Efficacy of cognitive-behavioural therapy interventions on reducing burden for caregivers of older adults with a neurocognitive disorder : A systematic review and metaanalysis

Background: By 2025, 34 million people worldwide will be living with Alzheimer's disease or another form of dementia (i.e., neurocognitive disorders). Symptoms of cognitive disorders include memory deficits and executive deficits; these and other symptoms have functional repercussions on daily activities such as doing chores, taking medication and preparing meals. People with neurocognitive disorders often rely on a caregiver to alleviate the impact of their symptoms, but this help has consequences for the caregiver. Indeed, caregivers report subjective burden, depressive symptoms, stress, anxiety and a lower quality of life than noncaregivers. Multiple cognitive-behavioural therapy (CBT) trials have been conducted to reduce these symptoms for caregivers, and two meta-analyses have suggested that this method could be beneficial in reducing depressive symptoms. However, no meta-analysis has been conducted to evaluate the efficacy of this type of intervention on reducing subjective burden. Method: Eligibility criteria for the individual studies were determined using the PICOS strategy recommended by the PRISMA Statement. Articles were selected from PsycNet, MEDLINE, AgeLine and ProQuest Dissertation and Theses for the period from 2000 to 2017. Article selection, data extraction and bias analysis for individual studies was completed by two independent authors who used a consensus procedure when discrepancies occurred. The statistics Q, df, p value, I-square and Tau-squared were computed. Standardized effect sizes (Hedges’s g) were also computed for all studies. Result: A total of 20 articles were included in the systematic review. Statistics suggested there was no significant heterogeneity, and a fixed-effect model was used. Ten studies (N = 200 caregivers) evaluated the efficacy of CBT in reducing subjective burden, and the meta-analysis suggested a significant reduction in subjective burden following CBT. Additionally, 17 studies (N = 437 caregivers) evaluated the efficacy of CBT in reducing depressive symptoms, and the meta-analysis revealed a significant reduction for these caregivers following CBT. Conclusion: CBT for caregivers of individuals with a neurocognitive disorder was beneficial in reducing subjective burden and depressive symptoms but had no impact on stress, anxiety or quality of life

Reducing burden for caregivers of older adults with mild cognitive impairment : a systematic review

Background/Rationale : This systematic review aims to evaluate the efficacy of the nonpharmacological interventions reducing burden, psychological symptoms, and improving quality of life of caregivers of individuals with mild cognitive impairment (MCI). Method : Databases reviewed included Medline, Cochrane Library, Embase, PsycNet, AgeLine, and ProQuest Dissertations and Theses. Studies using an experimental/quasi-experimental design including nonpharmacological intervention were included. Four studies were included, and no meta-analysis was conducted. Results : Calendar training and note-taking (cognitive intervention) significantly decreased caregiver’s depressive symptoms and prevented worsening of subjective burden 6 months posttreatment. Daily engagement of meaningful activity combined with problem-solving therapy and educational material reduced depressive symptoms 3 months posttreatment. Moreover, educational intervention and social conversation phone calls decreased caregiver burden 3 months posttreatment. Conclusion : Studies suggest that nonpharmacological interventions can support caregivers of older adults with MCI, but the few published articles present some bias and are inconclusive. Randomized-controlled trials targeting specifically caregivers are needed to determine the most efficient type of interventions for those individuals