J Clin Neurol.  2017 Oct;13(4):394-404. 10.3988/jcn.2017.13.4.394.

Effectiveness of Cognitive Behavioral Therapy for Caregivers of People with Dementia: A Systematic Review and Meta-Analysis

• Kwon OY
• Ahn HS
• Kim HJ
• Park KW

• KMID: 2392136
• DOI: http://doi.org/10.3988/jcn.2017.13.4.394

Abstract

BACKGROUND AND PURPOSE
Caregivers endure tremendous physical, emotional, and financial burdens while caring for people with dementia. The current study aimed to estimate the effectiveness of cognitive behavioral therapy (CBT) for caregivers of people with dementia (CGPWD).
METHODS
Studies in the MEDLINE, EMBASE, Cochrane Library, Web of Science, and SCOPUS databases were screened. Studies with a randomized controlled design and which produced CBT outcomes for CGPWD were included in this study, and we investigated these outcomes.
RESULTS
The screening of abstracts of 263 studies resulted in 12 randomized controlled trials being included in this study. The mean age of the CGPWD ranged from 51.5 to 66.2 years. The caregiver role was most frequently adopted by a female spouse or daughter. CBT for the CGPWD resulted in positive effects on various conditions, including depression, anxiety, stress, and dysfunctional thoughts. Depression was the most commonly evaluated condition, and the Center for Epidemiologic Studies Depression Scale (CES-D) was most frequently used as an inventory for depressive symptoms. The mean differences between the baseline and postintervention CES-D scores were compared between the CBT-intervention and control groups. The CES-D score decreased significantly more in the CBT-intervention group than in the control group. The difference in pooled mean differences between the two groups was −4.98.
CONCLUSIONS
CBT is an efficient intervention tool for reducing the various emotional burdens experienced by CGPWD. This meta-analysis found that CBT significantly improved the depressive symptoms of CGPWD.

Keyword

dementia; caregivers; depression; cognitive therapy; behavioral therapy

MeSH Terms

Anxiety
Caregivers*
Cognitive Therapy*
Dementia*
Depression
Epidemiologic Studies
Female
Humans
Mass Screening
Nuclear Family
Spouses

Figure

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  Fig. 1 Flow diagram for identifying relevant studies. In total, 263 studies were identified by searching 5 databases and manually searching relevant bibliographies as follows: 37 studies from MEDLINE, 18 from EMBASE, 30 from Cochrane Library, 33 from Web of Science, 144 from SCOPUS, and 1 by manual searching. We excluded 39 duplicate studies, plus an additional 196 of the remaining 224 studies that did not satisfy the selection criteria. We reviewed the full texts of the remaining 28 studies, which resulted in a further 16 studies being excluded based on the selection criteria. The reasons for exclusion of these 16 studies were no outcome data (n=7), no or poor randomization (n=5), no control group (n=3), and duplication due to incorrect publication year (n=1). After reviewing the full texts, 12 studies were finally included in this study.

• 

  Fig. 2 Mean difference in CES-D scores between baseline and postintervention (MD[post-pre]). The mean difference was compared between CGPWD in the CBT-intervention and control groups. The mean difference was much greater in the 161 caregivers with a CBT intervention and 139 CGPWD in the control group for all 6 studies. The CES-D score was lower in the CBT-intervention group than in the control group. The pooled difference in the MD[post-pre] between the two groups in CES-D score estimated using the fixed-effects model was −5.02 (out of total score of 60), and the 95% CI was −7.52 to −2.52. The heterogeneity among the studies was low based on the forest plot and statistical measures (Q=1.34, p=0.93; I2=0%). CBT: cognitive behavioral therapy, CES-D: Center for Epidemiologic Studies Depression Scale, CI: confidence interval, CGPWD: caregivers of people with dementia, MD[post-pre]: the mean difference between the baseline and postintervention CES-D scores, SD: standard deviation.

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