- Dementia is a leading cause of death and disability among older adults in the United States.
- Two symptoms often co-occurring with the condition are depression and anxiety.
- New research indicates that talk therapy can significantly reduce depression and anxiety among individuals with dementia, offering implications for better treatment approaches.
- More research is needed to better understand the effectiveness of talk therapy at different stages of dementia.
Dementia is a disorder that affects a person’s memory and cognition and interferes with everyday functioning.
There is currently no cure for dementia, but various treatment and lifestyle approaches can help individuals cope with the condition.
The findings offer insight into improved treatment approaches for people with dementia.
Researchers analyzed data from 2,515,402 participants diagnosed with depression or anxiety who received talk therapy treatment from 2012 to 2019. Of this number, 1,549 were also diagnosed with dementia.
Therapy was accessed via the U.K. National Health Service (NHS) initiative, Improving Access to Psychological Therapies (IAPT), which combines cognitive behavioral therapy (CBT), counseling, and guided self-help sessions.
The researchers found that 63% of participants with dementia experienced fewer depressive and anxiety symptoms following therapy. In addition, around 40% saw their symptoms improve to the point that they were no longer diagnosed as having depression or anxiety.
Participants with dementia over 65 had significantly higher success rates than their younger counterparts, but this did not surprise researchers.
“Research has shown that older people tend to have better treatment outcomes in IAPT on average than younger people,” Dr. Amber John, from UCL’s Department of Psychology & Language Studies and co-senior author of the research, told Healthline.
“It is therefore plausible that this may also be the case for people living with dementia, [although] this has not yet been systematically tested.”
In addition, individuals who had depression or anxiety but did not have dementia saw slightly higher success rates following IAPT. In this group, 70% of participants saw an improvement in symptoms, and 47% fully recovered.
Be that as it may, the results indicate a step forward in treating depression and anxiety among those with dementia.
“I wasn’t surprised that people with dementia could benefit [from IAPT], although I was a bit surprised at how effective it seemed to be,” John said. “I was encouraged by the findings.”
Dementia cannot be categorized as a single disease. Types of dementia include:
- Alzheimer’s disease (AD)
- Lewy body dementia (LBD)
- vascular dementia
- Parkinson’s disease
- frontotemporal dementia
Across all types of dementia, “it has been reported that 38% of people with mild dementia, 41% with moderate dementia, and 37% with severe dementia have depression,” John noted.
She added that risk factors in the development of dementia might include:
- social isolation or loneliness
- a reaction to the diagnosis and perceived impacts of the diagnosis
- response to noticing physical and cognitive symptoms
- side effects of medication
Symptoms of dementia-related anxiety and depression can also vary depending on the stage of dementia a person is in, which could be intense following a diagnosis.
According to Dr. Jason Krellman, a neuropsychologist at Columbia University Irving Medical Center, varying symptoms associated with dementia “are often driven by the affected person’s awareness of the cognitive deficits and the impact on their daily life activities.”
Krellman explained that as dementia progresses to moderate or severe, depressive traits may worsen.
“The person is less able to develop good coping strategies and remember to use these consistently and effectively,” Krellman told Healthline, adding that dementia may also result in apathy and disconnection as it progresses.
Dr. Reza Hosseini Ghomi, a neuropsychiatrist and co-founder of Frontier Psychiatry in Montana, said this level of apathy “is a lack of motivation” that causes a person to retreat from their life and the world around them.
“It’s very particular in dementia and very common,” Ghomi told Healthline, adding that in the later stages of dementia, anxiety may also co-occur with other complications.
According to Krellman, certain types of dementia may present a higher risk for depression and anxiety.
“People with dementia caused by cerebrovascular disease are more likely to experience psychological distress than those with Alzheimer’s disease dementia,” he said.
Ghomi added that the type of depression that occurs with dementia is often a unique entity in and of itself.
Prescription drugs are typically used to treat depression and anxiety at all ages — but they may not always be suitable for treating symptoms of dementia.
