In spouses of patients with Alzheimer's disease, participating in a counseling and long-term support program substantially eases their depression, and the mental health benefits appear to be long-lasting, according to a recent study.

"The intensive intervention was very brief, yet that seems to have had a very long-lasting effect," said lead author Mary Mittelman, DrPH, and director of the Psychosocial Research and Support Program, William and Silvia Silberstein Institute on Aging and Dementia, at the NYU School of Medicine.
"I explain it as a snowball effect, whereby the benefits that started in the counseling sessions led to changes that many families made in the way they interacted afterwards."

The study, titled "Sustained Benefit of Supportive Intervention for Depressive Symptoms in Caregivers of Patients With Alzheimer's Disease," was co-authored by David Roth, MD, of the University of Alabama at Birmingham; David Coon, PhD, of the National Institute on Aging; and William Haley, PhD, of the University of South Florida. It was one part of the much larger New York University (NYU) Spouse-Caregiver Intervention Study, a longstanding research endeavor devoted to testing interventions to improve the mental health and well-being of caregivers for people with Alzheimer's.

Alzheimer's disease is a tragedy not only for its victims but also for their caregivers, Dr. Mittelman said. Spouses, who are usually the primary caregivers, often experience stress, depression and other mental health problems as a result of the continuing and demanding levels of care required by patients with the disease, which is the most common form of dementia affecting people over 65.

A total of 406 caregivers were enrolled in the study, which began in 1987. They were divided into two groups. A control group received the usual counseling, which involved sessions provided on an ad-hoc basis upon request.

The other caregivers were assigned to an enhanced treatment group. They received three additional types of counseling: two sessions of individual counseling, four sessions of counseling with their family, and weekly meetings with a caregiver support group. A key feature of this group is that each member was served by a single counselor for the duration of the study to ensure continuity.

After one year, 29.8 percent of the caregivers in the enhanced treatment group had symptoms of clinical depression, compared with 45.1 percent of those in the control group.

Three years later caregivers who received enhanced therapy were still exhibiting fewer symptoms of depression on average than those in the control group. This was true even for caregivers whose spouses had been sent to a nursing home, which is known to be a highly stressful event for caregivers, or who had died.

The particular value of this study is that it follows the progress of caregivers well beyond their intensive counseling period, Dr. Mittelman emphasized.

"Many of the effects of these therapeutic interventions are not felt immediately,” she said. “In fact, the two groups of caregivers began to show significant differences in their depression symptoms after only a year … since they enrolled in the study."

The use of multiple types of coordinated therapy seems to be one of the most important factors in decreasing depression among caregivers, since each form benefits the caregiver in a different way, Mittelman explained.

Another important aspect of the study is that the counseling was tailored to the particular coping challenges faced by each of the caregivers and their families. For instance, even when caregivers have supportive family networks, communication difficulties still may exist between caregivers and their adult children that need to be resolved through counseling.

"Caregivers often ask too much or too little of their adult children, while children can offer too little, offer the wrong things, or impose themselves in ways that are upsetting," said Dr. Mittelman.

"Adult children and other family members are not really aware of the extent to which the person with dementia becomes less and less of a companion to the caregiver as the illness progresses."

After about 5 years, the study showed the level of depression among caregivers in the control group dropped to that of caregivers in the enhanced group. Nevertheless, the study pointed to a significant improvement in quality of life for the enhanced group during that 5-year period.


"For a person who's 80 years old and depressed, 5 years is a long time," Dr. Mittelman noted.


She hopes the study will encourage more doctors to refer caregivers to counseling and support programs and will increase the availability of these types of intensive interventions.


"More and more people are living to an age where Alzheimer's disease is likely to afflict a spouse," she said. "So it's important for physicians to know such counseling programs have proved value."

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Our work, and that of other groups, has shown that problems with identifying common smells can be an effective early marker of the disease,' Dr. Matthias H. Tabert of Columbia University College of Physicians and Surgeons, New York, told Reuters Health.

Starting with the 40-item University of Pennsylvania Smell Identification Test (UPSIT), Tabert and his colleagues tested 147 patients with mild cognitive impairment, 100 with Alzheimer's disease and 63 healthy controls. The aim was identify particular odors connected to a risk of Alzheimer's disease.

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