Talk therapy to improve mental health in dementia patients

Could talk therapy help people living with dementia improve their mental health? Research suggests that it is beneficial for anxiety and depression

UCL researchers have found that talking therapies available on the NHS may benefit dementia patients who are suffering from anxiety or depression.

Depression and anxiety are very common in people with dementia with as many as 38% of people with mild dementia suffering from these mental health conditions, and others.

A new study published in eClinicalMedicine hopes that it can provide insight into this widespread issue and tackle mental health issues amongst dementia patients.

It is the first research project and study to consider and assess talking therapy – which is routinely available on the NHS – as a viable option to relieve symptoms.

2,515,402 people who had clinically significant anxiety or depression and completed a course of treatment via the national ‘Improving Access to Psychological Therapies’ (IAPT) service in England between 2012 and 2019 were examined.

To be involved in the study, participants had to have either:

• Clinical levels of depressive symptoms as measured using a standard questionnaire* which considers factors such as a lack of interest in doing things, issues with sleep, and feelings of low mood.
• Clinical levels of anxiety based on a standard measure** which asks patients questions about how much they worry or have trouble relaxing.

To examine outcomes for people living with dementia, the researchers analysed all the results of those who had a dementia diagnosis before starting IAPT treatment – which was 1,549 people.

A control group of 1,329 people was also used to assess whether therapy outcomes for those living with dementia differed from those without dementia. This was done by selecting a group of people from the full dataset who were similar to the people with dementia in terms of the following:

• Age
• Gender
• Depression
• Anxiety severity when starting treatment

The researchers found that among the dementia patients, the treatment proved to be clinically beneficial and 63% of them saw a reduction in symptoms of depression and anxiety, following IAPT. Meanwhile, approximately 40% recovered completely.

In comparison, in the control group, 70% of participants saw an improvement in symptoms and 47% recovered.

Largest study of its kind

Lead author, PhD candidate Georgia Bell (UCL Psychology & Language Sciences), commented: “Anxiety and depression are very common in people with dementia. They are extremely debilitating and associated with worse outcomes for both the person with dementia and their carers.

Anxiety and depression are very common in people with dementia

“This is the largest ever study to investigate outcomes of psychological therapies in people living with dementia. Our findings suggest that while people with dementia are less likely to improve or recover than those without dementia, psychological therapies offered in primary care mental health services can be beneficial for them.

“Consequently, our findings support the use of IAPT to treat anxiety and depression in people with dementia. We hope this study will have implications for encouraging referrals and adaptations to increase access and enhance outcomes for people living with dementia.”

Previously, there was limited evidence that talking therapies were adequately effective for people with dementia, but a review of evidence led by UCL researchers confirmed their efficacy earlier this year.*** This latest study adds to that, by confirming that NHS treatment offerings can confer such a benefit.

The study was funded by the Alzheimer’s Society and Wellcome.

Dr Richard Oakley, Associate Director of Research at Alzheimer’s Society, said: “Many people living with dementia also have depression and anxiety, making it even harder for them and their carers to cope with symptoms and for some people even leading to a faster decline in memory and thinking problems. Consistent and accessible mental health support after a diagnosis is vital.

“This Alzheimer’s Society-funded research is the first study looking at the effectiveness of therapy for people living with dementia in a real-world setting. It showed that people living with dementia showed a significant improvement in symptoms of anxiety and depression when treated with therapy, even though their response wasn’t as strong as that shown in the general population.

This research underpins the importance of timely access to mental health support

“This research underpins the importance of timely access to mental health support, as revealed in our recent Left To Cope Alone report. We found 61% of people affected by dementia are currently in need of mental health support, and yet, in 2018, of 1 million annual referrals to Improving Access to Psychological Therapies (IAPT) services, just 0.2% were for people with dementia.

“Though this study didn’t compare the types of therapy, types of dementia, or if there were adaptations made for people living with the disease, it still highlights the urgent need to improve real-world therapy for those living with dementia – with adaptations to improve its effectiveness and accessibility.

“Alzheimer’s Society can provide advice, emotional support, and guidance for those living with, or affected by the condition. Visit alzheimers.org.uk or call 0333 150 3456.”

Are there any limitations of the study?

Like with any research project, the answer is yes.

Researchers were unable to infer causal relationships between receiving therapy and having an improvement in symptoms because this study was observational in nature. A randomised control design would be needed to establish this causality.

Moreover, while there is evidence to suggest that questionnaires for measuring anxiety and depression can be validly completed by people with dementia, the anxiety scale used has not been validated for use in a sample of people living with dementia. Therefore, it may not accurately measure anxiety.

The team was also unable to distinguish the type of therapy given to the patients during their IAPT treatment so it is unclear whether one type of therapy may be better than any other in treating anxiety and depression in people living with dementia.

Finally, the identification of people living with dementia was based on linked records, so some who attended IAPT may have been missed. Additionally, the severity of dementia could also not be accounted for at the time of psychological treatment.