Cognitivebehavioural therapy for anxiety in

dementia: pilot randomised controlled trial

Aimee Spector , Georgina Charlesworth , Michael King , Miles Lattimer , Susan Sadek , Louise
Marston , Amritpal Rehill , Juanita Hoe , Afifa Qazi , Martin Knapp , Martin Orrell
DOI: 10.1192/bjp.bp.113.140087 Published 19 February 2015

Abstract
Background
Anxiety is common and problematic in dementia, yet there is a lack of effective treatments.
Aims
To develop a cognitivebehavioural therapy (CBT) manual for anxiety in dementia and
determine its feasibility through a randomised controlled trial.
Method
A ten-session CBT manual was developed. Participants with dementia and anxiety (and their
carers) were randomly allocated to CBT plus treatment as usual (TAU) (n = 25) or TAU (n = 25).
Outcome and cost measures were administered at baseline, 15 weeks and 6 months.
Results
At 15 weeks, there was an adjusted difference in anxiety (using the Rating Anxiety in Dementia
scale) of (3.10, 95% CI 6.55 to 0.34) for CBT compared with TAU, which just fell short of
statistical significance. There were significant improvements in depression at 15 weeks after

adjustment (5.37, 95% CI 9.50 to 1.25). Improvements remained significant at 6 months.

CBT was cost neutral.
Conclusions
CBT was feasible (in terms of recruitment, acceptability and attrition) and effective. A fully
powered RCT is now required.

Modifiable Predictors of Dementia in Mild

Cognitive Impairment: A Systematic Review
and Meta-Analysis
Claudia Cooper, Ph.D., M.R.C.Psych.; Andrew Sommerlad, M.R.C.Psych.; Constantine G.
Lyketsos, M.D., M.H.S.; Gill Livingston, M.D., F.R.C.Psych.
http://dx.doi.org/10.1176/appi.ajp.2014.14070878
Abstract
Objective:
Public health campaigns encouraging early help seeking have increased rates of mild cognitive
impairment (MCI) diagnosis in Western countries, but we know little about how to treat or
predict dementia outcomes in persons with the condition.
Method:
The authors searched electronic databases and references for longitudinal studies reporting
potentially modifiable risk factors for incident dementia after MCI. Two authors independently
evaluated study quality using a checklist. Meta-analyses were conducted of three or more
studies.
Results:
There were 76 eligible articles. Diabetes and prediabetes increased risk of conversion from
amnestic MCI to Alzheimers dementia; risk in treated versus untreated diabetes was lower in
one study. Diabetes was also associated with increased risk of conversion from any-type or
nonamnestic MCI to all-cause dementia. Metabolic syndrome and prediabetes predicted all-cause
dementia in people with amnestic and any-type MCI, respectively. Mediterranean diet decreased
the risk of conversion to Alzheimers dementia. The presence of neuropsychiatric symptoms or

lower serum folate levels predicted conversion from any-type MCI to all-cause dementia, but
less formal education did not. Depressive symptoms predicted conversion from any-type MCI to
all-cause dementia in epidemiological but not clinical studies.
Conclusions:
Diabetes increased the risk of conversion to dementia. Other prognostic factors that are
potentially manageable are prediabetes and the metabolic syndrome, neuropsychiatric symptoms,
and low dietary folate. Dietary interventions and interventions to reduce neuropsychiatric
symptoms, including depression, that increase risk of conversion to dementia may decrease new
incidence of dementia.