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PATHFINDER Study: Results show some benefits but need to examine the effect of more intensive and longer-term therapy

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19 April 2024

The randomised control trial explored the use of Problem Adaptation Therapy (PATH) for individuals with mild to moderate dementia and depression and found that although benefits were not sustained after three months there were positive signs immediately after treatment.

Depression is commonly experienced by people with dementia with approximately 3 out of 10 people with Alzheimer’s Disease living with a major depressive disorder. This has many negative effects including reduced quality if life, increased caregiver burden and restricting functional abilities.

The study was a randomized controlled trial to assess adapted Problem Adaptation Therapy (PATH) for depression in mild/moderate dementia caused by Alzheimer's disease. Problem Adaptation Therapy (PATH) aims to improve emotion regulation through situation selection and modification, attentional deployment, cognitive change, and response modulation, using a problem-solving approach and caregiver participation. The study recruited 336 participants with an average age of 77 years.

The results of the study have now been published in the Alzheimer’s Association Alzheimer’s & Dementia journal. Evaluation has found that the eight-session course of the adapted PATH and two boosted sessions delivered within NHS dementia services was not effective treatment for depression in people with mild and moderate dementia. The study team are now planning to investigate the effects of a longer sustained intervention in a new trial.

Professor Rob Howard, Professor of Old Age Psychiatry at UCL and Chief Investigator on the study, said

“This was a great study to be involved in, despite COVID-19 arriving as we were in recruitment. Depression in people with dementia is particularly difficult to treat and does not respond to antidepressants. Although our trial had an overall negative result, in that we found that participants who had received Problem Adaptation Therapy were not improved three months after the therapy finished, there were benefits with treatment immediately after delivery of therapy.”

“We are planning a new study, building on this, in which Problem Adaptation Therapy will be delivered for longer so that benefits are sustained. Many thanks to our friends at Camden and Islington Trust, who sponsored and supported the study.”

The study was sponsored by Camden & Islington NHS Foundation Trust, now part of the North London Mental Health Partnership. Funding was provided by the National Institute for Health and Care Research Health Technology Assessment Programme.

The full publication is available to read in the Alzheimer’s & Dementia journal: Adapted problem adaptation therapy for depression in mild to moderate Alzheimer's disease dementia: A randomized controlled trial



Image: Olly