Counseling and social support for Alzheimer caregivers has been found to reduce depression even when their relatives with Alzheimer’s disease receive drug treatment.
According to lead author Mary Sherman Mittelman of The William and Sylvia Silberstein Institute for Aging and Dementia at NYU Langone Medical Center, this is the first study to evaluate the effect of a pharmacologic intervention for patients combined with a psychosocial intervention for caregivers in three countries simultaneously.
The study looked at change in symptoms of depression in a total of 158 pairs of spouse-caregivers and patients with Alzheimer’s disease at NYU Medical Center in New York City; the University of Manchester in Manchester, UK; and the Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales in Sydney, Australia.
All the Alzheimer’s patients were prescribed donepezil at no cost while they participated in the study.
Half the caregivers were given a comprehensive psychosocial intervention that included two individual and three family counseling sessions within three months of enrolling in the study, and counseling on demand for two years after enrolling, generally on the telephone; caregivers in the control group only received resource information upon request.
Symptoms of depression in the caregivers were measured at intake, and at follow-up assessments conducted at regular intervals for 24 months. The independent study was funded by an unrestricted grant from Pfizer, Inc.
Over the two years they were in the study, symptoms of depression decreased among caregivers who received the five sessions of individual and family counseling, while depression increased among those who did not receive counseling.
The results provide evidence that a multi-component counseling and support program for caregivers, modeled after the NYU Caregiver Intervention, can have significant benefits in reducing symptoms of depression in caregivers whose spouses are taking donepezil.
“As we search for a cure or a way of preventing Alzheimer’s disease, we cannot forget about the millions of family members who are caring for relatives who are currently ill,” says Dr. Mittelman, noting that estimates suggest there are 9.8 million Alzheimer’s caregivers just in the United States.
“These findings show that counseling and support of family members can be of significant benefit to Alzheimer’s caregivers even when the patients are receiving medications for the disease. Caregivers who are less depressed are better able to take care of their ill family members. Social support and counseling for family members of people with Alzheimer’s disease should be considered essential components of optimal comprehensive care.”
According to Dr. Mittelman, the benefit of the psychosocial intervention increased over the 24-month period caregivers were in the study, even though the scheduled individual and family counseling sessions occurred during the first three months.
Participants remained in the study for as long as two years, or until the patients went into nursing homes or died. Almost all of the patients were in the early stages of Alzheimer’s disease when they and their spouses entered the study.
Dr. Mittelman’s original study, which began in 1987 and lasted more than 20 years, included 406 spouse-caregivers enrolled over a 9-1/2 year period. With community partners, she is currently looking at how this intervention can work in a variety of settings.
She has worked with service providers to replicate the original NYU Caregiver Intervention (NYUCI) in various parts of the United States and in the Netherlands. The partnership with the State of Minnesota, funded by the Administration on Aging, just received an award from the Roselynn Carter Caregiver Institute.
The William and Sylvia Silberstein Institute for Aging and Dementia is a center for the advancement of research, professional training and clinical care that brings together the knowledge and skill of researchers and clinicians at the New York University School of Medicine and the Nathan Kline Institute.
The Center’s programs represent both basic and clinical research on brain aging and neurodegenerative diseases as well as services provided by healthcare professionals directly to patients and their families.
These findings are reported in “A Three-Country Randomized Controlled Trial of a Psychosocial Intervention for Caregivers Combined with Pharmacological Treatment for Patients with Alzheimer’s Disease: Effects on Caregiver Depression,” published in the November issue of the American Journal of Geriatric Psychiatry.