What’s New in Psychology?
Can Therapy Slow Dementia?
Jim Windell
Dementia is related to aging and there’s nothing you can do about it, right?
Conventional wisdom would have it that psychotherapy cannot delay the steady progression of dementia.
But what if conventional thinking is wrong?
A new study that comes out of the University of Texas Southwestern Medical Center suggests that there is an alternative to a slow, but steady decline into dementia. Recently published in JAMA Psychiatry, the study shows that a novel combination of therapy slowed cognitive decline in elderly patients with a history of depression.
Dementia, which includes Alzheimer’s disease and other related disorders, is a chronic condition affecting memory, thinking, and social abilities severely enough to impair daily life. Over time, dementia limits a person’s ability to function independently. About 10 % of adults, ages 70 and older, suffer from dementia. However, according to the Population Reference Bureau, the share of older people with dementia is decreasing 1% to 2.5% per year. Yet, PRB says that as the large baby boomer population ages, the total number of people with dementia will rise. Estimates vary, but experts suggest that more than 7 million people ages 65 or older had dementia in 2020. If current demographic and health trends continue, more than 9 million Americans could have dementia by 2030 and nearly 12 million by 2040.
Depression has been found to be a risk factor for dementia. “A history of depression – even at younger ages – doubles the risk of dementia in older adults, and no intervention to date has been shown to reduce this risk,” says Tarek Rajji, M.D., Chair and Professor of Psychiatry at UT Southwestern.
Rajii, along with colleagues, conducted the study which featured a randomized trial of 375 older adults with remitted major depressive disorder, mild cognitive impairment, or both. Study participants received either a control intervention or a combination of two therapies: cognitive remediation puzzles and logic problems, along with transcranial direct current stimulation, a mild, noninvasive form of electrical neuromodulation targeting the prefrontal cortex, a critical region of the brain for cognitive compensation in aging adults. Participants received treatment five days a week for eight weeks, with follow-up sessions every six months.
The results showed that the participants who received cognitive remediation plus transcranial direct current stimulation experienced slower cognitive decline compared with those in the control group. Positive outcomes were even more pronounced in participants with remitted major depressive disorder, either with or without cognitive impairment, than those who only had cognitive impairment.
“The combined therapy strategy has been used in older adults with mild cognitive impairment for short-term treatment,” Dr. Rajji said. “This is the first time it has been evaluated in older adults with depression who either have mild cognitive impairment or do not, in addition to patients with mild cognitive impairment on its own, with up to six years of follow-up.”
Rajii indicates that the next step is to confirm the study’s findings using a larger and more diverse sample of participants. “UT Southwestern is an ideal place to build on this work going forward, especially considering our expanding research in neuromodulation that is taking place across various departments,” Rajji says. “It’s also possible we could develop a complementary intervention for home use that would allow many more individuals to be helped.”
To read the study in JAMA Psychiatry, find it with this reference:
Rajji TK, Bowie CR, Herrmann N, et al. (2024). Slowing Cognitive Decline in Major Depressive Disorder and Mild Cognitive Impairment: A Randomized Clinical Trial. JAMA Psychiatry. Published online October 30, 2024. doi:10.1001/jamapsychiatry.2024.3241