American university-based healthcare system, can be successfully applied in an NHS setting and with patients who are representative of those seen with dementia and depression in the NHS.The first phase of the project will develop a manual that can be used by carers, under the supervision and guidance of NHS staff, to apply the principles of PATH to the person with dementia that they live with or care for. The acceptability of this will be tested as well as the willingness of patients and their carers to be involved in a subsequent trial.
The second phase of the research is a randomised clinical trial, comparing 12 weeks of the modified PATH treatment with current treatment offered as usual within the NHS. Outcomes at 0, 3, 6 and 12 months will be measured. The most important outcome of the trial will be improvement in symptoms of depression at 6 months in participants with dementia, but also measured will be quality of life, activities of daily living, cognitive function, anxiety symptoms, satisfaction with therapy and cost-effectiveness of the intervention. The mental health and perceptions of burden in carers will be examined.
Summary of Results
This study investigated whether a talking therapy, called Problem Adaptation Therapy (PATH), could improve the symptoms of depression in people with Alzheimer's disease.
( PATH was further adapted for the current study using a person-centred qualitative approach by members of the original PATH team and PATHFINDER investigators, specifically for use with people with the full range of cognitive impairment in moderate dementia and major depression *)A total of 336 people with Alzheimer's disease and those who help to look after them participated in the study. Half were randomly allocated to receive up to 8 sessions of Problem Adaptation Therapy and half were allocated to receive just their usual care and to act as a comparison for the Therapy. Everyone in the study was followed for 12 months and asked to complete tests of their mood and quality of life.
The Study showed that people who received the Problem Adaptation Therapy showed a small improvement in their symptoms of depression and overall quality of life compared with those who did not have the therapy. Unfortunately, these benefits were only fairly short-lived.Initial improvements in depression symptoms, that did not persist after the end of therapy, should encourage the development and assessment of similar adapted PATH interventions that are given for longer or until the resolution of depressed mood. A longer form of Problem Adaptation Therapy has potential not only to improve mood but also provide support to people with dementia and their families.
*Ref
McCombie C, Cort E, Gould RL, et al. Adapting and optimizing problem adaptation therapy (PATH) for people with mild-moderate dementia and depression. Am J Geriatr Psychiatry 2021;29:192-203.
Has the registry been updated to include summary results?: No
If yes - please enter the URL to summary results:
If no - why not?: The trialists have submitted the main outcomes paper, the health economic paper and a qualitative paper as listed below.Papers submitted for review:
McCrombie C, Cort E, Gould RL, Howard R, Lawrence VC (submitted) "Why am I just falling apart?": A portrait of depression in dementia.Howard R, Cort E, Rawlinson C, Wiegand M, Downey AM, Lawrence V, Banerjee S, Bentham P, Fox C, Harwood R, Livingston G, Moniz-Cook E, Raczek M, Ivenso C, Russell G, Thomas A, Wilkinson P, Freemantle N, Gould RL (submitted) Adapted Problem Adaptation Therapy for depression in mild to moderate Alzheimer's disease dementia: A randomised controlled trial.
Panca M, Howard R, Cort E, Rawlinson C, Wiegand M, Downey AM, Lawrence V, Banerjee S, Bentham P, Fox C, Harwood R, Livingston G, Moniz-Cook E, Raczek M, Ivenso C, Russell G, Thomas A, Wilkinson P, Freemantle N, Gould RL, Hunter RM (submitted) Cost-utility analysis of Adapted Problem Adaptation Therapy for depression in mild to moderate Alzheimer's disease dementia: PATHFINDER randomised controlled trial.
REC name
Wales REC 4
REC reference
18/WA/0209
Date of REC Opinion
15 Jun 2018
REC opinion
Favourable Opinion