Effects of a modified mindfulness-based cognitive therapy for family caregivers of people with dementia: A randomized clinical trial

Pui Kin Kor, P. Justina Yat Wah Liu, J. & Tong Chien, W. (2020) |Effects of a modified mindfulness-based cognitive therapy for family caregivers of people with dementia: A randomized clinical trial| The Gerentologist | https://doi.org/10.1093/geront/gnaa125

The latest issue of The Gerentologist features a study that examined the impact of MBCT for caregivers of people with dementia, the authors of the study report that the MBCT reduce the caregivers’ stress and promote their psychological well-being over 6-month follow-up.

Abstract

Background and Objectives

Family caregivers of people with dementia (PWD) experience high levels of stress resulting from caregiving. This study aimed to investigate the effects of a modified of Mindfulness-Based Cognitive Therapy (MBCT) for dementia caregiving

Research Design and Methods

113 family caregivers of PWD were randomized to either the intervention group, receiving the 7-session modified MBCT over 10 weeks with telephone follow-up; or the control group, receiving the brief education on dementia care and usual care. The caregiving stress (primary outcome), and various psychological outcomes of caregivers and the behavioral and psychological symptoms of dementia(BPSD) in the care-recipients were assessed and compared at baseline (T0), post-intervention (T1), and at the 6-month follow-up (T2)

Results

At both T1 and T2, the intervention group had a statistically greater improvement in stress, depression, anxiety and BPSD-related caregivers’ distress. A significant greater improvement was also demonstrated in mental health-related QoL at T2 and BPSD of the care-recipients at T1. The increased caregivers’ level of mindfulness was significantly correlated with the improvement of various psychological outcomes at T1 and T2 with correlation coefficient -0.64 to 0.43

Discussion and Implications

The modified MBCT enhanced the level of mindfulness in the caregivers and was effective to reduce the caregivers’ stress and promote their psychological well-being over 6-month follow-up. Future research is recommended to further examine its effects on the varieties of psychological and behavioural outcomes of both caregivers and care-recipients and their dyadic relationships, as well as explore its mechanism of action in facilitating dementia caregiving (Source: The Gerentologist)

This article can be requested by Rotherham NHS staff here

Mindfulness-based interventions for people with dementia and their caregivers

This editorial looks at how mindfulness based interventions can be of benefit to the well-being of people with Dementia and their caregivers.

Martin P. J. van Boxtel, et al. | Mindfulness-based interventions for people with dementia and their caregivers: keeping a dyadic balance | Aging & Mental Health | Published online 02 April 2019

Exploring Effects of Aerobic Exercise and Mindfulness Training on Cognitive Function in Older Adults at Risk of Dementia: The Active Minds Study

Salmoirago-Blotcher, E. et al| 2018|Exploring Effects of Aerobic Exercise and Mindfulness Training on Cognitive Function in Older Adults at Risk of Dementia: The Active Minds Study| Circulation| 138|Suppl_1| A12009-A12009.

New research studied participants with two risk factors for dementia to determine whether mindfulness training (MT) and aerobic training (AT) had an impact on their cognitive function. 

Abstract

Introduction: We conducted a pilot RCT to explore whether mindfulness training (MT), an intervention design to increase the moment-to-moment awareness of physical sensations, affective states and thoughts, alone or in combination with aerobic exercise training (AT), may improve cognitive function in individuals at risk of dementia.

Hypothesis: We hypothesized that MT and AT would improve cognitive function at the end of the intervention.

Methods: Participants with at least two risk factors for dementia were randomized to AT alone (3 sessions/week for 12 weeks), MT alone (1 session/week for 8 weeks), both interventions (MT+AT), or usual care (UC). Assessments of cognitive function including attention (Digital Symbol Substitution Test), executive function (F-A-S verbal fluency test), and episodic memory (International Shopping List Test) were conducted at baseline and end of treatment (EOT – 3 months since baseline). Scores from each measure were used to calculate a composite score (Z-scores of Attention, Verbal fluency, and Episodic memory for Non-demented adults – ZAVEN). Mixed effects longitudinal models were used to estimate intervention effects on ZAVEN scores at EOT controlling for baseline.

Results: Of the 160 screened participants, 75 were eligible and 27 were randomized. Retention rates were 96.3%. At EOT, MT alone had significantly higher ZAVEN scores compared to UC and nearly significantly higher scores compared to AT alone. Findings were driven mostly by effects of MT on executive function and episodic memory.

Conclusions: These results suggest a possible effect of MT on cognitive function in older individuals at risk of dementia. AT did not improve cognitive function and may require a longer intervention duration to show an effect. These promising findings need to be confirmed in a larger RCT.

Rotherham NHS staff can request this article here 

Mindfulness‐based stress reduction for family carers of people with dementia

Liu, Z., Sun, Y. Y., & Zhong, B. L. |2018 | Mindfulness‐based stress reduction for family carers of people with dementia| The Cochrane Library.

A new review from Cochrane posed the question: How effective is mindfulness‐based stress reduction (MBSR) in reducing stress‐related problems of family carers of people with dementia? 