Dementia apathy, in particular, “responds differently to medication,” Ghomi said, noting that drugs like Prozac and Zoloft may not be as effective for people with dementia. Others, however, such as Citalopram and Celexa, may have a benefit, he said.
It’s not entirely known why some drugs are less effective at treating depression and anxiety among those with dementia.
However, one theory is that depression in dementia is, as Ghomi put it, “a different biological entity.”
This means while medications can create more of a variable response, talk therapy may have the potential to provide benefits on a more universal and wide-reaching scale.
“Talk therapy, I believe, could be useful for just about anyone,” said Dr. Alex Dimitriu, double board certified in psychiatry and sleep medicine and founder of Menlo Park Psychiatry & Sleep Medicine and BrainfoodMD.
“Any attention and investigation into the workings of our feelings can reduce depressive or anxious feelings. Awareness alone can go a long way. In the hands of a skilled therapist, these feelings can be identified and ameliorated.”
According to Krellman, talk therapy can help individuals with early dementia:
- get support in dealing with the diagnosis
- learn ways to emotionally cope with cognitive changes
- problem-solve practical issues such as financial planning
- weigh their future care options
Because the UCL study used previously recorded data, John noted they “were only able to identify whether there was a recorded diagnosis of dementia or not.”
The researchers, therefore, did not study the stages of dementia among participants.
Still, John hypothesized that it was “highly likely” the participants with dementia receiving IAPT treatment were in the earlier stages of the condition.
At this point, she said, they still have many of their faculties and are aware of what’s happening — meaning that traditional therapies, such as CBT, can still be engaged with.
But as dementia progresses in a person, there will likely be a “high degree of memory, planning, and language difficulties,” John said.
This means talk therapies should be modified accordingly to suit the needs of an individual with dementia depending on the severity of their diagnosis.
Dementia impacts short-term memory before longer-term recollections, so many with the condition can still talk about their childhood and earlier years.
“Reminiscing therapy” involves a therapist or counselor encouraging the individual to share stories and experiences from their past.
According to the Social Care Institute of Excellence, reminiscing “can give people with dementia a sense of competence and confidence.”
The reminiscing approach can be extended outside of talking, too.
“We’ve found that, in people with moderate dementia, putting them in an environment where they’re reminded of their younger days, [such as playing] music they used to listen to, really has a positive effect,” Ghomi said.
Getting support from loved ones
As dementia progresses, friends and family can play a crucial role in ensuring their loved one continues to hear and practice such mechanisms.
“Repetition and reinforcement are key when teaching coping and problem-solving skills to individuals with dementia in psychotherapy,” Krellman said.
“Involving close friends, family members, or other caregivers is often critical to assist the person in remembering skills taught in therapy.”
Breathing and meditation exercises
Confusion and loss of memory can exacerbate anxiety in people who have dementia.
But Dimitriu explained that practicing mindfulness techniques to bring them back to the present can encourage a sense of calm.
These could include “breathing [exercises], [guided] relaxation, and even meditation,” he said.
If you or a loved one has been diagnosed with dementia and you’re interested in learning how talk therapy could help alleviate any mental health concerns, speaking with a primary care physician is a good starting point.
Ghomi noted that taking family members along with you can help you advocate your needs.
You might also research a psychologist or counselor who specializes in dementia.
For instance, the Alzheimer’s Association helpline is a 24/7 service with consultants able to advise on finding a psychologist or counselor.
Depression and anxiety are common co-occurring symptoms of various dementias.
While some drugs have yielded mixed results in treating dementia-related depression and anxiety, new research suggests talk therapy could be a beneficial alternative.
The effectiveness of traditional talk therapy, such as CBT, will likely be more significant in the earlier stages of dementia. Still, methods can be adapted to assist those in the later stages of the disease.
“Appropriateness for therapy and necessary adaptations should be determined on a case-by-case basis,” John said.