Prevention of Depression in Spouses of People With Cognitive Impairment

• Depressive symptoms [ Time Frame: Measured at baseline and Months 1, 3, 6, and 12 post-treatment ] [ Designated as safety issue: No ]
• Anxiety symptoms [ Time Frame: Measured at baseline and Months 1, 3, 6, and 12 post-treatment ] [ Designated as safety issue: No ]

• Measured at Month 6 and 12 months post-intervention: Depressive symptoms
• Anxiety symptoms
• Social problem-solving abilities

• Objective caregiver burden [ Time Frame: Measured at baseline and Months 1, 3, 6, and 12 post-treatment ] [ Designated as safety issue: No ]
• Subjective caregiver burden [ Time Frame: Measured at baseline and Months 1, 3, 6, and 12 post-treatment ] [ Designated as safety issue: No ]
• Household management and care giving responsibilities [ Time Frame: Measured at baseline and Months 1, 3, 6, and 12 post-treatment ] [ Designated as safety issue: No ]
• Coping abilities [ Time Frame: Measured at baseline and Months 1, 3, 6, and 12 post-treatment ] [ Designated as safety issue: No ]
• Quality of the marital relationship [ Time Frame: Measured at baseline and Months 1, 3, 6, and 12 post-treatment ] [ Designated as safety issue: No ]
• Social support [ Time Frame: Measured at baseline and Months 1, 3, 6, and 12 post-treatment ] [ Designated as safety issue: No ]
• Anticipatory grief [ Time Frame: Measured at baseline and Months 1, 3, 6, and 12 post-treatment ] [ Designated as safety issue: No ]
• Social problem solving abilities [ Time Frame: Measured at baseline and Months 1, 3, 6, and 12 post-treatment ] [ Designated as safety issue: No ]
• Quality of Life [ Time Frame: Measured at baseline and Months 1, 3, 6, and 12 post-treatment ] [ Designated as safety issue: No ]

• Measured at Month 6 and 12 months post-intervention: Objective caregiver burden
• Subjective caregiver burden
• Household management and care giving responsibilities
• Stress related to MCI behavior
• Coping abilities
• Quality of the marital relationship
• Social support

This study evaluates the effectiveness of a problem-solving training program in preventing depression in the spouses or family caregivers of persons with mild cognitive impairment or early dementia.

People with a diagnosis of mild cognitive impairment (MCI) have an estimated 12% probability each year of progressing to a dementing disorder. Pilot data suggest that the spouses of people with MCI begin to adopt the caregiver role and its burdens as they cope with this condition. Although levels of caregiver burden and psychiatric illness are lower than those typically observed in family dementia caregiving samples, our findings suggest that MCI spousal caregivers have already begun to experience distress associated with elevated caregiver burden. In order to protect the mental health and well-being of caregivers as they cope with their spouses' current and future health care needs, it may be ideal to implement selective preventive strategies while they are in the very earliest stages of caregiving. This study evaluates the effectiveness of a problem-solving training program in preventing depression in the spouses or significant others of people with MCI.

Participants in this open-label study are randomly assigned to receive either a self-management intervention targeted at problem-solving training or an attention-matched intervention targeted at nutritional education. The self-management intervention trains participants to effectively use problem-solving skills with the aim of strengthening their ability to cope with burdens of caregiving and preventing the onset or worsening of depressive and anxiety disorders. The nutritional education program is based on the new USDA dietary recommendations. All participants attend weekly individual training sessions, either in their home or another convenient location for a total of 6 weeks. At the end of 6 weeks, participants receive a weekly phone call for an additional 3 weeks to support the training they received. Follow-up data is collected at Months 1, 3, 6, and 12 post-intervention. If a participant's spouse is diagnosed with dementia during the study, additional follow-up data is collected after the Month 12 visit.

• Behavioral: Problem-solving therapy
  The self-management intervention will train participants to effectively use problem-solving skills with the aim of strengthening their ability to cope and preventing the onset or worsening of depressive and anxiety disorders. All participants attend weekly individual training sessions, either in their home, another convenient location, or by telephone for a total of 9 weeks.
• Behavioral: Nutritional education program
  The nutritional education program will be based on the new USDA dietary recommendations. All participants attend weekly individual training sessions, either in their home or another convenient location for a total of 6 weeks.

• Experimental: 1
  Participants assigned to receive self-management intervention targeted at problem-solving training
  Intervention: Behavioral: Problem-solving therapy
• Active Comparator: 2
  Participants assigned to receive attention-matched intervention targeted at nutritional education
  Intervention: Behavioral: Nutritional education program

Inclusion Criteria:

• Spouse or non-married partner of a patient being treated at the University of Pittsburgh Alzheimer's Disease Research Center (ADRC) for a new or subsequent diagnosis of MCI

Exclusion Criteria:

• Does not speak English
• Cohabitating adult child of a person with MCI
• Resides in an institutional or assisted-living setting