Amritpal Rehill

Cognitive-behavioural therapy for anxiety in dementia: pilot randomised controlled trial.

BACKGROUND Anxiety is common and problematic in dementia, yet there is a lack of effective treatments. AIMS To develop a cognitive-behavioural 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.

Cost-effectiveness of exercise as a therapy for behavioural and psychological symptoms of dementia within the EVIDEM-E randomised controlled trial

Although available evidence is modest, exercise could be beneficial in reducing behavioural and psychological symptoms of dementia. We aim to evaluate the cost‐effectiveness of a dyadic exercise regimen for individuals with dementia and their main carer as therapy for behavioural and psychological symptoms of dementia.

Cognitive Behavioural Therapy (CBT) for anxiety in dementia: A pilot Randomised Controlled Trial.

Background Anxiety is common and problematic in dementia, yet there lacks effective treatments. Aims To develop a CBT manual for anxiety in dementia, and determine its feasibility through an RCT. Methods A ten session CBT manual was developed following literature search, expert consultation, consensus conference and field testing. Fifty participants with dementia and anxiety (and their carer) 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 RAID) of (-3.10; 95% CI -6.55, 0.34) for CBT compared to TAU, which fell short of statistical significance. There were significant improvements in depression at 15 weeks after adjustment (-5.37; 95% CI - 9.50, -1.25). Improvements remained significant at six 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.

Evaluation of the implementation of the Meeting Centres Support Program in Italy, Poland, and the UK; exploration of the effects on people with dementia

MEETINGDEM investigated whether the Dutch Meeting Centres Support Programme (MCSP) could be implemented in Italy, Poland, and the UK with comparable benefits. This paper reports on the impact on people living with dementia attending pilot Meeting Centres in the 3 countries.

A cost effectiveness analysis of maintenance cognitive stimulation therapy (MCST) for people with dementia: examining the influence of cognitive ability and living arrangements

ABSTRACT Objectives: Identify if cost-effectiveness of Maintenance Cognitive Simulation Therapy (MCST) differs by type of living arrangement and cognitive ability of the person with dementia. Next, a value of information analysis is performed to inform decisions about future research. Methods: Incremental cost-effectiveness analysis applying seemingly unrelated regressions using data from a multicentre RCT of MCST versus treatment as usual in a population which had already received 7 weeks of CST for dementia (ISRCTN: 26286067). The findings from the cost-effectiveness analysis are used to inform a value of information analysis. Results: The results are dependent upon how quality adjusted life years (QALYs) are measured. MCST might be cost-effective compared to standard treatment for those who live alone and those with higher levels of cognitive functioning. If a further RCT was to be conducted for this sub-group of the population, value of information analysis suggests a total sample of 48 complete cases for both sub-groups would be required for a two-arm trial. The expected net gain of conducting this future research is £920 million. Conclusion: Preliminary results suggest that MCST may be most cost-efficient for people with dementia who live alone and/or who have higher cognition. Future research in this area is needed.