Depression in people with dementia and their carers

Year: July 1, 2016


Program Overview:

Alzheimer’s disease (AD) is a common condition of ageing and occurs in around 6.5% of people over the age of 65. Behavioural and psychological symptoms, such has depression, are frequent and a major source of distress for suffers and those who care for them. Carers of those with AD are more likely to experience depressive symptoms and carer burden during the course of the illness. Treatment of these symptoms is complex and may be associated with unacceptable side effects and difficulty accessing treatment services. Clinical evidence in support of psychological and pharmacological treatments is poor and it is therefore important that we strive to identify safe and effective, evidence based treatments for these common symptoms.

Cognitive bias modification (CBM) is a novel, simple and safe intervention that targets negative biases associated with depression and anxiety. In the proposed trial this will be done through two approaches. The first exposes participants to a set of two emotionally discrepant faces displayed on a computer screen followed by a circle or square placed in the position that one of the faces occupied. The participant is then required to indicate if they see a circle or square through a response box. In active CBM the shape will always be placed over the neutral/happy face and in the control intervention the shape will occur equally over the neutral/happy and sad/angry face. The second technique involves being shown an ambiguous stem word followed by two words below. One of these words is related to this word in a negative or positive/neutral manner and the other is unrelated to it. The person is asked to indicate if the related word (negative or positive/neutral) is on the left or the right of the screen by pushing the corresponding button on the response box.

Active CBM will always use positive or neutral words while the control intervention will involve an equal mix of positive/neutral and negative words. CBM uses implicit memory (i.e. memory not accessible to conscious thought processes) systems, which are spared until late in the course of the illness. CBM is effective at reducing depressive symptoms in adults without cognitive impairment and our early data indicate that this is a feasible and, most likely, efficacious treatment for people with depression in AD but this needs to be tested in a properly designed, randomised controlled trial.

The proposed trial aims to determine if CBM is effective in alleviating depressive symptoms in people with AD and their carers. We additionally aim to explore if CBM results in improved quality of life and reduced carer burden. We will test this through a novel trial design that will enrol patients and their primary carers and randomly expose both to active or control CBM (patients and carers may receive either type of treatment). Participants will undergo 16 treatments in total over 6 months and be carefully monitored for evidence of depression over this time. We all also collect demographic, lifestyle (e.g. alcohol use, physical exercise) and clinical data and monitor quality of life/carer burden. CBM for this trial will be delivered at the respective research centres in Perth and Melbourne to ensure that our findings are valid and methodologically rigorous. If CBM is proven to be effective, we will then aim to make this intervention freely available via the internet. This would allow those with AD and their carers to access CBM in the comfort of their own home when it suits them.

This is a highly innovative and carefully designed trial that brings together an accomplished team of investigators with expertise in ageing research, depression, dementia, CBM, randomised trials and in translation of research findings into clinical practice. This study will produce definitive high quality evidence for the benefits of CBM in improving the quality of life of people with AD and those who care for them and facilitate the translation of this evidence into an important and growing clinical population.

Read the Final Report

Successful DCRC grant recipient 2016

Other team members:
T/L: Dr Andrew Ford, University of Western Australia
Prof Osvaldo Almeida, University of Western Australia
Prof Colin MacLeod, University of Western Australia
Prof Leon Flicker, University of Western Australia
Dr Chrisos Plakiotis, Monash University