A Cochrane review included 6 studies with a total of 439 patients with dementia. The studies included people with dementia living in the community or in nursing home. The studies used the different psychological approaches of cognitive behavioural therapy (CBT), interpersonal therapy and counselling. Two studies were of multimodal interventions including a specific psychological therapy. The duration of the psychological intervention varied from 6 weeks to 12 months. The comparison groups received either usual care, attention-control educational programs, diagnostic feedback or services slightly above usual care. Meta-analysis showed a positive effect of psychological treatments on depression (SMD -0.22; 95% CI -0.41 to -0.03; 6 trials, n=439) and on clinician-rated anxiety (MD -4.57; 95% CI -7.81 to -1.32; 2 trials, n=65), but not on self-rated anxiety (SMD 0.05; 95% CI -0.44 to 0.54; 2 trials, n=65) or carer-rated anxiety (MD -2.40; 95% CI -4.96 to 0.16; 1 trial, n=26). There was no effect on secondary outcomes of patient quality of life, activities of daily living (ADLs), neuropsychiatric symptoms and cognition, or on carers' self-rated depressive symptoms, but most of the studies did not measure these outcomes. There were no reports of adverse events.
Comment: The quality of the evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes) and imprecise results (few patients for each comparison).
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