Cognitive behavioral therapy (CBT) is associated with improvements in anxiety, depression, and quality of life in patients with mild cognitive impairment (MCI) and dementia, with further possible efficacy in insomnia and other sleep disorders, according to a systematic review. Researchers presented the findings in a poster at the virtual 2021 American Psychiatric Association Annual Meeting.
“Today, no reviews have analyzed specific adaptations and their potential efficacies in mood and sleep disorders for persons with cognitive impairment and dementia,” said lead author Jeff Wang, an MD candidate at the McGovern Medical School, Austin, Texas.
Researchers conducted a literature search of PubMed, Embase, and PsycINFO databases up to March 2020. The review included 12 studies that were categorized based on intervention focuses and primary and secondary outcomes. Primary and secondary outcomes were sorted into 4 categories: depression, anxiety, quality of life, and insomnia.
“CBT showed a reduction in insomnia and improvements in sleep quality. However, the lack of studies analyzing the effects of CBT on insomnia suggest that there is insufficient evidence to draw conclusions on overall efficacy. These results may inform the design of future clinical trials in dementia and warrant further investigation into insomnia outcomes,” researchers said.
“CBT is an intervention aiming to modify individuals thought processes to improve emotional and behavioral distress. In persons with dementia, it has the potential to address mood and sleep disorder needs in both a safe and effective manner,” said Wang. “However, the application of CBT in persons with cognitive impairments include several potential barriers: practice adherence, therapy attendance, limited content learning, and skill retention.”
The positive effects from memory and content adaptations indicate a potential method to limit the adverse effects of cognitive impairment on CBT delivery, the study found. In addition to CBT, other non-pharmacological interventions, such as cognitive stimulation and meditation, have demonstrated mood improvement in patients with dementia or MCI.
Researchers noted that 6 studies were at moderate risk of randomization and allocation bias, and all 12 studies were at high risk of performance bias. The high risk of performance bias is due to the inability to blind participants from the nature of the interventions, researchers said in the poster.
Jin JW, Nowakowski S, Taylor A, et al. Cognitive behavioral therapy for mood and insomnia in persons with dementia: a systematic review. Poster presented at the American Psychiatric Association 2021 Annual Meeting; May 1-3, 2021; Virtual.