Bartels Claudia, Abdel-Hamid Mona, Wiltfang Jens, Schneider Anja, Belz Michael
Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany.
Department of Psychiatry and Psychotherapy, University of Duisburg-Essen, LVR-Hospital Essen, Essen, Germany.
J Alzheimers Dis. 2022;90(4):1725-1737. doi: 10.3233/JAD-220578.
The multimodal CORDIAL treatment concept for mild dementia, combining cognitive rehabilitation, cognitive behavioral and humanistic psychology interventions, has proven its feasibility and demonstrated a reduction of depressive symptoms in individual dyadic/triadic settings.
We investigate antidepressant effects of an adapted group-based CORDIAL program in clinical routine care.
During 2013 and 2017, 51 outpatients with mild dementia (45% female, mean age 72.4 years, 67% Alzheimer's dementia, mean MMST 24.8) periodically received a modified CORDIAL group treatment as part of our regular outpatient care. Treatment comprised 10 bi-weekly sessions, partly involving caregivers. Systematic pre- and post-treatment assessments of clinical routine data were evaluated retrospectively (median time-interval of 6.6 months).
Depressive symptoms as measured by the Geriatric Depression Scale significantly decreased over time (p = 0.007, Cohen's d = 0.39), and irrespective of gender. Patients with longer disease duration before treatment start showed significantly higher initial levels of depressive symptoms (p = 0.044), followed by a reduction to a level of those with shorter disease duration (ns). Most secondary outcomes (cognitive symptoms, disease severity, quality of life, caregiver burden) remained unchanged (ns), while competence in activities of daily living declined from pre- to post-measurement (p = 0.033).
A group-based CORDIAL treatment is feasible in a clinical routine setting and demonstrated antidepressant effects comparable to those of the individual treatment design, further suggesting its implementation in regular care. Future trials might also investigate its potentially preventive effects by reducing depressive symptoms in pre-dementia stages, even at a subsyndromal level.
针对轻度痴呆的多模式CORDIAL治疗理念，结合认知康复、认知行为和人本主义心理学干预，已证明其可行性，并在个体二元/三元治疗环境中显示出抑郁症状的减轻。
我们研究在临床常规护理中，基于小组的适应性CORDIAL项目的抗抑郁效果。
在2013年至2017年期间，51名轻度痴呆门诊患者（45%为女性，平均年龄72.4岁，67%为阿尔茨海默病性痴呆，平均简易精神状态检查表评分为24.8）作为我们常规门诊护理的一部分，定期接受改良的CORDIAL小组治疗。治疗包括10次每两周一次的疗程，部分疗程有护理人员参与。对临床常规数据进行系统的治疗前和治疗后评估，并进行回顾性分析（中位时间间隔为6.6个月）。
通过老年抑郁量表测量的抑郁症状随时间显著降低（p = 0.007，科恩d值 = 0.39），且与性别无关。治疗开始前疾病持续时间较长的患者，其初始抑郁症状水平显著较高（p = 0.044），随后降至疾病持续时间较短患者的水平（无显著差异）。大多数次要结果（认知症状、疾病严重程度、生活质量、护理人员负担）保持不变（无显著差异），而日常生活活动能力从测量前到测量后有所下降（p = 0.033）。
基于小组的CORDIAL治疗在临床常规环境中是可行的，并且显示出与个体治疗设计相当的抗抑郁效果，进一步表明其可在常规护理中实施。未来的试验也可能研究其通过在痴呆前阶段甚至亚综合征水平减轻抑郁症状而产生的潜在预防作用。