Background

Dementia has become a public health burden worldwide. Caring for people with dementia is highly stressful, thus carers are more likely to suffer from psychological problems, such as depression and anxiety, than general population. Mindfulness‐based stress reduction is a potentially promising intervention to target these issues. More information is needed about whether MBSR can help family carers of people with dementia.

Study characteristics

We searched for evidence up to September 2017 and found five randomised controlled trials (clinical trials where people are randomly assigned to one of two or more treatment groups) comparing MBSR to a variety of other interventions. We reported the effects of MBSR programmes compared with active controls (interventions in which participants received a similar amount of attention to those in the MBSR group, such as social support or progressive muscle relaxation) or inactive controls (interventions in which participants received less attention than those in the MBSR group, such as self help education).

Key results

We were able to analyse study data from five randomised controlled trials involving a total of 201 carers. Findings from three studies (135 carers) showed that carers receiving MBSR may have a lower level of depressive symptoms at the end of treatment than those receiving an active control treatment. However, we found no clear evidence of any effect on depression when MBSR was compared with an inactive control treatment. Mindfulness‐based stress reduction may also lead to a reduction in carers’ anxiety symptoms at the end of treatment. Mindfulness‐based stress reduction may slightly increase carers’ feelings of burden. However, the results on anxiety and burden were very uncertain. We were unable to draw conclusions about carers’ coping strategies and the risk of dropping out of treatment due to the very low quality of the evidence.

None of the studies measured quality of life of carers or people with dementia, or the rate of admission of people with dementia to care homes or hospitals.

Only one included study reported on adverse events, noting one minor adverse event (neck strain in one participant practising yoga at home)

Quality of the evidence

We considered the quality of the evidence to be low or very low, mainly because the studies were small and the way they were designed or conducted put them at risk of giving biased results. Consequently, we have limited confidence in the results.

Conclusion

To summarise, the review provides preliminary evidence on the effect of MBSR in treating some stress‐related problems of family carers of people with dementia. More good‐quality studies are needed before we can confirm whether or not MBSR is beneficial for family carers of people with dementia.

Read the full review at the Cochrane Library here  

Mindfulness Training for People With Dementia and Their Caregivers

Berk, L., Warmenhoven, F., van Os, J., & van Boxtel, M| 2018|  Mindfulness Training for People with Dementia and their Caregivers: Rationale, Current Research, and Future Directions| Frontiers in Psychology| 9| 982.

Frontiers in Psychology has published a new article that provides an overview of studies for people with dementia and/ or their caregivers, the review also gives recommendations and suggests areas that require further research.

Abstract

The world population is aging and the prevalence of dementia is increasing. By 2050, those aged 60 years and older are expected to make up a quarter of the population. With that, the number of people with dementia is increasing. Unfortunately, there is no cure for dementia. The progression of symptoms with no hope of improvement is difficult to cope with, both for patients and their caregivers. New and evidence-based strategies are needed to support the well-being of both caregiver and patient. Mindfulness training is a body-mind intervention that has shown to improve psychological well-being in a variety of mental health conditions. Mindfulness, a non-judgmental attention to one’s experience in the present moment, is a skill that can be developed with a standard 8-week training. Research has shown preliminary but promising results for mindfulness-based interventions to benefit people with dementia and caregivers. The aim of this review is (a) to provide a rationale for the application of mindfulness in the context of dementia care by giving an overview of studies on mindfulness for people with dementia and/or their caregivers and (b) to provide suggestions for future projects on mindfulness in the context of dementia and to give recommendations for future research.

The full article can be read from Frontiers of Psychology 

 

Can mindfulness-based interventions influence cognitive functioning in older adults?

An increased need exists to examine factors that protect against age-related cognitive decline. There is preliminary evidence that meditation can improve cognitive function | Aging & Mental Health 

However, most studies are cross-sectional and examine a wide variety of meditation techniques. This review focuses on the standard eight-week mindfulness-based interventions (MBIs) such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT).

We conclude that eight-week MBI for older adults are feasible, but results on cognitive improvement are inconclusive due a limited number of studies, small sample sizes, and a high risk of bias. Rather than a narrow focus on cognitive training per se, future research may productively shift to investigate MBI as a tool to alleviate suffering in older adults, and to prevent cognitive problems in later life already in younger target populations.

Full reference: Berk, L. et al. (2017) Can mindfulness-based interventions influence cognitive functioning in older adults? A review and considerations for future research. Aging & Mental Health. Vol. 21 (Issue 11) pp. 1113-1120

An adapted mindfulness intervention for people with dementia in care homes

Clarke, A.C. et al. International Journal of Geriatric Psychiatry. Published online: 7 February 2017

Objective: Depression and anxiety are common in dementia. There is a need to develop effective psychosocial interventions. This study sought to develop a group-based adapted mindfulness programme for people with mild to moderate dementia in care homes and to determine its feasibility and potential benefits.

Conclusions: The intervention was feasible in terms of recruitment, retention, attrition and acceptability and was associated with significant positive changes in quality of life. A fully powered randomised controlled trial is required.

Read the full abstract here